Inspection on 05/02/07 for The Clough Residential Home

This inspection was carried out on 5th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Clough Residential Home 18/03/09

The Clough Residential Home 17/01/06

The Clough Residential Home 05/08/05

The Clough Residential Home 06/01/05

The Clough Residential Home 04/08/04

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 Clough Residential Home Chorley New Road Bolton Lancashire BL1 5BB Lead Inspector Jenny Andrew Unannounced Inspection 5th February 2007 08:30 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 Clough Residential Home DS0000009285.V308226.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 Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Clough Residential Home Address Chorley New Road Bolton Lancashire BL1 5BB 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) 01204 492462 01204 495314 wendy.williams@arc-homes.co.uk Aegis Residential Care Homes Limited Mrs W Williams Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 32 service users, to include: up to 32 service users in the category of OP (Older People) The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 17th January 2006 Date of last inspection Brief Description of the Service: The Clough is a detached converted property situated in a quiet residential area of Bolton, off Chorley New Road. The house is set in its own very large beautifully kept gardens and there is ample parking. There is easy access to Bolton town centre and the surrounding motorway network. Whilst the main door is accessed via a number of steps, the door at the side of the home allows a level access for wheelchair users and people who have problems climbing steps. With the exception of 2 shared rooms, accommodation is in single bedrooms, which are on the ground and first floor levels. A large lounge overlooks the garden at the front of the house plus a large dining room. Attached to this is a conservatory. There is also a smaller lounge area that is known as the library. Most of the toilets and bathrooms have aids to assist any resident with a disability or mobility problem. Weekly fees are from £345.04 - £475.00 as at February 2007. The higher charges are made to people who pay for themselves if they want a larger ensuite bedroom. Additional charges are made for private chiropody, newspapers/magazines, dry cleaning, day trips and hairdressing. The provider makes information about the service available in the form of a Service User Guide and Statement of Purpose, which are given to new residents. A copy of the Commission for Social Care (CSCI) inspection report is displayed in the entrance hall so the residents and visitors to the home may read it. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over eight and a quarter hours and was done by one inspector. The home had not been told beforehand that the inspector would visit. The inspector checked what was written down about the residents (care plans), looked around some of the building and also looked at a number of records. In order to get more information about the home, the manager, 7 residents, 2 care assistants, 2 senior care assistants, the cook and 2 visitors were spoken to. The inspector also watched how the staff cared for the residents. In addition, comment cards were sent out before the inspection to professional visitors, relatives and residents. Of these 8 relative and 6 residents questionnaires were returned and these, together with other information, which had been received about the service, over the last few months, has been used as evidence in the report. What the service does well: Before residents went into the home, the manager visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. Residents spoke well about the staff who cared for them and the manager. They said the staff were, “good”, “very nice”, “hard working”, “give me the help I need”, “come quickly if you press the buzzer” and one person said “the manager comes round for a chat with us”. Relatives also spoke well of the staff with comments being made such as “my mother went to live in The Clough last year and has settled in well, mainly because of the excellent care she receives; the staff are very good indeed and she is always kept very clean and comfortable”. Another relative said, “up until now I’ve had no complaints and am pleased with every aspect and am sure it will continue”. The manager and staff team knew how important it was when looking after people, to make sure their privacy and dignity was upheld, to allow them to do as much as possible for themselves and to have choices in their daily routines. The home was clean, well decorated and furnished and provided residents with a good choice of sitting areas. The gardens were large and exceptionally well kept. Residents commented “it’s lovely to sit outside on the patio in summer”, “when its good weather we sit outside and the staff give us drinks of juice” and “my room is kept spotlessly clean”. One relative comment card said, “The room of the person I visit is lovely and is always kept very clean and welcoming”. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 6 Mealtimes were considered to be an important part of the residents’ day. The dining room was a bright, well decorated and furnished room which the residents enjoyed using. Whilst there was no set choice of food offered at the main lunchtime meal, the menu was varied and the majority of the residents said they really enjoyed their meals. The home tried to make sure that all the staff received the right kind of training in order for them to be able to do their jobs properly and care safely for the residents. A lot of the staff had worked in the home for many years and had got to know the residents well. This meant they knew their likes and dislikes and how they wanted to be looked after. What has improved since the last inspection? What they could do better: The residents’ records (care plans) needed to be more detailed so that all staff had the right information to be able to care for them in the same way. Where residents had been shown to be at risk, their assessments were not being updated so that staff had the information to care safely for them. Not all the staff had done training in what to do if they thought a resident was at risk of being abused, which could result in them not reporting it properly. A laundry assistant needed to be employed so that the care staff could spend more time with the residents. When new staff started work, they did some training but it did not cover all the areas, which are set out in the Skills for Care training. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 7 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 Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 8 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 Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 9 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): 3 : Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process was good with relevant information being given to residents before they moved in and an assessment taking place to ensure the home could meet their identified needs. EVIDENCE: The Service User Guide and Statement of Purpose had recently been updated to reflect the new management structure of the organisation. The Statement of Purpose was displayed in the entrance hall and each of the residents had a copy of the guide in their bedrooms. The admission policy/procedure was detailed in the Statement of Purpose, as was the emergency admission criteria. Three files for the most recently admitted residents were checked. Each contained a detailed assessment undertaken by the manager or a senior carer, either in the person’s own home or in hospital. Even when a resident had been referred by a care manager, the manager said she would always undertake her own assessment in order to be sure that the home would be able to meet their needs. She said she tried to encourage residents to visit the home first before The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 10 making a decision, but that very often it was the relatives who arranged the admission process. Emergency admissions were said to be rare. However, the manager said that in such instances, she would request the care manager fax through as much information about the person as possible or if the person were privately funding, she would undertake an assessment within the first 24 hours of admission. The manager was clear that if the home could not meet the needs of a resident admitted in an emergency, the care manager would be requested to find an alternative placement. Feedback from residents and relatives indicated they were appropriately involved in the assessment process and considered the home was able to meet their needs. Information from the assessment documents had, where relevant, been included in the residents care plans. Standard 6 does not apply as the home does not provide intermediate care. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs were being well met but this was not always reflected in the documentation, which could result in staff being inconsistent in their approach. EVIDENCE: Three care plans were checked for residents with differing needs. The current care plan Standex system did not have sufficient space to allow much detail to be written on the assessment/long term care plan and the home were not always using the short term care plan when any additional problems were identified e.g. behavioural issues, prevention of pressure sores, weight loss etc. It was clear from observations made that the staff knew what to do when a resident became distressed and started to shout. They quietly comforted the person and spoke reassuringly to him. In respect of care of people with pressure areas, charts were in place in order to make sure that the staff regularly assisted the resident in turning over in bed so they would not remain in the same position for too long. Pressure relieving aids were also in use. Areas for improvement were discussed during the inspection, when the manager and a senior care assistant started to check the care plans and The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 12 include more detail on them. Some gaps were seen where information in respect of religion, communication, daily routines, personal care and social activities had not been recorded. There was no key worker system in place although the manager said this had recently been discussed and she was considering the merits of such a system. The key worker could then become more involved in the reviewing of care plans, as they would have the knowledge and awareness of the changing needs of their residents. In the main, risk assessments were in place for nutrition, moving/handling and skin care but whilst records indicated both care plans and risk assessments had been updated monthly, a discrepancy was identified where a resident’s mobility had deteriorated but the moving/handling assessment had not been updated to reflect this. Where risk assessments show medium to high risk in any area, it is essential that the care plan identifies how the risk is to be managed and again, this had not always been recorded. Since the last inspection, residents/relatives had been involved in the care planning process and had signed their care plan to show agreement with it. Whilst the care planning documents were not sufficiently detailed and in some cases not up to date, the staff spoken to were able to demonstrate their knowledge of the needs of the residents for whom they were caring. They advised the inspector of peoples preferred routines, bathing requests, medical conditions, likes and dislikes and how they wanted to be cared for. Due to the relatively low staff turnover, the staff team worked well together and passed over information from one shift to the next, so that the residents’ care would be consistently met. The residents spoken to felt they were extremely well cared for in respect of staff assisting with their personal care needs and all felt they were well looked after. Inspection of the care files identified that the residents had access to health care professionals, such as dentists, opticians, chiropodists and district nurses. A district nurse was visiting the home whilst the Inspector was there but was too busy to spend time with the inspector. All health care professionals visits to the home were recorded on each residents’ file, together with any action that needed to be taken. Residents all felt their health care needs were being well met. One person said when she had asked for a Doctor’s visit, the staff had arranged one without delay. Another person commented how her health had improved since coming to live at the home. The morning medication round, done by the senior carer was seen during the inspection. The Boots medication system was in place and the manager followed the policies/procedures. There were no residents taking their own The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 