CARE HOMES FOR OLDER PEOPLE
North Clifton Hall North Clifton Newark Nottinghamshire NG23 7AZ Lead Inspector
Linda Hirst Unannounced Inspection 20th December 2005 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 North Clifton Hall DS0000062446.V270160.R02.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. North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service North Clifton Hall Address North Clifton Newark Nottinghamshire NG23 7AZ 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) 01777 228229 01777 228 100 Loyalty Care Limited Debra Greenwood Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (3), Terminally ill (3) of places North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes, whose primary needs fall within the following categories: Old Age (OP) (27) Terminally Ill (TI) (3) Physically Disability (PD) (3) The maximum number of service users to be accommodated is 27 Date of last inspection 4th May 2005 Brief Description of the Service: North Clifton Hall is an adapted period property situated in its own grounds on the outskirts of the village of North Clifton. The home is registered for up to 27 people in the category of old age, up to three places may be used for younger adults with a physical disability and two of these three places are currently occupied. A variation was submitted and accepted by the Commission for one named resident who has Dementia to be accommodated at the home. The accommodation at the home is over two floors and a vertical lift provides access to the second floor. Both single and double bedrooms are available, and the new proprietors are in the process of upgrading the environment. There is a comfortable lounge and a dining room overlooking the private gardens and car parking is available at the front of the building. Access to shops and public houses involves a car ride for the residents. North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive. Two of the people selected have a very limited ability to understand and communicate; only one resident was able to give her opinions about living at the home. Some of the judgements in this report are therefore from observation and reading residents records and documents in respect of the residents who could not help in this process. During this visit the record of activities, fire tests, plans for refurbishment and redecoration, staff files, the staff rota and the record of accidents were inspected. Staff were observed interacting with residents and one person was spoken to in more depth about her role. What the service does well:
The new provider and manager should be commended on the hard work they have put in to improve the standards at the home and ensure residents and staff are properly supported, well cared for and comfortable. The staff are committed and caring and the social and health care provided is good. Residents are treated with dignity and respect and their privacy is maintained. Their wishes and preferences are recorded and upheld. There is a good range of activities available if residents wish to join in. The staff have access to good training opportunities and work well together. They are clear about the limitation of their roles and communication between them is good. North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The manager must make sure that fire drills and emergency lighting tests are carried out at the correct intervals. The care planning system has been overhauled and where this has provided clearer, well organised and easy to read plans, some care plans and risk assessments are not detailed enough to guide staff in the action they need to take to meet residents’ needs and minimise risk. There is also no evidence that the residents or their representatives are involved in developing and reviewing their care plans.
North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 7 The manager must ensure that all staff have undertaken the statutory training courses to make sure they are working safely. Staff files must be checked to make sure they have all of the documents and information needed to protect residents from harm or abuse. 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. North Clifton Hall DS0000062446.V270160.R02.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 North Clifton Hall DS0000062446.V270160.R02.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): 3, 6 All prospective residents are assessed before admission to make sure their needs can be met at the home and to avoid unnecessary moves. EVIDENCE: Care plans were inspected to ensure that all residents are properly assessed before being admitted to the home. There was evidence that this now takes place to make sure that staff can meet the needs of prospective residents, thus avoiding unnecessary moves. Intermediate care is not provided at the home and this standard is not applicable. North Clifton Hall DS0000062446.V270160.R02.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, 10 There have been improvements to the care planning process but some require greater detail to properly guide staff in meeting the more complex needs of residents. Health care needs are properly assessed and met at the home. The manager has worked hard to improve liaison with local health service providers and this has benefited the residents. Residents are treated with respect and their rights to privacy and dignity are upheld and supported by the staff. EVIDENCE: The manager has overhauled the care planning system to make this easier for staff to understand and clearer about needs. Physical health needs are covered well within these plans, however the core care planning process which is used is less effective when covering more complex emotional, social and behavioural needs and these areas must be covered in more individual detail. In particular, where the nursing assessment tools highlight a risk, an action
North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 11 plan must be in place which details the actions staff must take to minimise the identified risks and evidence that this is being done should be available. To support this work, the use of Antecedent, Behaviour, Consequence charts is recommended. There is no evidence that residents/their representatives have been involved in the care planning process and this must be addressed. The staff at the home provide well for the health needs of the residents and communication with the Doctor’s surgeries has significantly improved in the past year. The staff undertake monthly observational checks on all residents and copies are given to the relevant GP. Smears and breast checks on female residents are arranged as necessary with the surgery. The staff member interviewed indicated that the qualified and unqualified staff at the home work well together and she was very clear about the tasks she could not undertake and of her reporting and monitoring responsibilities. She said the qualified staff properly inform her if she is to monitor any aspect of a resident’s health (e.g. fluid or food intake) and she said there are regular handovers. The resident who was interviewed stated that the staff offer help willingly, in a kind and supportive manner. She said the staff are respectful of her privacy (she uses a cordless phone and takes calls in her own bedroom, can receive visitors privately and receives her mail unopened). She said that she never feels that her dignity is compromised. Other residents were observed at the carol concert held during the visit, they looked very comfortable and the interactions seen between residents and staff were relaxed and positive. North Clifton Hall DS0000062446.V270160.R02.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): 12, 13, 14 Residents’ social needs and interests are assessed as part of the care planning process. Activities are provided regularly at the home and arranged by the activities co-ordinator, residents can choose whether to be involved. Residents are encouraged to maintain their relationships with family and friends and to form new ones if they so wish. The wishes and preferences of residents are recorded and upheld. EVIDENCE: The care plans are now more detailed in terms of identifying the social needs, interests, hobbies and the background of the residents. In addition an activities co-ordinator has been employed for 20 hours a week to organise and promote leisure interests. A written activity programme has been developed and received positively by the staff and the residents. During this visit a carol concert was taking place in the home and the residents were joining in and enjoying the singing. The resident interviewed stated that she could choose whether to join in activities, but said she preferred her own company and found it easy to occupy her time by doing puzzles, watching TV and reading. The resident who was interviewed said that she goes out regularly with her
