Inspection on 11/07/06 for Clinton House Care Home

This inspection was carried out on 11th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Clinton House Care Home 08/07/08

Clinton House Care Home 03/07/07

Clinton House Care Home 15/11/06

Clinton House Care Home 27/02/06

Clinton House Care Home 06/12/05

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Clinton House Care Home 75 Truro Road St Austell Cornwall PL25 5JQ Lead Inspector Elaine Bruce Key Unannounced Inspection 08:45 11 and 12th July 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clinton House Care Home Address 75 Truro Road St Austell Cornwall PL25 5JQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01726 63663 01726 69003 clinton.house@btconnect.com Morleigh Ltd Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (39), Terminally ill (39) of places Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include one named person out of category. Date of last inspection 27th February 2006 Brief Description of the Service: Clinton House is a period residence with an extension added in the early eighties. The home is situated close to St Austell town centre and provides nursing care for up to 39 older people. There is a garden with a lawn to the front of the home and adequate car parking space. A patio area is situated outside the lounge/dining room on the ground floor. Accommodation is provided on two floors, accessed by a shaft and stair lift. Assisted bathing facilities are provided and all rooms have call bells. There is good wheelchair access within the home and to the patio. There are two spacious lounges with two separate dining areas. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection at Clinton House was a key inspection that took place over one and a half days. One of the directors of the Company was actively part of the inspection as was the acting manager and nurse in charge. The application to register the manager is anticipated soon by the CSCI. A number of service users were spoken to during the course of the day. They expressed some concerns which were mainly related to staffing issues at the home. These concerns formed the basis of the inspection. On day two of the inspection staffing levels were confirmed to be not satisfactory and a discussion followed with management to address the situation immediately. What the service does well: What has improved since the last inspection? What they could do better: Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 6 Improvements to staffing levels must be made to ensure that at all times the basic care needs of the service users are being met. 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. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The nurse in charge assesses all service users prior to admission to the home to ensure that the home will be able to meet their care needs. EVIDENCE: Prior to admission to the home an assessment of care needs takes place by the nurse in charge to establish that the care needs of the service user can be met. Information is included in the service user guide on the admission assessment procedure and visits to the home. Respite care can be provided by the home as well as a longer stay. The home is not running at full occupancy at this time. On day two of the inspection three emergency admissions took place where due to the crises of the situation pre admission assessments could not take place. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Although care planning documentation would indicate that the care needs of the service users are being met, other documentation and observations indicate that this is not the case. Improvements were noted to medication administration since the last inspection. Service users expressed concerns about the delivery of care during the course of the inspection. EVIDENCE: The service users’ health and personal care needs are set out in an individual plan of care. The care plans are reviewed monthly to reflect the changing needs of the service users, although it was noted that there are some gaps in the monthly reviews due to staff changes. Risk assessments are in place as is a “pen picture” which includes important information on the past experiences and happy events of the service user. The nurses at the home have responsibility for care planning documentation to include the daily records. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 10 Supporting records are completed by the care staff to include for example the bathing records. It was noted that service users who are at the home for respite care have no care plans in place. This should be addressed as a priority. On day two of the inspection following discussion with the service users and staff it was noted that no baths (or showers) had been undertaken on that day and records also indicated that some service users had not been offered a bath/shower for a considerable period of time. All the service users are registered with a general practitioner. Each service user is assessed by a registered nurse to identify the risks and treatment of pressure sores. The home or health service provides pressure relieving equipment for those at risk of developing pressure sores. It was noted and discussed with one of the directors of the Company the shortage of hoists at the home which could be contributing to the problems re the lack of bathing being offered to the service users. Improvements were noted to the medication administration since the inspection of the 27th February 2006. The monitored dosage system is now being correctly administered but there were some gaps in the signing of the medication administration records. Service users were spoken to during the course of the inspection in the privacy of their rooms. Each service user expressed some concerns about the home which were mainly related to their care which in turn is related to staffing levels, for example the length of time the call bell takes to be answered. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 16 and 18 The home has a satisfactory complaints policy and procedure provided to the service users in the service user guide. Adult protection policies and procedures have been reviewed but updated training for staff is still to take place. EVIDENCE: Should a service user wish to make a complaint information on this process is available in the service user guide. In addition the complaints policy and procedure is displayed in the home. The home has in place an adult protection policy and procedure that has recently been updated by the acting manager. There are plans for the staff to receive more training in this important area and this is planned to take place soon. On the first day of the inspection the acting manager had to evoke the adult protection procedures and it was noted that she carried out these duties competently. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 13 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 the following standard(s): These standards were not assessed. They were assessed at the inspection on the 27th February 2006 where they were all found to be met. EVIDENCE: Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): During the course of the inspection staffing levels were found to be not meeting the needs of the service users. The home was left with an immediate requirement to address this. Recruitment procedures are not satisfactory and statutory training must be updated. EVIDENCE: On day one of the inspection a number of service users were spoken to. They gave information that suggested that they are having to wait a long time for call bells to be answered. This was discussed with management at the end of day one and the morning of day two was spent looking at the staffing levels and duties. On arrival at the home on day two a staff member was off sick and cover was not arranged until a number of hours later. There was observed to be no staffing cover in the dining room for considerable periods of time. This is unacceptable with service users being at high risk without any supervision. During the course of the morning it was also apparent that not one service user had been offered a bath or shower as the staff said that they were too busy to do this. Direct observation of this confirmed that they are extremely busy but the staffing levels must be improved to ensure that these basic care needs can be met. It is accepted that the home is having a difficult time with Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 15 staffing but the care needs of the service users must not be compromised into risk situations. The print out of the call bell ringing times confirmed that there are a number of occasions when the call bells are ringing for an unacceptable amount of time. Again this must be reviewed and addressed. All care staff are encouraged to undertake NVQ training in care but due to staff changes it is difficult at present to establish the position with updated training. It is noted that some statutory training is due to be updated which again must be addressed. It was noted on the day of the inspection that a staff member employed and working at the home did not have the correct recruitment procedures in place to include a check on the adult protection register and or a criminal records bureau check. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 and 37 The change of ownership at Clinton House has been difficult for management and staff and the new owners. This key unannounced inspection has established that the staffing situation at the home is not satisfactory. A random inspection will follow soon to ensure that staffing requirements are met and that the service users care needs are being met. All policies and procedures should be updated and reviewed as soon as possible. EVIDENCE: The acting manager has obtained her registered managers award qualification. The CSCI is awaiting the completion of her application with a view to registration as manager. It has been a difficult time at the home following significant management changes at the same time as change of ownership and Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 17 the appointment of a new nurse in charge. The management structure is in place with roles and responsibilities defined for progress to be made but staff turnover and difficulties are now creating problems with the delivery of care. This must be addressed. The registered providers are very involved in the running of the home and it is hoped that this will be a positive factor in addressing the serious concerns of this inspection. All policies and procedures should be updated as discussed at the time of the inspection. It is understood that this will be achieved between the acting manager and nurse in charge in approximately three months. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 x x x x x x x x STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 x x x x 2 x Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1) Requirement The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall not employ a person unless that person is fit to work at the care home. The registered person shall ensure that the persons employed by the care home receive training appropriate to the work they are to perform. DS0000064606.V298283.R01.S.doc Timescale for action 31/07/06 2. OP8 12(1) 31/07/06 3. OP27 18(1) 31/07/06 4. OP29 19(1) 31/07/06 5. OP30 18(1) 31/08/06 Clinton House Care Home Version 5.2 Page 20 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 OP7 Good Practice Recommendations To ensure that monthly reviews of the care plans are consistently in place and complete care plans on the service users who are in the home for respite care. To carry out a review of the moving and handling equipment and purchase new equipment where necessary. To hold on the premises records of the comfort fund for audit purposes. To update the basic food hygiene certificate training to all the kitchen staff. To include information in the service user guide on advocacy and the rights of the service users. To provide updated adult protection training to the staff at the home as soon as is possible. To review the call bell system and address the problems where the call bells are ringing for an unacceptable amount of time. To involve the service users in a quality monitoring review following the change of ownership. To encourage all staff to undertake NVQ training. To ensure that medication records are consistently signed. DS0000064606.V298283.R01.S.doc Version 5.2 Page 21 2. OP8 3. OP12 4. OP15 5. OP17 6. OP18 7. OP27 8. OP33 9. 10. OP28 OP9 Clinton House Care Home 10. OP37 To review and where necessary update all policies and procedures. Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Clinton House Care Home DS0000064606.V298283.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!