Care Home: Clifton House

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What the care home does well All the residents had gone through an assessment process before they were admitted to the home. This consisted of the manager seeing people in their homes or hospital and people visiting the home for lunch or tea before deciding to take up a place. The manager completed an assessment form which formed the basis of a care plan. This was to make sure that the home could meet the persons needs and that the care workers knew what they needed to do to meet these needs. The care plans seen were well organised which meant that the information could be found easily. All the residents we spoke with on the day of the inspection said that they were very happy with the care they received. They said that `their privacy and dignity was respected;` `that they were well looked after;` `that the staff were very good, kind and caring.` The care plans showed that the health care needs of the residents were met through visits by the GP, district nurse and visits to consultants as and when necessary. There was an activities organiser who as part of her duties accompanied people to hospital visits if family were not available. Clifton House was clean and tidy and free from any offensive odours. The gardens were also maintained to a satisfactory standard. The home had a stable staff team with some of the staff having worked their for about eighteen years. There had been no new staff employed since the previous inspection of April 2008. The care staff that we spoke with or received a survey from said that; `they liked working at the home`; ` that they felt the residents were well cared for`; `that they had training to help them to do their work;` `that the food was very good.`. The majority of the care workers had a National Vocational Qualification (NVQ). Other training was ongoing such as moving and handling and safeguarding adults. The manager had conducted a quality assurance survey with the residents of the home. A copy of the overall results was given to us. It showed that the people living at the home were pleased with the care they were receiving. The manager in the AQAA said that there were policies and procedures in place and that they were reviewed regularly. What has improved since the last inspection? A number of recommendations were given at the previous inspection of April 2008. All these had been implemented or were to be completed in the near future. The service user guide had been amended to reflect the change of address of the Commission.The assessment documentation was now distinct from the care plan which made it easier to find the information. The carpet in the dining room and the hall, stairs and landing had been replaced. The application form had been amended with regard to employment history in order to protect the residents from unsuitable care workers. A quality assurance report was sent to us for the year ending March 2009. The manager had kept us informed of events throughout out the year as required. What the care home could do better: The daily recordings contained basic information only. These could be improved to give a better picture of what the person had done during the day and the evening. The care plan agreements need to be signed by the resident or their representative to confirm that the plan had been seen and that it had been agreed. The residents should be made aware of what is on the menu. This is to allow them to make choices about the food being served and if they required an alternative. The manager should risk assess the steps leading from the dining room to the garden and take appropriate action in order to keep people safe. The toilets should have nurse call bells fitted so that people can call for assistance. The toilet which had no hot water should have this turned back on in the interests of hygiene and infection control. The radiators in some of the bedrooms and in the toilets were very hot to the touch and as such represented a danger to the residents. The manager should make arrangements to address this. The manager should make sure that formal supervision takes place more often with more consistency. This is to make sure that the staff have the time to voice their opinions, discuss their training needs and any problems they may have. The manager should look at the training that staff have taken in order to assess if refresher training is required. This is to make sure that their knowledge is up to date for the job that they are doing. The manager should introduce a system of a fire drill that is recorded and includes the names of the staff present to ensure that health and safety of the staff and residents. A record of any accident should also be recorded in the individuals daily diary as well as the accident record. More information should also be given. This is to make sure that the staff team on the next shift are fully aware of what has happened earlier. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clifton House 3 Clifton Road Heaton Moor Stockport Cheshire SK4 4DD     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: Jacqueline Kelly     Date: 1 4 0 4 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: Clifton House 3 Clifton Road Heaton Moor Stockport Cheshire SK4 4DD 0161-4328287 F/P01614328287 cliftonrch@mailauth.co.uk 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) : Clifton House (RCH) Limited care home 12 Number of places (if applicable): Under 65 Over 65 0 12 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 12 0 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 12 Date of last inspection Brief description of the care home Clifton House is a residential care home that provided care for up to 12 people whose primary care needs were due to their old age, including up to three people who may have a diagnosis of mental illness. Mr and Mrs Hudson are the proprietors of