Inspection on 20/12/07 for North Clifton Hall Nursing Home

This inspection was carried out on 20th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

North Clifton Hall Nursing Home 30/03/09

North Clifton Hall Nursing Home 22/07/06

North Clifton Hall Nursing Home 20/12/05

North Clifton Hall Nursing Home 02/12/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE North Clifton Hall Nursing Home Main Road North Clifton Newark Nottinghamshire NG23 7AZ Lead Inspector Linda Hirst Unannounced Inspection 20th December 2007 11:30 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 Nursing Home DS0000062446.V354851.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. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service North Clifton Hall Nursing Home Address Main Road North Clifton Newark Nottinghamshire NG23 7AZ 01777 228 229 01777 228 100 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) loyaltycare@btconnect.com Loyalty Care Limited Position Vacant 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 Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 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 22nd July 2006 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 village does not have a shop or pub facilities and these facilities can be accessed by using a car. There is a church close by. It is equal distances from Lincoln, Newark and Gainsborough and is on the main bus route to Gainsborough and Newark. The service provides personal and nursing care for up to twenty-seven older people of both sexes, with up to three places for younger adults with a physical disability. A qualified nurse is on duty at all times. The residents are housed in twenty-five single rooms, two of which have ensuite toilets and hand-wash basins, and two double bedrooms which are available for married couples. A passenger lift provides access to the upper floor. The home’s owners are still in the process of ongoing re-decoration and refurbishment programme. There is one lounge and one dining room, which overlook the gardens. There are five toilets and two bathrooms, one with a jacuzzi and a shower room. The gardens provide a tranquil outdoor area for residents in good weather. There are car parking spaces at the front of the building. The fees range from £420 - £440 per week, the fees do not include hairdressing, chiropody, dental fees, papers or personal clothing. The manager told us that a copy of the last report is available in the office if people ask, but there are no notices to tell people this at the moment. Prospective residents are only given a copy of the brochure at the moment. All existing and prospective residents must be given a copy of the service user guide. The service user guide must include the summary of the latest North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 5 inspection report and should guide people as to how they can access the full report. The current systems for providing information must improve to make sure that residents are clear about the service they can expect at the home. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We did not receive this back from the manager in time for us to be able to use it to plan our visit and to decide what areas to look at. We did this inspection with one inspector; it was unannounced and took place over two days, including lunchtime. The main method of inspection we use is called ‘case tracking’ which involves us choosing three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We observed some residents receiving help from the staff over lunchtime and some judgements in this report come from these observations. There are no people living at the service currently from minority ethnic groups, and all of the staff are white, British. We spoke to two members of staff and asked for the views of another resident who was not part of the “case tracking” to form an opinion about the quality of the service. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. We did a partial tour of the building, including all communal areas and a sample of bedrooms to make sure that the environment is safe and homely. We have reviewed of all the information we have received about the home since the last inspection and considered this in planning the visit and deciding what areas to look at. Due to the short notice of this inspection, no surveys were sent out to residents and relatives but we spoke to two residents, one relative and observed others interacting with staff. What the service does well: North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 7 We found the manager and staff to be honest about when they are unable to meet the needs of existing residents and found they have taken positive action to have the residents re assessed for more suitable accommodation. We found the staff very good at understanding the upheaval moving into a care home can cause for residents, and they were supportive of residents in this respect. The healthcare needs of residents are assessed and provided for well by nursing staff at the home, or referral to other professionals. We found most of the staff to be respectful, supportive and reassuring with the residents. They are patient and calm in a crisis and the residents told us they are “lovely.” The visitors we spoke with said they are welcomed into the home and are given good information very regularly about residents’ health and wellbeing. They are encouraged to be as involved as they wish, from helping with care tasks such as eating to visits home. We found the staff are supportive of residents’ choices in terms of their daily routines and they will try and be flexible around this, for example one resident told us she has her tea later than everyone else as she has always done this. The staff respect and provide for her preferred routine. We found the staff we interviewed understand what is abusive behaviour and they have blown the whistle on poor practice of staff. This means the residents can be assured that the staff put their safety and protection first. The home is clean and hygienic. The manager was highly praised by everyone we