Care Home: Clifden House

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What the care home does well During the inspection visit it was noted that residents were able to spend time with who they wanted, and where they wanted. Staff responded to both their physical and emotional needs in a respectful way, and staff worked hard to engage with residents, spending time talking and walking with them, or in a group activity. There was enough staff to help residents to participate in leisure activity, and to respond to effectively to a challenging incident between two residents, ensuring resident safety. The care documentation ensured the basic care needs of residents are attended to, and recorded the contact with community health care professionals. What the care home could do better: Although each resident has a plan of care these are based on templates that are not always amended to reflect the specific individual needs of residents. A more person centered approach to the provision of care needs to be adopted. The MAR charts were found to be clear and reflect that medicines are administered as prescribed. It was however recommended that any medicine prescribed on an `as required basis` is done soin accordance with individual written guidelines. Records relating to complaints were not full, and did not demonstrate that the home takes all complaints seriously, or uses them to improve the service. The management arrangements for the home including the on call arrangements, need to be reflected clearly on duty rota, with staff having access to additional staff when required. During this inspection visit the overall management of the home was discussed with the appointed manager, who advised that she is working on an action plan for the home to ensure that it is run in accordance with the Care standards Act 2000, and agreed to supply the Care Quality Commission with a copy of this action plan. Random inspection report Care homes for older people Name: Address: Clifden House 82-88 Claremont Road Seaford East Sussex BN25 2QD two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Melanie Freeman Date: 2 6 0 8 2 0 0 9 Information about the care home Name of care home: Address: Clifden House 82-88 Claremont Road Seaford East Sussex BN25 2QD 01323896460 01323896518 office@clifdenhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Nial Joyce Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 52 Number of places (if applicable): Under 65 Over 65 0 52 dementia old age, not falling within any other category Conditions of registration: 52 0 The maximum number of service users to be accommodated is fifty-two (52). The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Clifden House Comprises of four adjoining properties situated in a residential; area within walking distance of the seafront and local shops. The home is registered to care Care Homes for Older People Page 2 of 11 Brief description of the care home for 52 older people with Dementia. Residents private accommodation is provided on two floors, which includes five rooms that are registered for shared/double occupancy. All bedrooms are equipped with a call bell and a passenger lifts provide level access to the first floor. Most bedrooms have en suite facilities. The garden is secured however needs further landscaping to be fully enjoyed by residents and visitors. The service provides prospective residents and their families with a welcome pack, which includes a copy of the service users guide, and the statement of purpose the last inspection report is also available in the home. Fees charged as from 1 April 2008 range from £410 to £625. These are dependant on the room to be occupied and the level of care an individual may need. All personal items like books newspapers magazines are charged for along with additional services like chiropody and hairdressing. Intermediate care is not provided at Clifden House. Care Homes for Older People Page 3 of 11 What we found: This random inspection was completed on Wednesday the 26 August 2009 and included an unannounced visit to the home. The visit lasted approximately four hours and included time to discuss matters with the newly appointed manager, who had taken up post on the 3 August 2009, and the deputy manager. It was completed following information received in respect of a safeguarding alert, and subsequent investigation that confirmed some concerns around the care of a resident who developed pressure sores, and the completion of the Annual Service Review (ASR) on 14 May 2009. The Annual service review confirmed that the Care Quality Commissions view on the home had changed. There was evidence to confirm that the management arrangements may not be adequate, and did not allow for the suitable supervision of staff, and care review of residents with often complex care needs, by skilled staff. Following the completion of the ASR a written complaint raised concerns around the care provision and the homes response to complaints made. The registered manager also left the homes employment. The Care Quality Commission needed to satisfy its self that suitable management arrangements had been put in place to ensure residents were being cared for appropriately, with staff being suitably supervised. In addition that suitable systems for dealing with complaints were being maintained. At the time of the visit there was 48 residents living in the home, and this random inspection focused on the personal/health care provision, and how the home responds to increasing care needs. How complaints are responded to, and what management arrangements, and structure has been established for the home. During the inspection visit time was spent with residents in the sitting room where they were engaged with staff, and the activities co-ordinator in a game of playing card bingo. Residents were seen to be dressed according to their wishes and individual personal hygiene needs were seen to be well attended to. Discussion with the appointed manager confirmed that if the home was not able, with the support of community health care professionals, to meet the needs of an individual they would be moved to a suitable placement accordingly. Clifden House is not registered to provide nursing care. One resident had a pressure sore that was being cared for under the direction of the District Nurses. The home has assessment tools in place to identify residents