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Inspection on 19/11/08 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 19th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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

People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. People using the service are supported to access specialist services such as the GP, district nurse and opticians as needed. People using the service are supported to live a life of their choosing which satisfies their needs and they are enabled to maintain relationships that are important to them. People using the service said, ` I am settled and happy living here, the staff are very kind and look after me,` and `the staff are very good, they help me when I need it.` A wholesome and appealing diet is on offer for people using the service and specialist diets are catered for. People using the service are protected from abuse and are assured that their complaints will be listened to and resolved. The environment is clean and comfortable, offering people who live there a homely environment. People using the service are supported by sufficient numbers of staff to meet their needs. People using the service are protected from unsuitable people being employed. Staff training in mandatory areas is at a good standard and staff are able to discuss how they use their training in their every day work to support people using the service.

What has improved since the last inspection?

Plans of care and risk management plans have improved. These are now in place for all highlighted needs and are more person centered. This means that people receive their care in their preferred way and risks are minimised. Medication administration and management has improved so that people using the service receive their medication as prescribed and they are protected by staff practices. Staff have received further training in caring for people who have diabetes mellitus so that people`s needs are fully met.

What the care home could do better:

Ensure that we are informed of all notified incidents so that we can monitor the service to ensure that people remain safe and protected.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clifton Manor Care Home Rivergreen Clifton Nottingham NG11 8AW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Karmon Hawley     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Clifton Manor Care Home Rivergreen Clifton Nottingham NG11 8AW 01159845859 01159845859 clifton.manor@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Monarch Healthcare Ltd care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 The maxim number of persons to be accommodated at Clifton Manor Care Home is 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 Date of last inspection Brief description of the care home 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 care home range from £365 Care Homes for Older People Page 4 of 26 Over 65 46 0 Brief description of the care home £465, these fees do not cover the cost of hairdressing or chiropody. Information about the fees and the care home is made available at the point of enquiry. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One regulatory inspector conducted the unannounced visit over 1 day, including the lunchtime period A review of all the information we have received about the home was considered in planning this visit and this helped decide what areas were looked at. Care Homes for Older People Page 6 of 26 The main method of inspection we use is called case tracking which involves selecting the care plans of 4 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager, members of staff and people who use the service were spoken with as part of this visit. A partial tour was undertaken by the regulatory inspector, which included looking at the bedrooms of those people who we case tracked and communal areas of the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 26 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may wish to use the service are assured that their needs will be assessed and met before they make a decision to move into the care home. The service does not offer intermediate care. Evidence: The manager visits people in the community to carry out an assessment to make sure that staff would be able to meet their needs if they moved into the care home. There is evidence of these assessments taking place within case files we examined. People who may wish to use the service can visit and spend time at the home to get a feel for what it would be like to live there before they make a decision to move in. One person using the service told us that they often come for a break at the home for Care Homes for Older People Page 11 of 26 Evidence: a couple of weeks and their daughter arranges this for them. The service does not offer intermediate care. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people using the service are met and they are protected by the medication practices taking place. Evidence: Plans of care examined are person centred and outline peoples specific needs, likes, dislikes and preferences so that they get help and support in their preferred way. Plans of care in regard to complex needs such as diabetes mellitus and dementia care are now more in depth and updated as required, so that staff have enough information to meet peoples needs. Risk assessment management plans have been readdressed and these are in place for all highlighted risks to ensure that these are reduced as far as practicable. Staff spoken with are aware of peoples individual needs and the support that they require to ensure that these are met. People using the service told us, I am happy with my care, I am looked after, the staff are very nice and they do anything that you Care Homes for Older People Page 13 of 26 Evidence: ask, I am well looked after, and I am happy here and get help when I need it. We observed staff caring for people using the service in a kind and professional manner. People using the service are supported to access