Inspection on 19/09/06 for Mona Cliffe Residential Care Home

This inspection was carried out on 19th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mona Cliffe Residential Care Home 20/02/06

Mona Cliffe Residential Care Home 31/10/05

Mona Cliffe Residential Care Home 25/10/04

Mona Cliffe Residential Care Home 19/04/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mona Cliffe Residential Care Home Blackstone Edge Old Road Littleborough Rochdale Lancashire OL15 0JG Lead Inspector Jenny Andrew Unannounced Inspection 19 September 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 Mona Cliffe Residential Care Home DS0000017348.V308142.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. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mona Cliffe Residential Care Home Address Blackstone Edge Old Road Littleborough Rochdale Lancashire OL15 0JG 01706 372566 F/P 01706 372566 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) Dr Ravi Kant Sharma Linda Anne Belshaw Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of places 23, OP age 65 years and over Date of last inspection 20th February 2006 Brief Description of the Service: Mona Cliffe is a care home providing personal care and accommodation for 23 older people over the age of 65 years. The home is not registered to provide nursing care. Service users in need of nursing care would need to access the community nursing service. Mona Cliffe is located on the outskirts of Littleborough, with easy access to transport links such as the motorway, train station and bus station. The home is only a short travelling distance from facilities such as shops, restaurants, Hollingworth Lake, and the Pennine Way, although service users would not easily access these facilities on foot. The home is a large stone house, which has been converted and extended to provide residential care. It is set in its own grounds, with ample car parking available to the front of the home. There are 15 single rooms and 4 double rooms. The bedrooms are situated on the ground and first floor. There is a passenger lift. Weekly fees are £336.42 for a double room and £341.42 for a single room as at September 2006. Additional charges are made for private chiropody, newspapers and hairdressing. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given to new residents. A copy of the Commission for Social Care (CSCI) inspection report is held in the office and may be seen upon request. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7 hours and was done by one inspector. The home had not been told beforehand that the inspector would visit. The inspector checked what was written down about the residents (care plans), looked around some of the building and also looked at a number of records. In order to get more information about the home, the manager, six residents, 3 care assistants, the cook, a domestic and 4 relatives were spoken to. The inspector also watched how the staff cared for the residents. In addition comment cards were sent out before the inspection to professional visitors to the home. Of these a District Nurse and 2 GP questionnaires were returned. Other information, which had been received about the service, over the last few months, has also been used as evidence in the report. What the service does well: What has improved since the last inspection? The owner of the home was continuing to keep it well maintained and safe for the people living there. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 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. Mona Cliffe Residential Care Home DS0000017348.V308142.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 Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The admission process was good with relevant information being given to residents before they moved in and an assessment taking place to ensure the home could meet their identified needs. EVIDENCE: Individual records were kept for each resident. Three files were inspected; each contained a detailed assessment undertaken by a care manager. With the exception of emergency placements, the manager also met with the prospective resident prior to admission in order to complete her own assessment and evidence of this assessment process was seen on the file of a resident whose admission had been planned. All 3 residents had been admitted in emergency situations. The manager had done her own assessments the day following admission as all 3 residents had been admitted over a weekend period. All assessment documents had been thoroughly completed. The manager was clear that if the home could not meet Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 9 the needs of a resident admitted in an emergency, the care manager would be requested to find an alternative placement. Feedback from residents and relatives indicated they were appropriately involved in the assessment process and considered the home was able to meet their needs. Information from the assessment documents had, where relevant, been included in the residents care plans. As the home had several mentally frail residents living there, the manager and 7 staff had undertaken a 12 week distance learning dementia care training course, in order to understand more fully how to meet these peoples needs. Mona Cliffe Residential Care Home DS0000017348.V308142.