Inspection on 18/07/07 for The Clitheroe Residential Care Home

This inspection was carried out on 18th July 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

The Clitheroe Residential Care... 26/02/09

The Clitheroe Residential Care... 11/09/08

The Clitheroe Residential Care... 28/02/08

The Clitheroe Residential Care... 16/05/06

The Clitheroe Residential Care... 09/11/05

The Clitheroe Residential Care... 11/05/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Clitheroe Residential Care Home Eshton Terrace Clitheroe Lancashire BB7 1BQ Lead Inspector Mrs Pat White Key Unannounced Inspection 18th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Clitheroe Residential Care Home DS0000061349.V340171.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. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Clitheroe Residential Care Home Address Eshton Terrace Clitheroe Lancashire BB7 1BQ 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) 01200 428891 01200 442166 admin@primecarehomes.co.uk Prime Care Homes Limited Mrs Jean Marie Wooff Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection Brief Description of the Service: The Clitheroe provides care and accommodation for 28 older people aged 65 years and over. 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 handrails and toilet aids) are provided to assist service users with independence and mobility. Current fees for accommodation at the home are £310.50 - £350 per week, with additional charges for hairdressing, toiletries, magazines and papers. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection site visit was carried out on the 18th July 2007. The site visit was part of an inspection to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous key inspection and a shorter “Random” inspection undertaken in May 2007. Two complaints referred to the Commission, and passed to the registered provider to investigate, were also monitored at the site visit. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents, discussion with the senior carer in charge of the home at the time of the visit and the home’s administrator. In addition an Annual Quality Assurance Assessment (AQAA) was completed for the Commission and information from this is included in the report. Seven residents were spoken with about their views on the home. Survey questionnaires from the Commission were sent to the home for residents and relatives to complete. Questionnaires were also sent to general practitioners (GPs) and social workers. Eight residents, 4 relatives and two GPs returned these questionnaires. A district nurse was also spoken with and gave some views about the home. Some of the views of these people are included in the report. What the service does well: Residents felt they were well looked after in the home, and they spoke highly of the staff. One resident said that staff, “were very kind and hard working”. One resident said “what more could you want, we have good food, a warm bed and we are well looked after”. Another said in a questionnaire, “I think it’s a marvellous place for elderly people, I really enjoy being here”. Relatives who completed the questionnaires also generally had a favourable view of the home. One relative said, “they are all very caring staff and the residents are very well looked after”. Residents have consistently praised the food served, and most of those who completed the questionnaire stated that they “always” enjoyed the meals. Some of those residents spoken with said that the food was good. One said, “I always enjoy my food”. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 6 There was a good programme of varied activities such as a “day at the races” and trips out round the local countryside in a specially adapted bus. Some residents said they appreciated these activities The home had suitable standards of décor and furnishing. Residents were generally satisfied with their private bedrooms and one resident said how much she enjoyed being in her bedroom in the evening. The building was a safe place for residents and staff. Residents’ monies were managed safely and good records were kept. What has improved since the last inspection? Residents and visitors were now given more written information about the home so that they knew about the services and facilities. The home’s service user guide was now given to all residents and /or families. Some written information about the residents needs for care had improved to help care staff care for residents according to their wishes, for example there was more information about oral care and more information about the risks that some residents faced, such as from falling, and from pressure areas. Some grumbles and minor complaints were now being recorded so that this information could be used to assess the overall level of satisfaction of residents and to highlight any problem areas. Some parts of the home had been made safer since the previous inspection, including the hot water temperatures. Water temperatures were being monitored regularly so that action could be taken to protect people from the dangers of water that is too hot. The procedures for recruiting new members of staff in the home had improved and staff had not commenced work until all the relevant checks had been undertaken. This helped to ensure that residents were protected from unsuitable staff, The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 7 The views of the residents, relatives and staff about the home were regularly obtained through questionnaires and these views were being used to influence the development of the services and facilities in the home. The CCTV camera had been removed from the office and this had improved the privacy and dignity of the staff working in this room. What they could do better: Although the written information that carers need to help them look after residents had improved in some ways (see above), it must be further improved so that care staff have accurate information about how residents should be looked after. For example care plans must be kept up to date so that when residents improve or deteriorate the written instructions to staff are accurate and reflect the care actually needed and being