Inspection on 17/04/07 for Clifton Manor Care Home

This inspection was carried out on 17th April 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.

Other inspections for this house

Clifton Manor Care Home 08/11/07

Clifton Manor Care Home 11/04/06

Clifton Manor Care Home 03/05/05

Clifton Manor Care Home 11/02/05

Clifton Manor Care Home 19/04/04

Clifton Manor Care Home 05/01/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Clifton Manor Care Home Rivergreen Clifton Nottingham NG11 8FZ Lead Inspector Linda Hirst Key Unannounced Inspection 17th April 2007 09:45 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 Care Home DS0000026432.V334830.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 Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifton Manor Care Home Address Rivergreen Clifton Nottingham NG11 8FZ 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) 0115 984 8485 0115 984 5859 clifton.manor@hotmail.co.uk Monarch Healthcare Ltd Eileen Teresa Spence Care Home 30 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (30), of places Physical disability (2) Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Clifton Manor Nursing Home is registered to provide accommodation and personal care to people of both sexes whose primary care needs fall within the following numbers and categories:Old age, not falling within any other category (OP) 30 All service users falling within the category of OP must be aged 65 years and over A maximum of 12 beds out of the 30 registered at Clifton Manor Nursing Home may be used to accommodate people over the age of 65 years whose primary care needs are Dementia (DE) A maximum of 2 beds out of the 30 registered at Clifton Manor Nursing Home may be used to accommodate people whose primary care need is Physical Disability (PD) All service users falling within the category PD must be aged 55 years or over One bed out of the 30 registered at Clifton Manor Nursing Home may be used to accommodate a named individual with PD who is under the age of 55 years (See the registration record dated 19/05/06 and the letter dated 19/04/06 within the variation application dated 28/03/06 for the identity of the service user) The communal space on the first floor at Clifton Manor Nursing Home must be used as additional space to that on the ground floor 11th April 2006 2. 3. 4. 5. 6. 7. Date of last inspection Brief Description of the Service: Clifton Manor Care Home (Nursing) is situated in the suburb of Clifton, southeast of Nottingham city and shares a site with its sister home which provides residential care only. The home was purpose built and the accommodation is over two floors with a vertical lift to provide easy access. There are three lounges used by residents, one of which is designated for people who have Dementia. There is a garden and patio area at the rear of the home but only the patio is useable as the rest of the garden slopes and is not safe. The provider has given assurances that this area will be worked on and completed within the next four weeks to enable the people at the home easy access to outdoors. The home provides personal care and nursing care to up to 30 older people, there are twelve beds which may be used by people with Dementia and two may be used for people with physical disabilities. The service complies with its conditions of registration. The fees for the service range from £309.76 to Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 5 £946.50 per week, the cost varies according to the dependency needs of the resident. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection involved one inspector; it was unannounced and took place over 10.5 daytime hours, including lunchtime. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore some judgements in this report are from observation of staff and resident interactions Three members of staff and three sets of relatives were spoken to as part of this inspection. In addition the views of a reviewing officer visiting the home were sought. Documents were read as part of this visit and medication was inspected to form an opinion about the quality of the service provided to . A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. Five residents returned questionnaires and one relative completed a survey, their views have been added in to this report. Comments received included, “staff are pleasant and if you wish them to help you they are always there,” and “it is better than I expected, my mum was a bit unsure about coming to a care home but she loves it.” People indicated that they got the care they needed and all said the staff listen and act on what residents want. There was however some confusion about who to speak to if they were unhappy and one did not know how to make a complaint. What the service does well: Residents are properly assessed before they are admitted to the home to make sure that their care needs can be met at the home. Health care is properly assessed and provided for to ensure the wellbeing of residents. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 7 Residents are treated with dignity and respect. Relatives are encouraged to visit and remain involved in the care of residents if they wish. Relatives said they are kept informed of the needs of residents and feel the care provided at the home is good. The home is clean and hygienic throughout to prevent infection passing to and between residents. The staffing levels are good and meet the needs of the residents, the staff were observed to be caring and kind. The staff are given lots of training to make sure they are competent at their job. The service is well managed and run. Residents are asked for their views on care, and action plans are developed in response to these which show how the service will improve. Residents’ finances are well recorded and residents’ interests are properly protected. Health and safety checks and servicing is carried out at the correct intervals to make sure that residents are safely cared for. What has improved since the last inspection? Staff have had some training about the types of abuse and are more aware of the signs which may indicate that residents are being abused. When the two identified staff start their National Vocational Qualification training at the end of April the service will be on line to meet the 50 target, ensuring that residents are supported by a trained workforce. All staff have now had training in key areas to make sure they work in a way which protects the health and safety of residents and staff. The owners have made several improvements to the environment to provide a more pleasant place for residents to live. There is more equipment in place to make sure that residents are moved and handled in a safe way. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 8 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 Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 9 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 Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 10 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, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are fully assessed before admission to make sure that their needs can be met at the home and to avoid unnecessary moves. EVIDENCE: Four out of the five people who returned resident surveys said that they did not receive a placement contract on moving into the home, although evidence from care plans would indicate that in most cases these were signed by relatives, not the resident. There were signed, written contracts in place for each of the “case tracked” service users, although the costs of care were not fully detailed in all cases. The care plan of the person who was most recently admitted to the home was inspected to ensure she had been properly assessed before admission. There Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 11 was a copy of the assessment by social care, Housing and Health staff on the file and this had been received by fax before the date of admission indicating that the manager had an opportunity to assess whether a placement at the home would be appropriate. The person had only been admitted the previous day but there was a written copy of the manager’s own initial assessment and several key risk assessments and care plans had already been written. All of the documents necessary for care planning were already in place and the service is very well organised in terms of admission procedures. The service user guide is given to residents before admission along with a copy of the brochure so they have information to make informed choices. The staff who were interviewed were not directly involved in the pre-admission process, but they said they were always informed about the needs of new residents verbally at handover, and could read the care plans and Social Work assessments. Staff felt that all residents are properly assessed and appropriately placed. The resident who was interviewed did not have any comments to make about the admission process, but said she did not like living at the home and would prefer to move into her own home it was suggested that the manager make a referral to a Social Worker. Three sets of relatives were interviewed, two had moved their loved one from a previous placement and had chosen Clifton Manor having looked at alternatives, the other was very pleased with how her husband had settled at the home. Intermediate care is not provided at the home and this standard is not applicable. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health care is well managed and promotes the residents’ wellbeing but the lack of awareness and recording of restraint places residents at risk of harm and abuse. EVIDENCE: The care plans of the “case tracked” residents were inspected to ensure that their needs were fully detailed and offered good guidance to staff on meeting these. The care plans are well organised, comprehensive and easy to read, the staff who were interviewed said they found them helpful and informative. However, one member of care staff said that she would like more time to read the plans as she found this more helpful than verbal information. Care plans consider issues of dignity, privacy and independence well to ensure quality of life for residents who need care. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 13 However, one plan implied that staff might need to use some restraint with one resident for valid reasons. The care plan detailed a series of methods for staff to try and avoid the use of restraint and staff who were interviewed were fully aware and used these in practice, but said the situation is unpredictable. The care plan was not sufficiently detailed to ensure that staff know when and how restraint should be used. There was no evidence of a record of the use of restraint, though it is clearly being used with the named resident and staff confirmed that this is the case. There is evidence of resident/relative involvement in care planning and the relatives who were interviewed confirmed that this is the case. They said that any changes to routine are discussed with them before being implemented, though one person said she would prefer that staff discuss the care plan once a month with relatives as they used to do. This matter was referred to the manager for action. The arrangements for promoting and maintaining the good health of residents are good and well managed. Health care needs are assessed in detail and risk assessed. There is good evidence on file of the involvement of Tissue Viability Nurses, District Nurses, Speech and Language Therapists, Dieticians, Physiotherapists and Occupational Therapists as needed. The residents who returned questionnaires said their health needs were either always or usually provided for, and all of the relatives who were interviewed said that the arrangements for health care were good. The staff who were interviewed were clear about their responsibilities for ensuring people have access to the health care services they need. The arrangements for medication were inspected to ensure that they were safe and that residents received their medication as prescribed by their GP. To this end, the lunchtime medication round was observed. The medication is stored appropriately in a trolley secured to the wall and a treatment room. There is cold storage available for medicines requiring this, and perishable medication is dated when opened to make sure it is the correct potency. No one at the home has any controlled drugs prescribed at present. The nurse on duty administers all medication and blister packs are used to reduce errors in medication administration. The staff member was seen to follow the correct procedure when administering medication but when the medication records were inspected there were unexplained gaps evident, although the medication had been administered. This needs attention and oversight. The residents and relatives who were interviewed were happy with the arrangements for medication and one said the manager had arranged for her mother to have all of her medicines in liquid form as she struggles to swallow. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 14 The qualified staff member who was interviewed was clear about her responsibilities to ensure that medication is safely stored, recorded and administered. Staff members who were interviewed demonstrated good levels of awareness about issues of privacy and dignity and gave examples of how they support people positively with personal care. All of the residents who returned surveys said the staff listen to them and act on what they say, and interactions between staff and residents throughout the course of this inspection were observed to be good. Relatives who were interviewed said the staff are “lovely” with the residents and treat them with respect and dignity. Another relative commented in her survey that “all the staff are friendly, they make everyone feel welcome and at ease. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for ensuring that residents have their choices recognised need to improve to ensure their rights are upheld. Residents engage in social activities and have regular contact with family and friends to improve their quality of life. EVIDENCE: An activities organiser is employed for three days a week and she was interviewed as part of this inspection. She works for five hours in total, and does floor games, bingo and jigsaws with the residents and has a reminiscence bag which she uses in one to one work with the people who have Dementia. She said that residents’ birthdays are celebrated with a cake and families are invited in and she will blow up balloons and make banners with the residents for special occasions such as anniversaries. Relatives confirmed that this was the case and said they appreciated the efforts made on special occasions. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 16 The staff said they have found the activities organiser helpful as they sometimes struggle to find the time to do activities with the residents. They said they sometimes do not have enough time to chat with residents, or one said if they do it would only be for a short time. Observation from various parts of the home would indicate that the residents are not occupied for significant parts of the day. In the case of the residents with Dementia this either led to people sleeping for long periods or, in one case to a person shouting for staff and asking them to spend time with her. It is therefore recommended that the hours the activity organiser does be reviewed to provide more opportunities for residents to be meaningfully occupied. Four of the people returning resident surveys said there were usually activities arranged, one person who was interviewed said she would like to get out more into the Community. There is evidence that the manager has tried to facilitate this but for reasons outside her control has not been able to achieve this as yet. There are no residents from Minority Ethnic Groups living at the home, though the staff are from a variety of cultural backgrounds and several speak languages other than English. This means the service has the potential to provide a better service to people whose first language is not English. A concern was raised by a relative before the inspection that relatives were “scared” of the manager and that they were restricted in assisting their loved ones, and by visiting times. These areas were focussed on and discussed with the manager, the staff and relatives during the inspection. During the course of the two days, significant numbers of relatives visited at varying times, several came at meal times and all of those who were interviewed come in at mealtimes and assist residents to eat, which they said they are encouraged and supported to do. The relatives who were interviewed said there were no restrictions on visiting and they come when they want. They were happy with the level of consultation and information they receive. A relative commented on her questionnaire “the staff are always very friendly and informative about my mum’s care.” She also said that if her mum wants to contact her they give her the cordless phone so she can speak to her in private. The staff confirmed that relatives can visit when they like and they are encouraged to be involved in caring for their loved ones. Observations throughout the inspection confirm that the rapport between staff and relatives is good and relationships are supportive. Some issues with regard to resident choices were raised during the inspection; one person said that she was assisted to bathe by a male carer which she did not consider acceptable, even though he was with a female carer at the time. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 17 Care plans do not record the preferences of residents regarding the gender of their carers, but this would be good practice. A relative said that the staff start taking residents to bed straight after tea at 17.40, the staff confirmed that some residents want to go early but said they are not forced to go. The care plans record each resident’s preferred rising and retiring time, none of those seen were excessively early. One relative felt the TV should be on in the main lounge, when this was discussed with the manager, she said it is to avoid staff watching TV when residents need support, though she said residents could watch the television in other lounges if they wished. The radio is on until the afternoon, but the volume in the lounge upstairs was too high and caused some distress to the residents with Dementia. They appeared happier when the volume was turned down. Lunch was observed to ensure that residents have an appetising and varied diet. Two meals choices were prepared, meat and a fish dish for those who do not eat meat. The menu was inspected and it indicates that choices are available at every meal, however, the menu was not displayed and when a resident asked a staff member what was for dinner she said she did not know but made no attempt to find out. It is difficult to see how residents can make an informed choice if they do not know what alternatives are available. The manager encourages residents to sit at the table, even if they have mobility difficulties and those who need assistance to eat were helped by care staff who sat beside them and encouraged them. This was done appropriately and sensitively. Two residents sat in the lounge and were assisted to eat by their relatives. The staff said the food is much improved in terms of quality and choices. All of the residents who completed surveys said they liked the meals served at the home. One resident who was interviewed said she did not like the vegetarian alternatives. This matter was raised with the manager and proprietor who said they had tried very hard to provide an appropriate diet to her and would continue to do so. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are responded to appropriately but not fully documented to ensure the service improves from comments made by residents and relatives. The manager and her staff are not aware of their responsibilities in terms of safeguarding adults and this places residents at risk of abuse. EVIDENCE: The complaints procedure is displayed in reception so that relatives and visitors can read it. The manager said there was no complaints record at the home, but then discovered that this was held centrally. None were recorded for the past year. As stated in OP 13, a relative had made a complaint to the Commission for Social Care Inspection. She had also raised the issues with the manager of the service, who had held a meeting to discuss the matters of concern. There were appropriate records of this meeting but the matter had not been documented as a complaint as required and as such there was no record of an outcome being sent to the complainant. This matter was resolved on the day of the inspection. There was a reference to a further complaint in the notes of the monthly visit by the proprietor, which again, had not been documented as a complaint, although the complaint had been upheld and the outcome was Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 19 satisfactory for the complainant. These matters were attended to before the end of the inspection. One person who completed a resident survey said they did not know whom to contact if they were unhappy with the service, and two people said they did not know how to make complaints. A requirement was set after the last inspection for all staff to have training on abuse and their obligations in the event of an allegation being made. This has been partially complied with, in that staff have had training on the types of abuse and their interviews demonstrated their awareness of this. However, it is clear from interviews with the staff and the manager that they remain unaware of their responsibilities if allegations are made. Two issues of concern were raised by relatives during this inspection and passed to the manager whose initial response was that the staff concerned would not act in such a way. This approach was also reflected in the interviews with staff who said that they would report allegations to the manager but they felt they would not be substantiated. This approach could lead to people being abused, and training on adult protection procedures is essential for all staff including the manager. Relatives who were interviewed believed that their loved ones were safe in the home and said they had never seen staff behave in an inappropriate way towards. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 20 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, 20, 23, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The accommodation is, in the main clean, well maintained and comfortable and meets the needs of the residents. EVIDENCE: A partial tour of the accommodation was undertaken to ensure that the home is clean, safe and comfortable for the residents who live there. There is a main lounge, a quiet lounge and a dining room on the ground floor, and a dining room and lounge on the first floor which is predominantly used by people with Dementia. Residents used both the lounges on the ground floor, relatives commented that the main lounge needed refurbishment and in particular some of the chairs needed replacing. A resident was observed to be Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 21 very uncomfortable in her chair, although the staff members brought her pillows to ease her back when requested to. This matter was brought to the attention of the provider, who confirmed that there are plans to upgrade the main lounge within four months. Security doors to ensure the safety of the residents who have Dementia provide access the first floor. The lounge is comfortable and pleasant. There is an outstanding requirement to make the garden safe for the residents, and this is even more important now as the home has been registered to accept people with Dementia who may want to access outdoor space as part of their care plan. The provider has give assurances that the garden will be made safe within four weeks of the inspection. A concern was raised by a relative about staff using her mother’s bedroom to store wheelchairs in after lunch and this was raised with the proprietor who said she would look into the issue. It is unacceptable to use ’ personal rooms as storage facilities. All areas of the home were clean, tidy and well maintained. This was confirmed by staff, who said that the home is well maintained and someone is employed to do all small repairs and maintenance. They feel the home is clean and that there are enough hours to keep the home clean and hygienic. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are sufficient staff employed at the home who are suitably trained but the recruitment processes that have been used are not robust enough to protect vulnerable residents from harm and abuse. EVIDENCE: The staff rota was inspected to make sure there are enough suitably qualified on duty staff to meet the needs of residents. The rota provides evidence that there are, although the residents have very high levels of dependency so the staff say they do not always have long to sit and chat to them. This view was supported by the observations over two days of inspection, although whenever staff assistance was needed or requested it was given immediately and very sensitively. One relative said on her questionnaire that staff “have the time to sit and talk to the residents and find out their wishes and needs and support them in their decisions.” Six staff have achieved National Vocational Qualification level 2 or above and a further two are due to start their training at the end of this month. The service is near to achieving the target of 50 of care staff trained to this level, thus Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 23 ensuring that residents are supported by suitably qualified staff. Relatives who were interviewed said that the staff seem competent and able at their job. Four staff files were inspected to make sure that they have the information and documentation required by Law to protect the residents from harm or abuse. Only one staff file (of the most recently appointed staff member) contained all of the necessary documents. The reference form used by the service is not adequate at present and does not enable the reader to identify who has given the reference, in what capacity and who they are in relation to the applicant. In one case there was only one written reference, in another there was no reference from the last employer and no explanation as to why, and in another neither reference appeared to be from the referees identified on the application form. Two people’s references were received after they started working at the home. This is not acceptable; two written references must be received before people start working at the home to make sure that residents are properly protected from unsuitable staff. Two of the four staff