at risk of developing pressure sores and staff training on this area has been progressed for seven senior care staff since the safeguarding alert. This ensures that a member of staff is working in the home at all times with the skills to respond to possible pressure area damage, appropriately. During the visit it was noted that the staff were responding to a residents dental care needs, arranging dentist appointments and liaising with the family. Discussion confirmed that dentists and opticians are sourced as required. As part of the inspection process two residents were case tracked, and this demonstrated that each resident had a plan of care and records to record the involvement of other Care Homes for Older People Page 4 of 11 health care professionals including the District Nursing team. The medicine administration records (MAR) charts seen, confirmed that medicines are administered according to prescriptions, and that as required medicines are only given when indicated. The deputy manager and appointed manager talked about reducing residents medication as far as possible in conjunction with their allocated doctors. The records relating to complaints were examined. Although some complaints were recorded and responded to, it was clear that not all complaints are documented. A log of complaints and safeguarding alerts/investigations, was not maintained. During the inspection an incident between two residents was dealt with appropriately ensuring both residents safety. A safeguarding guarding referral was also made by the home in timely fashion, with direct contact being made with Social Services. As mentioned previously a new manager has been appointed and started working in the home on 3 August 2009. She had a full job discription and said that she would be applying for registration with the Care Quality Commission in the near future. She also advised that she had regular contact with Mr Joyce the Registered Provider, and was working with him on an action plan for the home to address any shortfalls, in a planned and structured way. The Registered Provider has yet to confirm the appointment of the new manager in writing to the the Care Quality Commission. The staff duty rota indicated that a senior carer was always on duty, with the deputy manager and appointed manager working all week days. There are on-call arrangements that provide senior staff cover, although these were not clearly recorded. This ensures that suitable staff are working in the home to provide the necessary supervision to all staff. The appointed manager confirmed that suitable records would be maintained in respect of all staff cover. She also advised that regular staff management meetings will be held in the future, and that there are daily hand-overs held three times a day, at each shift change. Shift sheets are used to record key information on the needs of residents to ensure specific care needs are attended to. What the care home does well: What they could do better: Although each resident has a plan of care these are based on templates that are not always amended to reflect the specific individual needs of residents. A more person centered approach to the provision of care needs to be adopted. The MAR charts were found to be clear and reflect that medicines are administered as prescribed. It was however recommended that any medicine prescribed on an as required basis is done so Care Homes for Older People Page 5 of 11 in accordance with individual written guidelines. Records relating to complaints were not full, and did not demonstrate that the home takes all complaints seriously, or uses them to improve the service. The management arrangements for the home including the on call arrangements, need to be reflected clearly on duty rota, with staff having access to additional staff when required. During this inspection visit the overall management of the home was discussed with the appointed manager, who advised that she is working on an action plan for the home to ensure that it is run in accordance with the Care standards Act 2000, and agreed to supply the Care Quality Commission with a copy of this action plan. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Plans of care must be 01/08/2008 composed and reviewed with input from the resident and or their advocate, unless the offer is declined. 2 9 13(2) That all medicine records are 01/06/2008 clear, accurate and up to date. 3 19 23(2) The registered provider 01/07/2008 needs to provide a schedule of works to address the necessary upgrading and redecoration to ensure all areas of the home are kept in a good state of repair internally and externally, and are reasonably decorated to promote resident safety and comfort. This should identify timescales for completion and be provided to the commission. 4 26 13(3) Suitable hand washing 01/07/2008 facilities need to be provided in all communal hand washing areas that include Page 7 of 11 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action liquid soap and paper towels to promoted good infection control practice. 5 26 13(3) The registered person needs 01/07/2008 to review the laundry provision in consultation with the Environmental Health Officer/Health Promotion Agency to ensure suitable facilities to deal with all the laundry and to prevent any cross contamination. Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That an accurate care plan is 02/11/2009 written setting out how the residents needs in respect of his/her health and welfare are to be met. This will ensure that staff are provided clear and correct guidelines on how to meet the assessed needs of residents. 2 16 22 That the registered provider 02/11/2009 ensures a suitable complaints procedure is established to ensure a suitable record of complaints is maintained. This will ensure a clear procedure for staff and complainants to follow and ensure clear records are held in the home. 3 31 8 That the registered provider 01/10/2009 needs to ensure suitable management arrangements are established at the home. Including confirmation of the appointment of a manager. Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 This will ensure that at all times the home is suitably managed and staff are suitably supervised. 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 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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