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents’ health and personal care needs were being well met and personal care and support was offered in such a way as to promote and protect residents’ privacy, dignity and independence. EVIDENCE: Three individual plans of care were inspected, two for residents who had been recently admitted and one for a resident who was very dependent. All 3 were detailed and had the information that staff needed in order to provide the right care and support to each person. The care plans were drawn up in consultation with the resident and/or relative and two of the plans had been signed. The other plan was awaiting the relative visiting so they could read through it and sign on behalf of one of the newer residents. Care plans were generally reviewed and updated on a monthly basis. However, one plan showed a gap of two months when the key worker had not reviewed the plan. The manager had recently checked through care plans and already addressed the matter. This was evidenced in the communication book. Daily cardex recordings were in place and where changes in residents’ health had been noted, action had Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 11 been taken to address the problem. Records relating to bathing were in place and residents spoken to all said they received sufficient baths. Residents had regular access to chiropodists, opticians and district nurses and the files of the two most recently admitted residents showed that shortly after coming into the home, they had received an optician’s visit and new glasses had been purchased. Their records also showed they had received a visit from the podiatrist. The manager was currently awaiting a phone call from the dentist, as two residents needed treatment. Referrals through G.P’s were made where staff identified problems in other areas. Visits by health care professionals were recorded on the individual resident’s file. One resident said “I’m very satisfied with the arrangements for health care” and another resident said “they send for the Doctor whenever I’m feeling ill”. The falls co-ordinator and continence nurse were also consulted, whenever the staff felt it was necessary. When health care professionals visited, staff escorted them and residents were seen in their bedrooms. This was seen during the inspection when a district nurse visited. Feedback from health care professional questionnaires all confirmed that the home worked in partnership with them, they were always able to see residents in private, that staff demonstrated a clear understanding of the residents’ care needs and they were satisfied with the overall care provided to the residents. All 3 files contained assessments relating to moving/handling, Waterlows (skin) and nutrition. Where other risks had been identified, assessments were in place for example self-medication and beds being fitted with safety sides. Where it was identified there was high risk, the care plan recorded how the risk was to be managed in order to lessen it. Whilst the manager and staff said the assessments were reviewed monthly, at the same time as care plans, the record sheets did not make this clear. The manager said she would amend the sheets accordingly. Food/fluid/turn charts were in use for a resident who was being cared for in bed and they had been appropriately completed. The manager had made a decision not to use the new Malnutrition Universal Screening Tool (MUST), which the Healthcare Trust was promoting in Rochdale. She said their own nutritional assessment tool was effective and staff were conversant with it. It is however, recommended that the MUST tool is introduced, following training from the dietician. From checking files, it was seen that nutritional assessments were in place, weight was regularly monitored and when residents were losing weight, appropriate steps to address the problem were being taken. A letter dated 31 August, had been sent to a G.P. requesting a referral to the dietician, for one resident, who had lost a significant amount of weight due to her reaction to a particular medication. As a result, records showed the action taken to address the weight loss; addition of full fat milk to diet, high fat and low sugar snacks between meals and staff to encourage the resident to eat more at mealtimes. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 12 The cardex recordings showed that staff were continuing to monitor progress and entries such as “”snacks and full fat milk given between meals” and “snacks continued between meals” were seen. Whilst this persons weight was being done monthly, where a resident is assessed at high risk, they should be weighed weekly. All residents spoken with felt they were being well cared for by the staff team. Relative feedback also indicated they were satisfied with the overall care provided by the home. Medication policies/procedures were in place, including self-medication and homely remedies. The administration, dispensing and storage of medication including controlled drugs were satisfactory. From observing the morning medication round, the senior carer was seen to administer the medication efficiently, signing the Medication Administration Records (MAR) after another care assistant had given out the medication and confirmed the person had taken it. The medication policy included self-medication but it was unusual for residents to hold anything other than inhalers or creams. Where self medication was taking place, risk assessments had been completed. Unused medication was regularly returned to the pharmacy and the home was not holding large stocks of medicines. All staff, responsible for giving out medication, had received appropriate training. The aims and objectives of the home reinforced the importance of treating residents with respect and dignity and a Resident Rights policy was in place. Care plans were also seen to refer to privacy, dignity and independence. Staff received training on key care values as part of their induction; this included the importance of upholding residents’ privacy and dignity. Residents interviewed were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity was respected at all times. This was also observed during the inspection. Relatives confirmed they were satisfied with the staff’s manner and attitude towards the people they visited. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines. These included using the right approach and giving gentle encouragement, explaining to people what they were going to do and why so they didn’t become angry and frustrated, encouraging people to be as independent as possible especially when bathing, keeping people covered when washing and knocking on doors before entering. Whilst bedroom doors were not fitted with locks, residents were asked, upon admission, whether they would like a lock fitted and this had recently been arranged for two residents. Lockable space in bedrooms was provided. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and to maintain contact with their relatives but social stimulation was lacking and resulted in residents being unfulfilled. EVIDENCE: All the residents spoken to were satisfied with their chosen daily routines. They said they could choose to get up and go to bed when they wanted, had choice of what to wear, where to eat, whether or not to use their room or the communal lounges and where to sit. The care plans recorded residents’ likes and dislikes and residents’ preferred rising and retiring times. Although the last inspection report identified a lack of social stimulation for the residents, no action had been taken to address this shortfall. The manager acknowledged that this was an area of weakness, but because of personal reasons, she had had some time away from the home during the summer and had prioritised other areas. There was no activity programme in place and residents spoken to, when asked how they spent their day, made the following comments: “nothing much organised”, “staff kept busy and not much time for chatting”, “I just walk about, there’s not much else to do”, “just watch Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 14 television” and, “there’s never any entertainment, we just make our own”. One resident said she sometimes went out with the staff to the shops in Littleborough and a couple of residents had been out on their own to the local pub. One resident said she would like large print books about science and this was passed onto the manager. The mobile library visited the home so she said she would try and organise this. The recently updated service user guide made reference to “activities for those who wished to participate every weekday, including bingo, arts and crafts, hand massages, manicures, singalongs and videos. It also referred to visiting entertainers. Other than manicures, which one carer said she enjoyed doing, none of the other activities were taking place and no entertainers had visited the home since the last inspection. If the owner is stating in the service user guide that the home has this provision, then action must be taken to provide it. At the last inspection, several residents had mentioned they would like more local trips out and this feedback had been passed to the manager. No trips out had however, been made this summer. From speaking to the staff, it was evident there was no-one responsible for undertaking activities and it was very much about doing something when there was time, without much planning or consultation taking place. They also said the residents were difficult to motivate and didn’t seem keen to join in with activities. As the residents presently living at the home had very differing needs and abilities, the key workers should spend time with their individual residents, finding out what sort of activities they would like to take part in. The programme should accommodate both individual and group activities and thought should be given to ensuring that those people who have memory loss are also catered for. In order to monitor the success of any programme which is implemented, the manager may wish to introduce activity sheets showing which residents had been involved in each activity and whether or not it had been enjoyed. Care plans addressed residents’ spiritual needs. At the time of the inspection, the Church of England Vicar was visiting only once every couple of months but this was said to be meeting people’s needs. The care plan for a new resident identified that before admission, she had enjoyed regular attendance at church. It had been agreed at her recent review, that when she was stronger, this would be arranged. Whilst residents may handle their own finances, at the time of the inspection, the relatives were tending to have control in this area. Discussion took place about advocacy arrangements and the manager said she would refer people to Age Concern should they have any problems. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 15 Relatives spoken to said they were made to feel welcome by the staff. They also said they were notified when their relative was ill or any changes to their condition were identified. Visiting relatives took some residents out on a regular basis and they looked forward to this. This helped to maintain community contacts for them. Staff did, on occasions, also take the more independent residents into Littleborough so they could use the community facilities. One resident had been to the local barbers and a carer said she was going to take a resident out for tea and to the local pub, in her own time. Staff also said they took residents to the local shop. The Cook had worked at Mona Cliffe for many years and also worked some shifts in a senior carer role. The kitchen assistant deputised for the cook in her absence. Both cooks knew each person’s likes/dislikes and portion sizes. Menus were inspected and seen to provide a balanced, nutritious and varied diet over a 4-week period. Whilst it was usual for residents to have a choice of grapefruit, cereal, porridge and toast for breakfast, sometimes one or two residents enjoyed scrambled eggs. Two hot choices were served at lunchtime with a dessert. Residents said that if they felt ill or didn’t like what was on the menu, they would be offered something else. All the residents spoken with were complimentary about the food, confirming they got a choice and sufficient to eat. One resident said she enjoyed fresh fruit and would like more with her breakfast cereal in a morning. She also said that whilst the home provided her with apples in her room, she would like some softer fruits such as grapes or pears. This feedback was given to the manager who said she would address the request. On the day of