given. There should be more information about some health and personal care matters such as dietary information, such as for people with diabetes, the use of bed rails, managing people’s difficult behaviour and moving and transfer needs. Some care practices must be improved for the well being of the residents, such as making sure that: residents are safe when being moved in wheelchairs; that bed rails are used safely according to the manufacturers instructions; all residents have the use of a call bell to summon help when in their bedrooms; all residents are moved safely and weights are recorded consistently and accurately. People’s dignity should be maintained at all times by making sure they have suitable clothing when being cared for in bed and ensuring that residents have their own flannels in shared rooms. People whose behaviour is aggressive and difficult to manage must be urgently reviewed and assessed so that they receive any necessary treatment and the right kind of care and supervision. The way medication is managed in the home must be further improved. Some written procedures were still not available for staff to follow and this could partly account for the fact that some practices were not as safe as they should be. For example people were not always getting their medication at the correct time in relation to food and residents did not always have their medication when they were out of the home. A wider variety of meals could be served in accordance with all residents’ tastes so that the same meals were not repeated so often. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 8 The way complaints about the home are managed and investigated must be improved so that the home can demonstrate how the investigations have been carried out and that all has been done to resolve the issues. The way the home deals with any allegations and suspicions of abuse must be improved, and the correct procedures according to local and Government guidance, must be followed to ensure that residents are protected from harm. Parts of the premises could be improved, such as replacing or restoring badly stained carpets, ensuring that all parts of the home are kept clean and free from unpleasant odours and that bedrooms are kept tidy. Toilet facilities on the ground floor in conjunction with care issues need to be reviewed to ensure that residents are not waiting an unacceptable length of time to use the toilet. The numbers of staff on duty and their skills and knowledge must be kept under constant review in respect of residents’ dependency and needs to ensure that the needs of all residents are met at all times. The induction which new members of staff without relevant qualifications undertake could be improved, so that it complies with Government (“Skills for Care”) guidance. This will help to make sure that they have the right skills and knowledge at the start of their employment. The registered person should make sure that the Commission is notified of all the incidents and accidents that affect the well being of the residents so that these can be monitored. 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. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 9 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 The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 10 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 & 5. Standard 6 was not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission procedures made sure that the needs of prospective residents were assessed before admission. Written information about the home was made available to help residents and relatives make a choice of whether or not the home would be suitable. However it was not clear that the home could meet the needs of some of the residents. EVIDENCE: The written information about the home – the Statement of Purpose and the Service User Guide - was not fully assessed at this inspection but had been previously assessed as meeting the Care Homes Regulations. Also according to a requirement made at the previous inspection the residents and relatives were now routinely given the Service User Guide on admission. Most of the residents and relatives that completed questionnaires were satisfied with the The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 11 level of information they received and said it helped them make a choice about whether or not the home was suitable for meeting the residents’ needs. The admission procedures for new residents were satisfactory. The manager visited people and carried out a pre admission assessment to help determine whether or not the home could meet their needs. People including relatives could visit the home to help them make a choice. However for a number of residents who had lived in the home for some time and who were described as having aggressive and difficult behaviour, there was no evidence that the home could meet these needs properly, and staff were not trained to look after residents with such behaviour. These people had not had their mental health and related needs reassessed. Two relatives who completed the questionnaires stated that they felt their relative’s needs were always met and they always received the care and support they needed and two said “usually”. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Not all the care plans contained enough up to date and accurate detail about all matters relating to health, personal and social care, including accurate assessments of risk associated with some aspects of care. Some care practices were not safe. Medication procedures did not ensure the correct administration of medicines to all residents. In general the residents right to privacy and dignity was upheld. EVIDENCE: Residents had written care plans based on an initial assessment. The care plans of three residents were viewed. Some details regarding continence and pressure area care had improved from the previous inspection. Though for one resident at risk of pressure sores when admitted, there was no supporting risk assessment which could be reviewed. The care plan, including a moving and The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 13 handling risk assessment, for one resident had not been reviewed