CARE HOMES FOR OLDER PEOPLE
Clifton Manor Residential Care Home Clifton Manor Rivergreen Clifton Nottingham NG11 8AW Lead Inspector
Sharon Rosenfeld Unannounced Inspection 12th April 2006 10:15 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.V288916.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 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) Manor Care Group Limited Mrs Deborah Kelly 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.V288916.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The agency is registered to provide personal care for service users of both sexes whose primary needs falls within the following category Old age, not falling within any other category (OP) (46) Within this number, one named individual may be accommodated under the category Mental Disorder over 65 years of age (MD [E]). See application for Variation to registration dated 01 August 2005 and 13 September 2005 for the identity of this individual 1st and 2nd November 2005 2. Date of last inspection 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.V288916.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours on 12th April 2006. The main method of inspection was ‘care tracking’. This involves selecting a number of residents, in this case five, and tracking different aspects of care they have received through the checking of their records, discussions with them, with the staff and their families and through direct and indirect observation of care practice. The company that owns the home was taken over in March 2006. The new provider is currently undertaking a comprehensive audit of the services provided and is making plans for further improvements. The impact and progress of these improvements will be more closely assessed at the next inspection. What the service does well: What has improved since the last inspection?
Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 6 The majority of the requirements made at the previous inspection have been met. The new provider will update the statement of Purpose. To reflect the new ownership and any relevant changes in the services provided. Since the last inspection improvements have been made to the laundry service. This had been the focus of a number of complaints by relatives prior to the last inspection. The care plans are specific about how often residents should be weighed, and the type of pressure relieving equipment that is to be used. A number of routines have been reviewed and amended that has improved the way residents personal dignity is preserved. For example, residents would routinely be dressed in nightclothes in the mid afternoon following their bath. This no longer happens unless the individual specifically requests this. Wider consultation has taken place about how residents wish to spend their time and what their interests are. The hot water supplies to the bedrooms have been adjusted and are now more reliable. 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.V288916.R01.S.doc Version 5.1 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.V288916.R01.S.doc Version 5.1 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): 3. Proper assessments take place before people are admitted to the home. People now receive assurances that the home can meet their needs. The home does not provide intermediate care services. EVIDENCE: Five of the resident’s records were examined. Their records contained the appropriate community care assessments. Additional assessments had been undertaken periodically, to determine their level of need in the following areas: nutrition; moving and handling; mobility and risk of falls; the risk of developing pressure sores and infection and dependency needs. Greater consideration is now being given to the assessment of resident’s needs to plan meaningful and enjoyable activity and meet their religious and cultural needs. The residents’ needs are reviewed at appropriate intervals. Each file seen contained a care plan that explained how their identified needs would be met. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 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, 8, 9, 10. The staff are trained to meet the residents personal care needs. The prompt referral to external professionals such as district nurses ensures that medical needs are also met in a timely manner. EVIDENCE: The five care plans seen contained information relevant to their assessment of need. All aspects of health and social care have been considered and the care provided during the night is now planned more effectively and monitored more closely. Significant observations and events at the home are being recorded and given an account of the actual care that is being provided. An assessment of social and recreational interests has been undertaken which the activities coordinator intends to use to plan future events. Appropriate records and notifications are made when people have accidents and injure themselves. The manager has used local specialists to assess people who are at risk of falling. An examination of records revealed that the falls risk assessment is not effective in determining the level of risk from falls. One person had fallen eleven times since the previous inspection yet her falls assessment indicated she was not at high risk of falling. This person’s
Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 10 medication was reviewed and the incidence of falls has subsequently decreased. It is good practice to arrange for the doctor to review residents in these circumstances. The falls risk assessment is being replaced by another model. A visiting district nurse gave positive feedback about the home. She was impressed by the quality of care provided and said they have developed good working relationships. No evidence was seen that resident’s rights to NHS services in, for example, chiropody for people with diabetes were promoted. The staff have received recent training in drug administration. They also completed a distance-learning course last year in the same subject. The staff were observed administering medication and the practice met with requirements. Appropriate records are maintained of the receipt and disposal of medication. A more considered approach is now taken to the ways in which residents dignity is upheld. People are no longer routinely changed into nightwear after having a bath mid afternoon. Those residents asked confirmed that the staff .are polite and helpful and they are satisfied with the way care is delivered. One gentleman confirmed that being helped with personal care by female staff, particularly younger ones, embarrasses him. He said he has grown more accustomed to this however . Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 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, 13, 14, 15. Improvements have been made to the provision of social activities and residents are now consulted more widely about their interests. The home meets the resident’s nutritional needs. EVIDENCE: An activities co-ordinator has been employed to facilitate social events and activities each afternoon, during the weekdays The staff stated that the introduction of activities has benefited some of the residents who have enjoyed the variety of activities offered so far. The staff assist in the activities. Residents are encouraged but not forced to participate. The afternoon’s event, planting flowers and painting pots appeared to be enjoyed by everyone who participated. Religious services take place at the home and are delivered by local clergy. One person attends the Catholic Church herself occasionally and is escorted by the registered manager. One person’s family were spoken with. They are pleased with the care provided and enjoy good relationships with the staff. They are aware of the complaints procedure and are confident that their views will be listened. to. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 12 A choice of meals is provided throughout the day. People who were not eating the meal prepared were offered a range of alternatives. Throughout the meal the staff were attentive to the individual needs of the residents and well informed about who required more assistance and encouragement. Drinks were served continuously, throughout the meal. The staff did not however sit discretely next to residents requiring assistance to eat. Residents spoken with at lunchtime said they looked forward to their meals. And they knew they could choose an alternative if they wished. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 13 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): Improvements in the way that complaints are addressed have been made. The lack of staff knowledge regarding adult protection procedures and definitions of abuse could compromise the safety of residents. EVIDENCE: Three complaints have been received at the home since the last inspection. These have been recorded appropriately and have all been resolved to the complainant’s satisfaction. Interviews with the staff evidenced that they were not conversant with adult protection protocols and procedures. Although they had some awareness of ways in which residents might be abused, their knowledge of this must also be improved. The registered manager is aware of the local procedures and must ensure that the staff are also conversant with them. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 14 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. Planned improvements to the garden will enhance the experience of people living at the home. Further improvements are required to the décor in parts of the home. One matter is outstanding from the last inspection, which could potentially put people at risk. EVIDENCE: Planned improvements to the environment and the garden will enhance the experience of people living at the home. One person said she is looking forward to having a nice patio to sit on and hopes to use the garden a lot. Residents can access all parts of the home, however not all parts of the garden are safe to access. The provider should consider alternative ways for the residents to access the proposed garden area. It is situated to the rear of the premises and access to this area is a lengthy walk for older people with mobility problems. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 15 Evidence was not seen that the building complies with the local fire service requirements. The previous requirement, to plan the replacement of bedroom doors to meet fire safety recommendations has not yet been actioned. The new provider needs to be given time to prioritise improvements however and therefore an extension will be made to the timescales for this work to take place. The condition of the home is generally good. There are some areas that require decoration. Some of the paintwork on the doors has been badly damaged. The cleanliness of the home has improved and new carpet cleaning equipment has recently been purchased. The manager stated that new chairs have been ordered for the small lounge. A complaint had been received prior to the last inspection about the poor quality of this furniture. Recent improvements have also been made to the laundry facilities. The number of complaints about this service has reduced and fewer clothes are being mislaid due to better labelling. The laundry is sited away from areas where food is stored and prepared. There is a system in place to manage infected material and clinical waste. A person is employed to do residents laundry and she has received infection control training. There were no offensive odours at the home. One person thought her nighttime medication had been omitted. She called the bell but no one came. Her bell was found to be faulty and was repaired immediately. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. The procedures for the recruitment of staff are more stringently applied and this will provide additional safeguards for people living at the home. The deployment and number of staff meets the residents’ needs. EVIDENCE: There were appropriate numbers of staff on duty to meet the residents’ needs. An additional staff member from the day shift assists the night staff in the evening to assist residents to bed. The staff confirmed that the new provider has addressed the pressure on them to work longer additional hours to cover staff shortages. Agency staff are now more widely used and two additional staff have recently been recruited. More robust recruitment practices are in place to meet the legislation. New staff are not able to start work until their Criminal Records Bureau (CRB) enhanced disclosure has been received. The staff files have been audited and contain the information required. The registered manager is effective in her role. She has the confidence of the staff and of the relatives spoken with. The staff training records were examined. All staff have registered to undertake their National Vocational Qualification(NVQ) level 2 in care. Two people have achieved this qualification. The manager is undertaking the registered managers award. Whilst this does not meet the requirement that 50 of the staff needed to have achieved this qualification by 31st December 2005, there is a plan to address this. The CSCI will assess progress at the
Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 17 next inspection. All of the staff have received training in the mandatory areas including moving and handling, food hygiene, first aid, and health and safety. The registered manager has been trained as a moving and handling trainer and has delivered this training on two occasions. The staff were observed using appropriate techniques and equipment. The manager has also attended the Fire Wardens course and has planned the training of staff at both the residential home and the adjoining nursing home in the forthcoming two weeks. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. The home is well managed and the staff have clear leadership and guidance. The practices in place promote and safeguard the well being of residents. EVIDENCE: The registered manager holds the confidence of the staff team. They said she is approachable, supportive and will always attempt to resolve any problems identified. The lines of accountability in the home are clearly defined. The new provider is implementing new quality assurance procedures. The views of residents, staff, relatives and other stakeholders will be captured through the use of questionnaires. The responses will be analysed and used to inform future practice at the home. The success of this system will be assessed at the next inspection. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 19 CSCI’s new format for the Regulation 37 notices were shared with the manager and it is recommended that they be used from now on. CSCI’s new format for the Regulation 37 notices were shared with the manager and it is recommended that they be used from now on. An audit of the mandatory training for staff revealed there are no gaps. Wherever possible the residents or their relatives manage their own personal finances. Some cash sums are managed for the payment of hairdressing and chiropody etc and records are kept about these. The homes electrical and gas systems are maintained on an annual basis. A maintenance worker monitors the water temperatures and the registered manager is responsible for doing the tests for Legionella at both Clifton Manor residential and nursing homes. The lift has recently been serviced and the lifting equipment at the home is due to be serviced within the next week. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13(6) 18(1) Requirement Timescale for action 30/05/06 2 OP19 23 3 OP38 13, 23 The registered provider must ensure that all staff are knowledgeable about the different types of abuse and about their responsibilities under the Nottinghamshire Committee for the Protection of Vulnerable Adults policies and procedures. The registered provider must 30/06/06 produce a plan of maintenance for the home that includes the re-decoration of bedrooms. In consultation with the fire 31/05/06 officer, produce a plan to replace the doors in the bedrooms to fire doors in accordance with his recommendations. (This requirement remains unmet from the last inspection). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 22 No. 1. 2. Refer to Standard *RCN OP19 Good Practice Recommendations The signs outside should not state the home is registered with the health authority and social services. The registered provider should consider how residents might more easily access the garden area. Clifton Manor Residential Care Home DS0000002299.V288916.R01.S.doc Version 5.1 Page 23 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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