the inspection, the shepherds pie with green beans was sampled and it was hot and tasty. The dessert was bakewell tart and custard and angel delight was the diabetic dessert. Teatime choices were celery soup, steak pie and peas or pork roll sandwiches. At teatime, the majority of residents were said to enjoy soup, followed either by sandwiches or a hot snack. In addition residents enjoyed supper at around 7.00 pm when toast or biscuits would be offered with a second supper offered after 9.00 p.m. when the night staff came on duty. Milky drinks were also available. In the main lounge, jugs of juice were available for residents to help themselves to and regular drinks were provided throughout the day. The special dietary needs of the residents were being met and the cook was aware of the differing needs of the residents with diabetes and those who required soft options, low fat or pureed meals. Residents were able to choose where to eat at mealtimes. Several preferred to sit in the lounges, with overchair tables being provided. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. An effective complaints system was in place which residents were familiar with and staff training and safe recruitment practices ensured that residents were protected from abuse. EVIDENCE: The complaints procedure was included with the service user guide, which was issued to each person on admission. The manager said a copy procedure was displayed behind each of the bedroom doors. From checking some of the bedrooms, it was noted that this was not the case, usually when a bedroom had been re-decorated. The manager was to check each room and replace the procedures as necessary. Good practice was noted when upon admission, each person was talked through the complaints procedure, the manager signing the assessment document to say this had taken place. The complaints book was seen. Since the last inspection, one complaint had been logged but action taken to address the complaint had not been recorded. The manager said this was because the owner had investigated the complaint, during her absence. She was however, conversant with the complaint and recorded the action taken to address it, during the inspection. The Commission for Social Care Inspection had not had cause to undertake any complaint investigations at the home this year. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 17 Residents spoken to were extremely satisfied with the care afforded to them, stating that should they have any problems or concerns, they would feel able to speak to either the manager or one of the staff who they felt would put things right. Of the 14 care staff employed, 10 had undertaken in-house protection of vulnerable adult training. Upon watching a video, a questionnaire had to be completed which was then sent off to be validated and certificates were provided. The Skills for Care Induction training also included a section on abuse, which was being completed by all new staff. In addition, the majority of staff had successfully completed NVQ level 2 training, abuse being one of the learning units. Discussion took place with the manager about her attending the Rochdale MBC Protection of Vulnerable Adult training course. Whilst elements of abuse had been included in her NVQ level 4 and Registered Managers Award training, it was felt it would be beneficial in order she would be fully conversant with how to implement, the Rochdale abuse policy/procedures should this be necessary. Staff were not starting work at the home until a Pova First check had been made. Following the check, they were able to start their induction, under the supervision of a more experienced staff, until their full Criminal Record Bureau check had been received. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home was clean, safe and well maintained providing a comfortable and homely environment for the residents. EVIDENCE: Upon walking around the home, it was seen to be clean, adequately decorated and no unpleasant odours were detected. Relatives also confirmed that the home was always clean and fresh when they visited. Two relatives said they had placed their relatives in Mona Cliffe due to the home not having any unpleasant odours. Since the last inspection, the owner had purchased a new cooker, 2 beds, a fridge/freezer (additional to the existing provision), new tube lighting in kitchen and 5 commodes. Two bedrooms had been re-decorated, the kitchen ceiling had been painted, dining room windows repaired and fire seals fitted to the lounge and kitchen doors. A new extractor fan had also been fitted in the Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 19 large ground floor toilet. Over the last 18 months a new call alarm system had been fitted and a new bath hoist provided in the ground floor bathroom. Only one area of the home was in need of some refurbishment and that was the small conservatory where residents were able to smoke. Some of the chairs in this area were in need of replacement. The home was well equipped, with appropriate aids and adaptations being fitted in bathrooms and toilets so that residents could maintain their independence as far as possible. The residents spoken with were all satisfied with their bedrooms and said the home was kept clean. One resident said, “my room is lovely” and another said, “everywhere is kept clean”; one person commented upon how comfortable their new bed was. The Environmental Health Officer had visited in March 2006 to introduce new health and safety recording measures and again in April to ensure the home was implementing the new recording system. This was being continued by both the cook and kitchen assistant. Hot water temperatures were randomly checked in bathrooms and found to be satisfactory. Window restrainers were fitted to all first floor bedroom windows. Level access was provided and a passenger lift was provided to the first floor. Residents said they could get around the home fairly easily and appropriate aids and adaptations were fitted in