Care Home: Clifton House (77)

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What the care home does well The home is able to demonstrate that it is assessing and meeting the needs of service users admitted to the home. The health care needs of residents are being well met. Prospective residents, their relatives and friends are able to visit and to assess the quality, facilities and suitability of the home. Residents are living in a homely, safe, well maintained environment, with access to safe, pleasant and comfortable facilities. Residents generally presented as well settled in their environment, and very satisfied with the communal and personal facilities provided. One relative told us that Clifton House is "a good home for my mother". One resident said "I like it here. I feel at home and the staff are so good to us". The home is being managed by the Proprietor in an open, professional and competent manner by Mr. Stephen Sparshott. What has improved since the last inspection? Since the last inspection improvements have been achieved in the following areas: 1. Fridge and freezer temperatures are now being checked daily and records taken. 2. A complete electrical systems check has been carried out and this is valid for 5 years. 3. Improvements have been achieved in ensuring that documentary evidence required under Standard 29 of the National Minimum Standards is gathered for all the staff members at Clifton House and is held on the staff files for review and inspection. 4. Fire drills are now being carried out consistently with the London Fire Brigade`s request. 5. All the refurbishments identified in the previous report have been completed. 6. All staff have received essential training as described in the previous report from a recognised and external training agency. 7. Staffing records for training are more clear, up to date and inclusive. What the care home could do better: Specific areas identified in this report that require some attention are as follows: Standard 29 Appropriately completed (signed and dated) staff contracts and supervision notes need to be put on the staffing files. It is a requirement that the Manager draws up and implements a system to ensure that all the appropriate documents are gained and are available for inspection. This will help to ensure that recruitment practices meet the required standards. Standard 30 It is a requirement that the Manager must ensure that all staff are asked to review the key policies and procedures for the home and to have a discussion in their supervision sessions over a period of time and to sign to say that for each individual key policy and procedure that they have read and understood them and have had the chance to discuss them with their supervisor. Standard 33 It is a requirement that a fully operational quality assurance process is established within the given timescales in order to ensure that the home is run in thebest interests of the residents and of the staff. Standard 36 It is highly recommended that the Manager must ensure the frequency of supervision is at least 6 times a year on an individual basis. A supervision recording format should be used that covers the areas outlined in this report in sufficient detail to ensure a useful record is maintained for both the staff and the management. All staff should be given a copy of their supervision records following the supervision meeting. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clifton House (77) 77 Brighton Road Coulsdon Surrey CR5 2BE     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: David Halliwell     Date: 2 7 0 3 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 32 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 32 Information about the care home Name of care home: Address: Clifton House (77) 77 Brighton Road Coulsdon Surrey CR5 2BE 02086683330 02086686667 clifton@sparshotts.freeserve.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) : Mr Stephen Sparshott care home 16 Number of places (if applicable): Under 65 Over 65 16 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 16 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 Date of last inspection Brief description of the care home Clifton House is a detached extended, residential property situated in Coulsdon that is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 16 older people of either gender. The home does not provide nursing or intermediate care. Communal areas comprise of a spacious lounge/dining area, separate quiet room / visitors facility, a private telephone room and gardens with patio area that is accessible via steps or a ramp for wheelchair users. The property stands on a main road and there is ample off-street parking to the front. The home has the usual additional facilities such as toilets and bathrooms on each floor and a laundry, office and kitchen. There are twelve single and two double bedrooms and six of the single rooms and both the double rooms have en-suite facilities. The Care Homes for Older People Page 4 of 32 Brief description of the care home owner of the home is also registered as the manager for the service. The home?s philosophy of care is stated as Clifton House aims to provide its service users with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance Care Homes for Older People 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: 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: This was an unannounced inspection visit over a period of 2 days that covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 2 members of staff and the Proprietor of the home. 4 residents were spoken with formally and more informal interviews were conducted with 5 other residents as a part of the tour of the home. 1 new requirement has been made as a result of this inspection and 2 of the previous requirements have been repeated. 