Inspection on 28/02/08 for The Clitheroe Residential Care Home

This inspection was carried out on 28th February 2008.

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 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

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

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

The Clitheroe Residential Care... 18/07/07

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 28th February 2008 10:00 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 The Clitheroe Residential Care Home DS0000061349.V356885.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.V356885.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 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.V356885.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 5th December 2007 Date of last inspection Brief Description of the Service: 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 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. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means that people who use the service experience adequate outcomes. This inspection site visit to The Clitheroe was carried out on the 28sth February 2008. The site visit was part of an inspection to determine an overall assessment on the quality of the services provided by the home (see above). 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 that had been the subject of an Improvement Plan submitted to the Commission. Since that time three Random Inspections have also been undertaken as part of the plan to improve the service. One Random inspection was undertaken on the 18/10/07 following the report of a complaint to the Commission (see main body of the report). Another was undertaken on 01/11/07 by the pharmacy inspector to investigate medicines management in the home (see main body of the report). The third Random inspection was carried out on the 05/12/07, the purpose of which was to monitor the Improvement Plan referred to above. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents and discussion with the manager. Seven residents spoken with gave their views on the home. In addition survey questionnaires from the Commission were sent to residents, relatives, staff and health professionals asking them for their opinion of the home. Eleven residents, six relatives and twelve members of staff returned completed questionnaires. In addition two visiting heath care professionals returned questionnaires. Some of the views of these people are included in the report. In addition the home provided the Commission with written information about the residents, staff and services provided, and some of this is also included in the report. What the service does well: Residents felt they were well looked after in the home, and they spoke highly of some of the staff. One resident said that staff, “were very kind and hard working”. Another said in discussion, “I think it’s a marvellous place for elderly people”. One resident in the questionnaire said, “Staff are always there for you”. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 6 Relatives who completed the questionnaires also generally had a favourable view of the home. One relative said, “They are all caring staff who make the residents feel at home”. Another said, “On the whole staff are kind and treat residents with respect” Residents have consistently praised the food served, and those who completed the questionnaires either “always” or “usually” enjoyed the meals. One said, “Of course I enjoy my food”. The residents spoken with were positive about the food. Relatives felt that the home created a friendly welcoming place for residents and visitors. In a questionnaire one said, “Staff make relatives and friends feel welcome and you feel part of a family – staff seem friendly and happy”. In general contact and communication between the home and relatives was good. The home had suitable standards of décor and furnishing. Residents were generally satisfied with their private bedrooms and appreciated being able to spend time in their rooms. What has improved since the last inspection? There had been a number of improvements since the previous Key Inspection. Residents’ mental health was being better monitored and the advice of mental health professionals was being sought to help the staff look after people with problems related to dementia and difficult behaviour. The written care plans had improved to help staff look after people and ensure that they received the care and support needed Medication management in the home had improved considerably and residents were now receiving medication safely and at the right time. The food menus had improved, there was a greater variety and a new cook was trying different ideas. Residents were more involved in the planning of the food. The way the home managed concerns and allegations of abuse by staff towards residents had improved and the manager was now ensuring that correct procedures were followed to ensure that residents were protected. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 7 Better records of these incidents were now being kept in the home so it was clear what action had been taken. Some parts of the environment had improved to make it more pleasant for the residents. The unpleasant odours in some of the bedrooms and communal areas had been eliminated. There were a lot of new carpets in the bedrooms and corridors replacing those that were badly stained. The bedrooms were also tidier and most nursing equipment stored out of site. This made the environment look more homely. The staffing numbers on duty were now being organised according to the needs of the residents and the shift pattern had changed to the advantage of residents and staff. The training staff were undertaking had improved and staff informed us that they and residents were benefiting from this. For example all staff had undertaken the recommended moving and handling training which enabled them to understand and safely carry out the residents moving and handling requirements. Staff had also undertaken suitable training in the protection of people from abuse and this will help to ensure that people are safe. The management of the home had improved. There was a new manager who was working on the areas in the home that needed improving and she showed commitment to continuing improvement. What they could do better: The assessment undertaken of the needs of people who want to come and live in the home to help decide whether or not the home can meet these needs, should be written down so that there is a basis for making this decision and so that staff have written information to follow. The care plans could be further improved and updated when the care needs of people change and also to give clearer guidance to staff about how to look after some people with behaviour that potentially puts staff and other residents at risk (see below). The process followed when people refuse to take medication should be in accordance with legislation to help ensure the right decisions are made about whether or not and how the medication should be given. The home needs to review the activities offered in the home to establish to make sure there are stimulating alternatives for people with specific difficulties such as those with dementia. Some residents and relatives felt that there were not enough suitable activities. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 8 The records kept of some complaints that had been investigated should be improved so that it is clear what action has been taken and how the matter has been resolved. The hot water temperatures in bedrooms and bathrooms were still unreliable, and were too hot at the outlets tested at the time of the site visit. This potentially put residents at risk and the monitoring system was not working as effectively as it should to identify and act on this risk. When recruiting new members of staff to work in the home the manager should make sure that the references sought and accepted are in accordance with good practice to ensure that a genuine view of applicants’ work performance and character is given and also that references are obtained before people commence work. The training programme could be further improved, and staff still needed training and guidance on how to look after people with difficult behaviour and how to manage this so people are not at risk. Some other aspects of the building’s safety could be improved and the gas appliances and the boilers must be suitably serviced and maintained. 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.V356885.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.V356885.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 helped prospective residents, relatives and staff decide whether or not the home would be suitable for people. However this process would be improved with written information about the pre admission assessment so that people’s needs are clear and whether the home can meet them. EVIDENCE: The written information about the home – the Statement of Purpose and the Service User Guide – had been updated since the previous inspection. This information was in accordance with the Regulations, and in a standard format, and provided people with useful information about the home. Most of the residents and relatives that completed questionnaires were satisfied with the 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 Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 11 The admission procedures for new residents were adequate. 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 one new resident whose records were viewed there were no records of the pre admission assessment to assist staff to understand her needs on admission. Therefore it was not clear whether or not the assessment was sufficiently comprehensive. Also there was no social work assessment to assist staff i8nn this process. An assessment of need that was 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. As part of the overall assessment process risk assessments regarding falls, nutrition, pressure areas and moving and handling were undertaken. However on some of the records viewed the falls risk assessments were of a general nature and not as specific to individuals as they should be. Since the previous key inspection some residents who had lived in the home for some time and who were described as having aggressive and difficult behaviour, had had their mental health needs assessed by the specialist team. For one resident whose records were viewed this assessment indicated that she should continue to live at the Clitheroe. However there was still a lack of clarity about how, and if staff, were equipped to manage this behaviour and whether or not the home was able to meet her needs (see next section). The survey questionnaires indicated that in general residents and relatives thought their needs were met within the home. Most resident said they always received the care and support needed though only five out of eleven said that staff were “always” available when needed. Most relatives also felt that the needs of the different residents were met and that people were supported to live the life they had chosen, though one commented that this depended on whether or not there were enough staff on duty. This view was supported by two visiting health care professionals who commented that the home appeared short of staff at certain times, particularly in the morning, and that at these times residents have to wait to have their basic personal care needs met (see next section). The Clitheroe Residential Care Home DS0000061349.V356885.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 adequate. This judgement has been made using available evidence including a visit to this service. All residents had written care plans which had been developed and improved, but not all yet included sufficient up todate information about all aspects of Health, Personal and Social Care to assist staff in the delivery of consistent care. Medication procedures had improved and ensured the correct and safe administration of medicines. The residents right to privacy was respected but some aspects of dignity could be improved. EVIDENCE: Viewing of records showed that residents had written care plans based on an initial assessment that began on admission. Some care plans that were viewed at the previous inspection were looked at again at this site visit to see how they had developed. All residents had new care plans, in a new format, including those that were referred to at the previous inspection. The care plans overall had improved and most of them included more useful detail and The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 13 more up to date information. There were risk assessments underpinning nutrition, moving and handling and pressure areas and these had also been developed and improved since the last key inspection. However for one resident who had an ongong history of verbal and physical aggression and who had a recent mental health assessment, there was not enough information or guidance on the care plan about this assessment and how staff should manage the behaviour. The assessment had also recommended training for staff in challenging behaviour to assist them with the care of this person. This had not yet been undertaken, and there was a lack of clarity as to the extent of this person’s aggressive behaviour. However the daily records showed that there were a number of recent incidents that potentially put staff and other residents at risk, and which indicated that further input may be required from the mental health team. Also another resident’s care needs had changed considerably over a short period of time but the care plan had not been updated including the risk assessment for pressure areas. The new manager was working in partnership with the health care professionals to promote the residents’ health. 