Clifton House with Mrs Hudson the registered manager. The accommodation was provided in a large, detached house set in its own grounds; all the rooms were single occupancy and it was clean and satisfactorily furnished. There was a full passenger lift to take people Care Homes for Older People Page 4 of 27 Brief description of the care home up to the first floor. The home is situated in the Heaton Moor area of Stockport. Local shops, cinema, library and park are within walking distance of the home. Stockport town centre, motorway network and public transport are easily accessible. The current weekly fees range from £340 to £400, dependent on the individual care needs of people living in the home. Further details regarding fees are available from the manager. Additional charges may also be made for hairdressing, chiropody and other personal requirements. There was information about the home available along with a copy of the most recent inspection report. 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: The quality rating for this inspection is 2 star. This means the people who use this service experience good quality outcomes. Before the inspection we asked the manager of the home to complete a form called an Annual quality Assurance Assessment, AQAA, to tell us what they felt they did well and what they could do better. We felt that time had been given to filling in the form and that it had been completed honestly. We last made an unannounced key inspection of this service on the 15 April 2008. This inspection was an unannounced key inspection and we spent just over four hours Care Homes for Older People Page 6 of 27 at the home. During the visit we spoke with the manager, seven residents and two members of staff. We looked at care files, daily records, medication records, accident records and staff records. Ten staff survey questionnaires were sent to the manager for distribution; two were returned to us. Eleven service user surveys were also sent to the home for each individual resident to complete. Information from these will be included in future assessments. There had been two complaints recorded by the manager both of which had been resolved. We had received a complaint which we asked the Environmental Health Department of Stockport MBC to investigate. Again this had been resolved in a satisfactory manner. There had been no safeguarding adult referrals or investigations. The report was written on behalf of the Care Quality Commission therefore throughout the report the terms we and us are used. What the care home does well: What has improved since the last inspection? A number of recommendations were given at the previous inspection of April 2008. All these had been implemented or were to be completed in the near future. The service user guide had been amended to reflect the change of address of the Commission. Care Homes for Older People Page 8 of 27 The assessment documentation was now distinct from the care plan which made it easier to find the information. The carpet in the dining room and the hall, stairs and landing had been replaced. The application form had been amended with regard to employment history in order to protect the residents from unsuitable care workers. A quality assurance report was sent to us for the year ending March 2009. The manager had kept us informed of events throughout out the year as required. What they could do better: The daily recordings contained basic information only. These could be improved to give a better picture of what the person had done during the day and the evening. The care plan agreements need to be signed by the resident or their representative to confirm that the plan had been seen and that it had been agreed. The residents should be made aware of what is on the menu. This is to allow them to make choices about the food being served and if they required an alternative. The manager should risk assess the steps leading from the dining room to the garden and take appropriate action in order to keep people safe. The toilets should have nurse call bells fitted so that people can call for assistance. The toilet which had no hot water should have this turned back on in the interests of hygiene and infection control. The radiators in some of the bedrooms and in the toilets were very hot to the touch and as such represented a danger to the residents. The manager should make arrangements to address this. The manager should make sure that formal supervision takes place more often with more consistency. This is to make sure that the staff have the time to voice their opinions, discuss their training needs and any problems they may have. The manager should look at the training that staff have taken in order to assess if refresher training is required. This is to make sure that their knowledge is up to date for the job that they are doing. The manager should introduce a system of a fire drill that is recorded and includes the names of the staff present to ensure that health and safety of the staff and residents. A record of any accident should also be recorded in the individuals daily diary as well as the accident record. More information should also be given. This is to make sure that the staff team on the next shift are fully aware of what has happened earlier. Care Homes for Older People Page 9 of 27 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 10 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 11 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. All the people who use the service had an assessment to make sure that the care workers could meet their needs. Evidence: All the people who were thinking of using the services of Clifton House were invited to look around the home or if they were not able a relative did this on their behalf. If after the visit the person wished too continue with the inquiry they received a home or hospital visit from the manager who completed an assessment