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Inspection on 12/06/07 for Clifton Manor Care Home

Also see our care home review for Clifton Manor Care Home for more information

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A warm and welcoming atmosphere was evident on entering the home. Staff were seen to talk freely with service users and relatives throughout the visit. Service users spoken with spoke highly of care received and said that staff were very kind and caring. All service users said they were settled and happy living in the home. The relative spoken with also spoke highly of standards within the home and said they felt confident that staff were well trained. The visiting professional said that staff were very professional and used their services appropriately. Staff training is at a good standard and staff were able to fully discuss service users needs. The environment has been redecorated and provides a comfortable and homely atmosphere for service users.

What has improved since the last inspection?

Staff have had further training in adult protection and staff spoken with demonstrated a good understanding ensuring service users are protected. A compliance manager has been employed by the service who is working with the manager in the continued improvement of quality assurance for the service.

What the care home could do better:

Systems must be in place to ensure that medication is administered correctly and recorded following administration to ensure service users receive medication as prescribed.

CARE HOMES FOR OLDER PEOPLE Clifton Manor Residential Care Home Clifton Manor Rivergreen Clifton Nottingham NG11 8AW Lead Inspector Karmon Hawley Key Unannounced Inspection 12th June 2007 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 Manor Residential Care Home DS0000002299.V338835.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 Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 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 clifton.manor@hotmail.co.uk 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) Monarch Healthcare Ltd 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.V338835.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Clifton Manor Care Home is registered to provide personal care for service users of both sexes whose primary needs fall within the following category:Old age, not falling within any other category (OP) 46 Within this number, one named individual may be accommodated at Clifton Manor Care Home under the category Mental Disorder over 65 years of age MD(E) See variation applications dated 01.08.05 and 13.09.05 The maxim number of persons to be accommodated at Clifton Manor Care Home is 46 12th April 2006 2. 3. 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. The current weekly fees for the home range from £320 - £336; these fees do not cover the cost of hairdressing or chiropody. Information about the fees and the home is made available on the point of enquiry. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by an inspector reviewing all the previous inspection records available, looking at information provided by the manager about Clifton Manor and by undertaking a visit to the service with the inspector using a method called “case tracking.” “Case tracking” involves identifying individual service users who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. The inspector also checked that information provided by the manager matched individual experiences of service users living at the home by talking with them and observing the care received. Six service users, one relative and a district nurse were spoken with, all of them expressed that care was at a good standard and staff were very kind and attentive. General records maintained by the service and staff records were looked at to ensure these were maintained and provided positive outcomes for service users. Two members of staff were spoken with. What the service does well: What has improved since the last inspection? Staff have had further training in adult protection and staff spoken with demonstrated a good understanding ensuring service users are protected. A compliance manager has been employed by the service who is working with the manager in the continued improvement of quality assurance for the service. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that service users needs are fully assessed and these can be met prior to admission. The service does not offer intermediate care. EVIDENCE: The manager visits prospective service users within the community to carry out a preadmission assessment prior to admission into the home. Evidence of the assessment taking place and the referral assessments being obtained were within service users plans of care. Prospective service users may visit the home and spend time their prior to making a decision to move in. One service user spoken with said that they had visited the home before moving in and had been shown around. The service does not offer intermediate care. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 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. 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 this service. Plans of care are in depth and ensure that service users health, personal and social care needs are met. There is a risk that service users will not receive their medication as prescribed due to administration practices. EVIDENCE: Service users undergo various assessments such as the activities of daily living, manual handling, pressure area care and nutritional needs. Information gained forms the plan of care. Plans of care were in place for all service users identified needs. Service users personal preferences had been assessed, however these were not fully reflected within plans of care. Risk assessments were in place for falls but had not been put in place for diabetes mellitus and choking, however the manager discussed the new whole person risk assessments that are now being introduced. These were seen and covered all possible risks that one may encounter. Plans of care were reviewed and updated on a regular basis ensuring continuity of care. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 10 Service users, the relative and the district nurse spoken with spoke highly of staff and care received. Service users expressed that staff were very kind and caring and met their needs. Staff spoken with were able to discuss service users needs and the support required. There was evidence available within service users files to show that the doctor, district nurse, dentist, optician and other specialist services are accessed as required. Specialist cushions and mattresses were seen during the tour of the home. One service user spoken with said that they may see the doctor at any time should they need to and another discussed how they used a hoist to transfer. The visiting district nurse spoken with stated that staff were very professional and used the services appropriately. Medication procedures were seen. Service users medication records corresponded with the prescription. Records of medication received into the building and returned to be destroyed were available. Fridge temperatures were recorded and the room had a thermometer on the wall. The lunchtime mediation round was observed. Whilst administering an inhaler, the staff member did not talk to the service user and give appropriate instructions; therefore the delivery of the medication was not effective, as the service user did not breath in the medication at the correct time. The staff member also signed for medication before it was administered, and on one occasion potted medication was put on a lunch tray for another staff member to take to a service user who was not sitting in the dinning room. Service users and the relative spoken with said that staff were respectful at all times and ensured that privacy is maintained. There are curtains available within shared rooms. Staff are instructed on maintaining service users privacy and dignity and to knock on doors prior to entering. The manager also carries out spot visits to the home to ensure this is being upheld. Staff were observed to be respectful to service users throughout the visit. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 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. 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 this service. Service users enjoy a flexible daily routine and they are supported to take part in activities of their choosing. Service users enabled to make their own decisions and make choices in their daily lives. EVIDENCE: Staff offer activities such as bingo, sing a longs, films, reminiscences, trips out and games during the afternoon. Outside entertainers also visit the home. Two service users spoken with said that they enjoyed the activities on offer whereas two said that they did not wish to join in. One service user was seen playing dominoes with a member of staff during the visit. There were records available within service users plans of care to show which activities they had join in and whether they had enjoyed them. Service users spoken with said that the routine of the home was flexible and they may spend their time as they wish. Service users were seen walking freely around the home, occupying themselves as they wished and visiting the hairdresser. There are two church services delivered within the home; Catholic and Church of England. Holy communion is also offered as required. There is a notice board in the main entrance, which holds church newsletters and other information of interest. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 12 There are no restrictions on visiting and visitors are welcomed into the home at any time. The relative spoken with said that they are always made welcome when they visit. Staff were seen to offer visitors refreshments. Two service users spoken with said that they enjoyed having visitors and they could see them in private if they wished. Staff were able to discuss issues with regard to equality and diversity, they stated that they ensure they get to know service users individual needs and preferences and ensure that their rights and choices are observed. The service have in the past gained religious support, advocacy services and a translator for service users as required, the manager stated that this would be done for any service user who required it in the future. The manager discussed how service uses are supported to maintain relationships when they enter the home, there are shared room for couples should they be required. A wholesome and appealing diet is on offer. Service users spoken with said that food was at a good standard, plentiful and choices were available. During the visit service users were seen to have different meals of their choice. Relevant records such as cleaning rotas and temperature controls were available. The cook was able to discuss the specialist diets such as diabetic diets on offer. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel confident that they may express any concerns or complaints and that staff will listen to these and respond appropriately. Policies and procedures in place and a knowledgeable staff team ensure service users are protected. EVIDENCE: Relevant policies and procedures were in place for dealing with complaints. A complaints policy was on display in the main entrance and service users also have a complaints leaflet in their room. There have been no complaints received since the previous inspection. Staff spoken with were able to discuss how they would deal with a complaint should it be received. Service users and the relative spoken with said they were happy with the care received and life within the home. No complaints were expressed. Relevant policies and procedures were in place for the protection of vulnerable adults. Staff spoken with had a good understanding of procedures and were able to discuss the action they would take should they suspect that abuse was occurring. All staff have undergone or are booked onto a training course for the protection of vulnerable adults. All staff employed have satisfactory Criminal Record Bureau checks in place (a police check to see if an individual has a criminal caution or conviction). Two members of staff spoken with confirmed this. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 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. 