1 recommendation has been made. Feedback on these were given verbally to the Manager at the end of the inspection visit. We found the residents and staff very helpful and they are to be thanked for the Care Homes for Older People Page 6 of 32 assistance that they provided over the course of this inspection visit. What the care home does well: What has improved since the last inspection? What they could do better: Specific areas identified in this report that require some attention are as follows: Standard 29 Appropriately completed (signed and dated) staff contracts and supervision notes need to be put on the staffing files. It is a requirement that the Manager draws up and implements a system to ensure that all the appropriate documents are gained and are available for inspection. This will help to ensure that recruitment practices meet the required standards. Standard 30 It is a requirement that the Manager must ensure that all staff are asked to review the key policies and procedures for the home and to have a discussion in their supervision sessions over a period of time and to sign to say that for each individual key policy and procedure that they have read and understood them and have had the chance to discuss them with their supervisor. Standard 33 It is a requirement that a fully operational quality assurance process is established within the given timescales in order to ensure that the home is run in the Care Homes for Older People Page 8 of 32 best interests of the residents and of the staff. Standard 36 It is highly recommended that the Manager must ensure the frequency of supervision is at least 6 times a year on an individual basis. A supervision recording format should be used that covers the areas outlined in this report in sufficient detail to ensure a useful record is maintained for both the staff and the management. All staff should be given a copy of their supervision records following the supervision meeting. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 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 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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service.Residents may be assured that their needs will be thoroughly assessed and reviewed by their referring agencies, they may also be assured that their needs will continue to be fully assessed at Clifton House and that fully completed documentation will always be held on their files. Standard 6 is not applicable to this home as it does not provide intermediate care. Evidence: We examined 3 of the 14 residents files at this inspection and found on each file an assessment of needs had been carried out by the home. These assessments have been based on information supplied by the referring professionals, usually the Local Authority care managers, and by the staffs own assessment of the persons needs. The needs assessment format covers the assessment of residents social care needs Care Homes for Older People Page 11 of 32 Evidence: including the residents cultural and religious needs. The assessment tool provides a useful way of comprehensively ensuring all the residents or prospective residents needs are taken into account at the assessment stage. This includes an assessment of the persons health, risk factors, mobility and the compatibility of the person to fit in with the current service users. The assessment is completed with the service user, his/her relative or representative and with the relevant professionals that have been associated with the referral. Religious and cultural needs are a part of the needs assessments seen in the residents files and all care plans are based on the information contained in the needs assessments. Evidence seen on the residents files indicates that internal care plan reviews are now held monthly or earlier if residents needs change. These reviews involve the residents and where appropriate their relatives and families and the homes care staff. This was confirmed by the staff, residents and relatives who we spoke to as a part of this inspection. Intermediate care is not provided for at Clifton House so this Standard has not been assessed. Care Homes for Older People Page 12 of 32 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.Residents can be assured that their health, personal and social care needs will be the central focus of their care plans and that these plans will be appropriately reviewed as and when required.Residents can also be assured that their healthcare needs will be met at Clifton House.Medication administration is being appropriately managed and properly recorded and stored, and residents are being protected by the homes policies and procedures for dealing with medicines. Evidence: We examined 3 of the residents files and found that most of the documents required in respect of each resident under Schedule 3 were seen on these files. On each residents file inspected an appropriate needs assessments had been drawn up. Care plans had been constructed from these needs assessments and we were impressed with the detail covered in these plans. All the care plans inspected were seen to be reviewed monthly or earlier if the needs of the residents change, the date of the Care Homes for Older People Page 13 of 32 Evidence: review and the signature of the staff reviewing the plan being recorded