Inspection on 03/05/05 for Clifton Manor Care Home

This inspection was carried out on 3rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 17/04/07

Clifton Manor Care Home 11/04/06

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 Sharon Rosenfeld Unannounced 3 May 2005 09:50 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 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 C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Clifton Manor Care Home Address Rivergreen Clifton Nottingham NG11 8FZ 0115 9848485 0115 9845859 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Sudram Rai. Mrs Rai. Vacant Care home 30 Category(ies) of Old age (OP), x 29 registration, with number Physical disability (PD), x 1 of places Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users shall be with category OP, within the total number of beds a maximum of 1 bed may be used for the category PD 2. Additional named SU under the age of 65 years for an initial period of 3 months. May be extended for further 3 months if needed Date of last inspection 11/02/05 Brief Description of the Service: Clifton Manor Care Home (Nursing) 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 Residential 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 nursing and personal care to a maximum of 30 service users. Of this number, 29 places are designated for use by older people (excluding any other category), and one place is registered for a person with a physical disability under the age of 65 years. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection mainly focussed on the standards relating to Health and Nutrition. The decision to do this was prompted by two independent concerns received by the CSCI. Evidence of the quality of services was gathered by direct and indirect observations of care practice, through conversations with three residents, three visitors, nursing, care and catering staff. The main method of inspection used was called case tracking which involved selecting four residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. The proprietor has written to the CSCI with a proposal for the future of the home and the management structure. These will be considered by the CSCI when a formal application is received. What the service does well: What has improved since the last inspection? The nursing staff have acted upon a CSCI request for information about how one health care professionals concerns had been addressed. Their response Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 6 was assessed at the inspection and all but one of the concerns have been appropriately addressed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Admissions of people who do not fall within the registration categories are made. The staff responsible for making decisions about admissions to the home was not fully aware of the law relating to this. The staff responsible for assessing referrals to the home do not reflect fully on the prospective residents range of needs and whether the home has the staff and resources to meet them. This has resulted in people’s needs not being consistently met and has led to them receiving poor quality of care in relation to some of their needs. EVIDENCE: Three people in residence are under the age of 65 years and one of the people admitted to the home recently has a primary care need of dementia. The majority of people living at Clifton Manor Nursing Home have high dependency needs and consistently require the help of two staff to meet them. The staff requested clarification on how many care staff are required at the home as the proprietor had left instructions to reduce the number of care staff due to lower occupancy levels. Pre-admission letters to confirm that the home can meet individuals assessed needs are not written. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9. The staff demonstrated the capacity to meet the care needs of some individuals but other people’s needs are not adequately met. Staff are failing to implement preventative treatment plans, safe systems of moving and handling and recording of prescribed treatments. This potentially puts residents at risk of harm. Residents or their representatives are not routinely involved in the care planning process. Opportunities to exercise choice are limited and people cannot therefore influence the delivery of care. EVIDENCE: A visiting healthcare professional outlined his concerns in writing that the complex care needs of one person who requires up to four care staff to assist her to move were not being met. The home appropriately addressed all but one of the concerns in a timely manner. However no risk management assessment or care plan has been produced to identify how this person’s care needs are to be managed safely after 8:00 pm when only two night staff are on duty. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 10 Three visitors felt that the home meets their relatives care needs. One has seen the care plan. One other person stated that her relative’s health had ‘dramatically’ improved since admission to the home. Two of these relatives visit the home on a daily basis and are also actively involved in the delivery of their relatives care needs, especially assisting them to eat. They stated the staff are very caring people who work hard to help residents. Four residents were case tracked. Risk assessments to inform the use of bed rails had not been consistently completed. Pressure relieving equipment and advice provided by a Tissue Viability Nurse had not been applied in practice in two cases. One person does not always consent to the prescribed treatment plan and this can be difficult for the staff to manage however, the Tissue Viability Nurse has not been informed about this. The care plans are based on a nursing model. Four care plans do not contain sufficient information to describe how the care needs are to be met. For example; a ‘Posture Belt’ is used to restrain one person in her wheelchair. There are no foot-rests fitted to this wheelchair. The belt was not fitted correctly and had ridden up to her armpits. There was no care plan or risk assessment regarding the use of this form of restraint. The CSCI guidance on the use of restraint was given to the nurse in charge for implementation. One moving and handling care plan states ‘use appropriate sling’ it does not state which sling to use. One person has Gingivitis. The care plan simply states ‘daily mouth care’. The care staff state they do not have time to read the care plans and are given verbal instructions by the nursing staff. The staff need to develop their knowledge of some of the specialist equipment in use. One person requires an air-flow cushion. This is not used as staff state the hoses to these products are broken. They were not aware that the hose can be detached from the mattress and applied to the cushion. One mattress was not programmed on the correct setting for the person’s weight. Two people at ‘high risk’ of developing pressure sores were seated directly on the canvass of the wheelchair not on a pressure-relieving cushion as required. The staff do not utilise the free training provided by the Primary Care Trust or the ‘link’ nurse system. There is no clear audit trail of how often people’s positions are changed. The Registered Manager of the adjoining unit confirmed there were no turning charts in place and subsequently provided copies of these. One person was admitted with clearly defined needs relating to emotional and psychological support. The records do not state how these needs will be met. Staff were observed using disposable gloves intended for single use for more than one personal care procedure. One staff confirmed that there is a plentiful supply of gloves and aprons. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 11 A falls risk assessment was completed in all four files seen, the care plans do not reflect up to date practice however and no contact is known to have been made with external support such as the ‘Falls Assessment Team’ at the City Hospital or information on the prevention of falls from the Department of Health. There is evidence that the oral hygiene needs of two residents are not being successfully met. The management and administration of medicines was not fully assessed. The medication charts of those residents case tracked were examined. One person is prescribed medication to be taken when necessary. The nurse in charge did not know why the medication had been prescribed and therefore would not know when it was appropriate to administer this. The food supplements are not recorded as prescriptions and therefore no record is maintained of when they are given. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15. The care planning system does not successfully describe how the resident’s interests are to be promoted. The home is highly task focussed and does not give priority to people’s need for meaningful, enjoyable occupation. Religious needs are catered for in-house. The management of dietary needs and the co-ordination of care by staff at meal times requires urgent review. Staff do not have the necessary knowledge of residents nutritional needs to ensure they are fully met. This may place people at risk. The standard of the meal sampled was poor. EVIDENCE: One person’s complaint that the home does not engage in activities with residents has been upheld. The programme of activities is displayed on the notice board. The activities were not carried out on the day of the inspection and when asked care staff confirmed that it was rarely followed. The activities programme is not designed to reflect individual preferences or needs. Friends and families are welcomed at the home at any time and two visitors confirmed this. People take their relatives out but one staff said that other than this people never go out. One visitor stated his wife always attended Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 13 church when she lived at home. He was satisfied that a Minister attended the home on a regular basis to meet her religious needs. One care staff was able to describe how people were offered choice. This mainly referred to people who were consistently able to make decisions themselves and included choice of which clothes to wear. Other people with dementia are not routinely consulted. Staff did not speak to one person with dementia whilst carrying out a hoisting procedure. A complaint about the reduced provision of milk was not upheld. The home had adequate quantities of full fat pasteurised milk in stock. This is good practice and meets nutritional guidance for older people. One person has been gradually losing weight over the last year. A nutritional risk assessment has been undertaken but the results have not been translated into practice and are not recorded in the care plan. Her dietary record indicates she receives a ‘soft diet’. She uses a feeder beaker to eat her meals. The cook stated he had not received any information about providing a higher calorific diet for this person. The diet provided at lunchtime was sampled. The vegetables were overcooked