Inspection on 22/07/06 for North Clifton Hall Nursing Home

This inspection was carried out on 22nd July 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

North Clifton Hall Nursing Home 30/03/09

North Clifton Hall Nursing Home 20/12/07

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 North Clifton Newark Nottinghamshire NG23 7AZ Lead Inspector Vanessa Gent Key Unannounced Inspection 22nd July 2006 18:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address North Clifton Hall DS0000062446.V303804.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 DS0000062446.V303804.R01.S.doc Version 5.2 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 228 229 01777 228 100 loyaltycare@btconnect.com 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.V303804.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 20th December 2005 Brief Description of the Service: North Clifton Hall is a privately run care home with nursing facilities, one of a group of three homes owned by the providers, who are involved directly with the day-to-day running of the home. It 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 although these are available in nearby villages. The home has a church close by. It is equal distances from Lincoln, Newark and Gainsborough and is on the main bus route to Gainsborough and Newark. It provides for up to twenty-seven older people of both sexes, many with nursing needs, 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 but it is now mostly pleasantly decorated. Communally, 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 £380 - £480. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit was made to the home as part of a key inspection. It lasted approximately six hours. Information already held on file was used to plan the visit. The main method of inspection used is called ‘case-tracking’, which involves selecting a proportion of residents, and tracking the care they receive through the checking of records, discussion with them, the care staff and observation of care practices. At the time of writing the report, the inspector had not received any survey forms from either residents, relatives or staff. A letter from relatives of a resident was complimentary in the efforts made and satisfactory compromise reached; for “the cleanliness of the bedroom” and “are very pleased with the degree of care and general provision made…” The visit to the home focused on whether key standards and requirements from previous inspections had been met and how the residents feel about the service provided. Three residents’ assessments and care plans were examined to ensure the health, safety and welfare of the residents is checked and that residents are allowed dignity, autonomy and choice. A partial tour of the home was made and a sample of other records examined. Three of the staff on duty were spoken with as were eight of the twenty-one current residents, including those being case-tracked. No relatives or visitors were available to add their comments during the inspector’s visit to the home. The manager was present throughout this inspection and she and the deputy manager spent time discussing some of the issues that arise in the running of a care home. What the service does well: The home is run by a competent, confident manager and supported by a good staff team who are well-trained and give care and support to the residents. The staff were observed to be kind and polite when speaking with residents. Residents spoke highly of the manager and staff team and say that the home is comfortable, clean and is homely to live in. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. North Clifton Hall DS0000062446.V303804.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 North Clifton Hall DS0000062446.V303804.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): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home are handled well. The residents or their representatives are aware of what the home has to offer before accepting a place there. EVIDENCE: A statement of purpose and a service user guide are in place and clearly describe the facilities, services and philosophy of the home. Comprehensive, detailed assessments of need are carried out on all residents before they are given a place in the home. Evidence of these were seen at the last inspection and in the care plans looked at, at this visit. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good care planning, contact with healthcare professionals and monitoring of health issues ensure that the health, social and emotional needs of residents are met. Residents are treated with dignity and respect. EVIDENCE: The care plans seen are detailed documents containing all the information necessary to care safely for the residents. The care plans show that good communication exists between the staff of the home and healthcare professionals, especially at the various doctor’s surgeries that care for the residents. This ensures that the health needs of the residents are met. The NHS Primary Care Trust continence advisor is in regular contact with the staff and residents when they need advice and assistance in this area of health care. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 10 Staff have been trained to use specialist documents such as fluid balance charts, so that they can check that residents are cared for adequately. Residents commented that the manager and staff really care for them and are meeting their needs. The nurses on the staff team administer all the medications. Although a full check of medication practices was not undertaken at this visit, they were found to be adequate at the last inspection. At that time, the deputy manager demonstrated a knowledge of acceptable medication practices. The nurses have training updates for the safe administration of medicines. Residents say they are treated with dignity and their privacy is respected. Some residents stay in their own rooms and staff were seen to knock on the doors and wait before entering. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 are mostly satisfied with the choice they have in their lives and the food provided. However, limiting their choices of activities and where they can eat their meals means that their wishes are not always catered for. EVIDENCE: The home does not now have a dedicated activities organiser. Some residents say there are not enough varied activities and life is pretty boring with not enough to do to keep them occupied. The manager says that activities such as a monthly karaoke, a tea dance once a quarter, an occasional river trip and being taken out in their wheelchairs are provided. Church attendance can be arranged on alternate Sundays for those who want. Regular activities in between these occasional events include bingo, dominoes, card-playing, nail painting and make-up. From the visitor’s signing in book, it was possible to see that not many visitors and relatives regularly come to visit. The manager says there are several families who do visit regularly although some residents do not have regular North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 12 visitors. A resident said that visitors are always made welcome. One resident says that the vicar calls sometimes. Residents say they can make full choices over their lives in the home, except for not having enough activities. Some prefer to stay in their rooms although the staff say they try to encourage as many people as possible to take lunch in the dining room, together. However, the dining room has space to only accommodate approximately twelve people, including those who use wheelchairs. The providers say that they are going through the process of getting planning permission for extensions to the dining room and lounge areas. This will provide extra space in the communal areas to give residents more choice. Everyone said the food is lovely, good, homemade and fresh. No-one complained about the quality or choice of food. The lunch was observed and looked an appetising, colourful, nutritious meal. Residents who needed assistance, such as cutting up food or helping with the food, were helped discreetly. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 13 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 judgement has been made using available evidence including a visit to this service. Measures are in place to acknowledge and deal with any concerns or complaints. Residents are safeguarded from the risk of abuse by robust procedures and good staff training. EVIDENCE: The complaints policy is in place and displayed to enable residents and relatives to make their concerns and complaints known. There have been three complaints received by the home over the past twelve months. All have been documented and dealt with adequately and appropriately. No complaints have been received directly by the Commission. Staff are trained to protect residents from induction onwards. They also have update training in staff meetings and by the manager and deputy manager. An allegation of abuse, made against a staff member, was handled quickly, discreetly and appropriately. Residents say they feel safe with the staff, who “are lovely”. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, tidy and well-maintained. It is a safe, mostly comfortable place for the residents to live and the staff to work in. EVIDENCE: The home has benefited from redecoration and refurbishment and most areas look bright and airy. Residents’ rooms are being renovated one by one, although one resident said that their room was in desperate need of furnishing renewal: the carpet was stained and “tatty”, the curtains had not been washed since they had moved in their several years before, and the furniture was old and not all in good condition. Communally, the dining room facilities are limited, with space for only approximately twelve residents to dine together. Others, who may wish to eat North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 15 there, are unable to make that choice, as described in the section entitled ‘Daily Life and Social Activities’. Specialist equipment to assist moving and handling and pressure sore prevention equipment is readily available in the home. Most of the window restrictors that were required to be installed at the last inspection have been out in place, the only three not done yet are in rooms not occupied. The manager says they will be done in order, and certainly before anyone occupies them. The home has hygiene measures in place. Although the laundry and kitchen were not inspected at this visit, they have previously been found to be satisfactory. One relative commented by letter that they “have always found a satisfactory level of cleanliness in the room whenever they visited”. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 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, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient well-trained and supported staff are on duty at all times to make sure that the residents are cared for safely and according to their needs and wishes. EVIDENCE: The pre-inspection questionnaire completed by the provider and manager includes staff rotas which indicate that staffing levels are satisfactory to cater for the needs of the residents at all times. They were also found to be sufficient at the previous inspection. There is always a trained nurse on duty. Staff say they work together as a good team and get on well. “We get on really well here.” “We have a laugh; the residents have a good laugh too.” Residents say that staff are “helpful and lovely”. Recruitment practices were checked. Staff files were found to be in order, with checks made for all staff with the Criminal Records Bureau and with the Protection of Vulnerable Adults Service. New employees are recruited with all documentation in place that is required by law. Staff say that the induction process is very thorough and usually lasts for up to three months. The deputy manager ‘signs them off’ when she has been North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 17 satisfied that they are competent in their knowledge and care practices. Staff also appreciate the training that the manager encourages and that is available. Staff also say there are plenty of staff meetings, which are minuted. At most of these, they go through previous training issues that they need updates on, in order to maintain their safe and competent care practice. They say they are well-supported by the providers, manager and her deputy, who everyone said is excellent and always there for them. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a manager who is well-qualified, well thought of and who ensures that residents are safeguarded and comfortable. Procedures are in place to make sure that residents are cared for in a safe, efficient and caring manner. EVIDENCE: The manager is well-qualified, has received her Registered Manager’s Award and maintains her personal training schedule. She is seen as supportive by staff. The residents say she is kind and considerate. A couple of residents said she is not always ‘visible’ enough but North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 19 they realise she is busy and is there if they need her. Residents spoken with say she talks to them every day she is on duty and is friendly and helpful. The provider/manager works at the home and administers its business needs. The provider visits at least monthly to monitor the home’s facilities, service provided and staff attitude and documents his findings. The manager conducts resident and relative as well as staff surveys. She is in the process of collating the results of the latest survey forms sent out in July this year. Although the capacity of many residents is limited and many are frail and unable to communicate their wishes clearly, residents’ meetings take place, and are minuted, to ensure their wishes are taken account of. Residents’ finances are protected by thorough accounting facilities, with clear records and all receipts kept and two signatures in place for each transaction. Staff supervision has commenced although this area needs further development to ensure that all staff are fully supported at all times and their learning and training needs identified. As described in the section entitled ‘Staffing’, staff say they feel well-supported and have plenty of staff meetings and a good level of involvement in the home. Health and safety issues, including the fitting of window restrictors that was identified at the last inspection, are now in place in all rooms that are occupied or used. The providers have put into place measures for ensuring the safety of residents and staff, such as fire safety procedures – fire checks, drills, alarmtesting – and maintaining the emergency lighting system. These changes have made the lives of the residents safer and more comfortable. North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X X 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 X X 3 North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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(2)(n) Requirement Activities must be provided in sufficient quantity and variety to meet the needs and wishes of the residents. The residents must have full autonomy and choice in their lives, including providing sufficient accommodation so they can decide where they wish to eat their meals. Timescale for action 30/09/06 2. OP14 OP15 OP20 12(3), 23(2)(e) 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations North Clifton Hall DS0000062446.V303804.R01.S.doc Version 5.2 Page 22 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 © 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 DS0000062446.V303804.R01.S.doc Version 5.2 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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