13 medication at the time of the inspection but the senior said this was looked into as part of the admission process. Several residents on respite stays had continued to self-medicate after a risk assessment had been done. Satisfactory arrangements were in place in relation to the dispensing and storage of controlled drugs but no one was on any of these drugs at this inspection. A visit by a representative of Boots, to check the system, had been made very recently, but the home had not yet received the report. The manager said there were only minor areas that they needed to improve on. Since the last inspection, photographs had been included in the front of the residents’ medication sheets and specimen staff signatures were displayed in the drugs room. It was noted that on medication administration records (MAR), where residents had brought in their own medication, handwritten details had been recorded on the MARs. In such instances, two staff should sign the record to show the correct information had been transferred to the record sheet. The manager and senior staff were responsible for the administration of medication and all had received relevant training. Certificates were seen in the files inspection. A senior was on duty on each shift, which ensured that there was always someone trained, should a resident need medication at any time. The aims and objectives of the home reinforced the importance of treating residents with respect and dignity. Residents interviewed were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity was respected at all times. One resident said “you are most definitely treated with respect by all the staff”. This was also observed during the inspection. Residents were taken to the toilet without having to wait, toilet doors were closed and staff knocked on bedroom doors before entering. Relatives confirmed they were satisfied with the staff’s manner and attitude towards the people they visited. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines. These included asking residents quietly if they needed the toilet, always making sure residents were kept covered when being assisted with personal care tasks, locking the bathroom door, allowing residents to wash themselves as far as possible and giving them a choice as to whether to stay in the toilet with them or stand outside until they buzzed. Service users were able to meet visiting professional visitors and family/friends within the privacy of their own rooms. Evidence of this was seen at the time of inspection when a district nurse visited. The telephone was situated in a quiet area of the home so that residents could use it without being overheard. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 14 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. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and food but improvements could be made to the activity programme in order to offer more variety on a daily basis. EVIDENCE: A programme of activities was displayed within the home showing that regular armchair exercises, flower arranging sessions and DVD films were being offered. Once a month a big screen film show was arranged and this was taking place on the day of the inspection. The home had a library, which included some large print books. The manager said that the care assistants would also spend one to one time with residents, playing board games or just chatting. The carers spoken to said they did indeed try to find time to spend on an individual basis with residents but on occasions it was difficult, due to their personal care needs having to take priority. The care plan files contained a section on social activities, but the recording sheets were not being regularly completed, so it was difficult to assess just how much time the more dependent people were being given. If a key worker system were in place, it would ensure that each resident was receiving some one to one stimulation. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 15 The more independent residents spoken to said they were fairly satisfied with what was being offered although two said they were looking forward to going out on short trips when the weather improved. One of the residents, who enjoyed spending time in her room, said she preferred not to take part in activities and that the staff respected her wishes. Feedback from the returned resident comment cards was positive with 5 stating they were satisfied with what was offered and one saying activities were usually arranged. The home also produced an informative monthly newsletter, which was displayed on the notice board. The religious needs of the residents were being met. A monthly service within the home was held, with hymns and communion for those who wanted it. A Roman Catholic priest was also said to visit individual residents and one or two residents went out to church with their relatives. Relatives returning questionnaires all considered they were welcomed into the home and could visit the person they wished to see in private. The two visitors spoken to also confirmed this, saying they were offered drinks and this was seen on the day of the visit. Residents said that they are able to have visitors at any reasonable time and they could see them either in their rooms or in one of the communal lounge areas. The choices residents made each day varied, dependent upon their mental frailty. All the residents spoken to felt they were able to follow their own preferred routines in respect of what time to get up, go to bed, use of their room, where to sit, what to wear and whether or not to take part in social activitie. One resident said “you can do what you want, when you want, because it’s our home”. Residents were encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. Four weekly menus were in place, which provided a varied and nutritious diet. Whilst there was a choice at teatime, there were no choices at lunchtime. At the time of the inspection, the menus were in the process of being changed and it is recommended that a second choice be added on the lunch menu. The Cook had spoken to the residents about what they would like to see introduced on the new menus and had taken meals off the menu that she felt residents were not keen on. Three of the residents said they had asked for lasagne, black puddings and spaghetti Bolognese to be added. These were all seen to have been included on the new menus. One resident said she would like more pork on the menu and the inspector passed her request to the