Inspection on 15/11/06 for Clinton House Care Home

This inspection was carried out on 15th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 11/07/06

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 15th November 2006 08:30 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.V313453.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.V313453.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 Miss Patricia Jennifer Nancarrow 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.V313453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include one named person out of category. To include three out of category service users by reason of age and disability. Service users to include one named person under 65 years of age for one weeks respite from 4th September 2006. 11th July 2006 Date of last inspection 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.V313453.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 8 hours on the 15th November 2006. One of the directors of the Company was actively part of the inspection. The nurse in charge of care came into the home in the morning from his annual leave to speak with the inspector about care planning. The registered manager spoke with the inspector after a morning training course that she had attended on employment legislation. The key inspection of the 11th and 12th July had identified concerns from some service users (and observations from the inspector) that staffing levels were not meeting their needs. Time was spent with the service users, as well as case tracking and it would appear that improvements have taken place at the home. Call bells that had previously been identified as ringing for a long time would appear now to not be an issue except in one relative/visitor comment card. In addition the lack of bathing/personal care delivery would appear to have been addressed. Although there were still some concerns expressed and written, these were found to be small points with some concerns expressed about the meals in particular. Some service users expressed very positive comments about the home. Prior to the inspection the home completed a pre inspection questionnaire and on the day of the inspection a number of service users comment cards and relatives/visitors cards were received. The responses re the meals that suggested that only sometimes does a service user like the food are to be followed up by one of the directors of the Company. The weekly range of fees for the home is from £293.25 to £444.25 What the service does well: The management structure for the home appears to now be working well with specific roles and responsibilities for the registered manager and the nurse in charge. The directors of the Company are very involved in the running of the home and are therefore fully aware where improvements are required and where the home is doing a good job. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clinton House Care Home DS0000064606.V313453.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.V313453.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. It is recommended that the pre admission assessment form is consistently dated after assessment. Where the assessment has been undertaken through care management arrangements the home has received a summary of the assessment and a copy of the plan. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 9 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. Although not formally assessed on this occasion it is noted that the service user guide has been updated. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning documentation is presently being updated and reviewed to ensure that evidence is in place that the care needs of the service users are being met at all times. Medication is being administered correctly to the service users. Staff are fully aware of the principles of respect, dignity and privacy in their delivery of care to the service users. EVIDENCE: The service users’ health and personal care needs are set out in an individual plan of care that is based on the activities of daily living. The care plans are presently being totally upgraded with new documentation and improvements Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 11 are immediately noted. A pen picture of each service user is also being evolved with input from family/representatives as is appropriate. Risk assessments are in place and a recommendation is made to include in care planning a recognised nutritional screening tool. The nurses at the home have responsibility for care planning documentation to include the daily records. Supporting records are completed by the care staff to include for example the bathing records. A discussion took place with the nurse in charge on the new care planning system. It is anticipated that daily records will also be improved on completion of this task. 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 any pressure sores. The home or health service provides pressure relieving equipment for those at risk of developing pressure sores. Medication administration records were found to be completed correctly on the day of the inspection including records for controlled medication. The storage of the medication was also found to be satisfactory. Some slight amendments (as discussed at the time of the inspection) are required to the recently updated medication administration policy and procedure. Service users who have the capacity are encouraged to keep and take their own medication. Documentation is in place to guide staff on privacy and dignity in regard to delivery of care. Induction training covers privacy and dignity. The home operates a key worker system to allow a special relationship with the service user to be built up through one to one time being spent together. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Visitors to the home are welcomed and encouraged. Improvements are noted to the assessment of the social care needs of the service users and the activities being provided at the home to meet these needs. Service user comment cards suggest that the service users are not always happy with the meals they receive at the home. This is to be followed up by one of the directors of the Company. EVIDENCE: Improvements are noted to the records held on the social care needs of the service users. Information in care planning includes a reference to the Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 13 interests of the service user and also includes them in making decisions on their daily routines for example the rising and sleeping times that they prefer. Families and representatives of the service users are asked to complete information in the form of a pen picture on the service user. A notice board in the lounge of the home displays the activities for the week. Recent activities have included a dance group, an accordion player, a visit from the Screech Owl Sanctuary and a speaker re life at Buckingham Palace. Service users spoken to during the course of the day expressed very positive comments on the recent dance group entertainment. Arrangements are in place for service users to take part in Communion should they so wish. The birthday of each service user is celebrated. One of the directors of the Company has recently purchased new games for the home to include scrabble and they are aiming for a weekly activity to take place at the home. It was noted during the course of the day the large number of visitors to the home. They were also noted to be welcomed into the home by a staff member and asked to sign into the visitors’ book on arrival at the home. The cook has responsibility for a large number of meals to include the home and a number of meals in the community. The menu is mainly traditional and changes over a four week period. The menu includes for example two roast dinners in the week and fish and chips on a Friday. An alternative choice to the main meal is always available. On the day before a care staff member asks each service user what they would like to eat for the following day. Special diets are catered for as are liquidised meals for example. Local suppliers are used to provide the meat and vegetables. As recommended all the cooks have obtained their basic food hygiene certificate qualification. The home has plans for all staff members to obtain this qualification. The requirements of the recent district council environmental health officer inspection have been addressed. It was noted positively during the course of the inspection that the time of breakfast for the service users was very variable depending on their wishes. Some concerns were expressed by the service users in their comment cards on the satisfaction of the meals being provided by the home. This is to be followed up by one of the directors of the company. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 and staff are due to receive training from the manager to ensure the safety of the service users at all times. 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. A complaint that the CSCI was aware of was investigated well by the manager with action points for improvements identified. The home has in place an adult protection policy and procedure that has recently been updated by the manager. The manager has recently attended external training and this knowledge/information is to be cascaded to all the Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 15 staff. The home has presented themselves well at recent adult protection strategy meetings. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clinton House is well maintained externally and internally with evidence of on going regular improvements taking place. EVIDENCE: Clinton House is well maintained internally and externally. The home employs one full time and one part time maintenance staff member. Gardens to the front of the home are provided with seating and there is a pleasant patio area to the side of the home. Parking is available in the grounds of the home. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 17 Bedrooms are individual and homely and are being painted and decorated as they become available. Communal areas are spacious and include a large main lounge with a dining room off, another spacious lounge and then a further more homely smaller lounge. Off this small lounge is an office and a hairdressing room. A shaft lift and stair lift is available to the first floor bedrooms in the home. Hoists and assisted bathing provision is also available. Grab rails and ramps are also in place. As discussed at the time of the inspection one service user’s bedroom carpet should be replaced. The premises were noted to be clean on the day of the inspection. There are designated housekeeping staff employed by the home. Bedrooms are cleaned very regularly. There are ample hand washing facilities for the staff and a good provision of protective clothing is provided to the staff for infection control purposes. Laundry facilities are satisfactory. All maintenance records for the home were found to be in place and up to date to include for example the gas safety record, fire officer inspection and insurance certificate. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to meet the needs of the service users. Recruitment procedures are satisfactory. Staff training is ongoing with a large amount of staff training planned over the next few months. EVIDENCE: Staff work a variety of shifts to include twenty four hour cover with a qualified nurse always on duty. On the day of the inspection six carers were on duty working a shift from 08.00 to 14.00 or 14:00 to 20:00. The nurse in charge of the shift was working from 08:00 to 20:00. The nurse in charge of care has responsibility for all the staffing rotas and is included in the rota over the week end hours. It is noted that amendments are made to staffing rotas to ensure that peak times for care delivery are covered. There is an acceptable use of any agency staff. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 19 Recruitment procedures were found to be satisfactory on the day of the inspection. All care staff are encouraged to undertake NVQ training in care and although the number of staff who have this qualification is under 50 there are an additional eight staff who are undertaking these studies, with three more due to commence studies in the New Year. The percentage of staff who will then have this qualification will increase considerably. At this time only one staff member is not qualified in moving and handling training. All the nursing staff have now received first aid training and there are plans for all senior staff to also have this qualification. Fire drill training is being provided as recommended by Cornwall County Council fire drill department. The manager is to undertake adult protection training to all staff over the next few months. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are noted to the running of the home since the inspection of the 11th and 12th July 2006. The home now has a registered manager and nurse in charge employed who are essential personnel in moving the home forward. EVIDENCE: The home now has an experienced and qualified registered manager employed. She has specific duties and responsibilities which are separate to the responsibilities and duties of the nurse in charge. This management Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 21 structure appears to be working well. In addition to the manager senior care staff have been employed again with specific duties and responsibilities. Financial and administration support hours are provided at the home and this support is provided to management as required. The directors of the Company are very involved in the running of the home. A quality assurance/monitoring assessment review of the home has recently taken place with an analysis of the results undertaken by one of the directors of the Company. There will be another audit carried out after Christmas in particular to review the meals being provided at the home. An audit of the finances that the home is holding on behalf of the service users was found to be satisfactory on the day of the inspection. All policies and procedures have recently been updated and these are presently being circulated to all the staff for reading. To meet the requirements of standard 38 it is recommended that an audit is carried out of the water temperatures at the home and where these have been controlled. It is also recommended that a staff member takes on health and safety duties and responsibilities. Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 22 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 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x 2 2 Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 continue to update the care plans and improve the daily records that evidence the delivery of the assessed care needs. To give consideration to including a recognised formal screening tool for nutrition in care planning. To amend the medication policy and procedure as discussed at the time of the inspection. To record all visitors to the service users. To provide updated adult protection training to all the staff at the home as soon as is possible. For the staff to continue to read the updated policies and procedures. To carry out an assessment of the hot water supply at the home and confirm where water temperatures are controlled. To give consideration to employing a staff member for health and safety responsibilities and duties. DS0000064606.V313453.R01.S.doc Version 5.2 Page 24 2. 3. 4. 3. 4. 5. OP8 OP9 OP13 OP18 OP37 OP38 Clinton House Care Home Clinton House Care Home DS0000064606.V313453.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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