or updated since being admitted in March and did not reflect the overall improvement in mobility, changed needs or the current care required. The moving and handling assessment of another resident did not reflect what carers were doing to transfer the resident, and which was potentially putting both the resident and the staff at risk from injury. For one resident who was described as aggressive and with “challenging behaviour” there was some information to help staff deal with situations but this was not based on a detailed assessment of need or clinical guidance (see previous section). The residents’ physical health was promoted and monitored. District nurses were involved as necessary, and supplied relief equipment to residents’ who were vulnerable to pressure areas. Professional advice was sought about the promotion of continence. Residents had access to specialist medical care, dentists and chiropody. The two medical practitioners who completed questionnaires and the district nurse that was spoken with felt that the residents in the home received all the medical care that they needed and that the staff in the home involved them appropriately and followed their advice. Of the eight residents who completed the questionnaires, 4 said that they always had the care and support needed, 3 said “usually” and one said “sometimes”. Five said they always had medical support when needed and 3 said “usually”. However there were some concerns identified at the site visit. There was insufficient written information to support the use of bedrails and how they should be fitted, and the risk assessments in place did not demonstrate that these were safe for individuals. One resident had bedrails in use at only one side but there was no supporting information about this in the care plan. The bedrails of another resident who was having all care in bed did not fit properly and there was a gap between the mattress and the rail on one side, increasing the risk of entrapment. This was also no bumper in place to help protect the resident. One resident was seen being moved in a wheelchair without a foot rest and her foot was in danger of being injured underneath. Nutrition assessments were carried out but they did not contain information about diabetes and neither did the care plans for one resident who had diabetes and which was controlled by diet. The resident’s weight was monitored but for one resident the weights had not been recorded properly and it was unclear whether a considerable amount of weight had been gained or lost. Prior to the site visit a complaint had been made to the Commission about some aspects of care, including poor care of catheter bags, poor personal support to residents in matters of personal hygiene and the communal use of flannels (see “Complaints and Protection section). These issues were monitored as part of the inspection at the site visit. There was evidence, including information from the district nurse that people’s catheters were being cared for appropriately. There was no evidence at the site that the residents The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 14 were not supported in their personal hygiene. However there was evidence through talking to residents and staff that residents sometimes had to wait longer than they would like for assistance, and also to use the toilet adapted for people using wheelchairs and which was conveniently situated to the communal areas. There was sometimes an unacceptable wait for residents to use this toilet at certain times of the day. Another resident did not have a call bell accessible to her and could not summon help when needed. Also residents did not have personal flannels therefore it was possible that residents in shared rooms did use the others’ flannels and therefore there was a risk of cross infection. The medication policies and procedures had not been developed according to the previous requirements, and some practices were not as safe as they should be, potentially putting residents’ health at risk. However there were some good practices, such as the medication of newly admitted residents was confirmed with the GP, prescriptions were checked for errors prior to dispensing and the records viewed of medication received into the home and leaving the home were up to date and accurate. Residents who wanted to administer their own medication were supported to do so. Medication was stored securely in a trolley in the “treatment” room, and the temperature in the room was monitored. Controlled Drugs were stored safely and appropriate records kept. However the following concerns were found: Some prescription creams were left out in the bathrooms. For one resident whose Medication Administration Record sheet (MAR) was viewed it was confirmed by talking to staff that one medicine was being given at the wrong time in relation to food intake and that the instructions on the MAR were not being followed. This can reduce the effectiveness of the medication and can increase any side effects. Also this same resident did not receive any morning medication on the day of a morning hospital appointment. There was not a system or procedure in place for this. There were also examples of medication being listed on the MARs, which were not being given and which staff said had been “discontinued”. There were also examples of medication listed on the MARs as “when required” but which had not been needed for some time. There was no supporting explanation for these or evidence of having been reviewed by the GP. Not all the MARs were completed accurately, and there were examples of gaps in recording so it wasn’t clear whether or not medication had been given, for example one residents’ inhalers. One resident’s MAR was not completed properly and the recording of administration was not accurate – a number of mistakes had been made which made it difficult to see when medication had been given. One medicine had been prescribed for two weeks in the middle of the month but the MAR had not been completed properly and one dose had been missed. Also not all hand written additions/alterations to the MARs were being entered correctly, and were not being dated or signed. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 15 One person had stopped taking a controlled drug prescribed to assist sleeping and there was a supply left in the home. These were kept in case the resident needed them again. There were no supporting instructions from the GP about this. There was evidence that there were not sufficient written instructions to assist staff to administer “when required” medication correctly, and there was a possibility that one resident who was spoken to was not receiving enough medication to control pain. This pain relief medication was being given as “when required”. However this was not written on the MAR, which also showed that it was not being given up to the maximum dose. There was no written guidance from the prescriber about how this medication should be given and no guidance or indicators as to when the resident needed it. Residents who were spoken with stated that staff treated them appropriately and in a way that respected their dignity. One resident stated how much she valued quiet time in her room in the evening after tea. Both GPs who completed questionnaires stated that they felt the home respected the residents’ rights to privacy and dignity. However one matter was observed on the site visit, which could be seen as not upholding the dignity of one resident who was having all care in bed, was discussed with the person in charge. The matter was rectified before the end of the site visit. The Clitheroe Residential Care Home DS0000061349.V340171.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 good. This judgement has been made using available evidence including a visit to this service. There were varied leisure activities which appeared to suit the needs and preferences of the majority of residents. Residents had sufficient choices in their everyday lives and were enabled to maintain contact with their relatives and the community. The food served suited the needs and the preferences of the residents but there was not a good variety. EVIDENCE: There was a variety of activities to suit the interests and capabilities of most of the residents. Records, and the homes notice board showed activities such as quizzes, board games, trips out round the local beauty spots, entertainers and reminiscence sessions. There were opportunities for contact in the local community through trips out and visitors to the home such as the Salvation Army. The care plans recorded residents’ interests. Religious preferences were recorded on some care plans, and ministers from the local churches visited to give Holy Communion. Of the residents who completed the questionnaires three out of eight said there were “always” suitable activities, 3 The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 17 said “usually” and 2 said “sometimes”. One resident who was spoken with said that there was enough going on and that she enjoyed some of the activities. All the 4 relatives who completed questionnaires stated that the home communicated with them about changes in the residents and helped them to keep in touch. Daily routines appeared flexible enough to meet the resident’s preferences. Staff and residents spoken with stated that residents could get up and go to bed at a time of their choosing. Residents also stated that they could spend time in their rooms if they wished. A complaint was made prior to the site visit that alleged that residents were made to get up too early in the morning and go to bed too early in the evening. There was no evidence from this inspection that this was the case. Also at past site visits residents have been seen having breakfast at about 10.00am. However there were no set regular residents meetings so it was not clear how residents’ views and choices were exercised in the home. From the residents spoken with and those who completed the questionnaires there was evidence that the food served suited most of the residents’ tastes and preferences. However the menus did not show much variation in dishes with a number of traditional meals being repeated every few days. However since the previous inspection a choice of two main meals was offered at lunch time. There was also an option of a cooked breakfast and home baked cakes were available. Suitable meals were served to those with diabetes and staff gave appropriate assistance to those who needed it. Some residents spoken with said they enjoyed the meal at the time of the site visit. Most said the food in general was good and some said it was “alright”. One said the food was “very good” and another said, “I always enjoy my food”. Of those who completed the questionnaires 6 out of eight said they “always” liked the meals and 2 said “usually”. However it was unclear how the residents’ choices were accommodated as the manager compiled the menus and passed these to the cook. Prior to the inspection visit a complaint was made about the poor quality of food served in the home. At the time of the site visit there was no evidence from the menus viewed, and the food stocks seen, that the food in general was of poor quality. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. The residents and relatives felt that their concerns were taken seriously but it was not clear that complaints were thoroughly investigated. The way the home deals with allegations and suspicions of abuse would not help to fully protect people from harm. EVIDENCE: The home had a complaints procedure that was accessible to residents and visitors. Since the previous inspection minor complaints/grumbles were being recorded and these records also showed how they had been dealt with. All residents who completed questionnaires stated that they knew who to speak to if they were not happy and knew how to make a complaint. The four relatives who completed questionnaires said they knew how to make a complaint and that the service had responded appropriately when they had made a complaint. Since the previous inspection, two complaints containing a number of different elements had been received by the Commission, and according to the Commission’s policy had been referred to the registered provider to investigate. The details of these investigations and the outcomes were submitted to the Commission, and the different elements of the