CARE HOMES FOR OLDER PEOPLE
Clifton Manor Residential Care Home Clifton Manor Rivergreen Clifton Nottingham NG11 8AW Lead Inspector
Sharon Rosenfeld 1 and 2
st nd Unannounced Inspection November 2005 4:00 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 Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 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 Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Clifton Manor Residential Care Home Address Clifton Manor Rivergreen Clifton Nottingham NG11 8AW 0115 984 5859 0115 984 5859 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) R & K Care Limited Mrs Manjula Rai Mrs Deborah Kelly Andrews Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st June 2005. Brief Description of the Service: Clifton Manor Care Home is a purpose built unit situated within a housing estate in a suburb south of Nottingham city centre. The accommodation is on two floors with access provided by both stairs and a lift. The home is adjoined to Clifton Manor Nursing Home, which is registered separately by the Commission for Social Care Inspection (CSCI). Local shops are close by as are public transport services to Nottingham. The home provides accommodation and personal care to a maximum of 46 older people over the age of 65 years. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was made in response to a complaint received by the CSCI. The complaint had thirteen elements to it. These were explored at the visit on the 1st November. Four were upheld, five were not upheld and four were not proven. The second day of the inspection mainly focussed on the standards relating to the residents perceptions of the quality of care provided. Evidence of the quality of services was gathered by direct and indirect observations of care practice, through conversations with four residents, and the Registered Manager. The main method of inspection used was called case tracking which involved selecting four residents and tracking the care they receive through the checking of their records, discussion with them and observation of care practices. What the service does well: What has improved since the last inspection?
Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 6 No further admissions have been made outside of the registration category of the home. The three care plans seen provided clear guidance to staff about how to meet residents’ needs. The fire door to the dining room has been repaired. The registered manager has held a number of staff meetings to address what time the rights of residents to determine their own bedtime. 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. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 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 Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. The absence of key information in the statement of purpose and service user guide may lead to service users needs not being met. New residents move into the home without assurances that their needs will be met. EVIDENCE: The information in the statement of purpose and service user guide needs to be amended or elaborated upon in a number of areas. Reference is made to the National Care Standards Commission being the regulatory body and this must be changed to the Commission for Social Care Inspection (CSCI). The signs outside state the home is registered with social services and the health authority and this is not the case and is therefore misleading. The information must leave the reader in no doubt about the actual arrangements that have been made to meet the elements described in Schedule 1 of the Care Homes Regulations 2001. This requirement remains unmet from previous inspections. A sample statement of purpose will be shared with the registered manager to advise her on how to meet this requirement. Prospective service users must receive written confirmation, prior to moving into the home, that the home can meet their assessed needs. This requirement remains unmet from the last inspection.
Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, 10. The sample of care plans seen generally provides staff with enough information on how to meet resident’s needs. Some practices observed do not promote residents’ privacy and dignity. The medication policies and procedures are clear. EVIDENCE: Three care plans were examined. They contained appropriate needs assessments and described the action staff must take to meet individual needs. The care plan of a person whose nutritional assessment gives ‘cause for concern’ states staff should weigh her regularly. The instruction must be more specific and guide staff about the action they must take if her weight continues to give rise to concern. Another persons’ care plan seen does not describe the type of pressure relieving equipment to be provided. One resident’s care plan states she requires encouragement and assistance at meal times. This has however improved since her admission to the home and the care plan should be updated to reflect this. The staff were otherwise well informed about the needs of the residents and their responsibilities to provide the care required.
Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 10 A visiting General Practitioner (GP) stated the staff always refer people promptly to the surgery if they have concerns about a residents health. He also said the staff work effectively with the team of district nurses. He said the staff have managed some difficult cases very well. Two elements of a complaint received by the CSCI claimed that residents are dressed in their night- clothes prior to having their tea and that some people’s attire does not protect their dignity. These elements of the complaints were upheld from observations made on the first day of the inspection. The staff state residents agree to this however some of the residents asked could not confirm that this was the case. Residents should be dressed in nightclothes when they are ready to retire to bed. The complaint that many people were assisted to bed very early was also upheld. This practice had been discovered by the registered manager and addressed in a timely manner at a recent team meeting. The medication policies are clear and include the arrangements for people to self medicate. The person who actually administers the medicine to the resident is the one who must sign the chart. Controlled drugs are appropriately managed. The temperature of the room where medicines are stored should be monitored daily to ensure that it does not exceed 25°C. The temperature of the medicines fridge was too high for a prolonged period before action was taken to de-frost it. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 It is not clear how resident’s social, cultural, recreational and occupational preferences are met. Residents enjoy the meals provided. EVIDENCE: The residents spoken with stated they choose how to spend their time and whether to participate in the activities run by the home. One person said they enjoy going out with family or for short walks alone. The advertised activities did not take place on the day of the inspection. One relative said she was very happy with the services provided at the home. She said the staff were ‘lovely and caring’ and took account of her relatives’ wishes. One person complained that the night staff do not provide the personal care assistance she requires promptly. The registered manager confirmed she would look into this. Three people spoken with commented that they enjoyed the variety of food provided and one person felt confident that the registered manager would provide alternatives if these were requested. Residents choose their preferred meal from a menu that is discussed with them on a daily basis. The tables were nicely set with napkins and a range of condiments. Aprons and wipes were also available in the dining room and this is good practice. One element of a complaint about the lack of particular foodstuffs was not upheld. One element of a complaint concerned a breach of agreement about the allocation of cigarettes to one resident. This complaint was upheld. The registered manager must make arrangements for the residents to have her cigarette according to the agreement reached between them.
Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Complaints and allegations of abuse are not handled properly to provide residents with confidence that their concerns will be listened to, acted upon and taken seriously. EVIDENCE: The provider was asked to investigate two complaints one of which included an adult protection element. The procedures for this were not followed and both will now be investigated by the CSCI. The manager’s records of complaints made were examined. These were well documented although the outcome of the complaint investigation needs to be recorded and shared with the complainant. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. There are a number of matters outstanding that may put people at risk of harm and do not provide safe and comfortable surroundings in which to live. EVIDENCE: A complaint was received and investigated by the CSCI on 1st November 2005. The complaint about the condition of the chairs in the smoking lounge was upheld. The furniture in this room requires repair or replacement. The protective cover on one chair was wet and had not been changed. There have been several complaints made about the quality of the homes laundry service. Although no evidence of this could be found by the CSCI, the registered manager must explore these concerns further with residents and relatives and any shortfalls must be addressed. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30. The number and skills of staff is sufficient to meet the needs of the residents. The recruitment policies are robust. EVIDENCE: There is not a high turnover of staff at the home. It has been some months since recruitment has taken place and this helps to provide a consistent service to the residents. The home had sufficient numbers of staff to meet the needs of the service users. Two staff files were examined. One long-standing member of staff does not have an enhanced criminal records bureau (CRB) disclosure. The registered manager states she has applied for this six times and each time the forms have been mislaid. There is no information about this in the staff file and no record to confirm what action the registered manager has taken to address the situation. The registered manager confirmed she is aware that staff cannot commence unsupervised work at the home without first obtaining a satisfactory enhanced CRB. The staff’s training records were seen and appropriate training is provided. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38. The home is generally being managed appropriately. Practices that promote the health, safety and welfare of residents are in place although a lack of investment in particular areas could put residents at risk. EVIDENCE: The registered manager has commenced a consultation exercise with residents and their relatives to obtain their views about the quality of care and services at the home. Responses are still being returned and the ones seen are favourable. The registered manager safeguards only small amounts of resident’ s money and services are often provided by the hairdresser and other service providers in lieu of payment. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 16 ` The registered manager maintains good records of the measures she takes to ensure that the health and wellbeing of residents is maintained. Accidents are recorded but the registered manager lacks knowledge about her obligations to report serious occurrences under Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). The Health and Safety Executive must be contacted to discuss the submission of retrospective reports under this legislation. The homes fire alarm systems are tested regularly and good records are maintained about this. A letter was seen by the Fire Officer to confirm that the bedroom doors are not fire doors and therefore a programme of replacement should be undertaken over a period of time. Confirmation was seen of other maintenance work and servicing including electrical and gas appliances, the call system and fire system. A complaint was received that there is not a consistent supply of hot water to the rooms in the corridor running to the right from the top of the main flight of stairs. This is not the first time this complaint has been made and it was upheld. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 17 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 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4, 5 Requirement The Statement of Purpose must explain the arrangements in place to meet all of the points identified in Schedule 1 of the Care Homes Regulations 2001. This requirement is outstanding from previous inspections. Prospective residents must receive written confirmation that the home can meet their assessed needs. This requirement remains outstanding from 22/07/05. Where necessary, be specific in care plans about how often a person must be weighed and the type of pressure relieving equipment to they are to use. Staff must give resident’s access to their cigarettes in accordance with agreements reached with them. Medicines must be stored at the appropriate temperature in the room and the fridge. The fridge must be de-frosted regularly so as not to affect the temperature. The resident’s must not routinely be dressed in their nightwear, by
DS0000002299.V262633.R01.S.doc Timescale for action 28/02/06 2 OP3 14 31/12/05 3 OP7 15 31/12/05 4 OP7OP10 12, 15 31/12/05 5 OP9 13 31/12/05 6 OP10 12 31/12/05 Clifton Manor Residential Care Home Version 5.0 Page 19 7 OP12 16 8 OP16OP18 22 9 10 OP19 OP26 23 13 11 OP29 19 12 OP38 13, 17 13 OP38 13, 23 14 OP38 13, 23 staff from mid afternoon onwards. Wider consultation must take place with residents about social and recreational activities they may wish to participate in. Once agreed, the arrangements must be implemented. All complaints received must be investigated thoroughly, wherever possible within the timescales given and an outcome and action taken must be recorded and shared with the complainant. Repair or replace the damaged furniture in the smoking lounge. Find out the resident’s and relatives, views about the quality of the laundry service and take appropriate action to improve the service if necessary. Record, in the staff file, any action taken to acquire an enhanced criminal record bureau disclosure and ensure that all staff has a CRB. Contact the Health and Safety Executive dealing with RIDDOR and establish the procedure for reporting under this regulation. Ensure this procedure is complied with. Ensure that hot water supplies are delivered efficiently to all bedrooms and that the water is delivered at the appropriate temperature. In consultation with the fire officer, make a plan to replace the doors in the bedrooms to fire doors in accordance with his recommendations. 31/01/06 31/12/05 31/03/06 31/01/06 31/12/05 31/12/05 31/12/05 31/01/06 Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 20 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 *RCN OP38 Good Practice Recommendations The signs outside should not state the home is registered with the health authority and social services. Obtain confirmation from the Health and Safety Executive if they require retrospective submissions of accidents that should have been reported under RIDDOR. Clifton Manor Residential Care Home DS0000002299.V262633.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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