of their needs. People were then asked if they wished to visit the home for lunch or tea before making a commitment to move into the home for a trial stay which was usually six weeks. This assessment process was to make sure that the staff of the home had the skills and experience to be able to provide the care they needed. The assessment also Care Homes for Older People Page 12 of 27 Evidence: provided information towards the completion of the care plan for the care workers to follow. The company did not provide intermediate care. Care Homes for Older People Page 13 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. The residents personal and health care needs are met and their privacy and dignity respected. Evidence: Care plans which provided the care workers with information about the person were in place including a falls risk assessment and moving and handling assessment. The care files also contained other information such as hospital appointments, notes of GP and District Nurse visits and dates when the manager had reviewed the care plans. However not all the care plan agreement forms had been signed by the residents or their representatives. This should be done to show that people had seen and agreed the care plan and that it would meet their needs. The care plan and daily records showed that the residents health care needs were met through the GP, district nurse and visits to hospital as and when necessary. The daily records could contain more information about what the person had done Care Homes for Older People Page 14 of 27 Evidence: during the day and evening. Medication administration records were kept which recorded what was prescribed, times when the medication had to be given and when it had been given. Senior care workers gave out the medication and they had completed a distance learning package with Stockport College on the safe handling of medication. One of the residents managed their own medication. A risk assessment had been completed although the resident had not signed it at the time of the inspection. All the residents had a single room. All those we spoke said that their privacy and dignity was respected. 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. The people who live at Clifton House are able to make choices and retain control over their lives. Evidence: The residents had their own rooms and were able to stay in their rooms and have their meals there if this was what they wanted to do. There was a small lounge on the first floor which people could use if they wished to see people in private but did not want to take them to their bedroom. An activities manager was employed to encourage and support residents with activities either in the home or out in the community. She accompanied people to hospital and GP appointments if family were not available. Representatives from the local church attended the home. An activities programme was available for people to see. All the people who lived at Clifton House were responsible for their own financial affairs or with help of others such as family or friends. Care Homes for Older People Page 16 of 27 Evidence: Everyone said that the food was good and that if they didnt like what was available they would be given an alternative. However no one knew what they were having for their lunch or for tea. This is something that the manager should look into. People should be aware of what is on the menu. 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 are protected through policies and procedures and care worker training. Evidence: We received a complaint shortly after the inspection to the home. The complaint was discussed with the manager and was investigated by the Environmental Health Division of Stockport MBC. Advice was given to the manager which the manager was putting in place. None of the staff or residents we spoke with on the day of the inspection had any complaints. The manager had recently completed a course on Deprivation of Liberty through the staff development section of Stockport MBC. Staff had received the alerter training for the safeguarding of adults. The manager had in place systems to obtain Criminal Record Bureau checks as required for new staff. 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. The home is comfortable and clean throughout and has no offensive odours. However the home is not safe in all areas as some of the fixtures could put the residents at risk from injury. Evidence: The home was clean throughout and had no offensive odours. Everyone had a single room and some of these had been personalised by the residents. There were two bathrooms one of which had a walk in shower cubicle. However the upstairs bathroom was not used as there was no hoist to help people in and out of the bath. New carpet had been put down in the dining room, entrance hall, downstairs corridor, stairs and upstairs corridor. The flooring in one of the toilets had also been replaced. The previous report said that one of the downstairs toilets needed renovation and another needed the lock replaced. As these repairs had not been done they were discussed with the manager who said that the work was in hand and would be completed in the near future. Care Homes for Older People Page 19 of 27 Evidence: We were informed that there was no nurse call bell in one of the toilets and we also noticed that the radiators were hot and were not covered. The manager needs to look into the lack of nurse call bells and the hot surface temperature of the radiators for the health and safety of the residents. One of the toilets had no hot water; again this needs to be seen to. Some to the radiators in other parts of the home were also not covered and were very hot. These were dangerous as they had the potential to give someone who may fall against them very serious burns. The manager should reduce this risk as soon as possible. The electric socket in a residents bedroom which had black tape over it to stop people using it should be repaired without further delay. Again this was discussed with the manager who said that it was in hand. There were steep concrete steps leading from the dining room door into the garden which had no handrail to the outside of the steps. We felt that the lack of handrails could be a potential health and safety risk to both staff and residents. The manager should look at ways of minimising the risk. The homes laundry facilities were located in the cellar; these were not looked at during this inspection. 