Inspection on 11/12/06 for Clifton Lodge

This inspection was carried out on 11th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Clifton Lodge 07/10/09

Clifton Lodge 17/06/09

Clifton Lodge 19/06/07

Clifton Lodge 22/02/06

Clifton Lodge 08/08/05

Clifton Lodge 22/02/05

Clifton Lodge 03/11/04

Clifton Lodge 01/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Clifton Lodge 16-18 Clifton Road Southbourne Bournemouth Dorset BH6 3PA Lead Inspector Marjorie Richards Key Unannounced Inspection 11th December 2006 10:00 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 Lodge DS0000050468.V316971.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 Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifton Lodge Address 16-18 Clifton Road Southbourne Bournemouth Dorset BH6 3PA 01202 428598 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) cliftonlodge@hotmail.com Beechrise Limited Mrs Gail Shaw Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mrs Shaw must obtain an NVQ 4 in management and care by 2005. Date of last inspection 22nd February 2006 Brief Description of the Service: Clifton Lodge is a large, detached property, situated in a quiet residential area of Southbourne in Bournemouth. Local shops are within level walking distance, with the main shopping area of Southbourne and all its amenities about half a mile away. Bus services are available a short walk from the home, providing transport to all parts of Bournemouth, Christchurch and beyond. The home is also situated fairly close to the cliff top where there are a number of pleasant walks. The property is set back from the road and approached via a short driveway with a small parking area for visitors. Additional parking is available on roads in the vicinity of the home. Clifton Lodge is registered to accommodate up to 16 older persons. The accommodation is arranged over two floors, with a passenger lift to aid access between the floors. There are three double and ten single bedrooms. None of the bedrooms are equipped with en-suite facilities. The dining room and two separate lounges are situated on the ground floor, one overlooking the front garden and the other with views over the well-maintained rear garden, with its large lawn and paved patio area, surrounded by mature trees. Twenty-four hour care is provided. Laundering of personal clothing etc is carried out on the premises. Activities and occasional entertainments are arranged. Meals are freshly prepared and cooked within the home. Although no choice of menu is offered, a variety of alternatives are always available to suit individual taste and preference. The fees for the home, as confirmed to the Commission for Social Care Inspection (CSCI) at the time of inspection, range from £430 - £560 per week. Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: - Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 5 http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoosing a care home .aspx A copy of the home’s inspection report is available to anyone wishing to read it in the Information File in the entrance hall. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 11.5 hours on the 11th December 2006. The main purpose of this unannounced inspection was to review all of the key National Minimum Standards, check that the residents living in the home were safe and properly cared for and to look at progress in meeting the requirements and recommendations made following the previous inspection. On the day of inspection, 14 residents were accommodated, including one short-term emergency admission. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Pre-inspection information had been completed and submitted before the inspection. In addition, the Commission received eleven eight completed comment cards from residents, eight from relatives and two from General Practitioners. All expressed general satisfaction with the care provided. Time was spent observing the interaction between residents and staff, as well as talking with five residents and two visitors to the home. The daily routine was also observed during the inspection. Discussion took place with Mrs Gail Shaw, the registered manager and members of staff on duty. Mr Hayward, the Responsible Individual on behalf of Beechrise Ltd., telephoned the home during the day to speak with the Inspector. For the purposes of this report, people who live at Clifton Lodge are referred to as residents as this is the term generally used within the care home. The Inspector was made to feel very welcome in the home throughout the visit. What the service does well: The Statement of Purpose and Service User Guide are well laid out and easy to read. They give a good indication of what a resident can expect from the home. In addition, information is available in the entrance hall, which includes a copy of the latest inspection report. Individual care records show that, prior to moving to the home, care needs are assessed. The outcome of pre-admission assessments is confirmed in writing, so prospective residents are fully assured that their care needs will be met. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 7 Health care needs are well met, with evidence of good support from community health professionals. The arrangements for storing and handling medicines in the home ensure residents’ safety. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. Residents appear comfortable and at ease with staff. Staff were seen throughout the inspection to be treating residents with courtesy and kindness, with due regard for dignity and respect. Residents are supported to maintain contact with family and friends and the wider community and to choose their own lifestyle within the home, where their individual preferences and routines are respected. Residents confirmed that they choose when to get up, when to go to bed and where they spend their day. Comments include, “I get up when I am ready.” “I come and go as I please.” Residents are able to bring their own possessions into the home to personalise their bedrooms. Clifton Lodge serves a balanced and varied selection of food. Residents may choose to eat their meals. The menu shows that residents enjoy a healthy, well-balanced diet. Fresh fruit and vegetables are used wherever possible and special diets can be catered for. Residents commented, The food here is excellent, just as I like it. The food is lovely and plenty of it. I have been spoiled since coming here. I enjoy my meals.” A relative commented, “I can honestly say the food is without fault.” Residents live in comfortable surroundings where standards are constantly improving. Prompt attention is paid to any minor defects and repairs whenever necessary. At the time of the inspection, the home was beautifully decorated for Christmas. Clifton Lodge is clean and there are no unpleasant smells, making life within the home more pleasurable. Residents commented, The laundry service is good. My room is kept very clean and tidy.” The home has now achieved the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. A Quality Assurance system is in place to obtain the views of residents, relatives and staff, to make sure that residents remain satisfied with all aspects of the home. Mrs Shaw says that new Quality Assurance questionnaires are due to be sent out to residents and relatives in January 2007. In order to protect residents, it is the policy of the home not to have any involvement in their personal finances. This means that, where necessary, the home pays for services such as chiropody and hairdressing and a record is maintained. This amount is then invoiced to residents, relatives or representatives for payment each quarter. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Clifton Lodge has a care planning system in place. However, there is sometimes a delay in drawing up care plans after admission, so staff do not always have the information they need to meet the needs of residents. More needs to be done to ensure that, wherever possible, initial care plans and any significant changes are agreed by the resident themselves, or, if this is not possible, by a relative or representative. Two of the comment cards returned to the Commission said that the management did not always keep them fully informed about important matters affecting care of their relatives. At present, care plans contain only limited information about residents background, social history, previous hobbies and interests etc. Recording such information will help to ensure that the activities on offer at Clifton Lodge will be person centred, meeting the individual needs, preferences and expectations of residents. A system is in place for dealing with any complaints but the method of recording must be improved. As a number of the staff do not speak English as their first language, it is recommended that the manager takes steps to ensure staff fully understand policies and procedures, such as Adult Protection, and such evidence be recorded. The home needs to review staffing levels to ensure there are always sufficient staff to meet the needs of residents and to ensure their safety and comfort. One of the comment cards received from relatives also raises concerns about staffing levels. Robust employment and recruiting procedures are still not in place to ensure the protection of residents when new staff are employed. This has been Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 9 identified in previous inspection reports, but has not been dealt with satisfactorily. The Commission will take enforcement action if recruiting procedures are not now improved. Staff are provided with training, but some improvements are necessary with induction and mandatory training, to ensure they will have all of the skills necessary to meet the assessed needs of residents. Mrs Shaw has still failed to comply with a condition of her registration and achieve her National Vocational Qualification level 4 in management and care, to ensure she has the necessary qualifications and knowledge to manage the care home. A final extension of time has been granted in which to complete these qualifications. Formal staff supervision is taking place to ensure good practice, but this is not always at the recommended intervals. Improvement is needed in the recording and notification of accidents and incidents. 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 Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 10 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 Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 11 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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Clifton Lodge. Information provided about Clifton Lodge and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met are offered places there. The outcome of pre-admission assessments is confirmed in writing, so prospective residents are fully assured that their care needs can be met. EVIDENCE: The Statement of Purpose and Service User Guide are well laid out, easy to read and contain all of the information required about Clifton Lodge and its facilities. These documents give a good indication of what a resident can expect from the home and are given to prospective residents and/or their representatives when they are at the point of selecting a care home. A copy is also available in each residents bedroom within the home. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 12 In addition, information is available in the entrance hall, which includes a copy of the latest inspection report. Clifton Lodge also has an e-mail address where further information can be requested at any time. Individual care records are kept for each resident and three of these were examined for recently admitted residents. The first showed that, prior to moving to the home, care needs had been assessed by the homes manager. It is important to ensure that such assessments are always signed and dated and contain as much information as possible. The second pre-admission assessment was carried out by the hospital and the home’s form filled in through discussion with a social worker over the telephone, as the prospective resident was situated outside of Dorset. A third care record showed that the resident had been admitted as an emergency so no pre-admission assessment was possible. However, the home had obtained a faxed copy of information provided by the Local Authority prior to admission. The outcome of pre-admission assessments is now confirmed in writing, so prospective residents are fully assured that their care needs will be met. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Clifton Lodge. Clifton Lodge has a care planning system in place. However, there is sometimes a delay in drawing up care plans after admission, so staff do not always have the information they need to meet the needs of residents. Health care needs are generally well met, with evidence of good support from community health professionals. The arrangements for storing and handling medicines in the home ensure residents’ safety. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 14 EVIDENCE: Following admission to the home, further assessments are carried out and a care plan is drawn up, identifying the needs of each resident and how staff are to meet these needs. Care records for three residents were examined and each contained a full range of assessments, although the information recorded on social assessments was limited. One of the care plans examined had not been written until seven months after the resident’s admission to the home. Care plans should be written as soon as possible after admission to ensure that staff have the information necessary to meet each resident’s care needs. Mrs Shaw says that, wherever possible, initial care plans and any significant changes are agreed by the resident themselves, or, if this is not possible, by a relative or representative. This was not fully evidenced on the care plans examined. Two of the comment cards returned to the Commission said that the management did not always keep them fully informed about important matters affecting care of their relatives. Examination of care plans showed that they are regularly reviewed and updated as necessary to reflect any changing needs. Good daily records are written by both day and night staff to evidence the care being provided. These show that residents have access to General Practitioners, district nurses, dentists, chiropodists, opticians etc and attend appointments as necessary. This was later confirmed in discussion with residents and staff. However, records show that when one resident had an accident in the home, staff did not provide first aid and were slow in seeking professional advice. The home has systems in place for managing medicines. Staff dealing with medication have to undertake a course of related training. Observation of the member of staff dispensing medication during the inspection demonstrated good practice. Medicines are stored securely, to ensure the protection of residents. A Monitored Dosage System is in use. Samples of the cassettes were checked with the Medicine Administration Records (MAR) charts, to ensure that medicines had been administered correctly, as prescribed and properly recorded. The MAR charts are clearly printed and details of any medicine sensitivity or “none known”, where applicable, recorded. Handwritten changes or additions to the MAR chart are countersigned to indicate that a second carer has checked them as correct. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 15 The audit trail for medicines has been improved by recording the date when a new pack is opened. Staff were seen to knock at bedroom doors and to offer personal care discreetly. Staff interact with residents in a friendly and caring manner. It was clear from the time spent with residents that they feel comfortable and at ease with staff. Staff were seen throughout the inspection to be treating service users with courtesy and kindness, with due regard for dignity and respect. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Clifton Lodge. The information recorded about individual resident’s social, cultural, religious and recreational needs is still limited, making it difficult to assess if their needs and expectations are fully met. Residents are supported to maintain contact with family and friends and the wider community and to choose their own lifestyle within the home, where their individual preferences and routines are respected. Clifton Lodge serves a balanced and varied selection of food that meets residents’ tastes and special dietary needs in surroundings of their choice and at times which are convenient to them. EVIDENCE: Activities available at Clifton Lodge include board games, armchair ball games, skittles, darts, a monthly exercise to music session and regular monthly reminiscence and entertainment sessions. Mrs Shaw says the activities are not structured and do not take place every day. Most are spontaneous rather than planned, according to the wishes of residents. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 17 At present, care plans contain only limited information about residents background, social history, previous hobbies and interests etc. Mrs Shaw demonstrated a good knowledge of individual resident’s interests, but this is not written down in any detail. Recording such information will help to ensure that the activities on offer at Clifton Lodge will be person centred, meeting the individual needs, preferences and expectations of residents. One resident attends a local church on a regular basis. Arrangements are made to assist individual residents in attending church if they so wish, or for clergy to visit them at Clifton Lodge. Mrs Shaw is currently investigating the possibility of having an inter-denominational service in the home on a monthly basis. Mrs Shaw says that visitors are welcome to visit the home at any time. Residents and staff confirm that visiting times at Clifton Lodge are unrestricted. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. Several residents are able to go out alone and others with staff or relatives. A cordless telephone is provided for residents and three also have their own telephones, so can easily maintain family and community links. The home’s Statement of Purpose and Service User Guide includes information on choice. Residents spoken with confirmed that they choose when to get up, when to go to bed and where they spend their day. Comments include, “I get up when I am ready.” “I come and go as I please.” Residents are able to bring their own possessions into the home to personalise their bedrooms and this was witnessed in the rooms viewed during the inspection. Lunch on the day of inspection was homemade fish and potato pie with parsley sauce, peas and sweetcorn, followed by rice pudding with jam. Alternatives such as omelettes and salads are always available to suit individual taste and preference. For the evening meal, residents enjoyed corned beef hash, followed by ice cream with fruit sauce. Residents may choose to eat their meals in the dining room, in their bedrooms or outside in the garden when the weather permits. Lunch in the dining room was observed to be served in a relaxed, unhurried atmosphere with discreet staff assistance provided wherever necessary. Mealtimes can be flexible to fit in with care needs, appointments etc. The menu shows that residents enjoy a healthy, well-balanced diet. Fresh fruit and vegetables are used wherever possible and special diets can be catered for, although there are none at the present time. The home has a good supply of foodstocks, all appropriately stored. Residents commented, The food here is excellent, just as I like it. The food is really Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 18 good, all the better as I don’t have to cook it. The food is lovely and plenty of it. I have been spoiled since coming here. I enjoy my meals.” A relative commented, “I can honestly say the food is without fault.” Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Clifton Lodge. A system is in place for dealing with any complaints but the method of recording must be improved. Residents are confident that complaints would be listened to and dealt with appropriately. The home has a comprehensive Adult Protection policy in place to ensure residents are protected from possible abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents in their bedrooms. A copy of the complaints procedure is also available to visitors in the entrance hall. Mrs Shaw said that no complaints have been received by the home since the last inspection. At present, if any complaints are received, these are documented in the file of the individual resident concerned. This has the potential to make complaint information more difficult to access or evaluate, especially if the file is archived. It is recommended that details of any complaints be recorded in a separate complaints record, showing when they were received, any subsequent investigation and the eventual outcome. The record should also include details of any evidence collected and responses made within timescales, as well as Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 20 any involvement from other sources, if necessary. Any resulting action must also be documented. Mrs Shaw agreed to implement a separate complaint record. Residents said they would feel able to voice a complaint if necessary and felt that their concerns would be taken seriously, and acted upon. Comments included: If I was worried about anything, I would tell the manager and leave it for her to sort out.” I have no complaints, no nothing but praise for this place. I would tell the manager if something wasnt right. I am very happy to be here.” A relative commented, A good relationship with manageress and staff seems to solve any ‘queries and concerns’ not really identified as ‘complaints.’ A concern was raised with the Commission for Social Care Inspection regarding the care of a resident following an accident in the home. This was discussed with Mrs Shaw during the inspection and the appropriate records viewed. Mrs Shaw was asked to investigate further and submit her findings and an action plan to the Commission. (This has subsequently been received.) The home has an Adult Protection policy in place to protect service users from possible abuse. This makes reference to the Department of Health No Secrets guidance, which is also available to staff. As a number of the staff do not speak English as their first language, it is recommended that the manager takes steps to ensure full comprehension of policies and procedures, such as Adult Protection, and such evidence be recorded. All except one new member of staff have received Adult Protection training, to ensure a proper response to any suspicion or allegation of abuse. Adult Protection training is planned for the remaining member of staff. Bournemouth Borough Council Social Services are currently investigating an Adult Protection referral. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Clifton Lodge. Residents live in comfortable surroundings where standards are constantly improving. Clifton Lodge is clean and there are no unpleasant odours, ensuring that residents live in a pleasant environment. EVIDENCE: Inspection of the premises confirms that routine maintenance is being carried out to keep the home and grounds in good condition. Detailed maintenance records are kept and prompt attention is paid to any minor defects and repairs whenever necessary. The home was beautifully decorated for Christmas and awaiting the delivery of a large Christmas tree later in the week. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 22 Since the last inspection the quiet lounge, lobby area, office and dining room have been redecorated. A new microwave and deep fat fryer have been provided in the kitchen. A new, permanent ramp is now in place to allow easier access at the front door for wheelchair users. A nonslip surface will be added within the next few days. Mrs Shaw says that new carpets are planned for all communal areas early in the New Year. Documentary evidence shows a regular maintenance programme is in place and equipment, such as hoists and the lift, are regularly serviced. A tour of the building also confirms that Clifton Lodge is well maintained. The fire records show appropriate checks and regular servicing being carried out on the fire warning system, emergency lighting and fire fighting equipment. The home is clean and there are no unpleasant smells, making life within the home more pleasurable. The home has suitable facilities and procedures in respect of dealing with laundry and the disposal of clinical waste. Residents commented, The laundry service is good. My room is kept very clean and tidy.” Clifton Lodge DS0000050468.V316971.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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Clifton Lodge. The home needs to review staffing levels to ensure there are always sufficient staff to meet the needs of residents and to ensure their safety and comfort. The home has now achieved the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Robust employment and recruiting procedures are still not in place to ensure the protection of residents. Staff are provided with training, but some improvements are necessary to ensure they will have all of the skills necessary to meet the assessed needs of residents. EVIDENCE: On the 08.00 14.00 20.00 20.00 day of inspection the following care staff were on duty: - 14.00 2 care assistants - 20.00 2 care assistants - 08.00 1 wakeful night care assistant. - 08.00 1 sleep-in night care assistant (wakeful from 20.00 - 23.00 and 06.00 - 08.00) DS0000050468.V316971.R01.S.doc Version 5.2 Page 24 Clifton Lodge A total of eight staff are employed, including five care staff, a cook (and parttime carer) and two housekeeping staff. At present, thirteen permanent residents are accommodated and an additional resident is receiving emergency short-term care. Three residents are described by the manager as having high dependency daytime care needs, requiring two staff to assist them with hoisting, getting washed, dressed, etc. Examination of the staffing roster demonstrates that there are only two care staff on duty from 8.00am until 8.00pm to meet the current needs of all residents. If they are both engaged in dealing with one of the high dependency residents, Mrs Shaw says she then helps out with the delivery of care when needed. However, there are times when this is not possible as Mrs Shaw is not in the home. If high dependency residents are to be admitted to the home staffing levels must be reviewed, especially as the number and care needs of existing residents could also increase. (One of the comment cards received from relatives also raises concerns about staffing levels.) Relationships between staff and residents were directly and indirectly observed throughout the course of the inspection. Staff were seen to be responding to residents appropriately and working to protect their need for privacy and dignity. Staff showed a friendly, relaxed and caring approach when dealing with residents. Residents commented, I am very well looked after here, I can’t praise them enough. The staff are all working hard for us. I would recommend this place to anyone who needs to be looked after.” The home has now achieved the target of 50 trained members of care staff with National Vocational Qualification (NVQ) level 2, to ensure residents at Clifton Lodge are in safe hands. Three of the six members of care staff have now attained NVQ level 2. Mrs Shaw says that it is hoped two will proceed onto NVQ level 3 in 2007. Considerable improvements in the recruitment procedure have taken place since the last inspection, but there are still issues to be resolved. There is a legal requirement on providers of care to check if an individual is included on the POVA (Protection of Vulnerable Adults) list before employing new staff that will have regular contact with residents in the course of their duties. Providers of care must ensure that such individuals do not commence employment until satisfactory results from Criminal Records Bureau (CRB) disclosures or POVAfirst checks have been issued. However, when the records for two members of staff employed earlier this year were examined, these showed that CRB disclosures and POVAfirst checks had been received after employment started. This issue has been identified in previous inspection reports. Subsequent discussion with Mrs Shaw demonstrated that she is now carrying out the appropriate checks prior to the commencement of employment. However, any Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 