specialist services such as the GP, district nurse and opticians as needed. We saw evidence of this in peoples care plans. Two people said that they could see the doctor if they needed to and that staff would arrange this and one person told us that the district nurse came to do their dressing. During the tour of the care home we saw that specialist equipment such as hoists are available. We saw two people sitting in their chair with the hoist sling underneath their legs, which caused one ladys dress to ride up her legs. This was discussed with the manager and staff due to the implications of pressure sores and maintaining peoples dignity. It was stated that this is not normal practice. Staff who administer medication have been trained to do so. The manager has been carrying out additional audits and supervisions with staff to ensure that medication practices are improved. The medication records seen are clear and up to date; medication that has been administered has been signed for to make sure that people get their medication as prescribed. We observed staff administering medication during the lunchtime meal and they were seen to follow good practice. Two members of staff now administer medication to ensure that good practices are maintained at all times. Staff spoken with are able to discuss how they ensure that peoples privacy and dignity are maintained and we saw staff being respectful to people throughout the visit. Plans of care also address the issues of ensuring peoples privacy and dignity are maintained whilst supporting them in personal care. People using the service told us, the staff are very kind, they are polite to me at all times, most of the staff are nice, and the staff are nice and friendly, we often have a chat. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and enabled to maintain contacts with people that are important to them and join in activities if they wish. Evidence: Staff spoken with said that there are a number of activities on offer for people to do, such as arts and crafts, reminiscence and various games. Special events are also celebrated and a bonfire party was recently held, which one person using the service said that they enjoyed. One relative also stated that there is often events taking place and that they are always made welcome to join them. On the day of the visit, we saw most people either occupying themselves, watching the television or listening to music. People using the service told us that they are settled living at the care home and that they could spend their time as they wish, one person said, I enjoy playing bingo and having a chat with the staff. Staff spoken with confirmed that the routine of the care home is flexible and they said Care Homes for Older People Page 15 of 26 Evidence: that they support people to make their own choices. Staff spoken with are able to discuss the individual needs of people and how they take time to get to known them and their personalities, so that they can offer them care that is personal to them. A church service is held at the home should people wish to join in this. Several visitors were seen throughout the visit and when spoken with a relative stated that they were always made welcome and were offered a drink. They said that staff are always polite and helpful and looked after their relative well. People using the service told us, I often have visitors, they take me out which I enjoy, my visitors are made welcome when they come, and I have more visitors now than I used to, they are made welcome, we often go to my room so that I can see them in private. People are offered a well balanced and wholesome diet, with choices available at each meal. The lunchtime meal on the day of the visit was plentiful and well presented. People using the service said, the food is very good, we have nice meals, there is plenty to eat,and the food is very good and tasty. Staff spoken with discussed the special diets that some people using the service need and how these are catered for. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected from abuse and are assured that their complaints will be listened to and acted upon. Evidence: Should people wish to complain about the service they have access to the complaints procedure, which is displayed in the care home. People using the service told us that they are happy living at the care home and offered the following comments, the staff are very kind, here, they listen to me if I have any problems, most of the staff are good and they are respectful, I would soon say something if I was unhappy, and I do not have any complaints, I am very happy here. One relative spoken with also told us that they had no concerns and that they are happy about the care that their relative is receiving. Staff spoken with are able to discuss how they would deal with a complaint should one be received to ensure that it is resolved. Staff have undertaken training in safeguarding adults and when spoken with demonstrate a good understanding of their roles and responsibilities in keeping people safe. Care Homes for Older People Page 17 of 26 Evidence: When asked people using the service told us that they felt safe living at the care home and that staff are always kind to them. Following the inspection we were made aware about an accident that had happened at the care home from a member of the public. We had not been informed about this as we should be, so that we can maintain our records and monitor the safety of people using the service. We discussed this issue with the manager, who offered explanations as to why this had happened and action has been taken so that this does not reoccur. We alerted Local Authority about this information so that they may look into this issue further. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a clean and comfortable environment which is well maintained. Evidence: There are various seating areas throughout the care home where people can spend their time as they wish. We saw evidence of routine maintenance continuing to take place and all areas of the care home are well maintained. People using the service told us that they felt that staff worked hard to keep the home clean and tidy. One relative told us how they felt that the providers are always spending money on the care home to make it look nice. The home is clean and tidy in all areas and peoples rooms are personalised with their belongings. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by sufficient numbers of staff who are well trained to carry out their job role. Evidence: Staff spoken with said, the staff team all get on well together and there are enough staff available to meet peoples needs, and we work well together as a team. People using the service told us that staff are available to help them when they need it, staff spend time with me when they are able, I tend to look after myself but they are there if I need them, and the staff are good to me, they help me when I need it. Staff were observed to be available to support people using the service throughout the visit. New members of staff undertake an induction to ensure that they are aware of their roles and responsibilities on commencing employment. One member of staff spoken with confirmed that they had undertaken an induction and said, it helped me to be part of the team and get to know people better. There is evidence in staff personnel files to demonstrate that inductions are taking place. Care Homes for Older People Page 20 of 26 Evidence: To ensure that staff have the necessary skills and knowledge to look after people using the service over 50 of staff have attained the National Vocational Qualification level 2 or above (a nationally recognised work and theory based qualification). There is evidence within staff training files to confirm that they have undertaken this training and one member of staff spoken with confirmed this. All staff employed undergo the necessary checks required by law to ensure that people using the service are protected from unsuitable people being employed. The necessary documentation such as references are within staff files to evidence this. Staff spoken with confirmed that they had undertaken a Criminal Record Bureau check (a police check to see if a person has a police caution or criminal record) before commencing employment. Staff spoken with said that they felt supported in their training and development needs and that they received sufficient training to meet the needs of people using the service. Staff training in mandatory areas is up to date and there is a good attendance rate for all staff. Staff spoken with are able to discuss the needs of people in regard to complex needs such as diabetes mellitus and dementia care needs. One relative spoken with told us, the staff are well trained to do their job, they look after my mother very well. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well run and managed where they are able to have their views and opinions fully considered in the running of the care home. Evidence: The manager remains up to date with training and she has completed the Registered Managers Award, which is designed to enhance management skills. Both staff members spoken with spoke highly of the manager and stated, she is firm but fair. They felt that she ensures high standards are maintained at all times. One relative spoken with said that they felt that the home was well run and managed. People using the service, relatives, staff and visiting professional such as GPs and district nurses have the opportunity to express their views about the service by way of questionnaires and reviews. The results of the last survey showed positive comments were received such as, staff are always approachable and pleasant, the home is Care Homes for Older People Page 22 of 26 Evidence: always warm and friendly, the food is very good and we always get a choice, and the quality of care we provide is good. There were only a few comments about how the service may be improved upon such as, we would like more films and books from early years. An action plan is in place to address these issues. One member of staff spoken with said that they had regular staff meetings and meetings for people using the service, which prove beneficial and give people the opportunity to express their views. People using the service can have their money kept in safe keeping in the office safe should they wish. Four personal allowance accounts examined, corresponded with the accounting sheet. Records of all transactions are kept and receipts are available. Financial arrangements and responsibilities are recorded within peoples plans of care so that staff are aware of the arrangements. Following the inspection we were made aware about an accident that had happened at the care home from a member of the public. We had not been informed about this as we should be, so that we can maintain our records and monitor the safety of people using the service. We discussed this issue with the manager, who offered explanations as to why this had happened and action has been taken so that this does not reoccur. We alerted Local Authority about this information so that they may look into this issue further. Maintenance certificates examined demonstrated that regular checks and servicing are taking place on equipment such as manual handling aids and the lift. The manager carries out a health and safety audit once a month to ensure that any areas of concern are addressed immediately. There were no obvious hazards observed during the tour of the care home. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 You must ensure that staff 14/01/2009 practices when using manual handling equipment is safe and does not infringe upon a persons dignity. This will ensure that people using the service are protected and their dignity is maintained. 2 37 37 You must ensure that we are 30/12/2008 informed of all notifiable incidents. This will ensure that we are able to monitor events that are happening at the care home to ensure that people using the service are protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!