from frozen and were luke-warm when served. The mashed potato was lumpy and of a consistency unsuitable for people on a liquidised diet or for use in a beaker. A number of people require food supplements and thickeners. These are not recorded as prescriptions and staff stated these are not given routinely. An inspection of the kitchen revealed a stock of food thickeners belonging to deceased residents. The cook stated that he had been instructed to use them for one person as ‘they were still in date’. The ‘use by’ dates were 11 January 2005 and 20th April 2005. The nurse in charge stated she was not aware of this. One person’s records state she is vegetarian but eats white meat. This person was served dark meat for lunch. When asked if he had taken lunch orders from the residents, the cook confirmed he had not. He said one person has a salad and he doesn’t need to ask others because he ‘knows what they like’. He stated he had not offered the vegetarian option because there are no vegetarians. One person has a physical disability. She continues to feed herself. A plate guard and adapted cutlery are not provided and therefore much of her diet falls off the plate onto the table and floor. Three people left their lunch. The staff were observed gently coaxing and encouraging people to eat this is good practice. The care staff informed the nursing staff about those who refused their food. There was no fresh fruit in the nursing home. In the adjoining residential home the cook responsible for making orders stated that each week 4.5kg (10lbs) of Banana’s and 900g (2lbs) of other fruit is purchased. The staff confirmed that many residents are ‘put to bed’ before supper time and therefore do not have their snack of a biscuit and a cup of tea Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 14 before bed. A more nutritional supper needs to be encouraged and available for all residents. One complaint that residents always have soup and sandwiches for tea is upheld. A large percentage of residents require assistance and encouragement to eat. The care staff were observed to do this with sensitivity. The organisation of staff at meal times does however require review. Staff moved from person to person and at one point there was some confusion as to whether one resident had received his lunch. The nurse in charge also assisted people to eat in between administering the medications. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) X Not assessed on this inspection. EVIDENCE: Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 26. The outdoor space requires attention so that it can be used safely and be enjoyed by residents. The communal areas of the home were clean however the repair of the carpet cleaner would assist in the control of the mal-odours that are present. The laundry service is poor. EVIDENCE: The garden was viewed and is not well maintained. This concern was raised in previous two inspection reports and the requirement remains unmet. The kitchen area needs to be cleaned more thoroughly. The Registered Provider needs to satisfy the CSCI that the home meets the standards expected by the Environmental Health Department. Two complaints were received about the laundry service and residents and relatives at have raised this at previous inspections. One person said that her mother regularly wears other people’s clothes and one person said she now does her relatives laundry herself. The clothes being worn by residents had not been ironed properly. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 17 As previously mentioned staff were seen to use gloves for more than one personal care procedure. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Not assessed on this inspection. However the Registered Individual has been asked to assess the number of staff required to adequately meet the needs of the residents. This requirement remains unmet from the previous inspection. EVIDENCE: Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36. The absence of a Registered Manager who has adequate supernumerary time to undertake the managerial responsibilities including the monitoring of care practice and ensuring the provision of appropriate clinical supervision to the nursing staff has had a negative impact on the home and may put the residents at risk. EVIDENCE: There is no Registered Manager at the home. The unit has experienced long periods of change and uncertainty because of the high turnover of managers. The current nursing staff are not confident to manage the home and require regular, planned clinical supervision. The Registered Manager of the adjoining residential unit has been delegated some responsibility for the management of the care staff and for ensuring equipment is maintained. This is not adequate however and although the Registered Provider has written to the CSCI with Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 20 proposals concerning the future of the home, until this is decided, the home must ensure appropriate management is in place and that clinical supervision is can be evidenced. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 x 15 1 COMPLAINTS AND PROTECTION x 1 x x x x x 1 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 x x x x 1 x x Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 4 Regulation 14 Requirement Timescale for action 03rd June 2005 2. 7 3. 7 4. 7 5. 7 6. 7 7. 8 Accommodation must not be provided to a service user unless it is confirmed in writing to them that the home can meet their assessed needs. 