on file. It was clear from the care plan records held on the files that all the appropriate people are usually involved in the care plan reviews including the resident and their relatives where appropriate or their representatives. We spoke to a relative of one of the residents who also confirmed that their mothers care plan is reviewed and that the resident is normally involved in the process. The Proprietor informed us that after the initial placement of a new resident an intermediate care plan is drawn up before the 6 week review. After the 6 week review, the care plan is revised and then reviewed monthly by keywork staff. On each of the 3 residents files inspected we saw risk assessments. These risk assessments covered essential areas of the residents lives, such as the risk of falling within the home. These risk assessments were seen to have been reviewed and updated where appropriate. A requirement made at the last inspection has been met, given that the Manager now ensures that a photograph of each of the residents is placed on their individual files. This is to ensure the correct identification of that resident and is particularly important for new or temporary staff that are or may be employed at Clifton House. This standard concerns the healthcare of each of the residents. The Proprietor informed us that all the residents have access to a GP. We were told that all residents have access to health care professionals who visit Clifton House on a regular basis. The optician visits regularly, the dentist visits once every 6 months and the chiropodist also visits on regular basis. This information was also supported by the residents and relatives and by staff who we spoke to over the course of this inspection. We were told by the Proprietor that for each resident a record is held on their files of every visit made to the residents by healthcare professionals. Evidence of this was seen on all 3 of the files inspected. The Manager informed us that dietary needs of residents are not assessed as a matter of course unless they have any special dietary needs and then a nutritional assessment could be arranged. We were provided with the agencies policies and procedures manual by the Proprietor and this file included an appropriate medication policy for the unit. He told us that the usual practice for the administration of medicines at Clifton House is for care staff to give the residents their medication. At a previous inspection a requirement was made to ensure that all care staff receive Care Homes for Older People Page 14 of 32 Evidence: training on the safe handling of medication. The Proprietor told us that all staff are booked onto this training on 11th May 2009 and evidence of this was seen by us. This is important so that all staff who administer medications to residents are kept up to date with best practice. Staff who receive the appropriate training should be better able to ensure that the residents are protected by safe and appropriate practices. Appropriate records (MAR sheets) were seen to have been completed properly for the administration of medicines to residents. Together with the Proprietor we carried out a random stock take check of the medicines held in the homes medicine cabinet and the levels of stock indicated on the MAR sheets. These tallied appropriately, confirming that the administration and storage practices staff are using are accurate and appropriate. We spoke with 6 of the residents at Clifton House about the quality of the care they receive to meet their needs. We were impressed with the positive remarks they made about the care and support that they receive from staff at Clifton House. We were also impressed by the commitment of the 2 staff, formally interviewed by us, to maintaining the dignity and privacy of the residents wherever possible. All the residents receive personal care and some are helped with washing and bathing, dressing and toileting. Care staff interviewed showed by their responses and comments their caring attitude towards the residents. All of the bedrooms have en suite toilet and washing facilities and this also helps residents to maintain a level of privacy that they welcome. The Proprietor told us that the staff induction programme which all new staff has to work through covers the core standards of privacy, dignity, independence, civil rights, fulfilment and choice. Evidence of the induction programme being carried out for the latest 2 staff recruit was seen by us on the staffing files inspected. Care Homes for Older People Page 15 of 32 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.Residents are likely to find that the lifestyle they experience at Clifton House matches their expectations and their preferences and satisfies their social, cultural, religious and recreational interests.Residents are encouraged to maintain contacts with their friends and families and service users are helped to exercise choice and control in their lives wherever possible. The meals and food provided to residents is well balanced, healthy and varied. Evidence: The Proprietor told us that a range of different entertainments and social activities are provided for the residents. These include music for health, where a therapist visits the home on 1 day each month and involves the residents in making music. 