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Care Home: Clifton House

  • 1 Grantley Road Boscombe Bournemouth Dorset BH5 1HW
  • Tel: 01202393385
  • Fax: 01202303620

Clifton House is situated in a quiet residential area of Boscombe and is close to all local amenities. It is a corner property with a pleasant rear garden and an outside laundry area. It is registered under the category mental disorder (MD excluding learning disability or dementia) for up to 23 male and female service users. The home has 21 single bedrooms, none have en-suite facilities. There are two bed-sits with a shared kitchen and bathroom on the ground floor which, can accommodate two service users assessed as suitable for more independent living. Clifton House is operated by Together an independent `not for profit` organisation that accommodates and supports 5012009 individuals with enduring mental health problems. Residents receive 24-hour emotional and practical support from a team of experienced residential care workers. The home is currently without a registered manager however, the day to day running is managed by Sheila Shutler, service manager. Fees are charged weekly; the fee range quoted by the service at the time of inspection was per person from £450; fees are adjusted in accordance with the assessed needs of each resident. Up to date information on fees can be obtained from the service.

  • Latitude: 50.724998474121
    Longitude: -1.8370000123978
  • Manager: Miss Sini Piritta Lehtinen
  • Price p/w: £450
  • UK
  • Total Capacity: 23
  • Type: Care home only
  • Provider: Together Working for Wellbeing
  • Ownership: Charity
  • Care Home ID: 4722
Residents Needs:
mental health, excluding learning disability or dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Clifton House.

Key inspection report Care homes for adults (18-65 years) Name: Address: Clifton House 1 Grantley Road Boscombe Bournemouth Dorset BH5 1HW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Joanne Pasker     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Clifton House 1 Grantley Road Boscombe Bournemouth Dorset BH5 1HW 01202393385 01202303620 cliftonhouse@together-uk.org www.together-uk.org Together Working for Wellbeing Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Five named adults (names known to CSCI) over the age of 65 years may be accommodated until such time as their assessed needs cannot be met by the home Date of last inspection Brief description of the care home Clifton House is situated in a quiet residential area of Boscombe and is close to all local amenities. It is a corner property with a pleasant rear garden and an outside laundry area. It is registered under the category mental disorder (MD excluding learning disability or dementia) for up to 23 male and female service users. The home has 21 single bedrooms, none have en-suite facilities. There are two bed-sits with a shared kitchen and bathroom on the ground floor which, can accommodate two service users assessed as suitable for more independent living. Clifton House is operated by Together an independent not for profit organisation that accommodates and supports Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 23 0 5 0 1 2 0 0 9 Brief description of the care home individuals with enduring mental health problems. Residents receive 24-hour emotional and practical support from a team of experienced residential care workers. The home is currently without a registered manager however, the day to day running is managed by Sheila Shutler, service manager. Fees are charged weekly; the fee range quoted by the service at the time of inspection was per person from £450; fees are adjusted in accordance with the assessed needs of each resident. Up to date information on fees can be obtained from the service. Care Homes for Adults (18-65 years) Page 5 of 32 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a statutory inspection required in accordance with the Care Standards Act 2000. This inspection was carried out by three inspectors-one being a specialist pharmacy inspector- and throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. This inspection was unannounced, the inspectors arrived at 10:15 on 30 November 2009, toured the premises and spoke to residents, staff, observed staff interaction with residents and the carrying out of routine tasks and discussed and examined documents regarding care provision and management of the home. Care Homes for Adults (18-65 years) Page 6 of 32 The duration of the inspection was 8 hours. During this inspection compliance with all key standards of the National Minimum Standards was assessed. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The home must ensure that each person who moves into the home has received a pre admission assessment identifying their needs and that the home can meet these needs. Each person must have an individualised plan of care which they are involved in drawing up, includes goal setting and identifies specific actions for staff to help support people in meeting their goals. Risk assessments must be in place for all identified risks, including nutrition and adequately identify specific actions to take to either minimise risks or in the event of increased risks. Care plans must be individualised, regularly updated and reflect resident involvement, individual needs and specific actions to help meet these. The complaints policy should be updated with the Care Quality Commissions correct title. Copies of staff certificates received for attending safeguarding training should be available within individual staff files. Care Homes for Adults (18-65 years) Page 8 of 32 Pre-employment check discussions held with staff should be held on file to show that risks and support needs have been considered and the individual is deemed suitable for employment. Certificates of training undertaken by care workers should be kept on file. An application for a suitable person to apply for the registered manager position must be submitted to the Commission. Monthly monitoring visits must be undertaken by the organisation and accurately reflect whether the running of the home is continuing in the best interests of the residents. 