bathrooms, toilets and corridors so that residents could remain as independent as possible. Everyone spoken with thought the home was a safe place to live and work in. An infection control policy was in place and the manager and 11 staff had attended infection control courses. In addition, the manager held a copy of the Department of Health’s “Infection Control Guidance”, issued in June 2006. The staff interviewed described safe infection control practice. Disposable gloves and aprons were provided for staff use and coloured tabards worn by staff for serving food. Liquid soap and paper towels were supplied in all bedrooms, bathrooms and toilets. In addition alcohol based hand wash was provided on both levels of the home and staff also carried small containers around with them. The laundry, which was clean and orderly, was sited in the basement, away from the food preparation area. Sufficient and suitable equipment was provided and the washer was equipped with a sluicing programme. Soiled washing was transported to the laundry in red bags to prevent cross contamination. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 20 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, 28, 29 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Sufficient numbers of staff, with an appropriate skill mix were provided and the manager ensured they received appropriate training so they could do their jobs efficiently. EVIDENCE: Inspection of rotas showed that staffing levels were generally adequate to meet the needs of the current resident group. However, on the week of the inspection, one of the care assistants was off sick. Emergency cover had been provided on the day of the inspection and the previous day, the manager had provided hands on assistance. The worker was expected to return to work the day following the inspection. Taking this into account the home had a shortfall of 6 hours, which the manager said she would address the following week. Sufficient ancillary staff were employed. Since the last inspection there had been some changes in the staff team. Whilst several staff had worked at the home for many years, others were relatively new. All those spoken to said they felt they worked well together as a team. In order to ensure that staff across the shifts worked consistently, there was a communication book being utilised and shift handovers took place. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 21 Whilst 4 male residents lived at the home, there were no male care workers employed. The manager said this was because they did not receive any male applicants for the jobs advertised. The male residents spoken with said they had no objection to female workers assisting them with their personal care. The staff team was all white British, except for the owner, but this reflected the current resident group. Feedback from the residents was very positive about the staff team and manager. From observations made during the report, it was evident that good relationships had been made between staff and residents and staff were seen to be respectful towards residents. Both the owner and manager were committed to offering training opportunities to the staff. Of the 14 staff employed 11 had successfully completed NVQ level 2 training and 1 person had done her NVQ level 3. This meant that the percentage of trained staff was 72 . In addition 2 of the new staff had registered to start their level 2 training and 2 of the existing staff had registered for level 3. Upon interview, applicants were asked whether they were prepared to undertake NVQ training and the manager only employed those who were. An equal opportunities policy was in place and the home were interviewing in line with the procedures. The application form specifically mentioned that people with a disability would not be discriminated against. Inspection of records showed that in the main, safe recruitment and selection practices were followed in line with the home’s procedure. However, for one of the newer workers, only 1 reference had been received, the other having been overlooked in the manager’s absence. The manager must ensure that the second reference is received. The personnel files inspected showed that, Protection of Vulnerable Adults (POVA) checks were received before staff started work. They were then closely supervised and did not work alone until a satisfactory Criminal Record Bureau (CRB) check had been received. Staff were also given copies of the General Social Care Council “Code of Practice” upon appointment. One of the newly recruited care assistants confirmed she had not started work until all her checks had been received by the home. The majority of staff personnel files contained staff photographs. The manager had requested the newer staff to bring a photograph in for record purposes. Skills for Care induction training records were in place for the two new staff who had started work in July and early September 2006. One had successfully completed her training except for food hygiene, health and safety and infection control. The other worker had made a good start with the training programme and the manager was arranging the outstanding training for both workers. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 22 From checking the staff training matrix, it was noted that all but the newest staff had received all mandatory training and attended refresher training as and when needed. The manager utilised Trafford College for food hygiene and health and safety training and Tameside College for medication, infection control, care skills and dementia. All were distance-learning courses that had to be validated. In addition, in house video training took place for basic first aid, fire and moving/handling. Following the videos, workbooks had to be completed. When undertaking moving/handling training, the manager, who was a registered nurse, said she did practical demonstrations, with the home’s equipment, to ensure the trainees were fully aware of how to use it. This meant that all training was up to date for the existing staff and training certificates were seen in the files checked. In addition to the above, new care assistants who had not previously worked in the care profession and did not have any NVQ qualifications, were enrolled on a care skills course. This included training in communication, hygiene, nutrition and pressure care and completion of the course gave them units to go towards their NVQ training which they were expected to take at a later stage. Six of the present team had completed this course. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 23 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, 33, 35, 36 & 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The manager provided effective leadership and support to staff ensuring that residents received a consistently good standard of care. EVIDENCE: The manager was a registered general nurse with experience in the National Health Service and private sector. She had undertaken regular clinical updates relevant to her working environment e.g. Protection of Vulnerable Adult training and dementia care and kept herself abreast of present care practice by reading relevant journals and magazines. She had successfully completed her NVQ level 4 care award in 2003, followed by the Registered Managers Award in 2004. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 24 Over the summer months, due to personal reasons, she had taken some time off work and did acknowledge that as a result, some management tasks had got behind. No resident or staff meetings had taken place since the last inspection although a staff meeting had been scheduled for October 2006. Staff personnel files showed that staff were receiving regular group supervision and one file showed a staff member to have received individual supervision. From interviewing staff and records seen, it was evident that the manager actively promoted staff training and development opportunities as already highlighted above. She had a good understanding of the areas in which the home still needed to improve and acknowledged that providing social stimulation for residents would be a priority area over the next few months. Feedback from both staff and residents was positive. Staff said she was “supportive” and “approachable” and one resident said “you can always see her if you’ve got a problem”. Staff also felt she provided good leadership and was fair and approachable. The home had achieved the “Investors in People” award 3 years ago and their re-assessment review had been held on 1 June 2006, resulting in the home retaining their award. At the last inspection, the home’s quality assurance annual report was seen. The next report was due to be done in January 2007 and questionnaires to residents, relatives and staff were to be sent out in the next few weeks. Discussion had taken place at the last inspection about the possibility of formulating a feedback questionnaire for other visitors to the home i.e. district nurses, Doctors etc. and the manager said she would consider this. Since the last inspection, no residents meetings had taken place. In order to try and involve the residents as much as possible in the running of the home, more regular meetings should take place. Policies and procedures were regularly reviewed in the light of changing legislation and the home worked co-operatively with the CSCI to implement any identified shortfalls. Any requirements made in reports were usually addressed within the given timescales. The home does did get involved in the handling of residents’ finances, except where residents and/or their relatives requested it. Small amounts of money could be deposited and in these instances, a system was in place to account for income and outgoings. Receipts were retained for any purchases made on behalf of individual residents. Secure facilities were provided for the safe keeping of money and valuables with limited key holders. The records of 3 residents were checked and all found to be in good order. The pre-inspection questionnaire recorded that all required health and safety policies and procedures were in place. In addition, the manager was vigilant in ensuring that staff received their health and safety training with refresher Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 25 courses being arranged as needed. The pre-inspection questionnaire also showed that maintenance checks were up to date. Random record sampling was undertaken of the public liability certificate, the Environmental Health Officer’s last report, fire book and servicing of thermostatic mixer valves. All the records were in order. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 26 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 27 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 OP12 Regulation 16 Requirement An activities programme must be formulated and implemented which meets the needs of all residents, including those who are mentally frail. (The previous timescale of 31/03/06 had not been met). Worn chairs in the conservatory must be replaced. Prior to employment of staff 2 satisfactory written references must be obtained Timescale for action 31/10/06 2. 3. OP19 OP29 16 17 30/11/06 31/10/06 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. 2. Refer to Standard OP7 OP8 Good Practice Recommendations Care plan evaluation forms should make clear that risk assessments had been reviewed at the same time as care plans. In order to comply with the local Health Care Trust, the Malnutrition Universal Screening Tool should be DS0000017348.V308142.R01.S.doc Version 5.2 Page 28 Mona Cliffe Residential Care Home 3. 4. OP12 OP33 implemented. In accordance with resident’s wishes, more local trips out should be arranged. More regular resident and staff meetings should be held. Mona Cliffe Residential Care Home DS0000017348.V308142.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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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