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. The recruitment and training of staff made sure that only suitable people were employed and trained to meet the residents personal and health care needs. Evidence: The number of care workers employed were appropriate to meet the current needs of the people who were living at Clifton House. There were two housekeepers but no cook was employed as the cooking was done by the senior person on duty. No new staff had been employed since the previous inspection twelve months ago. However the manager was aware of best practice when recruiting and selecting staff. Eight of the staff had completed a National Vocational Qualification (NVQ) level 2 in care and three people also held a NVQ level 3. Two others were undertaking the qualification one at level 2 and one at level 3. Care Homes for Older People Page 21 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. The home is run in the best interests of the residents. Evidence: The manager of Clifton House who was also one of the directors of the care home had the necessary qualifications and skills to be in control of the day to day running of the home. Questionnaires had been distributed to the residents and their relatives by the manager in order to obtain their opinions and views about the service. The results of these were included in the Quality Assurance report ending March 2009 a copy of which was sent to us. Nine of the eleven surveys were returned to the manager and all were very positive about the service received. All the residents had control over their own money and finances. Care Homes for Older People Page 22 of 27 Evidence: Formal supervision whereby the manager spends time with a member of staff to talk about the work they do, their training needs and is recorded should take place more often and be more consistent. Moving and handling, infection control, food hygiene and first aid training had taken place. However for some of the staff team the training had been taken some time ago. The manager should look at this and assess if it is necessary for staff to do refresher courses to make sure that their knowledge is up to date. The gas safety certificate was obtained shortly after the inspection. The manager said that the electrical safety certificate was due this September 2009. The fire alarm system was tested at the same time each week. Whilst this is satisfactory the manager should set off the fire alarms at least once a year without telling anyone and on a different day and time from the usual test. This is to make sure that the staff act according to the fire procedures in order to keep people safe. This process may have to be done more than once in order to make sure all the staff undertake this exercise. The date of the fire drill and who was present should be recorded. Risk assessments were in place and kept on individual resident files. Accidents were recorded however the written information could be improved to include more detail. A record should be made in the daily notes as well as the accident record. This is to make sure that the staff on the next shift were aware of what had happened. Care Homes for Older People Page 23 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 24 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 The care plan agreements need to be signed by the resident or their representative to confirm that the plan had been seen and that it had been agreed. The daily recordings contained basic information only. These could be improved to give a better picture of what the person had done during the day and the evening. The residents should be made aware of what is on the menu. This is to allow them to make choices about the food being served and if they required an alternative. The toilets should have nurse call bells fitted so that people can call for assistance. The toilet which had no hot water should have this turned back on in the interests of hygiene and infection control. The manager should risk assess the steps leading from the dining room to the garden and take appropriate action in order to keep people safe. The radiators in some of the bedrooms and in the toilets were very hot to the touch and as such represented a danger to the residents. The manager should make arrangements to address this. 2 7 3 15 4 19 5 19 6 25 Care Homes for Older People Page 25 of 27 7 36 The manager should make sure that formal supervision takes place more often with more consistency. This is to make sure that the staff have the time to voice their opinions, discuss their training needs and any problems they may have. A record of any accident should also be recorded in the individuals daily diary as well as the accident record. More information should also be given. This is to make sure that the staff team on the next shift are fully aware of what has happened earlier. The manager should introduce a system of a fire drill that is recorded and includes the names of the staff present to ensure tha health and safety of the staff and residents. The manager should look at the training that staff have taken in order to assess if refresher training is required. This is to make sure that their knowledge is up to date for the job that they are doing. 8 38 9 38 10 38 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. 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