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. Since the previous key inspection the new manager had realised the importance of monitoring and assessing the mental health of residents. Most residents who completed the questionnaires said that they always had the care and support they needed and always had medical support when needed. Most relatives also felt that residents always got the care and support that residents needed, and that was agreed. However according to the visiting professionals who completed the questionnaire, health problems were not always reported as early as they should be and they have noted that sometimes residents have to wait to have their basic care needs attended to, particularly in the morning when the home appears to be short staffed. One relative also raised a matter about personal care and dignity in a questionnaire that was discussed with the deputy manager subsequent to the site visit. The management of the risk to some residents of falling out of bed had improved. Bed rails were not used without a full risk assessment and “crash mat” on the floor were used instead of bedrails if this was deemed more appropriate. Also on this inspection all residents had access to a call bell to summon help if needed. The resident’s weights were monitored and recorded and this was now being done accurately and uniformly, so it was clear whether people had gained or lost weight. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 14 A pharmacy inspector from the Commission had inspected medication in November 2007 and found a number of practices that caused concern. At this key inspection it was found that the procedures and practices had been improved and developed according to the requirements made by the pharmacy inspector. There were some good practices, such as prescriptions being checked for errors prior to dispensing, and the records viewed of medication received into the home and leaving the home were in general 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. The training for staff had improved and regular internal audits were being undertaken to identify and rectify mistakes. The MAR sheets viewed were accurately completed and showed residents were receiving the correct medication at the right time. Most medication had been booked into the home accurately; only one omission was noted. However the following improvements could be made: The criteria for when to administer a controlled drug to one resident needed to be clearer, more detailed and written down. In addition the process followed for administering medication covertly to one resident was not clear, and their was insufficient supporting documentation of the decisions made and why. Although it was clear the General Practitioner had been involved, correct procedures under the legislation (The Mental Capacity Act) and the Royal Pharmaceutical Guidelines of Great Britain had not been followed. Most residents who were spoken with stated that most staff treated them appropriately with respect and in a way that upheld their dignity. However there were some residents who had reported concerns about staff attitude to the manager, and who had addressed these concerns (see Complaints and Protection). Two observations made at the site visit that affected residents’ dignity were also discussed with the deputy manager. One of these was regarding the way food was presented to a resident in their bedroom and the other was regarding finger - nail care. The visiting professionals also commented in the questionnaire that, “privacy and dignity of residents has sometimes been compromised” The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 15 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. The lifestyle experienced in the home met the expectations and preferences of most of the residents but the range of leisure activities could be improved to include all 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 and there was sufficient 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, entertainers and music sessions. However their were no specific activities to suit the needs of people with dementia and this was being reviewed by the manager and staff. There were opportunities for contact in the local community through visitors to the home such as the Salvation Army. Some care plans recorded residents’ interests but this was The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 16 not detailed on one care plan viewed. Religious preferences were recorded on some care plans, and ministers from the local churches visited to give Holy Communion. Of the 11 residents who completed the questionnaires most residents thought there were “usually” or “sometimes” suitable activities. The residents spoken with at the site visit said that there were good activities around Christmas time but that these had tailed off now. The comments made by relatives were inconclusive. One said that there seemed to be “quite a lot of activities and parties” and another said “there could be more activities”. However relatives were positive about the home and staff helping the residents keep in touch with them and communicating with them about important matters. They also felt they were made welcome in the home. Comments were made such as “visitors are made welcome and get a cup of tea”, and “staff make relatives and friends feel welcome and you feel part of a family”. 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 From the residents spoken with and those who completed the questionnaires there was evidence that the food served suited residents’ tastes and preferences. One said, “the meals are very good”, another said, “of course I like the meals”. The menus had also been reviewed since the previous key inspection and showed more variation with some new more non - traditional dishes being tried. There was a choice of two main meals 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. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 17 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 good. 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 and concerns and complaints were investigated. The policies and procedures and staff training regarding Adult Safeguarding would help to protect people from abuse. EVIDENCE: The home had a complaints procedure that was accessible to residents and visitors. 