CARE HOMES FOR OLDER PEOPLE
CLIFTON MEADOWS Badsley Moor Lane Rotherham, South Yorkshire S65 2BA Lead Inspector
Ramchand Samachetty Unannounced 02 August 2005 09:00 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 MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Clifton Meadows Address Badsley Moor Lane, Rotherham, South Yorkshire, S65 2BA 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) 01709 838639 01709 838913 walkerd@anchor.org.uk Anchor Trust Janice Linda Scott Care home only 65 Category(ies) of Old age, not falling within any other category registration, with number (65) of places CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Mrs Scott must acquire the required management qualification in line with the National Minimum Standards - Older People Date of last inspection 17-Mar-2005 Brief Description of the Service: Clifton Meadows is a Care Home registered to care for 65 older people. It is owned and managed by Anchor trust, which is a national voluntary organisation providing a range of services for older people. The Home is situated in the residential area of Clifton, within easy reach of Rotherham town centre and other leisure facilities, including Clifton Park and Herringthorpe playing fields. The Home consists of 2 two-storey buildings, adjacent to each other. It also shares its premises with some units of sheltered accommodation which are provided by Anchor Trust. All residents bedrooms are single and have en-suite facilities. Bedrooms and some communal facilities are grouped in smaller units to facilitate group living. Each building is equipped with a kitchen, a laundry, dining areas, lounges and a range of hygiene facilities. Meals are prepared in only one of the buildings and it is transported to the other building in a heated trolley. There is a passenger lift in each building to facilitate access between the floors. There are some garden areas and car parking spaces around the Home. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out on 8 August 2005, starting at 09.00 hours and finished at 17.30 hours. The inspection included a tour of the premises, conversations with twelve residents and six relatives, four members of staff and the manager. Care documentation and other records were checked. Some aspects of care provision were also observed. What the service does well: What has improved since the last inspection?
The merger of the two separate Homes into one has been completed. There is now one management team overseeing both sections of the Home. The merger has brought some support services together and this helps to avoid duplication, to reduce costs and to improve services. All staff who administer medicines have been enrolled on an accredited medicines administration course, which is due to end in November this year. Arrangements for the storage of medicines have been reviewed and a metal cabinet has been ordered. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 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 MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 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) 1,3 and 5. Residents and their relatives appear to have adequate information about Clifton Meadows and this is of help to them in making a choice of Home. However, its statement of purpose, which is a corporate document, has not yet been adapted for the Home and it does not meet the regulations. More work must be undertaken to improve the statement of purpose and to ensure it is accessible to all interested parties. Prospective residents and their relatives are also encouraged to visit the Home and to check whether it is suitable, before making their choice of Home. The care needs of residents are assessed on admission to ensure that identified needs can be met. However, assessments were not always comprehensive and specific enough to address all areas of needs. This can lead to needs not being fully met. The assessment process must be improved and staff should ensure that they are able to carry out assessments in accordance with good practice. EVIDENCE: The relatives of residents, who were recently admitted to the Home, commented that they had not received a copy of its statement of purpose.
CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 9 However, they felt that they had enough information before choosing the Home. One resident said ‘ The Home was recommended to me by a good family friend. I visited it twice and spent time talking to staff and other residents and also had lunch. I was happy with it.’ A copy of the statement of purpose was available. It was a corporate one from Anchor Homes and it had not yet been customised for the Home. Also, it did not fully meet the required standard. The care records of four residents were checked. A full assessment was only available in the case of one of the resident, who was placed at the Home through the local Social Services Department. Some needs assessments were evidenced for the other privately funded residents, but they were basic and did not cover various areas of needs, and as a consequence such needs were not always addressed. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 10 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 and 10. Staff usually try to provide a very good standard of care to residents. This is in line with the Home’s values and philosophy of care. Whilst documentation for care planning was available, staff were not developing and reviewing individual care plans for residents in an appropriate and timely manner. These shortfalls have a potential to place residents at risk. Care staff make adequate efforts to ensure that the identified health care needs of residents appropriately met. The management of medicines was satisfactory. Staff attitude and approach to care was based on respect for the individual and this helped to safeguard and enhance the rights and dignity of residents. EVIDENCE: Residents and relatives, who spoke to the inspector, stated that staff were ‘ very good and dedicated ’. Interactions between staff and residents were noted to be friendly and courteous and this helped to maintain a good atmosphere at the Home. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 11 Residents were offered assistance with their personal care in the privacy of their own rooms or in bathrooms. Residents were in good attire and this enhanced their self-confidence and dignity. The care plans of three residents were checked. They did not address important areas of care needs, such as action to address confusion and other areas of risks. In some cases, action to meet identified needs was not specific enough. Some care plans were also not regularly reviewed. A sample of medicines administration records were checked and they show that medicines were appropriately administered. The storage of medicines has been improved. A new metal cabinet to store certain items of medicines has been ordered. The registered manager must ensure that the cabinet is duly installed and used as advised. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 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 and 15. Social events and leisure activities are organised to provide some stimulation and interest for residents. However, not all residents are able or prefer such activities, which are mostly organised for the whole resident group. This has led some residents to miss out on their preferred way to spend their time. Social care needs of residents should be appropriately assessed and catered for, in order to meet the varied and continuing needs of individual residents. Meals are nourishing, balanced and offer a healthy and varied diet for the resident group. On occasions, meals transported to and served at one of the units, are of lower temperature and appear drier. Catering arrangements should be reviewed to ensure that all food served to residents are of the optimum temperature and of equally of good quality. EVIDENCE: There was a coffee morning in each of the two units, on the morning of this inspection. A number of residents, relatives and friends attended the coffee mornings. A small number of residents helped with organising and the running of the coffee morning. Residents stated that it was a way’ to raise some money for the ‘residents fund’. Other activities that are organised, many of them by the ‘ Friends Group’ include bingo nights, movie nights, entertainment nights and occasional trips. Residents, who spoke to the inspector, commented that far fewer activities, in particular in-house ones, are currently being organised.
CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 13 They felt it was due to staff being ‘ over worked’. One resident said ‘ staff have no time to relax and to have a friendly chat with residents. We never get taken out of doors for a little walk. But I must say that we are kept clean, comfortable, warm and fed, all in very nice surroundings.’ Other residents agreed that there appeared to be less ‘one to one’ social interaction between staff and residents. Care plans that were checked showed inadequate assessment of residents’ social needs. ‘ Likes and dislikes’ of some leisure activities were noted, but these were basic and not always acted upon. Residents confirmed that they were asked for their food choices for the day. Staff were aware of the food and drink preferences of the residents. Residents commented that the meals served at the Home were ‘ good, well cooked and tasty ‘. However, residents in the building, to which meals are brought in by heated trolleys, stated that on occasions, the food is at a lower temperature and appear drier, when it is served from the trolley. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 14 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) 16 and 18. Complaints are handled appropriately and in accordance to established procedures. This provides reassurance to residents and their relatives that their concerns are taken seriously and acted upon. The adult protection policy ensures that residents are protected from all forms of abuse. EVIDENCE: The Home has a detailed complaints procedure, which is well publicised. Residents and relatives, who spoke to the inspector, stated that they could always raise their concerns to the staff with the knowledge that ‘ they would look into the matter’. There has been no complaint since the last inspection. An adult protection procedure is in place. Staff spoken to, were aware of the adult protection issues. Newer members of staff were made aware of adult protection issues during their induction and more in depth training is being organised for them. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 15 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) 19 and 26. There has been a merger of the two previously separate Homes on the site into one Home with two buildings. The two buildings and their surroundings are well maintained, thereby enhancing their appearance and facilities. They provide a comfortable standard of both private and communal accommodation. The Home is kept clean and hygienic. However, the storage of equipment is starting to impinge on communal areas used by residents. Action must be taken to ensure that residents have safe and unhindered access to all communal areas of the Home. EVIDENCE: The inspector, accompanied by senior staff, undertook a tour of the two buildings. The communal areas and some residents’ private rooms, which were viewed (the latter with residents’ permission), appeared to be in good condition and in good decorative state. There is an ongoing programme of repairs and refurbishment to ensure that standards are improved and CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 16 maintained. Both buildings were found to be clean and had no malodours. However, one of the bathrooms was seen to contain stored items of equipment, which rendered the bathroom inaccessible to, and unusable, by residents. An alternative area for storage of such equipment must be provided. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 17 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 and 29. The deployment and number of care staff for daytime appeared adequate to meet the needs of the residents. However, the number of care staff scheduled to work during the night was unacceptably low on occasions, and posed a risk to the welfare of residents. The procedures for the recruitment and selection of staff are not always adhered to, and therefore this may compromise the level of protection and safety that residents usually benefit from. EVIDENCE: There were seven carers, two senior carers, support services staff and the manager on duty for the two sections of the Home, which accommodated a total of 53 residents on the day of this inspection. The duty rota was checked and it showed that on occasions, only two carers were deployed in one of the buildings where there were 34 residents. Staff spoken to, also confirmed this shortfall in the level of care staffing on night duty. A previous complaint had also drawn attention to inadequate care staffing at night and an action plan was put in place to address any such future shortfall. The manager agreed to take the necessary action to increase the number of care staff on night to a minimum of three, subject to review of occupancy and dependency levels. A number of residents commented that staff were ‘ excellent’ but they felt, there were ‘ not enough hands’ in particular, when there were staff absences. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 18 The staff files of two newer members of the care team were checked. In one instance, a reference had not been sought and received from the applicant’s last employer. The latter was a care provider and it was highly relevant that this employer be approached for a reference. All other pre-employment checks were undertaken. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 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) 31and 38. The overall management of the merged service appears adequate to provide leadership and guidance to staff and to ensure that residents receive a good standard of care. Some areas relating to access and health and safety issues require further attention, in order to enhance the welfare of both staff and residents. EVIDENCE: The registered manager has successfully completed her ‘Registered Manager Care Award’. In the new management arrangements for the merged service, she has overall responsibility for the two sections of the Home. There are two deputy managers and a number of senior carers to assist in the management of care. Residents, relatives and staff, who spoke to the inspector, were satisfied with the way the Home is managed. The residents’ safety and welfare, were safeguarded by providing staff with training on a range of topics including ‘ moving and handling, fire safety and
CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 20 food hygiene. However, some records relating to accidents and incidents within the Home were not available for inspection. The storage of equipment in one of the bathrooms, constitute a potential health and safety hazard to residents. An alternative storage place that does not impinge on areas used by residents must be found. (See Standard 19). CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 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 2 x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 2 CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 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 OP 1 Regulation 4,5& 12 Requirement The Homes statement of purpose must be improved to meet the regulation. Copies of the document must be made available to this office of the Commission and to other interested parties. Assessment of care needs must be improved to ensure that all health, personal and social care needs are considered. The assessment must be in sufficient detail to enable care staff to meet the residents needs, and it must be kept under review and have regard to any change of circumstances and be revised as necessary. Timescale for action 14/11/05 2. OP 3 12, 13 & 14 28/ 11/05 3. OP 7 12, 15 Individual care plans of residents 28/11/05. must be developed in an appropriate and timely fashion. Care plans must be in sufficient details to provide clear guidance to staff on the actions to be taken to meet identified needs. Care plans must be appropriately and regularly reviewed. CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 23 4. OP 9 12 & 13 5. OP 19 & 38 12, 23 6. OP 27 12,18 7. OP 38 12, 13 8. OP 29 12, 19 The registered manager must ensure that all staff who administer medicines at the Home have received the appropriate training to do so. The manager must also ensure that a metal cabinet is duly installed for certain items of medicines to be appropriately stored in it. Equipment stored in one of the bathrooms, must be relocated and the bathroom made accessible to residents. The level of care staff on night duty must be increased and be no less than a ratio of one to ten residents. Records relating to accidents or incidents in the Home, must be kept at the Home at all times and be made available for inspection. The registered manager must ensure that all job applicants are asked to provide two references, one of whom must be their last employer, if they were previously employed. 14/11/05 14/11/05. Immediate and on going. 14/11/05. Immediate and on going. 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 12 Good Practice Recommendations The individual social care needs and preferences of residents, in particular the one-to-one interaction, should be appropriately taken into account when organising activities in the Home, catered for and recorded. A review of the catering arrangements should be undertaken to ensure that all meals are served at the optimum temperature and of consistently good quality. 2. 15 CLIFTON MEADOWS 20050802 Clifton Meadows X00015 UN Stage 4 S3101 V216736 J55.doc Version 1.40 Page 24 Commission for Social Care Inspection First Floor, Barclay Court Heavens Walk Doncaster South Yorkshire. DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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