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 this service. Service users live in a comfortable and homely environment, which is safe and clean. EVIDENCE: The home is well maintained both externally and internally and ongoing maintenance is taking place throughout the home. Redecoration of the home is nearly complete and the maintenance person was seen to be finishing off the last area. Following this new carpets are to be laid and appropriate fire doors installed. Service users are able to smoke in the small lounge. Staff supervise service users and ensure that cigarettes are disposed of correctly. The smoking arrangements were discussed with both smokers and non-smokers, both were satisfied with the arrangements. Relevant equipment such as industrial washing machines, tumble dryers and hand washing facilities were in place. Sufficient domestic staff are employed to Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 15 ensure the home remains clean and fresh throughout. One service user spoken with said that the home was always kept nice and tidy. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available to support service users to meet their needs. A well-trained and knowledgeable staff team supports service users. EVIDENCE: The duty rota showed that six to seven care staff are on duty throughout the day and four during the night. The manager works in addition to this number and the staff team consists of a deputy manager, senior care staff and care assistants. Staff spoken with said that there was enough staff available to meet service users needs. Service users and the relative spoken with also stated that there was enough staff available. The induction programme remains in depth and covers service users needs, health and safety issues. There was evidence that staff had undertaken an induction in staff personnel files. Four members of staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification) level 2 and five are working towards this qualification. One cleaner has attained the National Vocational Qualification in cleaning level one and one member of staff is working towards this. Evidence of staff undertaking this training was available within staff personnel files. Four staff personnel files were seen, all contained the required documentation such as proof of identity, an application form and references. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 17 Staff continue to carry out compulsory and specialist training such as manual handling, first aid, dementia care, nutritional need and medication. Each member of staff has a training plan and there was evidence of training undertaken in staff files seen. Staff spoken with said that they felt supported by the management in their training and development and training was at a good standard. The relative spoken with said that they had every confidence in the staff and they thought they were trained for their job. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and the views of service users and relevant others are fully considered. Systems are in place to ensure service users and staffs’ health, safety and welfare are promoted and protected. EVIDENCE: The manager has been in post for four years, she is currently undertaking the Registered Managers Award (a nationally recognised work and theory based qualification). She feels supported by the proprietors in her job role. Staff spoken with spoke very highly of the manager and said that she was always approachable. Service users and the relative spoken with said that the home was well run. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 19 The manager undertakes various audits such as staff training, accidents, care planning and medication. A compliance manager has been employed by the home and they are currently assisting the manager with the quality assurance policies and procedures. Annual questionnaires are sent to service users, relatives, staff and visiting professional, results are analysed and an action plan formed to address any concerns if needed. Results from the surveys were as follows: Forty staff questionnaires were sent, fourteen replied - many positive comments were made about the management and the environment. An action plan was in place to address concerns such as time for activities. Thirty-five relative questionnaires were sent, fifteen replied - very positive feedback was given. Seven service users completed questionnaires all responses ranged from excellent to good. Fifteen visiting professional questionnaires were sent, nine were returned - all gave excellent feedback. Four service users personal allowances were checked. Each service user has an individual accounting sheet; these corresponded with the money held by the service. Receipts were available for all transactions and two members of staff signed these. The manager said that service users have access to their money at any time. Relevant maintenance certificates such as the gas, electrics, hoist and lift were seen. There is an in depth fire risk assessment in place and the fire alarm systems are checked weekly and the emergency lights monthly. There was evidence to show that staff had attended fire drills. Accident records contained significant information and appropriate action was taken following an accident. Water temperatures are recorded and monitored to protect service users from hot water. The manager said that appropriate fire doors are to be installed once the new carpets have been laid, sample fire doors were at the home and the proprietor was in the process of making a decision as to which one would be used. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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.V338835.R01.S.doc Version 5.2 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 OP9 Regulation 13(2) Requirement Timescale for action 30/07/07 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 OP7 OP9 Good Practice Recommendations Develop plans of care further to include service users personal preferences. Room temperatures in the clinical room are recorded to show that medication is recorded at the recommended temperatures. Clifton Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Manor Residential Care Home DS0000002299.V338835.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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