12, 15 A care plan must be written to describe the action staff must take to meet every assessed need. 7, 12 The care plans must describe how the service users care needs are to be met during the daytime and night time. 7, 12, 13 The care plans must describe how the service users moving and handling needs are to be met during the day time and night time. 12, 15 The care plans must accurately describe the equipment to be used to meet assessed needs. This includes pressure relieving equipment and sling types. 12, 13, 15 A referral must be made to the Community Occupational Therapist to review the use of the posture belt for the named individual. 12, 13 The treatment plans prescribed by the Tissue Viability Nurses must be actioned. Where this is C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc 30th June 2005 30th June 2005 30th June 2005 30rd June 2005 06rd May 2005 03rd June 2005 Page 23 Clifton Manor Care Home Version 1.30 8. 8 9. 8 10. 7, 8 11. 7, 8 12. 7, 8 13. 7, 8 14. 7, 8 15. 9 not practicable, this must be recorded and a review must be arranged. 12, 13 The pressure relieving equipment prescribed by the Tissue Viability Nurses must be provided. and used in accordance with the manufacturers instructions. 12, 13, 15 The staff must receive instructions on how to safely use the equipment provided by the home. This includes pressure relieving equipment and the posture belt. 12, 17 The guidance on the use of restraint given to the nurse in charge must be applied. Care plans must record the circumstances when the posture belt should be used 12, 13 The mouth hygiene care instructions must be detailed in the care plans and applied in practice by the care staff. 12, 13 All service users who are assessed to be at risk of developing pressure sores must be given pressure relieving equipment to sit on. The type of equipment to be used by each individual must be recorded in the care plan. 12, 13,15 The care plans must indicate how peoples assessed needs in relation to emotional and psychological support are to be met. 12, 13, 15 The Responsible Individual must make information and advice available in relation to the prevention of falls that can then be put into practice and applied in care planning. 13 The reason why as required medicines have been prescribed must be recorded to enable the C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc 03rd June 2005 30th June 2005 03rd June 2005 03rd June 2005 03rd June 2005 03rd June 2005 30th June 2005 03rd June 2005 Page 24 Clifton Manor Care Home Version 1.30 16. 17. 9 15 18. 7, 8, 15 19. 7, 8, 15 20. 7, 8, 15 21. 9, 15 22. 15 23. 26 24. 27 instructions for administration to be appied safely. 12, 13 The administration of prescribed supplements must be recorded. 17 Records of food provided to service users including any special diets must be maintained and available for inspection at all times. 12, 15, 16 The Responsible Individual must evidence that the food provided to all service users is wholesome and nutritious and properly prepared. 16 The Community Dietician must be contacted to request a diet plan for two named people. One who requires a weight incresing diet and one who requires a weight reducing diet. 12, 15, 16 The cooks must be provided with sufficient information about the service users assessed dietary needs and requests so that an appropriate diet can be prepared and served. 12, 13, Prescribed food thickeners are 15, 16 the property of the named service user and must be disposed of when no longer needed or out of date. They must not be administered to other service users. 12 The deployment of staff to assist servic users to eat at mealtimes must be reviewed and organised in a manner which respects their dignity. 13 The staff must follow good practice guidance to prevent the spread of infection at the home. Gloves must be disposed of following single use. 18 The responsible individual must employ sufficient staff to meet the service users assessed needs. A review of the current staffing arrangements based on C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc 03rd May 2005 03rd June 2005 03rd June 2005 03rd June 2005 03rd June 2005 03rd June 2005 03rd June 2005 03rd June 2005 06th May 2005 Clifton Manor Care Home Version 1.30 Page 25 25. 36 18 26. 27. 28. 15 26 26 16 23 16 29. 8 18 30. 8 18 an assessment of the current care needs of individual service users is required. The nursing staff must be suitably competent to undertake their role and must receive clinical supervision. Provide an adequate snack for all service users in the evening. Repair or replace the broken dishwasher. Provide evidence to the CSCI that the home meets the standards of hygiene expected by the Environmental Health Department. The nursing staff and must be trained in Wound Management; Pressure Ulcer Prevention; and Tissue Viability practice. The Healthcare assistants must receive training about Tissue Viability. 03rd June 2005 03rd May 2005 30th June 2005 30th June 2005 31st July 200 15th September 2005 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. Refer to Standard 7 Good Practice Recommendations Social and nursing care needs must be clearly defined and should be written in a manner which enables staff to access this information easily to identify what action they must take to meet the individual needs of the residents. Clifton Manor Care Home C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 C53 C03 S26432 Clifton Manor V224801 030505 Stage 4.doc Version 1.30 Page 27 - 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. 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