CARE HOMES FOR OLDER PEOPLE
Cloverdale Care Home 68 Butt Lane Laceby Grimsby North East Lincs DN37 7AH Lead Inspector
Beverley Hill Unannounced Inspection 3rd March 2006 09:30 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 Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 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. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cloverdale Care Home Address 68 Butt Lane Laceby Grimsby North East Lincs DN37 7AH 01472 877000 01472 877111 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) Dryband One Ltd Lynette Amy Green Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st October 2005 Brief Description of the Service: Cloverdale Care Home is registered for the care of forty service users with residential care needs. The home is situated on the outskirts of Laceby village, in North East Lincolnshire, about six miles south of the town of Grimsby. The home is purpose built, all service user accommodation being provided at ground level. All forty bedrooms are single and thirty-nine have en-suite facilities. The home has four bathrooms with toilets and an assisted shower room. There are also four single toilets throughout the home strategically placed for ease of access. The home has two lounges and a dining room with a seating area at one end for service users who wish to smoke. Cloverdale Care Home is set in its own grounds and enjoys a pleasant aspect of open countryside. A paved walkway surrounds the home and there are ample parking spaces to the front of the building. The home is well maintained, clean and has a homely feel. Cloverdale Care Home is owned and operated by a private company, Dryband One Ltd. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager, one care staff member, one laundry worker and two catering staff that was on duty at the time of the inspection. Throughout the day the Inspector spoke to nine people who lived at Cloverdale and one relative. The inspector looked at a range of paperwork in relation to care plans, daily recordings, menus, staff recruitment, training and supervision, complaints, risk assessments, quality monitoring, service users finances and activity logs. The inspector also checked that people who lived in and who worked at the home had the opportunity to suggest changes and were listened to. The inspector completed a partial tour of the building and checked that all the things that needed to be done from the last inspection had been done. What the service does well:
The home always made sure that service users had an assessment of their needs prior to admission to help staff determine whether their needs could be met in the home. The home was purpose built with all bedrooms on one level and was very clean and tidy. People spoken said they were happy with their bedrooms and the cleanliness generally and that staff worked hard to keep up the standards. The home has wide corridors, which are very useful to people in wheelchairs and was nicely decorated. People spoken to state that the meals continued to be were very good and there was plenty to eat and drink. They had hot and cold choices at mealtimes and home baking. A meal sampled on the day was well cooked and presented. People who lived at the home were complimentary about the staff and state they were friendly, knocked on doors and respected privacy and dignity. They felt able to make choices about aspects of their lives and felt able to complain if they needed to. The staff said the home was a nice place to work in and they all tended to get on with each other, although communication could be improved. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The staff could ensure that the care plans contain all assessed needs and that they are more individualised. One person had developed further needs that were not incorporated into the care plan so the staff did not have clear written guidance on how to consistently manage that part of their care. The way the home recruits staff could be better. One file examined did not have two references and sometimes gaps in employment history were not explored. New staff did not have a formal interview. Good recruitment practices were essential to ensure the right staff members were employed and service users were protected. The manager needs to update training information, as the inspector did not have an accurate picture of who had completed essential training. Staff spoken to did state that they had participated in training. Communication and consultation could be improved within the home. Staff stated they did not always receive full information when they came on duty, problems sometimes took quite a while to be resolved and there had not been a full staff meeting for several months. The manager did say that they met with staff daily to exchange information. Service users also did not have formal
Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 7 meetings although the manager did have one to one discussions with people. This needs to be expanded to ensure that service users views were expressed and addressed. The home needs to send the results of the quality monitoring to the CSCI. 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. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 8 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 Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 9 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): 4 The home demonstrated its capacity to meet the current needs of service users admitted to the home. EVIDENCE: Since the last inspection two service users have had their needs reassessed by care management. For one person this meant a move to another residential home. The home completed assessments of need prior to admission and obtained assessments completed by care management. This enabled them to develop a care plan to meet the needs. The home had sufficient equipment within the home to meet a range of needs and specialist equipment was obtained via district nursing services as required. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 Although service users spoken to felt that health and personal care needs were met, care plans were not consistently individualised to the required degree and as a result care needs could be missed. The lack of appropriate risk assessments for one service user could mean their needs were not fully met. The staff provided care to service users in a way that promoted their privacy and dignity and improvements were noted in the management of medication. EVIDENCE: Four care files were examined in detail to check that requirements made at the last inspection had been addressed. Some improvements were noted in care plans formulated for two new admissions to the home regarding ensuring that all assessed needs were covered with clear tasks for staff. The care plans formulated were pre-printed sheets for each identified need and then individualised for each service user. Generally the care plans were comprehensive and it was clear a lot of effort had gone into their initial formulation. However, it was noted in the files examined that not all assessed needs were covered and some care plans were not individualised to the degree required. For example one person had health
Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 11 conditions that affected their mobility and comfort and a review had mentioned changes and increased need for support with eating but these were not mentioned in the care plan. The manager confirmed that they were auditing all care plans regarding assessed needs and was approximately three quarters of the way through. Evaluations of care plans were written monthly and there was evidence that a new service user admitted to the home had seen and signed agreement to their care plan. Service users spoken to felt that their health and personal care needs were met in a way that maintained their privacy and dignity. Comments were, ‘the staff are very kind and patient’, ‘they take their time but they are very busy’, they knock on doors, no one bothers you if you don’t want them to’. One person described how staff members left them to manage their own personal care but kept coming back to check they were ok. Staff members spoken to were aware of service users needs and described how they promoted privacy and dignity. Each bedroom had a green light on the outside that when pressed by staff or service user indicated to others not to enter. There was use of individual risk identification tools for nutrition, dependency skills, bedrails, falls, smoking and moving and handling needs. The manager showed the inspector a form used to bring together all identified risks on one sheet of paper. However not all areas of risk were identified and planned for. For example one service user had developed psychological and behavioural issues and a risk assessment was required to support them and ensure that staff members were fully aware of a consistent approach. The same service user required a risk assessment for moving and handling with guidance for staff. Daily recording of the care people received had improved and the manager confirmed this was an area they were monitoring to ensure care needed was not missed. The management of medication had improved since the last inspection. The requirements issued regarding transcribing medication correctly, and the signing into the home of respite medication and topical creams when applied had been addressed. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 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 the following standard(s): 14 and 15 The home promoted choice and independence and provided a balanced diet sufficient to meet service users needs. EVIDENCE: Service users confirmed in discussions that they were able to make choices about aspects of their lives. As examples they cited flexible routines within the home with regard to rising and retiring, choices at mealtimes, whether they wanted to manage their own medication and money, activities, personalising their bedrooms and seeing visitors in private. Some service user had their own telephones installed and others had mobile phones. Two people had chosen to install sky television for their enjoyment. Staff spoken to described ways in which they supported people to make choices. For example checking whether they preferred a male of female carer, ensuring independence as much as possible, holding up choices of clothes for people when assisting with personal care and generally asking people what they would like instead of taking things for granted. Service users spoken to were complimentary about the food stating, ‘it’s as you would get at home, meat and gravy’. One person stated, ‘the cook knows what we like, they have lists in the kitchen’. They commented there was enough to eat with hot and cold drinks served throughout the day.
Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 13 The inspector spoke to two catering staff. Menus were rotated on a four weekly basis and although only one main choice was served at the main meal there was evidence that alternatives were provided. Catering staff received information from care staff about likes and dislikes and visited service users each morning regarding the main course or alternatives. There was evidence of fresh fruit and vegetables and specialist diets were catered for, for example diabetic, low fat and vegetarian. A dietician had been involved for one service user in the past. The inspector sampled a meal during the inspection, which was well cooked and presented. It consisted of battered fish, home made chips and mushy peas. Poached fish in sauce was provided as a healthier option. The home provided some activities for people to participate in and entertainers visited the home at least once a month. One service user would like more opportunity to go out into the community. Staff spoken to confirmed it was difficult to motivate people sometimes as some service users were happy staying in their own rooms and more outings occurred in the warmer weather. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 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 the following standard(s): 16 The home provided an atmosphere whereby people felt able to make complaints and that they would be resolved. EVIDENCE: Since the last inspection the manager and staff are more aware of the importance of documenting all concerns and complaints. The home maintains a suggestion book in the entrance for visitors. Staff members spoken to were aware of the complaints process and stated they always tried to deal with niggles or concerns straight away. They passed on complaints they could not deal with to the senior in charge or the manager. Service users spoken to stated that complaints would be made to the manager or head carer and they would, ‘sort it out’. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Standards 19 and 26 were assessed and met at the last inspection. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 16 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): 28, 29 and 30 Whilst there was some evidence to indicate an active training programme, which included NVQ training the manager was not able to provide up to date evidence of training completed. The recruitment practices in the home had not been adequately implemented in all cases to ensure sufficient protection for service users. EVIDENCE: The homes individual training logs for mandatory training were not up to date so the inspector was unable to assess Standard 30 sufficiently. The home did have a training plan and had access to local authority training courses. The company used a range of training methods, for example, in-house moving and handling instructors, external facilitators, distance learning booklets and videos. Staff spoken to describe a range of training courses they had participated in such as first aid, health and safety, infection control, fire safety, adult protection and basic food hygiene. Records indicated that out of twenty-two care staff, eight had completed training up to NVQ level 2 and 3 with a further five staff progressing through the course. When those progressing through the course complete it the home will have over 50 of staff trained to this level. This was a measure of staff members’ commitment to participate in training although they commented that the incentive to do other than just mandatory training was limited due to the homes policy of unpaid training days.
Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 17 There were some areas to address regarding the staff recruitment process. Four staff files were examined. Gaps in employment history were not always explored with applicants, one application form had not been completed fully and signed and one person had one reference which only confirmed they had worked for the company. The interview structure for assessing potential staff was discussed with the manager as the homes policies and procedures state that a full formal interview is conducted. It was apparent that the formal interview was more an exchange of practical information rather than assessment of the applicants’ ability to perform as a carer. The manager is to devise a more appropriate interview structure for new staff as a good practice measure. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 18 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, 33, 35, 36 and 38 The manager is very service user focussed however some management systems within the home require further improvements to ensure service users welfare and safety are promoted. EVIDENCE: The manager had completed the Registered Manager Award and is a moving and handling trainer for the company. The manager was very focussed on meeting service users needs. Although there was some progress noted in some of the management systems, for example supervision of staff had started, and service users finances was managed well, improving systems was an ongoing process for the manager. Some staff members commented on communication difficulties and lack of information after handovers as only the oncoming senior was involved, however the manager confirmed they met with staff on a daily basis and was always available. Others commented on the length of time it took for problems
Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 19 raised to be addressed. There had not been a staff meeting since last year. The manager stated that there was a low turn out for staff meetings due to staff not wanting to attend in their own time. It was important for staff to meet at regular intervals to exchange information and make suggestions about how the home is managed. Communication systems need to be improved in the home. Despite these issues staff commented the home was a nice place to work, moral was quite high, the team got on well with each other and had a good rapport with service users and relatives. There were no residents meetings, although the manager stated they met with service users for one to one chats and this was confirmed in discussions with some people who stated they could express their views and were listened to. The quality assurance system consisted of questionnaires to service users, relatives and other professional visitors to the home and various environmental audits. The manager confirmed that information was collated and action plans drawn up to address shortfalls. The inspector was unable to see any of the QA information as the proprietor was collating it for the annual service review. A copy of survey results with action plans for identified shortfalls that have been evaluated for their effectiveness needs to be forwarded to the CSCI. The home needs to collate the views of staff members as part of the quality assurance programme. The manager and senior staff had made a start on care staff supervision but only fourteen staff members to date have had supervision. This needs to be organised on a rolling plan to ensure all care staff receive up to six sessions a year. The supervision session needed expansion to explore how the staff member was progressing with their role and tasks, the difficulty they may experience with their key worker role, any service user issues, staff dynamics, their recording abilities, training needs and developmental opportunities with information exchange, positive feedback and care file checks. Current discussions were noted to be limited in content. The manager must ensure that effective formal supervision of staff takes place. Not to do so could place service users at risk of inadequate care. Since the last inspection health and safety issues of sluice access to service users had been addressed and the home had obtained a wider selection of slings for the hoists to meet a variety of needs. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 20 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 X 3 X X 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 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 1 X 3 Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 15 Requirement The registered person must ensure that care plans are individualised (previous timescale of 31/03/05 not met) The registered person must ensure that all assessed needs are care planned (previous timescale of 20/01/06 not met) The registered person must ensure that all care staff members receive at least six formal supervision sessions per year (previous timescale of 28/02/05 not met) All care staff to have received at least one supervision session by timescale for action date. The registered manager must continue the start made regarding service user consultation via regular meetings. Minutes must be made available of discussions held (previous timescale of 31/12/06 not met) The registered person must ensure that a behaviour
DS0000002780.V285437.R01.S.doc Timescale for action 30/04/06 2. OP7 15 30/04/06 3. OP36 18(2) 30/04/06 4. OP32 12(1) a 16(2) m n 24(1) 30/04/06 5. OP8 13(4) 14/04/06 Cloverdale Care Home Version 5.1 Page 22 6. OP29 19 7. 8. OP30 OP31 17 & 18 12(1)(a) 9. 10. OP32 OP33 12(1)(a) 24 management plan and risk assessments are in place for a specific service user. The registered person must ensure that gaps in employment are consistently explored and two written references consistently obtained prior to employment. The registered person must ensure that accurate training records are maintained. The registered manager must continue to improve management systems to ensure the smooth running of the home. The registered person must ensure that communication within the home is improved. The registered person must ensure that the quality assurance system includes the views of staff working in the home and results of surveys to be made available to all parties and a copy forwarded to the CSCI. 31/03/06 31/05/06 30/04/06 30/04/06 30/04/06 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 OP12 Good Practice Recommendations The registered manager should consider obtaining advice from occupational therapists on assessment techniques of older people regarding social activities and the types of activities that would be appropriate for them. The home should continue to work towards 50 of staff trained to NVQ Level 2. The registered manager should devise an appropriate method of interviewing staff in order to determine their ability as a carer for vulnerable people.
DS0000002780.V285437.R01.S.doc Version 5.1 Page 23 2. 3. OP28 OP29 Cloverdale Care Home 4. 5. OP30 OP36 The registered person should ensure that staff receive three paid training days per year. The registered person/manager should document supportive discussions/supervision held between the proprietor and the manager. Cloverdale Care Home DS0000002780.V285437.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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