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 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 Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clear statement of purpose is available describing the facilities and needs of people that the home can meet. However no evidence was seen of pre admission assessments of prospective residents needs and whether Clifton House would be the most suitable home for them. Evidence: The statement of purpose was looked at and found to have been updated since the last visit, meeting a requirement made in the last random report. It now clearly states what facilities Clifton House offers and what needs of prospective residents they can meet. It says: Residents prepare their own breakfast and tea with support from staff and we have a cook who prepares lunches 7 days a week. A sample of four persons care files were seen, including three recently admitted people. None of them contained a pre admission assessment to see if individuals needs could be met by the home, before moving into Clifton House. A requirement was made about this in the last random report and is repeated in this report. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. People who use the service do not all have individual plans of their goals and support needs or are involved in developing them. People are supported to make decisions and take responsible risks but this is not always well documented. Evidence: We reviewed the care documentation for three people living at the home. We found that the documentation used and standard of recording was variable. All contained information on aspects of personal and social support, healthcare needs, leisure activities and independent living skills. However all of the files contained varying documentation regarding needs, goals and risks and one did not have a goal plan. The individual plans were dated and signed by the resident in one file, to evidence that they had discussed and agreed them but not in the other two. There was written evidence of recent reviews taking place for all three residents and keyworker meetings being held on a regular basis. Staff spoken with confirmed that they were aware of individuals needs and any interventions preferred. However Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: documentation regarding addressing individuals goals, was not clear and specific in all files. One care plan stated XXX is to be encouraged to be more confident and less suspicious of people but did not say how this would be achieved. A requirement was made in the last random report regarding individualised care plans and this has been repeated in this report. People were seen being supported to make their own decisions during the course of the visit but records again, did not evidence that this happened or stated conflicting advice. For example, one persons risk assessment stated that XXX has no concept of budgeting, however a budgeting agreement seen, stated no help needed and their daily notes indicated that XXX needed assistance with banking and finances. Budgeting agreements had only been signed by one person in the three files we looked at. Discussions with the people and staff members and observations during the inspection, confirmed that people are actively encouraged to make decisions that affect their everyday lives. People were seen being supported to make their own decisions. These included making their own drinks when they liked, choosing to eat when it suited them and going out at different times of the day. Residents spoken with confirmed that they could choose what to do, with some going to the shops/bank or out with friends and family. The risks to all three of the people in their day-to-day lives had been assessed and documented, although it was not clear how much each person had been involved in the development of these assessments, as only one was signed and dated. Two of the persons risk assessments gave specific interventions and actions for staff to deal with the identified risks. The third file stated that XXX could become paranoid when out in public and had a history of being verbally aggressive and swearing at members of the public. The risk assessment did not say what staff should do if they are out with the person in public and this happens. Another persons daily records showed that they had a high intake of only a few types of food, through choice and were reluctant to try other things. However this was not reflected on the care plan, although staff were very aware of this preference. No dietary referral or advice had been sought either and the risk assessment did not reflect the risk of dietary problems or neglect. A requirement was made in the last random report regarding this and has been repeated in this report. Generally we found that different documents within all three files said different things. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: These would benefit from being incorporated into one document where all risks can be identified with information about how to minimise risks. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. People participate in a range of social, leisure, and educational and occupational opportunities. Mostly they have opportunities to maintain appropriate and fulfilling lifestyles in and outside the home although records could more accurately reflect how staff will support them achieve this. Evidence: People spoken with said they spent their days in varied ways including: going shopping or out for a walk, meeting friends or family and eating out. One person attends college. Everyone has a key to their room and people said that staff do not enter until they let them in and this was observed during the day. People said that they can have visitors to the home and they are always welcomed Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: and people chose where to spend their time and were free to come and go, in and out of the home. Staff and residents spoke about various activities and events that were available and these were also clearly displayed on posters in the home. Two support workers organise all the activities and these included: bingo, yoga, massage, games and cards. Themed food evenings are also held and a christmas party was being organised. The notes on one persons file said that one of their interests and hobbies was watching football and we heard staff discussing this with the resident during the day. However there was no other information on the file advising how staff might support this person with their interest in football or how this might be achieved. The menus and observation of lunchtime showed that nutritious and varied meals are now provided by a full time chef employed by the home. Several people choose to go out during the day however everyone is provided with a cooked lunchtime meal, which is appropriately stored until they return home later, giving them the opportunity to still have one. People spoken with said they enjoyed the food served and were very happy with the meal choices provided, which everyone helps decide. Peoples food preferences and choices were well recorded, as were dietary requirements such as a diabetic diet and specific foods required. Daily food records seen for 2 people and these were well recorded. One showed a clear varied intake of nutritious meals at least twice a day. The other recorded a high intake of mainly cereal and cheese although it was not documented on the care plan that this was the individuals choice and preference to eat these types of food. There was also no evidence of any dietary advice or referral being sought for this person or a risk assessment regarding possible dietary neglect, as identified in the previous outcome area. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff respect people and promote their dignity and privacy and medication systems in place are safe. The health and personal care that people in this home receive is not always based on their individual needs though and could be improved. Evidence: Positive relationships and interactions were observed between staff and the people who live at the home. Some people commented that they got on well with staff, particularly their keyworker and felt supported by the majority of staff. People living at the home do not require any hands on personal care but some may need some prompting from staff to maintain personal hygiene. This is identified in the care plans if necessary, although does not always give specific actions and interventions to help staff achieve this. Individuals health records and care plans showed that their right to good quality physical and mental health care is generally well promoted. Records show that people are supported to attend the dentist, GP and chiropodist appointments and have regular contact with their care co-ordinators. Information in individual care files varied Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: though and some care plans lacked specific actions and interventions for staff to help people attain their health goals. One care plan stated XXX will experience improved self esteem if XXX is clean and well dressed. XXX enjoys comments about their achievements when XXX has showered and dressed. Another care plan stated the aim to be For XXX to lose or maintain weight however there was no further information on how they would be supported with this and no weight chart was available to demonstrate how the home were monitoring this. Our Pharmacist Inspector looked at all the areas of medicine handling in the home. The home has recently put in place new procedures for recording and auditing the medicines. This system will make sure that all medicines can be accounted for at all times. Each person has an individual file which contains the record of the medicines they have taken, risk assessments and guidelines for their medicines, stock checks and re-ordering details. Some people manage their own medicines with support from the staff. The risks to people involved in this process had been documented and were reviewed regularly. Each persons file had information specifically relating to them and their medicines, some that we looked at had not been reviewed and were dated up to a year ago, so staff using these files would not know if the information was current. We saw people being given their medicines in an individual manner, having regard to the level of support they need. All medicines are stored securely. The home does not currently have any controlled drugs, but the manager must give consideration to the safe storage of such medicines should they be needed in the future, as a legal controlled drug cupboard would be required. A comprehensive policy and procedure is available to the staff in addition to the Together policy for medication. Staff who administer medicines have been trained in safe handling and the home is currently auditing the training that people have received. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The people who live in this home are able to express their concerns and know whom to speak to if they are unhappy or feel unsafe. They are supported by a staff team who have a good knowledge of how to respond to any suspicion of abuse. Evidence: There have been no complaints made to the Care Quality Commission about the home since the last inspection. 