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Inspection on 06/12/05 for Clinton House Care Home

Also see our care home review for Clinton House Care Home for more information

This inspection was carried out on 6th December 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The nurse in charge although not new to the home is new to some of her responsibilities and has worked hard in relation to care planning documentation.

What has improved since the last inspection?

The good practice recommendations of the last inspection report (21/04/05 under previous ownership) have been addressed.

What the care home could do better:

To organise the lunch breaks of the staff so that the floor is not understaffed which on the day of the inspection resulted in the care needs of the service users not being met.

CARE HOMES FOR OLDER PEOPLE Clinton House Care Home 75 Truro Road St Austell Cornwall PL25 5JQ Lead Inspector Elaine Bruce Unannounced Inspection 6th December 2005 08:45 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.V265544.R01.S.doc Version 5.0 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.V265544.R01.S.doc Version 5.0 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 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.V265544.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 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.V265544.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of Clinton House under the new ownership of Morleigh Limited. One of the directors of the Company was present during the course of the inspection as was the acting manager. The inspection took place over 7 hours and was carried out as an unannounced inspection. Considerable time was spent with one of the directors of the Company during the course of the inspection discussing the improvements that the Company are planning to make to the home. Service users were spoken to during the course of the inspection. Care plans and staff files were inspected as was the medication system. Time was also spent with the nurse in charge discussing changes to some of the documentation systems that have taken place and are taking place What the service does well: What has improved since the last inspection? The good practice recommendations of the last inspection report (21/04/05 under previous ownership) have been addressed. Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 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. Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 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.V265544.R01.S.doc Version 5.0 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: The nurse in charge undertakes an assessment of all new service users prior to admission to the home to ensure that the care needs of the individual can be met. It is recommended that the documentation being used to carry out the pre admission assessment is clearly identified as such. Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 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): 7,8,9,10 and 11 The service user’s health, personal and social care needs are being met by the staff and multidisciplinary staff as required. Medication is being administered correctly to the service users but three good practice recommendations are made as a result of this inspection. Changes to staff routines are required to ensure that the care needs of the service users are being met at all times. EVIDENCE: The service users health, social and personal care needs are set out in an individual care plan. The care plans are reviewed monthly to reflect the changing needs of the service users. Risk assessments are in place for each service user. Documentary evidence is in place that the care plans are drawn up with the involvement of the service user and their representative. A nice form called a “pen picture” includes important information on the past experiences and happy events of the service user. Good daily recording Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 Page 10 supports the care plans. The nurse in charge has responsibility for care planning and has worked hard with this new responsibility. 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 mattresses for those at risk of developing pressure sores. Service users have access to specialist medical and nursing services according to their individual needs. The home has updated their medication policy and procedure and it is recommended that all nurses now sign to say they have read and understood the contents of the policy and procedure. The medication system is administered from a monitored dosage system and the home appear to have a very good working relationship with the pharmacy that supplies the medication. They regularly inspect the system and leave documentation to this affect. Medication administration records were found to be completed appropriately in the main records. There were though some gaps in the administration time of medicine in the controlled drug register which must be addressed. Some of the service users (and a relative) expressed very positive comments on the standard of care being delivered at the home. Some service users expressed negative comments in relation to waiting times for a response to the call bell. This was directly observed after lunch when the majority of the staff took a lunch break together. These observations were discussed during feedback and a commitment given for changes to take place immediately to ensure that there are the appropriate number of staff on the floor at all times. Information was noted to be missing in the care plans inspected on the wishes of the service users re death and dying. This should be addressed as a good practice recommendation. Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 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.V265544.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection. EVIDENCE: Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 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): 19,20 The Company who have recently taken over ownership of the home are already making improvements to the environment to the benefit of the service users. EVIDENCE: The new owners are improving the premises to include recent decoration in the corridors of the home, improvements to the entrance reception and the addition of a private room for hairdressing for example. The gardens are well maintained and provided with seating. There is a pleasant patio area to the side of the home. Bedrooms are individual and homely in presentation. Bedrooms are available on the ground and first floor of the home. A passenger lift and stair lift are available to the first floor. The service users are involved in the choice of décor for their bedrooms. Communal areas are spacious and generally well maintained. It was though Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 Page 14 noted a carpet immediately outside the main lounges of the home is in need of attention which is apparently to be dealt with very soon. Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 Page 15 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): 27 and 29 Although the staffing rota was satisfactory on the day of the inspection the needs of the service users were not being met due to a large number of staff having a meal break at the same time. EVIDENCE: Staffing levels are presently being reviewed by the registered manager and the Company. The nurse in charge has responsibility for the staffing rota. On the day of the inspection after the lunch it was noted that the care needs of the service users were not being met as the majority of staff were taking a lunch break. This was agreed to be reviewed and changed as a priority. Recruitment procedures are mainly satisfactory but a risk assessment must be put in place when a positive criminal records bureau check is received. Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 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 36 The Company and the acting manager are committed to meeting standards to ensure that the care needs of the service users are being met. EVIDENCE: The acting manager has been seconded from her registered manager post at another home that is owned by the Company. This is a temporary position at this time for three months as agreed by The Commission for Social Care Inspection. The directors of the Company are very involved in the running of the home to include attendance there on most days of the week. They were very open during the inspection in stating that the change of ownership has been difficult but they are committed to ensuring that the home delivers a good standard of care. Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 Page 17 The acting manager has commenced staff meetings and all staff have now been included in a formal meeting. From these meetings appraisal forms have been completed by staff and in the new year the appraisals will take place. Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 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 3 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 3 x x x x x x 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 3 3 x x x x x x Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 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. 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 2 3 4 5 6 7 8 Refer to Standard OP3 OP9 OP9 OP9 OP10 OP19 OP29 OP11 Good Practice Recommendations To clearly name the document being used for the pre admission assessment process. To evidence that the nursing staff have read and understood the medication policy and procedure. To consistently use black ink in the controlled drug register as stated in the medication policy and procedure. To ensure at all times the time of the medication being given is entered in the controlled drug register. To ensure that at all times there are enough staff members on the floor to meet the care needs of the service users. To replace the carpet immediately outside the main lounges of the home. To risk assessment any positive enhanced criminal records bureau check. To include information on the wishes of the service user re death and dying. DS0000064606.V265544.R01.S.doc Version 5.0 Page 20 Clinton House Care Home Clinton House Care Home DS0000064606.V265544.R01.S.doc Version 5.0 Page 21 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.V265544.R01.S.doc Version 5.0 Page 22 - 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!