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Inspection on 11/09/08 for The Clitheroe Residential Care Home

Also see our care home review for The Clitheroe Residential Care Home for more information

This inspection was carried out on 11th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This was a Random Inspection. All outcome areas were not assessed.

What the care home could do better:

This was a Random Inspection. All outcome areas were not assessed.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: The Clitheroe Residential Care Home Eshton Terrace Clitheroe Lancashire BB7 1BQ The quality rating for this care home is: The rating was made on: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Pat White Date: 1 1 0 9 2 0 0 8 Information about the care home Name of care home: Address: The Clitheroe Residential Care Home Eshton Terrace Clitheroe Lancashire BB7 1BQ 01200428891 01200442166 admin@primecarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Prime Care Homes Ltd care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category 0 Over 65 28 Conditions of registration: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 28 Date of last inspection Brief description of the care home The Clitheroe provides care and accommodation for 28 older people. Prime Care Homes Ltd owns the home. The house is a detached property located in a residential area, near to town centre shops and facilities and close to a bus route. There is a car park and enclosed patio area with garden seating at the front. Accommodation is on 3 floors, linked by a passenger lift. Altogether there are 18 single bedrooms (one with an en-suite) and 5 double bedrooms (with privacy screening), a two part lounge, a conservatory and two dining rooms. Various adaptations and equipment (such as Care Homes for Older People Page 2 of 11 handrails and toilet aids) are provided to assist service users with independence and mobility. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide is issued to all residents and their relatives/representatives on admission. The fees from 1st April 2008 will range from £346 to £402.64p for care and accommodation. Additional charges are made for such things as hairdressing, papers and private chiropody. Care Homes for Older People Page 3 of 11 What we found: The reason for this inspection was to monitor some ongoing issues from previous inspections. Therefore, progress on some requirements made at the last key inspection was checked and also some of the recommendations. To do this 3 residents care plans and some of the homes records were viewed. Some medicines management procedures in the homes were checked. The relevant parts of the premises were looked at and the hot water temperature tested. All matters were discussed with the manager, Beverley Cooper, and the deputy manager. Overall there had been further progress in some areas but there were still a few outstanding issues. The specific outcome are as follows: Admission and Assessment Procedures At the last inspection for one new resident whose records were viewed there were no records of a pre-admission assessment to assist staff to understand her needs on admission. Also the assessment of need undertaken after admission but did not include sufficient detail on all matters related to Personal, Health and Social Care, such as oral care and leisure interests and social contacts. At this Random Inspection site visit the records of a resident that had been admitted about a month previously, showed that the admission procedures had been improved. There was a comprehensive preadmission assessment that had been written down so staff had useful information about this person on admission. The assessment had continued after admission, so further details had been obtained, and a comprehensive care plan had been developed. Records showed that as part of the overall assessment process risk assessments recording falls, nutrition, pressure areas and moving and handling were undertaken. These records also showed that the falls risk assessments had improved from the previous key inspection, and were specific to individuals with useful management strategies, rather than of a general nature as they had been previously. Therefore a number of previous good good practice recommendations had been met. Health and Personal Care Care Plans At the previous inspection one care plan of a resident who had an ongoing history of verbal and physical aggression did not include enough information or guidance about how staff should manage the behaviour. A medical re-assessment of her mental health had also recommended training for staff in challenging behaviour to assist them with the care of this person. Another care plan was in urgent need of updating as the persons care needs had changed considerably. At this inspection not all aspects of the care plan were assessed, we concentrated on the requirements from the previous inspection. We found there was evidence that the content of the care plans had been further improved and they had all been reviewed and updated. With respect to the two residents referred to above the care plans had been developed according to the previous requirements. The care plan of the resident with challenging behaviour had greater clarity about the triggers of this behaviour and how staff should respond. Staff said that they now understood her better and that she was now more settled. Care Homes for Older People Page 4 of 11 Medication At this random inspection the previous requirement and recommendations were checked and the medicines of 3 residents were checked against the records kept. This showed that medication was being given as prescribed and that Medication Administration Records were accurate and well kept. Since the previous inspection regular internal audits were being undertaken and recorded by the manager to identify and rectify mistakes and provide an audit of these and the action taken. However the following improvements could be made. At the last inspection a requirement was made to develop procedures for the covert administration of medication in accordance with the Mental Capacity Act and the Royal Pharmaceutical Society of Great Britain Guidelines. This was identified as necessary through a person living at the home at this time. At the Random Inspection site visit these procedures were still not sufficiently developed though the person for whom the lack of procedures was identified was no longer living in the home. Also the procedures did not sufficiently distinguish between those who cannot take certain forms of medication and those who refuse medication. written information and instructions about when to give when required medication had been developed, but there was still a lack of