interviewed, people feel she is making a positive difference to the home and the lives of the residents. With time she intends to make a number of improvements to the service to benefit the residents and staff. The health and safety testing and servicing of equipment is undertaken at the correct intervals to make sure the staff and residents are safe and protected from injury. What has improved since the last inspection? What they could do better: North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 8 The manager could provide a service user guide to all of the people who live at the home so that they know what they can expect from the service. She could also make sure that all of the residents and their families see a copy of the summary of our latest report so they know how well the service is doing. The manager must make sure that she is sure that the staff have been trained to understand and can meet the needs of people who are admitted to the home. We found they need to be quicker at developing care plans to guide the staff on how to meet the residents’ needs. We found that the care plans could be much more detailed and up to date to make sure that the staff know how to support the residents with their needs. We found that the current system for recording and administering medication was not proving to be the safest or most effective and this results in some residents having to wait for medication which has been prescribed for them. The residents told us they do not have enough to do and they said that the lack of activities means they are often bored. We that the residents would like the menu to change and reflect their preferences more, and we felt that some staff could help people in a more dignified way. We found that the residents have made verbal and written complaints which have not been recorded, and that the staff don’t necessarily tell the manager about complaints. This makes it very difficult for the manager to know the true nature of resident and relatives’ concern and in some cases may mean that she is not able to safeguard residents properly. We felt that the staff could benefit from some training on the local safeguarding procedures to make sure they are clear about their reporting obligations and can keep residents safe and protected from those who may abuse them. We found the ground floor of the home cold and draughty and the residents said the heating does not work well enough to keep them warm and comfortable. Some of the residents wanted their bedrooms to be refurbished to provide a nicer environment for them to live in. We found that there are not enough staff to meet the needs of the people living at the home at the moment and that this was having a negative effect on some of the residents. We also found there was little evidence that staff at the home have the training they need to provide good quality, safe care to the residents. We found that some pieces of information were missing from staff files and these are needed to prove that staff are competent to help the residents with their needs. We found the service could improve by doing Quality Assurance questionnaires, having residents’ meetings and possibly newsletters to give residents the chance to air their views and make sure the service runs for their benefit. We also found the recording and management of residents’ money could improve to make sure their financial interests are better protected. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 9 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. The summary of this inspection report can be made available in other formats on request. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 10 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 Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are properly assessed before admission to make sure their needs can be met, but they are slow to develop care plans and staff do not have the guidance they need to provide a good quality and consistent service. EVIDENCE: Please see our comments under the “brief description of the service” in relation to the service user guide and the last inspection report. We looked at the assessment of the last person to be admitted to the service. The person is receiving respite care and was admitted just over a month ago. The staff told us that the manager or nurse usually goes out and assesses prospective residents and then tells staff about their needs verbally. There was North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 12 a copy of the social worker’s assessment on the file of the last person admitted to the service and the admission was appropriate, but there is no care plan in place for this person to guide staff in meeting her needs, in spite of the fact that she first came to the home for respite in May this year. This is not acceptable. The residents we spoke with told us they visited before they decided on living at the home, but they also said one person (who was admitted by the previous manager) seems to have very high levels of need that the staff struggle to cope with, on further investigation her needs are different to the ones the home is registered to accept. This is an offence and must not happen again. The staff we spoke with said the nurse sits with new residents and goes through all the paperwork. Care staff talk to them, find out what their preferences are and try and settle them in as “it can be hard to get used to a new place.” Intermediate care is not provided at the service and this standard is not applicable. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have their healthcare needs assessed and met in a manner, which supports their personal dignity. However, the arrangements for care planning and the system in place for the administration of medication need to improve to ensure that residents’ have their needs met in a safe and consistent way. EVIDENCE: We looked at three care plans and found pre populated care plans in place for most areas of need. We found these give insufficient detail on issues such as supporting people with challenging behaviour, orientation issues and disinhibition caused by Dementia. Most of the plans we saw were written in 2005, and although these have been reviewed, and in several cases changes are indicated, the original plan remained in place suggesting they are not being actively used. The care staff we spoke with said the nurses write the care plans and they felt it would be nice to have more detail about residents’ North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 14 personal history, “who they are where they are from.” They also told us that care plans could be improved to give better guidance to staff, especially on how to support people with challenging behaviour. One of the residents we spoke to said she has being going through her care plan with the new manager, another resident and a relative said they had not looked at care plans. The staff, relatives and residents we spoke with all said that the health care support at the service is good. A member of staff we spoke with said the nurses are, “caring and vigilant,” and a resident told us that the manager is “a very dedicated nurse.” We saw care plans in place to manage residents’ health care needs, such as pressure area care, nutrition, infection risks and continence, although again, many needed to be more personalised and would benefit from being rewritten. We also saw evidence of referral onto specialist health professionals where necessary such as for rehabilitation services or outpatient appointments. The residents told us that they have to go to Hospital without escorts as staffing levels will not allow for this. We observed a medication round, the nurse was seen asking people if they would like their painkillers before administering them. One person has crushable Epilim and the Nurse we spoke with said that they check with the pharmacist before they crush any tablets to ensure it does not have an effect on the potency and effectiveness. Medication is administered directly from boxes and this is because the Doctors also dispense the medication and will not provide a Monitored Dosage System, which would be an easier and safer method. The nurses we spoke with said they would be happier with the Monitored Dosage System as there is less chance of an error occurring and it would be an easier system. There has been a medication error at the home since the last inspection concerning a mix up in identity. Residents we spoke with said that if they are prescribed a medication on Thursday or Friday they have to wait until the following week to receive this as the surgery require 48 hours to dispense and are not open on a weekend. One person told us that he had to wait a week for a prescribed cream. We raised this with manager who will discuss starting a Monitored Dosage System with the GP surgery, following advice from the Primary Care Trust. The medication trolley is very well organised and the medication for each service user is stored in a box with their name on. We saw the nurse giving out medication, waiting for it to be taken and then signing the record. There were no gaps on Medication Administration Record sheets. I checked some of the medication in boxes against Medication Administration Record sheets and found the records of receipt and administration did not tally with the tablets remaining in the boxes. The Nurse told me that medication is checked in and out but the staff do not count the existing stock into the receipt records, they said they just get a new box when the old one runs out which makes clear auditing very difficult. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 15 We found that the Controlled Drugs are stored and recorded appropriately and the amounts tally with the records held. We observed staff during the lunchtime period and found them to be (with the exception of one situation – see O15) very respectful and supportive towards residents. We found they are very reassuring with residents in distress, patient and calm. Residents told us, “the staff are lovely,” and they said they are treated with dignity and respect. The staff member we spoke with gave us good examples of how she promotes and protects the dignity of residents. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can choose how to spend their day and their visitors are welcomed into the home, but there are insufficient activities to occupy and entertain the residents and their social needs are not being met. Menus need to be reviewed to offer variety and choice to the residents in line with their suggestions and wishes. EVIDENCE: We made a requirement after our last inspection for the frequency and variety of activities to improve, but the evidence we have found indicates that this has not been addressed. We did not see a record of activities during our visit and the residents we spoke with said, “there is nothing to do here.” They told us they tend to stay in their rooms. One person said they used to sit in the conservatory during summer so they could see people coming and going, but “it’s too cold at the moment.” They told us that a singer came to the home at the weekend and he usually comes in every two months. They said the staff do not have time to do activities with them and they get bored. There are no trips North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 17 organised, they “would like to go out on trips.” The staff we spoke with confirmed that they do not have enough time to do activities with the residents although they would like to. This matter needs to be addressed by the next inspection to avoid enforcement action being taken. We spoke with one of the visitors who said he is always made welcome and comes every day as the resident he visits has not settled well, He said he takes her out with him or visits his home. He told us the staff chat to him, and keep him up to date with what is going on. We found that the staff do try hard to give residents choices in their daily life. One person told us that the night staff get him up, wash and dress him, he chooses this as, “if it were left to the day staff to dress me, God knows what time I would get done.” Another resident told us she does all of her own personal