manager. The manager had arranged a resident meeting in the next couple of weeks and said she would be checking out whether there were any further requests before she and the cook finalised the menus. On the day of the visit, the lunch meal was beefsteak pudding, chips, peas and gravy followed by jam coconut sponge and The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 16 custard. The inspector sampled the main meal and found it to be hot and tasty. Suitable provision was made for those needing special diets i.e. diabetic and soft diets and plate guards were used to promote residents’ independence. The dining room was clean, bright, nicely decorated and furnished with matching table linen and napkins. The table settings were attractive with wine glasses being used for the fresh orange juice that was served. There was a good atmosphere during the meal with residents sitting with the people whom they had formed friendships with. The residents spoke positively of the food provided. Comments made included: “the food is good”, “can’t grumble”, “it’s well cooked” and “lots of home baking”. Of the 6 questionnaires received from the residents, 5 said they always liked the food and one said sometimes. The Clough Residential Home DS0000009285.V308226.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. An effective complaints system was in place which residents were familiar with and safe recruitment practices ensured that residents were protected from abuse. EVIDENCE: A complaints procedure was in place which was included in the service user guide and statement of purpose. It was also displayed within the home. A complaints log book was in place and since the last inspection, 1 complaint had been logged. The manager had taken appropriatre action to address the problems which had been raised. The outcome had been recorded and all parties had been kept advised. The Commission for Social Care Inspection had not had cause to investigate any complaints about the home over the last 12 months. All the residents spoken to said if they had any complaints or grumbles, they would feel able to speak to any of the staff or the manager. They all felt that they would be listened to and taken seriously. The 6 returned resident comment cards also recorded they knew who to make a complaint to. A procedure for responding to allegations of abuse was available as was the Bolton Inter-Agency Protection of Vulnerable Adults (POVA) procedure. No protection investigations had taken place over the last year. From checking the training matrix, it was noted that 14 of the 19 staff employed had undertaken an in-house open learning POVA course although not all the The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 18 booklets had been signed off by the manager. All staff must undertake this training. A high percentage of the staff team had NVQ qualifications, with one of the units covering protection issues. Staff files showed that Criminal Record Bureau and POVA first checks had been done before any new staff started work so as to ensure that the staff were suitable to work with vulnerable people. The Clough Residential Home DS0000009285.V308226.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 & 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 situated within beautiful well-kept grounds and it was clean, well decorated and maintained, providing a safe, comfortable and homely environment for the residents. EVIDENCE: The home was situated just off the main road between Horwich and Bolton, which had a regular bus route. It was set in its own grounds with beautiful gardens and lawns surrounding it. A patio area was provided to the front of the building. Several residents commented about how much they enjoyed sitting in the garden in the summer, especially on the patio. One resident said “the staff provide us with cold drinks and it’s a lovely way to spend your day”. There was a maintenance programme in place and since the last inspection, the dining room, conservatory and main lounge had all been fitted with new carpets. In addition all new table linen, crockery and cutlery had been purchased making the dining room an attractive place in which to have a meal. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 20 The previously unguarded radiators had now been fitted with new guards in order to ensure residents would not burn themselves. The entrance hall was very welcoming and the corridors were wide with grab rails. Residents had a choice of 3 lounge areas in which to sit, a large lounge, conservatory and library, all of which were well decorated and furnished. The good choice of lounges enabled the residents to move around the home, especially if they did not wish to take part in any of the organised activities. On the day of the visit several people were sitting in the library as they had chosen not to wash the large screen film, being shown in the large lounge. A new large flat screen television had recently been provided. All the lounges had a good assortment of seating. The library was comfortably furnished with tables and footstools and a good supply of large print books, as well as other hard and paper back books. A moveable ramp was kept in the conservatory so it could be used for anyone in a wheelchair to go from the dining room to the conservatory. Access on to the patio area from the conservatory was down a very slight step. The toilets were clean and apart from 2, were suitably adapted for disabled use. One of the toilets upstairs, adjacent to the bathroom with the small bath, was not assisted. This had recently been re-decorated and the manager said the handyman had not yet re-fitted the grab rail. The toilet in the adjacent toilet similarly did not have a grab rail fitted to assist the less able residents. The day following the visit, the inspector spoke by telephone to the manager who confirmed that both toilets had now been fitted with appropriate aids. The bedrooms seen were bright well decorated and very personalised. It was evident that there was an ongoing programme of redecoration and refurbishment. Since the last inspection, all bedroom doors had been fitted with safety locks. However, at the time of the visit, only one person had been issued with a key. From checking care plan files, it was identified that no risk assessments were in place, identifying why residents could not hold their own keys. This should be done and where the advantages, outweigh risks, then residents should be offered a key. A fire inspection had taken place