clarity for some residents as to whether or not pain relief was being, or should be, administered as when required. Also there were no written instructions for staff to guided them on how much medication to give when the dose was prescribed as variable. Environment and Management and Administration At the last inspection in February this year the hot water temperatures at the bedroom taps tested were found to be considerably higher than the acceptable range and the monitoring system had failed to identify and rectify the problem. At this time were told that the boiler was in need of repair or replacement and that this should solve the problem. We were subsequently informed that the necessary work would be carried out when the warmer weather came and the central heating could be turned off. At this random inspection the hot water temperatures tested were of a safe temperature. However the necessary work on the boiler to regulate the central heating and hot water temperatures had not been completed. We were told that at the present time the central heating and the hot water systems were linked in such a way as the temperatures could not be regulated separately and that the higher the temperature of the central heating the higher the hot water temperature. During the summer the central heating had been turned down and the hot water temperatures were therefore lower and the risk of scalding reduced. We were also informed that further work was required on the boiler to separate the two systems, and to replace the thermostatic mixer valves on the individual water outlets. The manager stated that this work was scheduled to be carried out at the end of September. This was not a requirement at the last inspection as we understood the work would be completed in the spring of 2008. Subsequent to this site visit you informed us of the date at which this work was to commence and this must be completed with priority. In addition the tour of the premises indicated that a number of the double glazing window units window units were in need of repair as the trapped condensation impaired the view. Staffing Care Homes for Older People Page 5 of 11 At the last key inspection the staff had not yet undertaken appropriate training in dementia and challenging behaviour so it was not clear that they had the skills to look after people with these needs. This was still the case at this Random inspection (see above). The manager said that she had until recently, been unable to find an appropriate course on challenging behaviour. She anticipated that staff would be able to undertake this course in the near future but also felt that the behaviour of the remaining resident for whom the training was needed had improved and that training was not as urgent as it had been. The records completed of the induction that new members of staff were undertaking showed that this had improved since the previous inspection. It was now suitable and sufficiently comprehensive for people without any previous experience of working in care. At the last key inspection some staff recruitment procedures needed to be improved. At this Random Inspection the previous requirement had been partly met and the records of those members of staff looked at showed that references had been obtained before they commenced work. However the references were not the most appropriate. For one member of staff one reference was from a friend and family member and the professional identity of the second referee was not clear. There were no authentic employment based references for this person. Another member of staff had previously worked in a care service but a reference from this employer had not been sought. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 7 15 (b)(c) All care plans must be 31/03/2008 reviewed and the written plan updated, including the one identified, when changes in residents? care needs and the care being given has changed, so that the correct support and care is given. This must include complete and accurate risk assessments such as for moving and handling and pressure areas. The medication policies and procedures regarding the covert administration of medication must be developed and followed according to the Royal Pharmaceutical Guidelines and the Mental Incapacity Act. People must not commence work in the care home until satisfactory references have been obtained. 30/04/2008 2 9 13(2) 3 29 19 (1)(c) 31/03/2008 4 30 18(1)(a) Staff must undertake training 31/05/2008 in challenging behaviour to assist them to understand and manage such behaviour effectively. Care Homes for Older People Page 7 of 11 5 38 13(4)(a) Residents must be protected 31/03/2008 from the hazards of water that is too hot and this should include a reliable system of temperature monitoring and adjustment. The gas appliances in the home must be appropriately maintained and serviced 31/03/2008 6 38 13(4)(a) Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 25 23 All parts of the home must 07/11/2008 be kept in good state of repair including the homes hot water system and the double glazing window units. For the wellbeing and safety of the residents. 2 29 19 References must always be 07/11/2008 sought from previous employers and especially from previous employers of a care service if this is an option. If employment references cannot be obtained there should be a full written explanation. To help ensure that suitable people are employed in the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should contain sufficient information in all areas of health, personal and social care, oral care and leisure interests. Page 9 of 11 Care Homes for Older People 2 9 The medication policies and procedures regarding the covert administration of medication should be developed and followed according to the Royal Pharmaceutical Guidelines and the Mental Incapacity Act. Whether or not pain killers are given as when required should be clarified with the General Practitioner. 3 4 10 12 The residents dignity should be upheld at all times through staff attitude and care practices. The leisure activities should be reviewed with the residents and a programme devised to include as many as possible. The home should provide some activities for people with specific needs such as those with dementia. Staff should undertake appropriate training in dementia and in challenging behaviour to assist them to understand and manage the behaviour of some residents. Staff should receive up to date training in infection control, which takes into account current good practice based upon department of health guidance for the safety and well being of users of the service. 5 30 6 38 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. 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