6 complaints made to the home between 2008 and 2009, were seen to be well documented and managed. The home had a copy of the corporate complaints policy and procedure by Together Working for Wellbeing and people spoken with were aware of how to raise a concern with staff or others, if needed. This does need to be updated with the Commissions correct current name. Records showed that all staff had received some form of safeguarding training although some had taken place more than 3 years ago and certificates were not always on file to evidence this. The manager told us that arrangements had been made for staff to access update training in this area from the local authority. A policy and procedure was seen for the protection of vulnerable adults, which makes reference to the local safeguarding policy, however also needs to be updated with the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: correct current name of the Commission. No copy of the local Pan Dorset multi agency safeguarding policy could be found. A recent Regulation 37 report regarding an incident between 2 residents was seen to have been appropriately reported to the local borough safeguarding team though, demonstrating that staff were aware of the correct procedure. Care Homes for Adults (18-65 years) Page 20 of 32 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. The home is well maintained and furnished so that people live in a homely, clean, comfortable environment. Evidence: There is a warm and welcoming atmosphere in the home and at the time of the visit, it was homely, comfortable and safe. People living there were able to move around easily and freely and to go to their bedrooms if they chose. People living in the home were happy to show us their bedrooms. The bedrooms reflected their individual lifestyles, interests and tastes. Communal areas include a good-sized garden, two large lounges, conservatory/games area and a large kitchen diner. A smoking shelter had been purchased and was waiting to be erected in the garden. People chose whether they wished to spend time in the communal areas or in their own rooms. Communal bathrooms and toilets were clean and had toilet rolls and facilities for washing and drying hands. People take responsibility for the cleaning of their own rooms and receive prompting and assistance from staff as needed. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: People do their own personal laundry and were seen using the laundry facilities, which were well maintained. Care Homes for Adults (18-65 years) Page 22 of 32 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Overall the home has suitable procedures in place to ensure that appropriate preemployment checks are carried out although there are areas that could be improved to ensure they are fully robust. Care workers have access to various training courses to support them in developing knowledge and skills for their role but record-keeping around this needs to be reviewed to ensure that their learning and development is clearly evidenced. Evidence: We looked at the recruitment records for four care workers employed at the home. We saw that the home operates a structured interview process where prospective care workers complete an application form and attend an interview. There was evidence of a full employment history being obtained in each case with an explanation of any gaps. Written references had also been obtained for each individual and there was proof of identity on their files. The home had carried out appropriate checks with the Criminal Records Bureau for each person and evidence of this was held on file. We identified that there was no information on record to show that any issues arising from pre-employment checks had been given consideration as part of the recruitment process. The manager told us that this would have been done at the organisations Head Office. We recommend that discussions that take place between the service and a prospective care worker in relation to pre-employment checks are documented on Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: file, that risks are assessed and a judgement made about their suitability to work in the home including any additional support or supervision that may be needed. We also reminded the manager that the regulations state that a recent photograph must be held on care workers records and therefore when obtaining this as part of the recruitment process they should be certain that the photograph is current. To improve their recruitment procedures further we have also recommended that references are verified with the referee to confirm their authenticity. We looked at the staff training file which is held in the home. This comprised various lists of people working in the home and training that has been undertaken by them. We also saw lists of training that had been booked for later in the year. The manager told us that they are looking to put together a training matrix in the form of a wall chart so that they can see what training has been completed and easily identify updates that are needed. We looked at the list of training that has been undertaken by four care workers. We found that care workers have had opportunities to do specialist training as part of their employment including training in complex needs and challenging behaviour, mental health awareness, the recovery model, managing boundaries and risk assessment. We saw that some staff had been booked onto future training which included motivational interviewing and train the trainer courses. We were advised by the manager that some of these courses may need to be postponed due to the service needing to prioritise at this time and to ensure care workers received the basic training they needed to fulfill their role such as training in care planning. For the four care workers whose records we looked at there was limited evidence of certificates on record to fully evidence the courses they had attended. We have recommended to the manager that certificates of training are held on peoples individual files. The manager showed awareness of how training needs should link with supervision and appraisal processes in the home so that it is clear how individuals are developing in their role and how training is being used to benefit people who use the service. We asked the manager whether consideration was being given to ensuring care workers have training in the Mental Capacity Act and Deprivation of Liberties legislation. She confirmed that training in the Mental Capacity Act was being rolled out to care workers but that training in Deprivation of Liberties was not. The manager told us that two relief workers who had recently been appointed were currently working through their induction programme. We saw on file the document used by the organisation to structure learning during the induction period. The framework was seen to follow the Common Induction Standards. The manager told us that some staff were undertaking National Vocational Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: Qualifications (NVQs) in Care. The service has links with the organisations NVQ Centre which enables care workers to access the training they need for their role. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. People benefit from living in an improving home. They know that their views will be listened to and that management and monitoring systems are improving. Evidence: At the time of this visit, Clifton House was without a registered manager. The day to day running of the home was being overseen by the service manager who was new in post, having been placed in the home to address the issues raised by the previous random inspection and support staff. The home has since notified us that a new manager has been appointed and an application to be registered manager of the home will be submitted to the Commission in a timely manner. Regular staff meetings take place and the minutes from the last residents meeting, held in November 2009, were seen on the board in the dining room. At the moment there are some auditing systems in place for monitoring of incidents and accidents but not care plans. An annual review is carried out based upon the results of surveys sent out to residents, staff and stakeholders. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: Regulation 26 monitoring visits are currently undertaken by a service manager but these have not been accurately reflecting the running of the home. These monitoring visits must be completed on a monthly basis as they are an integral part of the quality assurance and monitoring systems. A sample of health and safety records were checked and these showed that health and safety matters are generally well managed. Staff training records for mandatory courses were not always supported with certificates to evidence their attendance though. Fire records seen showed that acceptable fire training, testing and assessments were in place. It was discussed with the home that due to the number of people who smoked out of any designated area (i.e in their bedrooms), consideration should be given to how this could be best managed by appropriate risk assessments. Care Homes for Adults (18-65 years) Page 27 of 32 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 14 The registered person must 12/03/2010 ensure that the needs of any prospective resident are appropriately assessed prior to moving in and a record of this kept. This is to make sure that Clifton House only offer places to people whose needs can be met by the home. 2 6 15 The registered person must 12/03/2010 ensure that all people have an individual plan of care which has drawn up with the involvement of the person, is based upon their Care Programme Approach assessment and is regularly reviewed. This is to make sure that peoples needs are correctly identified and personal care plans involve the individual resident and reflect their chosen goals and needs. 3 39 26 The registered person shall provide an accurate and current reflection of the running of the home in their monthly visit reports. This is to ensure that any changes to the running of 12/03/2010 Care Homes for Adults (18-65 years) Page 28 of 32 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 the home are adequately monitored and seen to be in the best interests of residents. Care Homes for Adults (18-65 years) Page 29 of 32 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 1 9 13 The registered person shall 12/03/2010 ensure that unnecessary risk to the health or welfare of residents are identified and so far as possible eliminated. This refers to risk assessments for nutrition. This is to ensure that risks are identified so measures can be put in place to reduce the risk. 2 18 15 The registered person shall, 09/04/2010 after consultation with the service user, or a representative of the service user, prepare a written plan (the service users care plan) as to how the service users needs in respect of health and welfare are to be met, and shall keep the plan under review. Care plans and other care records must be improved Care Homes for Adults (18-65 years) Page 30 of 32 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 and reflect resident involvement, individual needs and specific actions to help meet these. 3 37 8 The registered provider must submit an application for a registered manager to the Commission. This is to ensure that a suitable and registered person manages the home. 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 31/03/2010 1 2 3 4 22 23 23 23 The complaints policy should be updated with the Care Quality Commissions correct title. The safeguarding policy should be updated with the Care Quality Commissions correct title. A copy of the local multi agency safeguarding policy and procedures should be available in the home. Copies of staff certificates received for attending safeguarding training should be available within individual staff files. You should ensure that records of discussions that take place with prospective care workers about issues arising from their pre-employment checks are held on file to show that risks and support needs have been considered and the individual is deemed suitable for employment. You should ensure that certificates of training undertaken by care workers are kept on file. 5 34 6 35 Care Homes for Adults (18-65 years) Page 31 of 32 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). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 32 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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