complaints were monitored at the site visit. The findings have been referred to in the relevant parts of the report. However the information supplied to the The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 19 Commission by the registered provider did not fully show how the investigations had been conducted or how conclusions had been determined. Records of these investigations were not available for viewing at the time of the site visit so it was not clear whether or not the complaints had been investigated thoroughly enough. Part of one of the complaints outlined above made to the Commission was an allegation that a member of staff had “bullied and threatened” a resident. This had not been dealt with appropriately according to procedures and Government guidance, although the member of staff concerned was no longer working in the home and residents were not at risk. Although the registered provider had informed the Commission of what action had been taken regarding this incident there were no records available for viewing at the time of the site visit to demonstrate this, including a record of the incident on the file of the resident concerned. The home’s written policies and procedures to protect residents from abuse were satisfactory, and in accordance with Government guidance. However these procedures had not been followed in the example given above. Staff had also undertaken in house training in this matter. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 20 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, 21, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was adequately maintained and furnished in most areas and provided comfortable accommodation. However some carpets were in need of restoring or replacing. There was a satisfactory standard of cleanliness in most areas of the home but some bedrooms had unpleasant odours. EVIDENCE: In general the home was maintained, decorated and furnished to a satisfactory standard. The AQAA stated that the grounds outside the home were regularly tidied and that the whole outside of the building had been decorated. The conservatory lighting had been renewed and a new central heating system installed. However the home’s boilers needed major renewal and replacement following a flood in the basement. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 21 Since the previous inspection the CCTV camera had been removed from the office and this increased the privacy of members of staff and visitors that used the office. There were two toilets conveniently accessible from the ground floor communal areas. However there was evidence that the facilities adapted for people with mobility problems were insufficient to meet the needs of the present group of residents, as residents had to sometimes wait an unacceptable length of time to use these facilities (see “health and personal care”). Residents’ bedrooms appeared to be suitable for their needs and most residents had brought small personal items with them. Residents spoken with were contented with their bedrooms. Hot water was tested at a number of random outlets and found to be within an acceptable range. This was therefore safer than at the last inspection. The person in charge of the home at the time of the site visit stated that the water temperatures were now monitored regularly and adjusted according. A complaint had been made to the CSCI about the unpleasant odours in the home, areas being unclean and unhygienic, and bathrooms “smelling of clinical waste”. The registered provider in his response to this complaint, and the AQAA, stated how all areas of the home were kept clean and odour free. However at the time of the site visit some bedrooms had an unpleasant odour and one en suite WC in particular had a very strong unpleasant odour of urine that affected the nearby corridor. The continence pads in this WC were not being removed frequently enough. In addition a number of carpets, both in bedrooms and in the corridors, were dirty and badly stained. District nurses’, and other equipment, was left on floors in bedrooms which made the rooms look untidy and institutionalised. However the communal bathrooms did not smell of “clinical waste” and the communal areas on the ground floor were clean and fresh. Of the resident who completed the questionnaires, four said that the home was “always” fresh and clean and 4 said “usually”. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It was not clear that the numbers and skills of the staff were meeting the needs of all the residents. Staff recruitment procedures were sufficiently thorough to help ensure that unsuitable staff did not work in the home. EVIDENCE: Following concerns at a previous inspection last year regarding staffing levels being suitable for meeting the needs of the residents, additional care hours were provided for a few hours in the afternoon so that 3 members of care staff including the manager were on duty from 8.00am until 10.oopm. However a complaint made to the CSCI in May 2007 alleged that the home was “understaffed”, according to the needs and dependency levels of the residents. This meant that residents “had to wait a long time for attention because the staff were too busy”. Investigations by the registered provider concluded that there were enough members of staff on duty at all times to meet the needs of the residents. Although some rotas were supplied to the Commission as part of his investigations to support these conclusions, no evidence was supplied which showed that the numbers of staff on duty were sufficient to meet the needs of the current group of residents. At the time of the inspection the home was staffed according to the rotas, including a cook and a cleaner working in the home. Staff on duty stated that The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 23 they felt there were enough staff on duty most of the time except when there were problems with sickness and staff vacancies as had happened recently. Agency staff were then used, which could have lead to problems with efficiency and time management and the some of the issues referred to in the complaints. However there were a number of residents who needed considerable supervision and