members had started work without a Criminal Records Bureau check and there was no evidence that a Protection of Vulnerable Adults First check had been done or received to make sure the staff member was suitable to work at the home. An urgent action letter has been sent in response to these concerns. The staff training record was inspected to make sure that staff have received the training they need to work at the home. There is evidence that a great deal of training has been provided in the past year and this was confirmed by the staff who were interviewed. Staff have received training in all of the courses required to make sure they work in a safe manner. All staff have had training on supporting people with Dementia and there is evidence that the manager and other qualified staff have undertaken training to update their nursing skills. One staff member expressed a desire for more information on the specific illnesses that the residents have. Observations confirm that staff are well trained and sensitive and work safely when supporting residents. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 24 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is managed efficiently and effectively and improvements are identified and acted upon to enhance the service provided to residents. EVIDENCE: The manager has been registered by the Commission as a fit person to run the home meaning she is experienced and suitable to do so. The staff, residents and relatives said the home was well run and the care provided is good. One relative felt that the manager ran the home in a “regimented” way and this affected how well she communicates with residents Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 25 and relatives, but this view was not supported by other relatives, staff and residents during this inspection. A reviewing officer was spoken with as part of this inspection and commented that she was very impressed with the changes in the home since last year. She said that the atmosphere at the home is calm and more positive and she feels the home is guided and directed now. The last Quality Assurance documents from July 2006 were inspected to check that the people living at the home were offered the opportunity to comment on potential improvements. There was evidence of analysis of the responses from staff, relatives and service users with action plans written to indicate how the service will be improved for residents. The provider has just employed a person to undertake quality assurance assessments and a new tool has been used to improve this process. The provider does monthly visits to the home, and the reports she provides on her visits are detailed and indicate that she checks that the home is being conducted in the best interests of residents. Residents’ finances were inspected to make sure that their interests are being properly safeguarded. There were good records maintained of expenditure and income and receipts are held for all payments. The balances, which are, recorded balance with the money held for individuals and there are no concerns about how the service manages residents’ money. Staff members confirmed that they obtain receipts for expenditure. The Health and Safety records and servicing were inspected to ensure that the wellbeing of residents and staff is being protected. These were all up to date, with servicing and tests being conducted as required. The staff said their health and safety is properly protected and they have the equipment they need to support residents safely. The reviewing officer commented that the staff are using safe ways to move and handle residents now. Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 26 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 2 3 X X 2 X X 3 STAFFING Standard No Score 27 3 28 3 29 1 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 Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1), Sch 3(3)(p) Requirement The care plan of the named person must be clear about when and how restraint will be used and a record must be kept of each time restraint is used to ensure that residents are properly protected. Medication must be signed for as administered or a code entered on the record to indicate why it was omitted to ensure residents get their medicines as prescribed. The registered provider must ensure that all staff (including the manager) are clear about their responsibilities under the Nottinghamshire Committee for the Protection of Vulnerable Adults policies and procedures to ensure they are protected from harm and abuse. Timescale of 30/5/06 not met. The registered provider must ensure that the grounds of the nursing home are safe for use by residents. Timescale of 31/5/06 not DS0000026432.V334830.R01.S.doc Timescale for action 18/05/07 2. OP8 13(2) 18/05/07 3. OP18 13(6), 18(1) 18/05/07 4. OP19 23(2)(o) 18/05/07 Clifton Manor Care Home Version 5.2 Page 28 met. 5. OP23 23(2)(l) The staff must not use residents’ 18/05/07 bedrooms to store wheelchairs or other equipment unless it is specifically provided for that person. This constitutes an infringement of their privacy. Suitable alternative storage must be provided. Staff files must contain the 16/05/07 information and documentation required by Regulation 19 and Schedule 2 to ensure that residents are properly protected from harm and abuse. 6. OP27 19, Sch 2 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. 3 4. 5. 6. Refer to Standard OP2 OP7 OP12 OP14 OP14 OP15 Good Practice Recommendations The costs of care on placement contracts should be fully detailed to ensure that residents and relatives are clear about the fees. It is recommended that be given more opportunity to read care plans and that these be discussed more frequently with relatives to ensure clarity. Review the hours of the activities organiser to provide activities every day for the residents to provide stimulation and interest. Residents’ preferences regarding the gender of their carer should be recorded and accommodated to ensure their choices are respected. Staff should ensure that the radio is not on at an excessively high volume and causing distress to residents. The arrangements for making residents aware of the daily meal choices should be reviewed and changes made to provide a more formal way of enabling residents to choose between menu options. The main lounge should be refurbished and the chairs replaced. DS0000026432.V334830.R01.S.doc Version 5.2 Page 29 7. OP19 Clifton Manor Care Home Clifton Manor Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 30 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 Care Home DS0000026432.V334830.R01.S.doc Version 5.2 Page 31 - 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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