Care Home: Canford Cliffs

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What the care home does well Before a person is admitted to the home, they have their needs assessed to ensure that these can be met at the home. Relatives are provided with a copy of the homes Statement of Purpose so that they are fully informed of the services and facilities provided at the home. Residents health care needs are met through good care planning and assessment of risk. Residents are treated with respect and dignity. Generally medication is administered safely and procedures comply with good practice. The home provides a range of communal activities for residents and individual time is also spent with residents to meet their social, leisure and recreational needs. Spirtual needs of residents are assessed and met. Visitors are made welcome and there are no restrictions on visiting times. Residents are provided with a good standard of food. The complaints procedure for the home is well publicised and the staff have been trained in adult protection. Canford Cliffs Residential Home provides a generally safe, comfortable and `homely` environment for its residents. The home has staffing levels that meets the assessed needs of the residents. Staff are suitably trained to meet needs of residents. The home is well managed and run in the interests of the residents. What has improved since the last inspection? Where hand entries have to be made to medication administration records these are now checked and signed by a second person. What the care home could do better: The home should consider using the MUST (Malnutrition Universal Screening Tool) in cases where residents are of low weight or who have a history of loosing weight. The home should consider purchasing a maximum/minimum thermometer to record the temperature range of the small fridge used for storing medication. Seeking more information about each resident`s life history would assist in understanding their recreational and social needs.Recommendations were made concerning infection control in communal bathrooms and concerning health and safety. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Canford Cliffs 2 Bessborough Road Canford Cliffs Poole Dorset BH13 7JS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Martin Bayne     Date: 1 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Canford Cliffs 2 Bessborough Road Canford Cliffs Poole Dorset BH13 7JS 01202700272 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : vicaskurn@yahoo.com Mrs Marie Rosemai Askurn care home 14 Number of places (if applicable): Under 65 Over 65 14 14 dementia mental disorder, excluding learning disability or dementia Additional conditions: 2 2 One named person (as known to CSCI) under the age of 65 may be accommodated. This condition will not apply after the person`s 65th birthday. The Home may accommodate up to 2 service users under the age of 65 whose care needs are compatible with those older service users already living at the home. Date of last inspection Brief description of the care home Canford Cliffs is registered to accommodate and provide personal care for up to 14 people over 65 who suffer from dementia. The home has been granted a variation of the conditions of registration to accommodate one named person who is under the age of 65. The home is located in a quiet residential area of Canford Cliffs, within 150 yards of the local parade of shops and local amenities. The home is provided on two floors with access to the first floor by means of a stair lift. There are 10 bedrooms on the ground floor six of which have ensuite toilet facilities. The communal areas of a lounge leading to the garden, kitchen and dining area are also on the ground floor. On the Care Homes for Older People Page 4 of 27 Brief description of the care home first floor there are a further four bedrooms, one of which has an ensuite toilet. From the first floor there are stairs that lead to private accommodation and the bedroom for the sleep-in staff. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out a key inspection of Canford Cliffs residential home between 9am and 2pm on 10th June 2009. The inspection was carried out by one inspector, but throughout the report the term we is used, to show that the report is the view of the Commission for Social Care Inspection. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons, and to follow up on the one recommendation made at the last key inspection in June 2007. We looked at the personal files of three residents and used these to track the records that the home must keep up-to-date as evidence of the care provided to residents at the home. We carried out a tour of the premises and spent much of the inspection time in the main lounge where all the residents were congregated. We spoke with six of the Care Homes for Older People Page 6 of 27 residents, two relatives who were visiting the home that day and with two members of staff. Additional information that helped form the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document completed by the home. What the care home does well: What has improved since the last inspection? What they could do better: The home should consider using the MUST (Malnutrition Universal Screening Tool) in cases where residents are of low weight or who have a history of loosing weight. The home should consider purchasing a maximum/minimum thermometer to record the temperature range of the small fridge used for storing medication. Seeking more information about each residents life history would assist in understanding their recreational and social needs. Care Homes for Older People Page 8 of 27 Recommendations were made concerning infection control in communal bathrooms and concerning health and safety. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having their needs assessed before being offered a placement at the home to ensure that the home does not accommodate people whose needs it cannot meet. Evidence: We saw that pre-admission assessments had been carried out and recorded for the three residents we tracked through the inspection. All three residents had been referred by care managers and Mr Askurn had obtained copies of the care management assessments before visiting the prospective residents to conduct his own assessment. We also saw that residents relatives have been able to visit the home to assist them in choosing a suitable placement and that they had been provided with a copy of the homes Statement of Purpose. These procedures ensure that the home can meet the needs of those people it admits as residents. When a decision is made to admit a resident, they or their relatives are informed in writing that needs can be met Care Homes for Older People Page 11 of 27 Evidence: and a trial placement is then arranged. One of the relatives we spoke with informed that the family had been fully involved in arranging a placement at the home. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their health and social needs being met through care planning and risk assessment and through their privace and dignity being maintained. Medication is generally managed in accordance with good practice. Evidence: We looked at the care plans in place for the three residents we tracked through the inspection. Thes had been developed from assessments of residents needs. At the front of each persons file there was a photograph of the person. This ensures that new staff can easily identify the person to whom the care plan applies. The care plans provided sufficient information for a new member of staff to provide support and care for the person concerned. The care plans were up to date and being reviewed regularly, with these reviews being recorded in the daily notes. We saw that relatives had been involved in developing the care plans with a record of their having been consulted. In view of the mental frailty of all the residents accommodated at the home, they were unable to be fully involved in developing their care plan. We saw that some risk assessments had been completed to to ensure that care is provided in the Care Homes for Older People Page 13 of 27 Evidence: safest way possible. Residents weights were being regularly recorded. We recommend that where a person is of low weight or who has been loosing weight, the MUST tool (Malnutrition Universal Screening Tool) is used as a nutritional assessment tool. We saw that the home had sought information about residents social needs, however we recommend that more is done to investigate their life histories, which would be of benefit to the staff in understanding each residents social needs. We saw evidence within the care plans and within the daily recording notes that health needs of residents were being met. Each resident is registered with a GP and we saw that referrals for GP visits or for district nursing intervention were made appropriately. The home also has good links with the community mental health team. We saw the dental, opthalmic and chiropody needs were assessed and responded to. On the day of our visit all of the residents were dressed in clean clothes and were well presented. We observed the interaction between staff and residents and there appeared to be good relationships between the two. Residents appeared comfortable and relaxed with the staff. The relatives we spoke with told us that that residents always looked well groomed and that they had peace of mind when leaving the home that their relatives were being looked after. One told us, I have been very happy with the my mothers care since she has moved into the home. We looked at how medication is administered in the home. Due to the mental frailty of all the residents accommodated, their medication was being adminstered by the staff. Medicines are kept locked within the two medication cabinets in the staff office. We looked at how medicines were stored. We were told that the home had ordered and were awaiting the delivery of a new controlled drugs cabinet that will meet new regulatory requirements. There is a small fridge in the office where medications that require refrigeration are stored. Temperatures of the fridge were being recorded, however we recommend that the home purchase a maximum/minimum thermometer to ensure that these medicines are stored within the correct temperature range. In other respects we found that medicines were being stored correctly. We looked at the medication administration records for all of the residents. We found good practice of photographs of each resident at the front of their administration records, checking and signing by a second member of staff where hand entries had had to be made to the records and any know allergies of residents also recorded. The records had been completed in full with no gaps within the records. One resident is an insulin dependent diabetic and the district nurses had trained and deemed competent some staff members to adminster insulin to this resident. It was agreed that the list of staff trained to carry out this procedure and also a list of the names of staff trained to administer medication, together with a sample of the staffs signatures be kept at the front of the medication administration records. Care Homes for Older People Page 14 of 27 Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from activities being provided, by being able to maintain conctact with friends and relatives and by their nutritional needs being met. Evidence: When a person is admitted to the home some information is gathered about their life history, however as has already been reported we recommend that more detailed life histories are developed, so that staff better understand the social needs of the residents. On the day of the inspection we spent much of the time sitting in the lounge with the residents, where background classical music was being played. We saw that some residents were provided with a daily newspaper of their choice. Other residents were occupied with puzzles and games whilst other residents talked amongst themselves in small groups. The staff were seen to be attentive to residents, talking with them and providing drinks and biscuits mid morning. One resident was taken for a walk around the garden by one of the staff. We were told that when the weather permits, residents are taken into the garden, which some very much enjoy. Some communal activites are arranged for residents. We were told that more activities have been added to the programme of activities since the last key inspection, such as Care Homes for Older People Page 16 of 27 Evidence: a music session and an exercise group run by a trained external provider. Staff record within the daily notes the activities they undertaken with each resident. We saw from looking at the daily notes of the residents we tracked thorugh the inspection that some kind of activity was being recorded each day. On the day of the inspection two relatives visited the home. They told us that they could visit any time unannounced and were always made welcome. Concerning religious needs, we saw that these are assessed when a person is admitted to the home and steps taken to meet these needs. We were told that at the time of the inspection there were no residents with unmet spiritual needs. We were told by the two relatives we spoke with that the standard of food provided was good. When a person is admitted to the home, we saw that the assessment covered peoples likes and dislikes and any special dietary needs. Meals are cooked by the staff and we were told that all staff who handled food had been trained in basic food hygiene. On the day of our inspection we saw that a wholesome meal was provided with portions of a reasonable size. Records are maintained of food provided to residents and from these it was possible to what each person had been provided with. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well publicised complaints procedure and through the staff beig trained in adult protection. Evidence: The complaints procedure for the home is detailed within the Statement of Purpose and within the homes Terms and Conditions of Residence. As relatives are given a copy of both these documents, they are therefore well informed of how to make a complaint. The complaits procedure is also displayed on the noticeboard in the reception area. We were told that since the last key inspection there have been no complaints made to the management and none have been brought to the attention of the Commission. We saw from the staff training records provided that all of the staff had been trained in adult protection and the prevention of abuse. The home has copies of all relavant policies and procedures for protection of vulnerable adults. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Canford Cliffs Residential Home provides a homely environment but some improvements could be made to ensure a safer environment. Evidence: As part of the inspection we carried out a tour of the premises. Canford Cliffs residential home provides a homely, comfortable environment for residents. On the day of the inspection we found the home to be clean with no unpleasant odours. Furniture and fittings were in good repair and the home was in reasonable decorative order. We made some recommendations with the aim of ensuring a safer environment. We found within two residents bedrooms denture cleaning agents that were accessible to residents. We recommend that these are stored away safely out of reach of the residents concerned as these products have been known to cause fatalities if ingested. We also found within some communal bathrooms tablets of soap and cotton towels. We recommend that in the interests of infection control that paper towels and liquid soap be provided in communal bathrooms. We also recommend that in these areas foot operated lidded bins also be provided as a measure to reduce the risks of spreading infection. We saw that residents were able to bring their own possessions to personalise their rooms. We recommend that in bedrooms, wardrobes are fixed to the wall to reduce the risk of wardrobes toppling. In one bedroom on the first floor of the home, we found that a window could be opened to a width that a person could get out Care Homes for Older People Page 19 of 27 Evidence: onto the flat roof. We recommend that a window restrictor be fitted to this window to prevent a potential accident. Radiators in the home have been covered to protect residents from hot surfaces and thermostatic mixer valves have been fitted to the hot water outlets of baths in order to protect residents from scalding water. The laundry facilities of the home are located in an outside building away from food preparation areas. The home has commercial machines capable of meeting the laundry needs of the home. Floor surfaces and walls were easily cleanable and handwashing facilities are provided. We saw that the home has a procedure for the staff to follow when cleaning commodes to prevent the risk of cross infection. We saw that staff are provided with protective clothing and gloves. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from adequate staffing levels beig in place to meet their needs and through the staff being recruited in line with Regulations. Evidence: Staffing levels remain the same as at the time of the last key inspection with 3 staff on duty between 8am and midday, four staff between midday and 2pm and the 2 staff between 2pm and 8pm. During the night time period there are two staff on duty who carry out an awake night duty. The home also employs domestic staff. Mr Askurn told us that this level of staffing met the needs of the residents accommodated. The relatives we spoke with told us that they had found that this level of staffing met the needs of residents. During the inspection we spoke with two members of staff who also confirmed this. The home has a longstanding staff team and since the last key inspection there have only been two members of staff recruited to the staff team. We looked at the recruitment records for these two members of staff and found that all of the required checks and records as required under Schedule 2 of the Care Homes Regulations 2001 had been complied with. We were shown a training matrix of all the training undertaken by the staff. There was Care Homes for Older People Page 21 of 27 Evidence: evidence that new members of staff receive full induction training and then training in core subjects such as moving and handling, adult protection, first aid, health and safety, basic food hygiene, fire safety and infection control. We also saw that staff are then able to go to more specialist training such as care of people with dementia. The staff we spoke with said that they were satisfied with the training on offer and that they had been given all the training to be able to care for residents. They also told us that they felt supported by the management and that there was a good morale amongst the staff. The returned AQAA informed that all of the staff teamhad been trained to at least the standard of NVQ level 2 or above. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a home that is well managed and run in the interests of the residents. Evidence: Mr Askurn has owned and managed the home for many years. He has completed the NVQ level 4 qualification in management and is also a qualified Registered Mental Nurse. We looked at the results of an annual quality survey carried out with residents and relatives. We found that generally there was very favourable support from relatives about the home. We saw comments such as, Very pleased with the the way my mother is being looked after and the care she is getting, Its a huge relief that my mother is receivig the highest standards of care. The home does not look after any monies on behalf of residents as relatives take on Care Homes for Older People Page 23 of 27 Evidence: this responsibility. The returned AQAA informed that equipment in the home was being tested and inspected to the appropriate timescales. We loked at the fire log book and found that tests and inspections to the fire safety system were being carried out to the specified timescales. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 We recommend that where residents are of low body weight or who have lost weight over a period of time, the MUST tool is used as an assessment tool to assist in meeting peoples nutritional needs. We recommend that the home does more to elicit information about each residents life history so as to better understand their leisure and social needs. 2 9 We recommend that the home purchase and use a maximum/minimum thermometer to record the temperature range of the small fridge used for storing medicines that require refrigeration. We recommend in interests of health and safety that wardrobes in residents bedrooms be fixed to the wall and that denture cleaning products are stored out of reach of residents. We recommend in interests of infection control that the following measures are taken: Liquid soap, paper towels and foot operated lidded bins be provided in communal bathrooms. 3 19 4 26 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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