support from two members of staff, including 2 residents having all their care in bed, and some with what staff described as “challenging behaviour” (see previous section). Observations at the site visit did not indicate that in general residents had to wait unacceptable lengths of time for assistance and most residents spoken with stated that staff attended them within a satisfactory time. Two residents said you do have to wait for attention some times, but one said “you can’t expect a member of staff all to yourself”. However one very dependent resident stated that staff did not attend as quickly as she would like, and some of the care practices referred to above could indicate that staff felt rushed. One resident stated on the questionnaire that the home “was short staffed at times”. One professional visitor to the home said that the home was “short staffed at times, particularly when there was only 2 staff on duty”. It was also not clear that the staff numbers, and expertise in relation to challenging behaviour, were sufficient to meet the needs of all the residents. There was also evidence that there were insufficient domestic hours to keep all parts of the home clean and fresh at all times (see “Environment”). Information supplied on the AQAA stated that 67 of care staff was qualified to at least NVQ 2. Therefore a previous requirement had been met and showed that more staff had gained the right qualifications for working with older people. Records and staff spoken with showed that all staff who administer medication had in house training and training by a training company. Most training was delivered “in house”, through DVDs. This included courses on abuse, infection control, health and safety and dementia. Also there was no evidence that a member of staff, who had been appointed as a care assistant without prior experience and qualifications, had undertaken the comprehensive Induction recommended by Government (“Skills for Care”) guidance. The procedures followed for staff recruitment had improved since the previous inspection and were now in accordance with the Care Homes Regulations. Records of two recently appointed members of staff showed that all the necessary employment checks had been completed prior to employment, including the Criminal Records Bureau and Protection of Vulnerable Adults checks and written references. However for one member of staff whose records were viewed, a friend had been used as one referee instead of an available employer of a care service. This meant that not enough available information had been sought about this person’s relevant work experience. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was managed by an experienced and qualified manager but there were matters in the home which were not being satisfactorily addressed. Quality assusrance policies and procedures were implemented which take into account the views of residents and relatives. Residents money was managed safely and efficiently and the health and safety of both residents and staff were promoted. EVIDENCE: An experienced and qualified manager, who was registered by the Commission in 2005, managed the home. She had worked in the home for a considerable time, and the residents and staff benefited from her experience and knowledge of the home. One member of staff described her as “an inspiration” and that The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 25 she was very approachable and encouraging. The registered person, Mr Mahmood Ahmad, visited the home on a regular basis and provided the Commission with a report of these visits in accordance with the Care Homes Regulations. Staff spoken with confirmed that regular staff meetings were held to assist communication and allow staff a voice in the running of the home. The home’s quality monitoring systems included 2x yearly questionnaires sent to residents, relatives and staff. Since the previous inspection the registered provider has demonstrated how these were analysed and used to develop the service. However a complaint had been made to the CSCI in March alleging that any questionnaires with negative views were shredded. Though some questionnaires were looked at it at the site visit, it was not possible to ascertain whether or not any had been previously shredded. All the residents who completed the questionnaires stated that the staff listen to them and act on what they say. Records of residents’ finances viewed, and discussion with the administrator, showed that the residents’ finances were managed efficiently and the records were well kept. All residents had bank accounts and paid fees through standing orders. Residents’ spending money was kept in the office safe. Accurate records were kept of money received and spent and a spot check on two residents’ monies showed that the amount remaining stated on the records balanced with the amount held in the safe. The home’s health and safety policies and procedures helped to ensure that the home was a safe place to live and work. Fire equipment, gas and electrical appliances and installations in the home had been serviced appropriately. There was a person competent in first aid on every shift. Fire precautions were satisfactory and staff had completed appropriate fire safety training. Other relevant health and safety training such as moving and handling, food hygiene and infection control training was done in house with DVDs (see “Staffing “ section). Not all “notifiable incidents” under the Care Homes Regulations were being reported to the Commission, so for example accidents and falls could not be monitored properly. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X 2 X 3 2 X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (2) Requirement The residents identified at the inspection must have their needs reassessed, including mental health needs and challenging behaviour to help determine whether or not the home has the right resources to look after them. All care plans must be reviewed and the written plan updated 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, pressure areas and the use of bed rails. There must also be supporting information about the use of only one side of the bedrails. The moving and handling transfer practices of the resident identified must be urgently reviewed to ensure that both the resident and staff are not in danger of injury. DS0000061349.V340171.R01.S.doc Timescale for action 21/08/07 2. OP7 15 (b)(c) 17/08/07 3. OP8 13 (5) 31/08/07 The Clitheroe Residential Care Home Version 5.2 Page 28 4. OP8 13 (4)(c) 5. OP8 13 (4)(c) 6. OP8 13 (4)(a) 7. OP9 13(2) 8. OP9 13(2) 9. OP9 13(2) 10. OP9 13(2) The registered person must ensure that the bedrails are fitted properly, and with bumpers, so that there are no gaps between the mattress and the rail and so eliminate the risk of entrapment. If a risk assessment determines that a resident cannot use a foot plate on a wheelchair the registered person must ensure that residents are transported safely and protected from the danger of injuring legs and feet caught under the wheel chair All residents must have access to a call bell in their bed rooms unless there is a risk assessment to indicate that this is inappropriate The medication policies and procedures must be developed and completed according to the Royal Pharmaceutical Guidelines and must include: Residents’ leave/visits away from the home, Use of Oxygen, PRN and Variable dose medication, Verbal changes and Covert administration. (Previous timescale of 30/06/06 not met) Medicines must always be given at the correct time as per the instructions on the Medication Administration Record in relation to before and after food. Failure to do this can affect the effectiveness of the medication and increase the side effects. Medication must always be given as prescribed including when residents leave the home for short periods such as hospital appointments. The instructions for “when required” medication and variable dose medication must DS0000061349.V340171.R01.S.doc 10/08/07 10/08/07 17/08/07 24/08/07 10/08/07 10/08/07 10/08/07 The Clitheroe Residential Care Home Version 5.2 Page 29 11. OP9 13(2) 12. OP9 17(1)(a), (3) (i) 13. OP16 17(2) (11) 14. OP18 13(6) 15. OP26 16(2)(k) 16. OP27 18(1)(a) be clearly clarified with the resident’s GP and the signs of when it should be administered must be written down on or near the MARs. This is so that residents take the correct medication according to their needs and the prescriber’s instructions. (Previous timescale of 17/06/06 not met) PRN medication and other medication that is no longer being taken, but still being prescribed or listed on the MARs must be reviewed with the GP. (Previous timescale of 17/06/06 not met) The MARs must be completed accurately with there must be no gaps in the recording of the administration of medication without supporting explanations. Details of all complaints received and investigated, including those passed to the provider from the Commission, must be fully recorded and records kept in the home. In order to protect residents from abuse the correct procedures, according to local and Government guidance and according to the home’s own procedures, must be followed. A plan must be urgently put in place to keep the en suite WC identified clean, hygienic and odour free. All other parts of the home must be kept clean and odour free. (Previous timescale of 30/06/06 not met) The registered person must ensure that there are sufficient members of staff in the right numbers and with the right knowledge and expertise to meet DS0000061349.V340171.R01.S.doc 17/08/07 10/08/07 10/08/07 10/08/07 10/08/07 31/08/07 The Clitheroe Residential Care Home Version 5.2 Page 30 the needs of all the residents at all times and to ensure that satisfactory levels of cleanliness and hygiene are maintained. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The care plans must include all the action to be taken to ensure all aspects of health, personal and social care needs of the service user are met, for example in relation to nutrition and diabetes, mental health and risk assessments in relation to pressure areas and the use of bed rails. The registered person should ensure that all resident’s weights are recorded consistently either in imperial or metric measurements and recorded accurately. Toilet facilities on the ground floor in conjunction with care issues need to be reviewed to ensure that residents are not waiting an unacceptable length of time to use the toilet. It is recommended that in shared rooms to enhance the residents’ dignity and personal hygiene residents have their own personal flannels. All medication, including creams, should be stored securely and not left out in bathrooms. Medication reviews should be prompted on a regular basis and in line with the recommendations in the National Service Framework for Older People (This recommendation carried forward from last 2 inspections) All hand written additions/alterations to the MARs should be dated, signed and witnessed to help ensure that the correct information is written down. There should be supporting instructions from the GP if controlled drugs are stored in the home for future use. The menus should be reviewed with residents to ensure that more choice and variation is introduced. These records must include all details of the investigations conducted and the people interviewed. DS0000061349.V340171.R01.S.doc Version 5.2 Page 31 2. 3. OP8 OP8 4. 5. 6. OP8 OP9 OP9 7. 8. 9. 10 OP9 OP9 OP15 OP16 The Clitheroe Residential Care Home 11. 12. 13. OP19 OP19 OP29 14. OP30 15. OP38 It is recommended that the equipment used by district nurses, and other equipment, is stored tidily and safely and out of sight. It is strongly recommended that all the badly stained carpets are replaced. It is recommended that employment based references are always sought when this is at all possible, and that referees from employers of a care service are always used when this is an option. Newly appointed staff who have not got previous experience in care, or relevant qualifications, should undertake a comprehensive induction in accordance with the “Skills for Care” guidance. The Commission should be notified of all the incidents and accidents that affect the well being of the residents. The Clitheroe Residential Care Home DS0000061349.V340171.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. 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