25 further failure to implement a robust recruitment procedure will result in enforcement action. The home provides staff training as a means of improving the standard of care provided and ensuring residents safety. Training records and discussions with staff confirm that training courses have included adult protection, moving and handling, first aid, basic food hygiene, health and safety, bereavement, continence, infection control and the administration of medicines. However, records show there are still a small number of staff that have not received all mandatory training, such as moving and handling, first aid etc. Mrs Shaw says she will arrange for further training, wherever necessary, as soon as possible. Mrs Shaw confirms that all new staff receive induction training. This includes a shorter introduction to the home followed by a six-week induction, which is based on the Skills for Care Common Induction Standards. No new staff have been recruited since the Common Induction Standards were introduced so induction training will be examined in more detail at the next inspection. Further information about staff training can be obtained from the following websites: www.picbdp.co.uk This is the Partners in Care web site and provides lots of information about funding streams for training including NVQ, Life skills and Leadership & Management. www.skillsforcare.org.uk This is the Skills for Care web site and there are downloadable knowledge sets and learning logs for: Dementia, Infection Control, Medication and also Workers not involved in direct care. These knowledge sets are the first 4 of approximately 30 that are currently planned. They are designed to improve consistency in underpinning knowledge for the adult social care work force in England. They identify learning outcomes and are designed to be used alongside the Common Induction Standards, which are also available from this web site. They also count as underpinning knowledge towards NVQs and link to the Health & Social Care National Occupational Standards. www.traintogain.gov.uk This is a programme and funding stream supported by the Learning and Skills Council and Business Link, who provide a skills brokerage role. (This project takes off from 1st August in Dorset.) Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 26 www.lsc.gov.uk/bdp/employer/eggt_intro.htm This is the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility. Clifton Lodge DS0000050468.V316971.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): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Clifton Lodge. Mrs Shaw demonstrates a good knowledge of the operation of the care home and the needs of its residents. However, she has still failed to comply with a condition of her registration and achieve her National Vocational Qualification level 4 in management and care, to ensure she has the necessary qualifications and knowledge to manage the care home. The home has implemented a quality assurance system to ensure that residents remain satisfied with all aspects of the home. Residents are assured of sound management of their financial interests. Formal staff supervision is taking place to ensure good practice, but this is not always at the recommended intervals. Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 28 The premises is well maintained and the home works to ensure the general health, safety and welfare of residents. However, improvement is needed in the recording and reporting of accidents and incidents. EVIDENCE: Mrs Shaw is currently undertaking the National Vocational Qualification (NVQ) Level 4 in management and care. This was a condition of her registration and was to have been completed by the end of 2005. This timescale was extended to 31/05/06, but has still not been met. A final extension has been agreed, but Mrs Shaw must now meet this condition of registration within the new timescale. Evidence of compliance must be forwarded to the Commission as soon as possible. Working relationships between management, staff and residents were directly and indirectly observed throughout the course of the inspection. They appear open and friendly, contributing to a relaxed atmosphere, which is beneficial to all in the home. A relative commented, “This is an excellent home, run in a very friendly manner.” Mr Hayward, the Responsible Individual on behalf of Beechrise Ltd. makes the required unannounced visits to the home at least monthly, to check on the standard of care provided. He prepares a written report on the conduct of the home and a copy of this is forwarded to the Commission. Mrs Shaw said that Quality Assurance questionnaires are due to be sent out to residents and relatives in January 2007. It is hoped to view the feedback from these at the next inspection. Mrs Shaw confirms that, in order to protect residents, it is the policy of the home not to have any involvement in their personal finances. Therefore, all residents who are unable to handle their own affairs or do not wish to, have a relative or other representative to deal with their finances etc. This means that, where necessary, the home pays for services such as chiropody and hairdressing and a record is maintained. This amount is then invoiced to residents, relatives or representatives for payment each quarter. Residents are encouraged not to bring valuables into the home and no possessions are being held for safekeeping at the present time. Information about advocacy services is available to residents should they wish to seek independent advice. In order to protect residents, policies are in place precluding staff acceptance of gifts or involvement in residents wills. Care staff should receive formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 29 the home and looking at individual career development needs etc. Examination of staff records shows that supervision is not always taking place on a regular basis. For example, one member of staff commenced employment in April 2006, but supervision is recorded as taking place only in July and November. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, gas appliances and call bell system are regularly serviced and maintained. An electrical certificate for the property is in place. Radiators are guarded to prevent residents coming into contact with hot surfaces. All substances that could be potentially hazardous to health are handled and stored safely. The majority of staff have received first aid and moving and handling training and further training is planned. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is arranged. Routine checks are carried out at appropriate intervals and staff confirm this. Staff fire training, including induction training for new staff, is taking place and fire drills are arranged so that staff are fully aware of the action to take in the event of a fire. Examination of records showed that not all accidents detailed in the daily notes were entered in the accident book. One entry demonstrated that staff did not provide any first aid at the time of an accident and it was some time before professional advice was sought. There were also discrepancies between the entry in the accident book and daily notes made by staff at the time. Regulation 37 of the Care Homes Regulations 2001 details the need to report the following incidents to the Commission within 24 hours of the occurrence, or as near as practicable under the circumstances: a) The death of any service user, including the circumstances of his death; b) The outbreak in the care home of any infectious disease which in the opinion of any registered medical practitioner attending persons in the care home is sufficiently serious to be so notified; c) Any serious injury to a service user; d) Serious illness of a service user at home at which nursing is not provided; Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 30 e) Any event in the care home which adversely affects the well-being or safety of any service user; f) Any theft, burglary or accident in the care home; g) Any allegation of misconduct by the registered person or any person who works at the care home. Recent Regulation 37 notifications made by the home have not been received within the specified timescale. Any notification made in accordance with this Regulation must also be confirmed in writing. Information about this and other matters of interest can be obtained from the Commission for Social Care Inspection website at www.csci.org.uk Clifton Lodge DS0000050468.V316971.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 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 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Clifton Lodge DS0000050468.V316971.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. Standard Regulation Requirement The registered persons must ensure that a care plan is prepared for each resident, as soon as possible after admission to the care home. All aspects of each resident s health, personal and social care needs must be recorded. Care plans are to be agreed and signed by the resident or their representative wherever possible. The registered person must make proper provision for the health and welfare of residents. Appropriate professional advice must be sought immediately when residents have accidents that result in serious or painful injuries. The registered person must review the staff rota and ensure sufficient care staff are on duty at all times, in accordance with the assessed needs of residents. The registered person must operate a thorough recruitment procedure to ensure the protection of residents. All staff DS0000050468.V316971.R01.S.doc Timescale for action 28/02/07 1 OP7 15(1) 2 OP7 14 and 15 28/02/07 3 OP8 12(1) 31/01/07 4 OP27 18 28/02/07 5 OP29 19(1) Schedule 2 28/02/07 Clifton Lodge Version 5.2 Page 33 6 OP30 18(1) 7 OP31 9(2)(b)(i) 8 9 OP36 OP38 18(2) 17(1)(2) Schedule 3 (j) and Schedule 4 (12) 37 must be properly checked before being employed. Previous timescales of 31/10/05 and 31/05/06 not met. The registered person must ensure that staff receive training, which is appropriate to the work they are to perform. This should include all mandatory training. It is a requirement that Mrs Shaw must obtain a National Vocational Qualification level 4 in management and care by 2005. Previous timescales of 31/12/05 and 31/05/06 not met. The registered persons must ensure that staff are appropriately supervised at the recommended intervals. The registered persons must fully record all accidents occurring in the care home. The registered persons must notify any death, illness or other event to the Commission within 24 hours of the occurrence. 31/03/07 30/09/07 28/02/07 28/02/07 31/01/07 10 OP38 Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 34 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 OP12 Good Practice Recommendations It is recommended that more be recorded about residents’ hobbies and interests, social and leisure preferences, cultural or religious needs, wishes and abilities etc. Such information will assist the home in ensuring social needs are met. It is recommended that a separate complaints record be maintained. It is recommended that the registered persons evidence that all staff have read and understood policies and procedures, including Adult Protection. 2 3 OP16 OP18 Clifton Lodge DS0000050468.V316971.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Lodge DS0000050468.V316971.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. 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