North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 13 family and friends and staff take her out for walks. She said that all visitors are made very welcome at the home and that she can have visitors whenever she wishes. She usually sees her visitors in her own room and they are offered tea and biscuits and made comfortable at the home. The care plans indicate the wishes and preferences of residents in many areas from activity, to sleep pattern, to food to wishes regarding death and dying. The resident indicated said she could choose how to spend her day. North Clifton Hall DS0000062446.V270160.R02.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): Residents know they can complain and feel confident in doing so and in the ability of the manager to resolve any issues raised. EVIDENCE: The complaints record was not inspected during this visit, this was undertaken during the last inspection. The resident who was interviewed said she has never had cause for complaint but if she did she would approach any member of staff and would be confident that the matter would be addressed and resolved. She said she feels safe at the home and has never seen or experienced anything which would worry her. North Clifton Hall DS0000062446.V270160.R02.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: North Clifton Hall DS0000062446.V270160.R02.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): 27, 28, 29, 30 There are sufficient staff available to meet the dependency needs of the residents and the evidence shows that they are being properly trained to make sure they are competent to meet the needs of the residents and undertake their role safely. Appropriate checks have been conducted on staff members to make sure that the residents are protected from harm and abuse with the exception of one reference. The staff are happy and the residents praised them highly. EVIDENCE: Staff rotas were inspected to ensure that there are sufficient staff to meet the needs of the residents. The staffing levels were acceptable for the number of residents. The new provider does not have a copy of the previous staffing notice and one will be located and sent to them to ensure they are clear of their staffing obligations. The member of staff who was interviewed said that there were enough staff to meet the needs of the residents and this is only difficult when there are unforeseen circumstances like late notification of staff illness. The resident interviewed confirmed there were enough staff around and said she did not have to wait long for help. The staff member who was interviewed stated that the best thing about the home is the quality of the care provided and this was also confirmed by one of the residents who said that the staff are patient, kind and they get on well with the residents. She said she feels content and happy with the quality of her life.
North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 17 Staff files were inspected during this visit to make sure that they contain all of the documents required for the protection of the residents. These are much improved since the last inspection. All staff now have Criminal Record Bureau (CRB) checks in place and the files themselves are well organised. One file inspected had a missing written reference which must be addressed but other than this the files comply with legal requirements and all of the necessary checks have been done to protect residents. The staff training file was inspected. There is a proforma in place to assess each staff member, including their existing qualifications and developmental needs. Since the beginning of the year, training has been provided in the Control of Substances Hazardous to Health, TOPPS approved inductions, Basic First Aid, Moving and Handling, Basic Food Hygiene for the catering staff, Fire Safety, 3 staff have done Abuse training, Infection Control, Health and Safety and Palliative Care. There are almost 50 of the staff trained to National Vocational Qualification Level 2 as required. Considering that none of the staff had undertaken any statutory training at the beginning of the year this is a very impressive achievement. The manager hopes to complete all statutory training for the staff group within six months. The staff member interviewed commented very positively about the new manager and proprietors and said the home was “on the up.” She said that plenty of training was provided and significant changes have been made to care practice and the environment. North Clifton Hall DS0000062446.V270160.R02.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): 38 The provider and manager have made significant improvements to the environment to improve the safety of residents and this is commendable. There are some matters outstanding which must be addressed in order to ensure the safety of the residents. EVIDENCE: Checks were conducted to make sure that various health and safety issues set as requirements during the previous inspection have been properly addressed. Fire safety checks are now being undertaken but there was evidence that the fire alarm and emergency lighting tests are not being conducted at the required intervals and an immediate requirement was left in respect of this issue. Grab rails have been fitted to toilets to enable residents to mobilise safely. Automatic self closing mechanisms have been fitted to most doors to enable
North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 19 them to be left open but assure resident safety in the event of a fire. There are some which still need fitting, and these are on order. Most of the windows have been fitted with restrictors to prevent accidental falls; one or two still need to be completed and this should be achieved shortly. To a large extent the providers have prioritised the environmental issues and have fitted a new fire alarm and call system and a new heating system. These changes have made the lives of the residents safer and more comfortable. North Clifton Hall DS0000062446.V270160.R02.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X 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 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 North Clifton Hall DS0000062446.V270160.R02.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 14, 15 Requirement Care plans and risk assessments must be up to date and detailed. They must provide evidence that residents/their representatives have been involved in the development and review of their plan unless there are valid, recorded reasons for this not to occur. Staff files must comply with Schedule 4. The registered person must ensure that all staff receive statutory training (Moving and Handling, Basic Food Hygiene, Basic First Aid, Health and Safety, Infection Control) Fire drills must be undertaken twice a year and emergency lighting tests must be undertaken monthly. Immediate requirement not met. This matter must be attended to immediately. Fit window restrictors to those
DS0000062446.V270160.R02.S.doc Timescale for action 20/03/06 2. 3. OP29 OP30 17(2) Sch 4 18 01/02/05 20/06/06 4. OP38 23 20/01/06 5. OP38 13 01/02/05
Page 22 North Clifton Hall Version 5.1 bedrooms which have not yet been completed. 6. OP38 23 Complete plans to fit automatic self closing mechanisms to the doors still requiring this. 01/02/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations If care plans indicate specific interventions are needed (E.g. fluid intake is specified) there should be evidence that these are being undertaken. The use of ABC charts to monitor behaviour is recommended. 2. OP7 North Clifton Hall DS0000062446.V270160.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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