in June 2006. The manager could not locate the fire report but confirmed that the requirements made had all been met. In order to promote independence, several doors around the home had been fitted with magnetic door closures so they could be left open and accessible for residents. Relatives and residents were very complimentary about the cleanliness within the home. One resident said, “the home is kept very clean and it always smells nice” and another resident said “its always spotless”. Feedback from the resident comment cards also commented positively upon the cleanliness and freshness within the home. A walk around the building supported this The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 21 view. Everyone spoken with thought the home was a safe place to live and work in. An infection control policy was in place and the majority of the staff had undertaken relevant training. Disposable gloves and coloured aprons were provided for staff use and to reduce the spread of infection, liquid soap and paper towels were supplied in all bedrooms, bathrooms and toilets. The laundry was sited away from the food preparation area and was clean, well decorated and orderly. Sufficient and suitable equipment was provided and the washers were equipped with sluicing facilities. Three of the residents spoken to said they had experienced clothing going missing and one of the relatives spoken to also confirmed this had happened. There was no laundry assistant in post, the laundry being done by the care staff. This is addressed in the staffing section below. The Clough Residential Home DS0000009285.V308226.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): 27, 28, 29 & 30 : Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of well-trained staff, with an appropriate skill mix were provided and the low turnover of staff enabled them to know how each resident liked to be cared for. EVIDENCE: At the time of the visit, 30 residents were living at the home. On the morning of the inspection, 3 care staff and a senior were on duty and this level was maintained throughout the day. The manager worked on a supernumerary basis but helped out as and when needed. The dependency levels of the residents varied, with some residents being very independent and others needing two staff to assist with moving/handling. One of the cooks did not work full-time and left before teas were given out. Cold meals were left ready plated and covered. This did however, mean that the care staff had to undertake kitchen duties as well as care for the residents. In addition, they were expected to undertake laundry duties. This was highlighted at the last inspection when a requirement was made to employ a part-time laundry person. The manager stated this had been implemented but the laundry assistant had left after only 3 weeks. Given the little time staff had to spend on a one to one time with the residents, a laundry assistant must be employed. The home had a very low turnover of staff, which really benefited the residents, who had formed good relationships with them. All the residents The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 23 spoken to said they trusted the staff team and commented upon how well they were looked after. One carer was leaving on the day of the visit and several residents said how sad they were to see her go. Throughout the inspection, staff were observed being polite and respectful to the residents and caring for them in a sensitive way. There was a good ethnic mix on the staff team but gender wise, the team were all female. This was not intentional, but simply because the home did not tend to get applications from male carers. Staff feedback indicated staff morale was high, resulting in good team work by an enthusiastic workforce that worked positively with residents to improve their quality of life. The manager made sure that staff had the necessary information to undertake their roles efficiently and effectively. Good communication systems were in place e.g. staff handovers, communication book, work rotas and diaries. Inspection of records showed that safe recruitment and selection practices were followed in line with the home’s procedure. These included receipt of 2 satisfactory references, Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) checks and completion of application forms. The manager said that when staff left without notice, they sometimes had to appoint staff before the full CRB check had been returned, but that a POVA first check would always be done. Such staff worked under close supervision until the CRB arrived. The Manager should be mindful that guidance from the Commission is that generally staff should not start until the full CRB has arrived at the home. The organisation was committed to offering training opportunities to the staff. Of the 19 care staff currently employed 12 had successfully completed NVQ level 2 training or above. A further 3 carers were currently doing their NVQ level 2, 3 doing NVQ level 3 and the deputy manager had completed her NVQ 4. This meant the home had already achieved 74 of trained staff. In addition a further 2 carers were in the process of doing level 3 and one was awaiting external verification. When new staff started work, they did induction training in order to learn how to do their jobs safely. The induction programme was not to the Skills for Care training specification and did not include all the required components. It was however, thorough and recorded in workbooks. In order to ensure that all Skills for Care training units are adequately addressed, this format must be used. Where new staff have already undertaken NVQ training, this can be cross referenced on the induction record but sections specific to the home must be fully completed by all new staff i.e. policies/procedures, aims/objectives and care practices. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 24 One training shortfall was identified with regard to equality and diversity and the manager should make this her next training priority. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 : Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed, ensuring that residents received a consistently good standard of care. EVIDENCE: The manager had worked at the home for 19 years, which included 9 years managing it. Before this, she had trained as a nurse and had recently completed her Registered Managers Award. She was therefore knowledgeable about the conditions and diseases associated with older age and up to date with management issues. She was mindful of the need to keep up to date with training and so far this year had been on courses in relation to supervision, medication and food hygiene. She had also undertaken a moving/handling facilitators course in June 2006 and done a 4 day first aid course. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 26 Feedback from the staff about the manager was positive with comments made such as “fair”, “approachable” and “offers support when needed”. Residents also said she spent time chatting to them and they felt she was always around if they needed to see her about anything. At the last inspection, the home was seen to have an annual development and business plan and the manager was in the process of updating the plan. In respect of quality assurance systems, the home had recently been reviewed and had retained their Investor In People award. In addition quality questionnaires were circulated to relatives and residents on an annual basis. These were sent directly back to Head Office so they could be collated, analysed and published. The manager said she had not received any feedback from the last lot of questionnaires which had been sent out in November 2006. In order that any comments received on the questionnaires can be acted upon, the organisation should ensure a speedier audit of feedback is undertaken and shared with the home. The manager may wish to consider circulating questionnaires to a wider range of people such as care managers, district nurses etc. In addition to the circulation of quality questionnaires, residents’ meetings were also arranged and minutes of these were seen. The manager had arranged another meeting in which she was going to discuss the menu changes, so that everyone could put forward their suggestions. Staff meetings were also arranged for seniors and for the full staff team. Formal supervision had been started and annual appraisals were taking place. Two staff interviewed confirmed they had each met for one to ones with the manager. A format for documenting supervision had been implemented. The organisation reviewed and updated policies and procedures as and when needed. The pre-inspection questionnaire recorded that all required health and safety policies and procedures were in place. There were good systems in place to ensure that residents’ financial interests were safeguarded. Money that is kept at the home on behalf of residents was recorded, as were all the transactions that were made on their behalf. The personal monies kept for three residents were checked and found to be in order. Hairdressing and chiropody accounts were also in place. The manager were vigilant in ensuring that staff received their health and safety training with refresher courses being arranged as needed. The staff training matrix showed that the majority of the staff had done all the required training but it could not be determined what date the training had taken place. It is recommended that dates are recorded either when the original training had taken place or when refresher training was due. The manager had recently met with her line manager to discuss the training needed for the remaining staff over the next 12 months. Sampling of 3 staff files and The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 27 speaking to staff, confirmed that refresher training was undertaken as needed. Training certificates were in place in the files inspected. The pre-inspection questionnaire identified that maintenance checks were up to date except for the servicing of the gas appliances. The Estates Manager spoke to the inspector during the visit and confirmed that this had now been arranged for the week after the visit. A fax was later received confirming the work was to take place. Proof of this work should be sent to the CSCI office. Random record sampling was undertaken of the public liability certificate, small electrical appliance testing and servicing of the thermostatic mixer valves (TMVs). Documentation in respect of the TMVs could not be found and this information must be forwarded to the CSCI office. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 28 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 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 Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement Detailed care plans for each resident must be in place, including residents’ spiritual needs in order that staff will be able to care properly for them. Risk assessments must be reviewed and updated on a regular basis so that staff have the right information to care safely for the residents. All staff must receive adult protection training in order they know how to report any issues relating to abuse. A part-time laundry assistant must be provided so that the care staff can spend more time with the residents (previous timescale of 31/03/06 not met). Timescale for action 31/03/07 2. OP8 13 31/03/07 3. OP18 13(6) 31/05/07 4. OP27 18 31/03/07 5. OP30 18(1)I (i) 6. OP38 13 & 23 All new staff must undertake 30/04/07 induction training to the Skills for Care specification so they will have the right knowledge to look after the residents in their care. Evidence of servicing of gas 31/03/07 appliances and thermostatic mixer valves must be forwarded DS0000009285.V308226.R01.S.doc Version 5.2 Page 30 The Clough Residential Home to the CSCI in order to ensure that all equipment is safe. 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP7 OP9 OP12 OP12 OP15 OP19 OP21 OP30 OP38 Good Practice Recommendations A key worker system should be introduced. When medication records are handwritten, 2 staff should sign to show the recordings are accurate. The social activity sheets on the care plan file should be completed. The daily activities programme should be expanded to meet both individual and group needs. The lunchtime menus should include a choice of meal. Residents should be offered a key to their door, unless the risk assessment states why this is not practicable. Consideration should be given to replacing the small bath with a disabled access shower facility (this recommendation has previously been made). Staff should receive equality and diversity training. The staff training matrix should record the date on which the training has taken place or when it is next due. The Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Clough Residential Home DS0000009285.V308226.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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