Inspection on 21/01/06 for Clyde Court Nursing Home

This inspection was carried out on 21st January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Clyde Court Nursing Home 16/05/06

Clyde Court Nursing Home 29/07/05

Clyde Court Nursing Home 18/11/04

Clyde Court Nursing Home 08/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Clyde Court Nursing Home 22/24 Lapwing Lane Didsbury Manchester M20 2NS Lead Inspector Leslie Hardy Unannounced Inspection 21st January 2006 11:00 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 Clyde Court Nursing Home DS0000021540.V278437.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. Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Clyde Court Nursing Home Address 22/24 Lapwing Lane Didsbury Manchester M20 2NS 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) 0161 434 1824 0161 448 8501 Provider Vancant Mrs Elizabeth Heather Martin Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The maximum number of service users requiring nursing care shall be 24. The maximum number of service users requiring personal care only shall be 9. Minimum staffing levels for service users requiring nursing care as specified in the Notice dated 10 November 2004 issued under Section 13 of the Care Standards Act 2000 shall be maintained. A copy of the Residential Forum Guidance ` Care Staffing in Care Homes for Older People` must be available in the home. Staffing levels for service users who require personal care only must comply with the minimum requirements of the Residential Forum guidance. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 29th July 2005 Date of last inspection Brief Description of the Service: Clyde Court Care Home is a large detached property built originally in 1895. The home has been adapted to accommodate a maximum of 33 service users. This number includes up to 24 who may require nursing care and 9 who require personal care. The home was first registered in 1992 and consists of a two-storey building, with a newer ground floor extension. There are twenty-two single rooms and five double rooms available. There is a passenger lift. The home is wheelchair accessible. A new passenger lift and a wall-mounted hoist has been installed recently. There is provision for parking at the front of the building. At the rear of the house there is a large patio leading from the dining area, from which, access via a ramp to the lower patio area and garden area can be obtained. There is easy access to local shops, pubs and public transport. Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection, which was unannounced, was carried out on a Saturday starting at 11:00am and lasted for 3.25 hours. During the inspection, 14 residents, 3 visitors and 8 staff were spoken with. The one requirement from the previous inspection report had been actioned by the home and partially met. Three recommendations made as a result of an additional inspection in October were found to have been fully actioned. During this inspection only a selection of key National Minimum Standards were assessed, therefore to gain the full picture of how the home meets the needs of residents, this report should be read with the previous reports. What the service does well: What has improved since the last inspection? Two bedrooms have been refurbished along with a corridor and two bathrooms. Staff at the home have undertaken training in the recognition and reporting of adult abuse, which should improve protection for the residents at the home. The home has also introduced an incident form for residents, visitors or staff to raise concerns about the home, which should provide a means to continually improve the care in the home. Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 6 All staff have been issued with antibacterial hand gel as a means to reduce cross infection. 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. Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 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 Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 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): None of these standards were assessed at this inspection. EVIDENCE: Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 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): 9 and 10. Residents in the home receive good care from staff that know and treat them with respect and as individuals. Medication policies and procedures were not being adhered to which could put residents at risk. EVIDENCE: At the inspection in July 2005, it was found that the home had safe medication procedures in place, apart from the fact that small containers such as eye drops and ointments did not have a patient identifier label on the actual container. As a result of the previous requirement, the home had written to their community-dispensing pharmacist asking for this to be undertaken. At this inspection two out of four containers did. Staff must not use and should return to the pharmacy containers not labelled, as this is outside of the Nurses and Midwives Council guidance and could put residents at risk if unlabelled containers were inadvertently placed in a box with another resident’s name on it. It was of concern to find that at the commencement of the inspection, a number of medicine pots contained medication for a number of residents that had been pre dispensed. These pots did not identify whom each medication was for. This could put residents potentially at risk of getting the wrong Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 10 medication and also medication could be removed and taken inappropriately. A requirement was made for this practice to stop immediately. Staff treated residents as individuals and there was a good relaxed atmosphere observed between residents, visitors and staff. This allowed residents to be able to express their personality. Staff addressed residents by name and when engaged with them were constantly telling them what they were doing. All residents were well dressed, with clean mouths and eyes and fingernails. Any physical care or treatment was noted to be given in privacy. Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 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): None of these standards was assessed at this inspection. EVIDENCE: Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 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 encourages residents, visitors and staff to raise concerns, but need to ensure that any raised are followed through. Staff is aware of the procedures in place to protect residents from abuse. EVIDENCE: The home has a complaints policy that is on display and have a complaints form that is used to record and track complaints to the home. This showed that one complaint had been made direct to the home since the inspection in July 2005. No complaints have been made to the Commission in that period. The home has introduced an incident report form that is used to record concerns, however minor, from residents, visitors and staff. Though there is space on the form for the investigation and outcome to be recorded, this was not always completed. On two occasions staff had raised concerns but there did not appear to have been any investigation and outcome. What is a very good tool was therefore not being used to its full potential and if feedback is not given, people may not stop using the system. It is recommended that the form is fully completed in all cases. An additional visit to the home was carried out in October 2005 as a result of two allegations of adult abuse which the home had treated seriously and appropriately apart for reporting, as required, under their own and local authorities’ policies. Requirements made in that report had been fully actioned. The Manager and Administrator had been on an updating course and two training days for staff, which were mandatory, were arranged, with the Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 13 second one to take place shortly. This training should ensure that correct procedures are followed in the event of any suspected abuse in the future. Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 14 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, 25 and 26 Ongoing refurbishment keeps the home looking cared for, but the hot water temperature in a refurbished bathroom could cause serious scalds to a resident. The home was clean, odour free and appropriate cross infection arrangements were in place. EVIDENCE: The home provides a suitable environment for the delivery of care to residents. An ongoing programme of refurbishment and redecoration has meant that two bedrooms and a corridor have been upgraded since the July inspection. Two bathrooms had also been upgraded. Unfortunately, the hot water supply to one of the baths (and wash hand basin) was in excess of 55°C, which coupled with only trickle of cold water out of the bath cold tap could put residents at risk of scalding if one tried to bathe by themselves without staff knowledge. The very clear procedure displayed for staff should ensure that an accompanied patient did not get into a bath of very hot water. A requirement Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 15 was made for the bathroom to be locked and only used if residents were accompanied and the problem must be resolved within 7 days. The home was very clean and there were no offensive odours. As well as there being an appropriate availability of soap and paper hand towels, all staff had been issued with hand disinfection gel to reduce the risk of cross infection that could put residents and staff at risk. Clyde Court Nursing Home DS0000021540.V278437.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): None of these standards were assessed at this inspection. EVIDENCE: Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 17 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 and 33. The home was well managed by a competent manager and good management systems are in place and are used for the home to check how they are doing. EVIDENCE: The home’s manager, who has been at the home for some years and is about to complete the Registered Managers award, is well thought of by residents who say they can approach her with any problems and get a good response. The number of systems in place to collect feedback about the home is commendable. Regular residents’ meetings are held, the last one being the day before the inspection, and residents spoke of what they had raised and that they not only felt listened to but also felt that if they raised concerns these would be dealt with. The home has introduced a short audit tool that is regularly given to residents so that they can comment on how they find the home. An external audit, which makes contact with external stakeholders as Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 18 well as residents and visitors, recently is also carried out. The outcome of all these audits is reported at the residents meetings. Regular staff meetings were also held with minutes taken which were available to all staff. These showed that staff felt free to raise not only concerns but also new ideas about how the home could operate and that these were listened and responded to. Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 19 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 STAFFING Standard No 27 28 29 30 Score X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 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 3 3 X X X X X 2 3 X X X X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X X X X X Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 20 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 OP9 Regulation 13 Requirement The home must ensure that all medication containers including eye drops have a label on the actual container (Previous timescale of 01/10/05 only partially met). Medication for one resident must be dispensed and given before other medication is dispensed. (Urgent requirement given at inspection) The water supply to the newly refurbished bathroom must be made safe (Urgent requirement given at inspection). Timescale for action 15/03/06 2. OP9 13 21/01/06 3. OP25 13 28/01/06 Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 21 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 OP16 Good Practice Recommendations It is recommended that the action taken and outcome is completed on all incident forms. Clyde Court Nursing Home DS0000021540.V278437.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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. 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