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. Five out of the 6 relatives who completed the questionnaires also said they knew how to make a complaint and one said they did not. Relatives were generally satisfied about the way their concerns were handled and from the “complaints and concerns” records seen it was clear that concerns had been reported and acted upon. Some residents spoken with said that they had been able to raise some matters of concern regarding staff, directly with the manager and that these matters had been dealt with and resolved. However full details of these investigations had not been recorded so the action taken and the outcome could not be confirmed. Since the previous key inspection one complaint containing a number of elements about infection control procedures had been reported to the Commission, and which led to a Random inspection being undertaken to investigate whether or not any Regulations had The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 18 been breached. Most elements were found to be unsubstantiated but the Commission highlighted a concern about laundry washing temperatures and a strong odour of urine in one of the bedrooms. Both these matters have since been rectified and the improvement sustained. The home’s written policies and procedures to protect residents from abuse were satisfactory, and in accordance with Government guidance. These had been implemented and followed when an allegation of abuse was made at the home in December 2007. The matter had been resolved, and events and action taken recorded, in such a way as to help protect residents from unsuitable staff. Since this incident staff had also undertaken more thorough training in this matter and this will also help to prevent such incidents and/or ensure appropriate action is taken. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 19 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, 23, 24, 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 was suitably maintained and furnished in most areas and provided comfortable accommodation, and a number of areas had been improved through refurbishment. There was a satisfactory standard of cleanliness in most areas of the home . EVIDENCE: A tour of the premises showed that there had been a continuing programme of refurbishment since the last inspection. This confirmed the information the home supplied to the Commission prior to the site visit. There were new carpets in the lounge areas, corridors, landing and bedrooms. Some bedrooms had been decorated and new soft furnishings purchased. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 20 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 considerably higher than the acceptable range. We were informed that the temperature of the boiler had subsequently been readjusted accordingly, that water temperatures at sink and bath outlets were cooler and that temperatures would be better monitored. The standard of hygiene and cleanliness in the home was of a satisfactory standard and there had been a number of improvements since the last key inspection. At this site visit, less bed - rooms had unpleasant odours of urine, and one room that had been particularly troublesome in this respect, was odour free. Several bedrooms were still malodorous but appropriate action was being taken to address this. Half the residents who completed the survey questionnaires said that the home was “always” fresh and clean, the other half said “usually”. The laundry facilities had improved. There was a new washing machine with a sluicing facility and a range of temperature settings for washing different types of laundry and also different procedures for the washing of soiled laundry. Therefore a requirement made at one of the previous Random inspections had been met (see “Complaints and Protection”). The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skills of the staff were meeting the needs of the majority residents though staff did not have the training to help them look after some residents specific care needs. Staff recruitment procedures needed improving to ensure residents were protected from unsuitable staff. EVIDENCE: At the time of the site visit we were informed that the staff numbers were sufficient to meet the needs of the residents. There was also a cook and a cleaner working in the home. The new manager had recently reorganised the staff shift patterns and the rotas, and she felt that the changes better met the needs of the residents and the staff. The residents’ survey questionnaires, and discussions with residents, indicated that in general staff were available when residents needed them, and that they received the care they needed. However one relative expressed the view that the home was sometimes short of staff and that her relative had to wait for care. The visiting professionals also expressed this view, and said they felt residents sometimes had to wait for basic care, especially in the morning. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 22 In the 12 staff survey questionnaires completed, 8 said there was “usually” enough staff on duty and 3 said “always”. One comment made was that “staffing has been a big problem in the past but it is now working really well” With respect to staff qualifications and training, 64 of staff were qualified to at least NVQ level 2 and the remaining staff were on NVQ courses. This was helping to ensure that staff had skills and knowledge to carry out their work. Relatives who completed the survey questionnaire felt that staff had the right skills for the job. The staff training programme had improved since the last key inspection. The new manager was introducing better training courses some involving external trainers - and this was giving staff a wider, more up to date, perspective. This included updated moving and handling and training in abuse and Safeguarding matters. According to the staff survey questionnaires, the staff appreciated this development. All 12 who completed the questionnaires said they were now given relevant up to date training that helped them meet the needs of the residents. Staff also felt that the Induction course, when they first started work, was suitable and covered everything they needed. However staff had still not 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 (see previous sections) The records of the two most recently appointed members of staff showed that the procedures followed for staff recruitment involved completing all the necessary checks, such Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks and written references. However these procedures could be improved. For one member of staff whose records were viewed she had commenced work with POVA but before the full CRB check and the references had been obtained. Also this person had no previous experience in care and the Induction records were incomplete so did not demonstrate that she had undertaken a suitably in depth Induction. For another member of staff two references had been sought from the same employer though there were other places of employment that could have been used to give a more reliable view about this person’s performance at work. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 & 38 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 who had improved some aspects of the home. Staf felt well supported and supervised. The health and safety of both residents and staff were promoted but some safety aspects of the home could be improved. EVIDENCE: A new manager was appointed to the home in October 2007 following the retirement of the previous manager. She had previous experience as a “unit manager” in a home looking after people with dementia and many more years experience working in care. She had gained a number of qualifications The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 24 including NVQ level 4 in Care. At the time of this site visit the manager had applied to the Commission for Registration and had begun the Registered Managers Award. Since her appointment the manager had implemented a number of changes and these have been referred to throughout the report. These had been implemented to ensure that previous requirements and recommendations and that the Improvement Plan for the home was implemented. From the questionnaires and a discussion with a member of staff it was apparent that most staff viewed the change of management style and work processes positively. One member of staff said “the service has greatly improved since the new manager’s arrival”. Another said, “she is very supportive”. The responsible individual and company representative visited the home regularly 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 staff survey questionnaires showed that staff felt that communication within the home worked well. The manager was now undertaking staff “one to one supervisions”, approximately every 2 months, and this was confirmed by members of staff who completed the questionnaires. This was helping to encourage and support staff through an unsettling period of change in the home. The home’s own quality monitoring measures were not fully assessed at this inspection, as they had been inspected at the last key inspection less than a year ago. However it was established that questionnaires were sent to residents and relatives at least once a year. All the residents who completed the Commission’s questionnaires stated that the staff listen to them and act on what they say. The home’s health and safety policies and procedures helped to ensure that the home was a safe place to live and work but some safety aspects could be improved. Fire equipment and electrical appliances and installations in the home had been serviced appropriately. There was a person with first aid training on every shift and information was given regarding the Commission’s guidance on the level of first aid cover required. Fire precautions were satisfactory and staff had completed appropriate fire safety training. However it was unclear whether or not the gas appliances were being appropriately serviced and maintained, including the central heating system as up to date records were not available at the time of the site visit. As recorded in a previous section of the report there was also a problem with the home’s boiler(s) and hot water temperatures. These problems were ongoing over a number of inspections, and though the hot water temperatures were being monitored and recorded, the problem at the time of the site visit had not been identified or brought to the attention of the manager, and no action had been taken. Since the site visit the owner provided reassurance to The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 25 the Commission that the boiler work required would be carried out when the weather turns warmer and discomfort to the residents will be minimum. As stated above the manager was reviewing staff training and this included plans for revamped training on infection control and health and safety. Records showed that some staff needed updated training in these topics. All staff had received recent moving and handling training from an external source and which had proved beneficial. Since the previous key inspection the manager was now notifying the Commission of relevant events affecting the residents so these could be monitored. The Clitheroe Residential Care Home DS0000061349.V356885.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 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x 3 3 2 2 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x x x 2 The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 (b)(c) Requirement All care plans must be 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. Staff must undertake training in “challenging behaviour” to assist them to understand and manage such behaviour effectively. Residents must be protected from the hazards of water that is too hot and this should include a DS0000061349.V356885.R01.S.doc Timescale for action 31/03/08 2. OP9 13(2) 30/04/08 3. OP29 19 (1)(c) 31/03/08 4. OP30 18(1)(a) 31/05/08 5. OP38 13(4)(a) 31/03/08 The Clitheroe Residential Care Home Version 5.2 Page 28 6. OP38 13(4)(a) reliable system of temperature monitoring and adjustment. The gas appliances in the home must be appropriately maintained and serviced 31/03/08 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. 2. Refer to Standard OP3 OP3 Good Practice Recommendations The pre admission assessment should be written down so that staff have written information to help them understand residents’ needs. The pre admission assessment should contain sufficient detail on all matters of health, personal and social care to enable staff to understand these needs and assist them look after people. Risk assessments for falls should be specific to individuals and indicate when and how the risk is likely to occur, under what circumstances and how the risk can be eliminated or reduced. Care plans should contain sufficient information in all areas of health, personal and social care, including the management of challenging behaviour, oral care and leisure interests. Clear criteria for the administration of all “when required” medication should be written down so that staff know when it should be given and when not. The medication audits to ensure mistakes are identified and rectified should be undertaken by the manager and records of these kept in the home. 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 provided some activities for people with specific needs such as those with dementia. All investigations made into a complaint should be fully recorded, including all interviews with people concerned and the action taken. DS0000061349.V356885.R01.S.doc Version 5.2 Page 29 3 OP3 4. OP7 5. OP9 6. 7. OP10 OP12 8. OP16 The Clitheroe Residential Care Home 9. 10. OP25 OP30 All parts of the home should be kept in good state of repair including the home’s boiler. Appropriate records should be kept of the Induction training undertaken by newly appointed staff to demonstrate that the induction is appropriate and in accordance with the Skills for Care guidance. Staff should undertake appropriate training in dementia. 11. OP38 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. The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 30 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. Extracts may not be used or reproduced without the express permission of CSCI The Clitheroe Residential Care Home DS0000061349.V356885.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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