care, gets up, goes to bed when she likes but said she is finding it hard to wake up in the morning because of disturbed nights and finds she sleeps in the afternoons too. She said the night staff, “occasionally” check on her but they are busy all the time with another service user (see OP27). A person we spoke with told us that she has her tea later than everyone else as, “I always had my tea late and I am used to it.” One of the people we spoke with said he feels more at ease with the older carers, and is concerned that they are about to lose the only male member of staff employed at the home. The staff we spoke to confirmed that residents can choose how they want to spend their day and said the lifestyle they choose is respected. A visitor raised concerns about a resident needing more clothes and things for their room it may be beneficial to involve an advocate in this situation. We observed lunch. We found that several residents were given aprons without being asked if they wanted them. When we queried this with a staff member she said they would have previously indicated that they wanted an apron on, but there was no record of this in care plans. When we discussed with the manager she agreed this is institutionalised practice and said she would raise this with staff. We found the residents were provided with adapted cutlery and crockery appropriate to their needs and abilities. One visitor sat with a resident and assisted her to eat. Quite a number of residents need assistance to eat and with the exception of one person they all sat beside the resident, took their time and explained what people were eating. We found the staff to be very kind and reassuring with residents, and an incident where a resident choked on her food was dealt with calmly and professionally. The cook drew up the menus and they have not been changed in two years, they are not changed seasonally. The residents we spoke with said the food is very good, but they said they are not offered a choice. One said, “we do get North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 18 bored with the menu, we said we would like something different like spaghetti bolognaise but we never got it. It would be nice to have something different.” They told us that the teas are predominantly sandwiches which they get fed up with. They said there used to be three tea choices every day. The staff we spoke with said the food is good, and they feel that the menu changes enough. They told us that residents can have snacks between meals if they want. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recording of complaints and safeguarding allegations is not adequate and needs to improve to ensure residents’ concerns are responded to appropriately and that they are safeguarded from those who may abuse them. EVIDENCE: We looked at the complaints procedure and this meets legal requirements but it is not displayed in the home and we asked the manager to do this. We have received a complaint since the previous inspection about the approach and behaviour of the previous manager. These issues were investigated by the provider and resulted in the manager resigning. There are no complaints recorded at the service, but two of the residents we spoke with told us that they and other people had made verbal and written complaints about a member of staff who was dismissed by the providers. The records of these were not available for inspection. The residents said they would feel confident if Lorraine dealt with any complaints although they said their impression is that “she is not very forceful.” The staff we spoke to have not dealt with a major complaint but said they would let the nurse know rather than the manager as, “I would not want to bother her.” This is an issue which needs to be addressed with staff so the manager is aware of concerns and complaints and can record and investigate these properly. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 20 There have been no safeguarding allegations since the last inspection of the service. One of the staff we spoke with told us that she had blown the whistle on poor practice before and had reported the attitude of a member of staff. She told us the matter was addressed straight away, the owners came and interviewed her and the member of staff was dismissed. We were not notified of these events. This staff member said she would have “absolute confidence” in the manager to deal with any allegations of abuse. She has not had any training on safeguarding but when we interviewed her, she was clear about what constitutes abusive behaviour and neglectful behaviour, but she said she is not confident about the reporting procedures. Visitors we interviewed said they feel residents are safe and cared for at the home. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is clean and hygienic but the heating on the ground floor is inadequate and it is cold, draughty and does not provide a comfortable environment for residents to live in. EVIDENCE: We did a partial tour of the accommodations. The owners have redecorated the lounge, dining room, conservatory and corridors. They have replaced carpets in the lounge and dining room and the corridors will be carpeted in the new year. This will be a considerable improvement. The ground floor felt cold and draughty during this inspection, especially in the lounge, conservatory, dining room and down the corridors. The residents and North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 22 visitor we spoke with told us it is always cold on the ground floor and they have to cover themselves with blankets to keep warm. There is no evidence that the service is using thermometers to check that the temperature of the areas used by residents is maintained at a comfortable temperature (71 degrees C). The issue about the heating must be addressed. The home was clean and odour free during our visit. The kitchen and laundry areas were well organised and hygienic. The residents we spoke with said the home is kept clean and tidy, though they said the bedrooms were in need of refurbishment. The staff we spoke with said that it would be beneficial to have more cleaning hours available to keep the home clean. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff are kind and caring, but there are not enough staff on duty to meet the needs of the current needs of the residents. The training records are wholly inadequate and do not provide evidence that staff have the training to be competent in their role. EVIDENCE: We looked at the staff rota and found that day shifts are covered by a trained nurse and three carers, in the afternoon this reduces to two and a nurse and overnight one nurse and one carer. We received overwhelming and consistent evidence from our interviews with staff, residents and visitors to indicate that these staffing levels are not sufficient to meet the needs of the current residents. This is especially true as two residents are taking up a lot of staff time because of the complexity and frequency of their need for attention, (See OP1). The manager has taken steps to get these residents reassessed and one is moving imminently. It was recommended to the manager that she seek additional staffing funding until the other resident can be found a suitable alternative placement. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 24 One person we spoke with said they feel, “forgotten” by the care staff as they do not have enough time to come to chat and check that residents in their room are ok. The residents told us that sometimes staff ring in at short notice, and although the manager tries to get agency cover, this is not always possible. One person said, “all of the staff are working long shifts, and getting over tired and it shows in their attitude and approach to us.” The manager told us that there are 19 care staff employed at the home (some of which are bank staff), 6 people have achieved their National Vocational Qualification Level 2 and a further two are working towards this. This still leaves a shortfall in terms of the target of 50 of the care staff trained to National Vocational Qualification Level 2. The induction for staff at the home does not meet the Skills for Care standard. Staff training records need updating and a matrix needs to be developed to address the training needed. Training files in a poor state. We looked at the staff training files and found these to be in a poor state, they were not up to date and they did not all contain certificated proof of the courses. There is no training matrix in place for the manager to be able to identify what training staff have done and when this needs to be updated. Staff we spoke with said that they have done their National Vocational Qualification 2, Basic First Aid, Fire, Health and Safety, Moving and Handling, Basic Food Hygiene and Infection Control. They had not received any training on the specific needs of residents (E.g. on Dementia care, Diabetes, Strokes and so on.) The residents we spoke with said the staff are kind and caring and seem competent at their job. We looked at the staff files and found that on the whole they contained most of the information required by Law. They did not all contain the dates of employment for staff. One of the staff we spoke with said she had started work without a Criminal Records Bureau check. She was employed by the previous manager. This must not reoccur. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is caring and is committed to the residents and improving the home, but better recording and involvement of those using the services are needed to ensure the home runs in the best interests of the residents. EVIDENCE: The new manager has applied for her Criminal Records Bureau check through us and once this is received she will apply to become registered as the manager. The comments from staff, residents and visitors indicate she is competent, caring and able. People commented, “she is the best thing that has ever happened to this home,” “she is very approachable and caring, a very North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 26 dedicated nurse and she is running the home to the best of her ability.” A staff member told us that the manager can be firm and will “put her foot down,” if she is not happy with the conduct of staff. She has already identified a series of areas she wants to improve upon (care planning, Quality Assurance, training records, the environment and resident involvement) she showed us different documents she has already researched in trying to find appropriate changes. The directors of the home have changed since the last inspection and the residents told us, “it would be nice to meet them, to know who they are. They appear in the lounge but we don’t know them and they do not introduce themselves.” The monthly reports by the owners should take account of the views of residents and visitors and report on these. The staff told us the new owners are approachable and visit the home once or twice a month and will come immediately if there is an issue of concern. There has been no Quality Assurance at the home in the past year. The manager wants to change this and is looking at suitable formats at the moment. We gave her advice and referred her to the internet or the Registered Homes Association for further advice and guidance. The residents we spoke with said they have not been asked for their views, and they said that there are no residents’ meetings, suggestions boxes or newsletters. One person commented to us that, “if someone has left the home we are never told how they are doing, these are people we know and like, it would be nice to know how they are.” We looked at the records of residents’ finances as there has been a complaint around this issue since the last inspection (see OP16 and 18.) We found that there are only small cash amounts held for a few residents, but the money is not held individually, expenditure has not always been supported by receipts and there are possible inconsistencies (which pre date the current manager’s appointment) which need further investigation and a safeguarding referral if these discrepancies cannot be accounted for. The information on Health and Safety testing and servicing provided to us by the manager has been reviewed and these records are up to date and equipment is tested for safety at the required intervals. The staff we spoke with told us that their health and safety is supported. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 27 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 1 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 X X 3 North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4 Requirement Timescale for action 28/02/08 2. *RQN 3. OP7 4. OP9 5. OP12 You must make give every existing and prospective resident a copy of the service user guide which must contain the summary of your latest inspection report so they are clear about the service they can expect to receive at the home. S 24 Care You must not admit a person Standards outside of your categories of Act 200 registration and whose needs the staff are not trained to understand and cannot meet. 15 You must ensure that the actions needed to meet the needs of residents are recorded in detail in care plans and that these documents reflect their current needs and offer clear guidance to staff so they can properly support residents. 13(2) You must improve stock control to ensure that residents do not run out of prescribed medicines and creams and that they are able to access these quickly once they have been prescribed. 16(2)(m & You must consult with the n) residents about their social DS0000062446.V354851.R01.S.doc 31/01/08 31/03/08 28/02/08 31/03/08 North Clifton Hall Nursing Home Version 5.2 Page 29 6. OP15 16(2)(i) 7. OP16 22 8. OP18 13(6) 9. OP18 13(6) 10. OP19 23(2)(p) 11. OP27 18(1)(a) needs and interests and arrange for more frequent and varied activities to ensure their social needs are met. This requirement is outstanding. Timescale of 30/9/06 not met. You must comply with this timescale to avoid further enforcement action being taken. You must consult with the residents about the menus and ensure you provide a varied and appetising menu in line with their suggestions and wishes. You must record all complaints whether they are verbal or written and keep records of your investigation and outcome. These records must be available for inspection to ensure that residents’ concerns are being heard and responded to. You must send us a copy of the investigation into the conduct of the identified ex employee following safeguarding allegations. You must ensure that all staff have training on local safeguarding procedures so they understand their reporting obligations and can keep residents safe from harm and abuse. You must ensure that all areas of the home, which are used by residents are maintained at a safe and comfortable temperature to ensure their health and wellbeing. You must review the dependency needs of the residents and provide evidence as to how your staffing levels meet these needs to ensure the health and wellbeing of residents. DS0000062446.V354851.R01.S.doc 28/02/08 31/01/08 15/02/08 01/06/08 31/01/08 28/02/08 North Clifton Hall Nursing Home Version 5.2 Page 30 12 OP29 7, 9, 19, Sch 2. You must ensure you have the information and documentation required to ensure that residents are supported by caring and trained staff by • 28/02/08 13. OP33 24 14. OP35 13(6) Maintaining certificated evidence of the training staff have undertaken • Recording the dates of employment for each member of staff. You must undertake Quality 30/06/08 Assurance audits of the service provided at the home, incorporating the views of residents and their relatives to ensure the service is being run in the best interests of the people who live there. You must ensure you protect the 28/02/08 financial interests of residents by: • • Ensuring their money is stored separately to enable easy auditing Investigating the discrepancies in financial records and making a safeguarding referral if these cannot be properly accounted for. Ensuring that all financial transactions are signed for by two people and a receipt supports all expenditure. • RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 31 No. 1 2. 3. 4. 5. Refer to Standard OP4 Good Practice Recommendations You should develop a care plan for newly admitted residents within 5 working days to ensure the staff understand how to support them with their needs. You should use a Monitored Dosage System for administering medication to provide a safer system with fewer risks of error in administration. You should count in stock medication with your receipt records to enable to check and audit that residents have received their medication as prescribed by their GP. You should ask the identified resident if they would like an advocate to assist them in representing their views. You must ensure that staff show respect for the decisions and dignity of residents by • Asking residents if they would like to wear an apron over their clothes at mealtimes. • Ensuring that the identified member of staff sits down when she assists residents to eat. • You should ensure that the staff record and report all concerns and complaints to enable you to take appropriate action in line with your policy and procedure. • You should display your complaints procedure in the home so that residents and their relatives know how to raise concerns with you. You should refurbish the residents’ bedrooms in accordance with their wishes to provide a pleasant and comfortable environment for them to live in. You should ensure your staff are competent in their support of residents by • Providing a Skills for Care induction • Ensuring that you meet your target of 50 of care staff trained to National Vocational Qualification level 2. You should develop a training matrix to identify which staff have undertaken which training and to ensure you are aware of the dates when staff should update their core training to ensure they are competent at providing safe and supportive care to residents. OP9 OP9 OP14 OP15 6. OP16 7. 8. OP24 OP28 9. OP30 North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI North Clifton Hall Nursing Home DS0000062446.V354851.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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