6 residents told us how much they enjoyed this activity, saying I really like this because we do all the old songs that I know and I can join in with too. We were told by the Proprietor and a member of staff that as well as this outside professional singers come to the home every month to entertain the residents. Residents that we spoke to said they enjoy this entertainment. Care Homes for Older People Page 16 of 32 Evidence: Other activities involve doing jigsaws; painting and drawing; armchair aerobics; and there is an activities person who works one day a week at Clifton House and who organises exercises and appropriate activities for the residents such as carpet bowls, reminiscent talks, quizzes, bingo and sing songs. We noted that many residents said they enjoyed this input. The Proprietor informed us that the residents religious and cultural needs are assessed as a part of their initial assessment and placement at Clifton House. A catholic and a C/E minister both visit the home weekly and residents are encouraged to attend the services if they wish to and staff will assist them to do so. 2 residents told us how they enjoy the opportunity to participate in these religious activities. We were told by the Proprietor and the staff that there are no specific visiting hours and that as long as a resident wishes to see a relative then visitors are welcome at most times of the day. A record of visitors was seen and visitors can be entertained in communal areas as well as the residents own bedrooms where relatives, families and friends can be seen in private if they wish. Residents confirmed this with us at this inspection. This standard explores issues relating to: managing financial affairs, advocacy, respecting of the right to personal possessions, and enabling access to information kept concerning a service user. The Proprietor informed us that the home does not handle or control any of the residents finances and where residents are unable to do so for themselves, relatives deal with these affairs on their behalf. As a part of the inspection we spoke with the Proprietor and discussed the menu planning and the food provided to the residents. He informed us that there is a rolling menu plan that is drawn up after consultation with the residents at the residents meeting, who are asked what they would like to eat. He also said that on most days he goes out and does the shopping himself and any special dietary requirements or individual daily requests are taken into account and provision is made in the menu plan and in the shopping purchased. At the start of this inspection we saw the Proprietor who had just returned from a shopping trip with fresh vegetables and food. We saw both the menu plan and the daily menus that provide a wide and healthy range of food for the residents. We were present for the lunch and we were able to speak to the residents at these times about the food. They said that they like the food on offer to them and they confirmed that they do have a choice. Care Homes for Older People Page 17 of 32 Evidence: Care staff was seen to provide assistance to the residents when this was necessary and staff were seen to ask the residents before they offered any help to them. Meal times were seen to be unhurried and any resident who chose to eat in their bedrooms was enabled to do so. At the last inspection a requirement was made for the unfinished work in the kitchen to be completed, this has now been done and so this requirement has now been met. This work was essential in order to maintain the appropriate levels of hygiene required in the kitchen area. Care Homes for Older People Page 18 of 32 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.Residents can be confident that the home will deal with complaints appropriately; information about the complaints procedure is readily available to all who may wish to express an opinion about the service. Residents can be assured that the processes in the home will protect them from potential abuse by staff or others. Evidence: The Proprietor showed us the complaints policy and procedure for Clifton House. This policy covers all the essential areas required for a complaints policy including a staged process with timescales and contacts for other agencies to contact in the event of dissatisfaction with the internal process of investigation. The Manager maintains a record of complaints and we saw this. No complaints had been recorded since the last inspection. A copy of the Complaints procedure and log record is kept on the residents notice board with a book available to document any complaints or concerns. After speaking with residents, it was clear that people who live in the home have great confidence that their concerns would be dealt with. This view was also reflected through reading the responses made by relatives on the 8 comment cards that we received as a part of this inspection. Care Homes for Older People Page 19 of 32 Evidence: Clifton House has an Adult Protection policy and the Proprietor showed us a copy of it. The policy is appropriate for the protection of the residents. Following inspection of the staff training records it is clear that all the staff team received POVA training in 2008 and 2009. This is important so as to ensure that vulnerable residents are properly protected from abuse. Care Homes for Older People 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, 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.Residents are living in a safe, well maintained environment, with access to safe, pleasant and comfortable facilities. Residents presented as being well settled in their environment. They told us that they are satisfied with the communal and personal facilities provided. Evidence: A tour of the premises was undertaken with the Proprietor as a part of this inspection and the home was seen to be clean and tidy in all areas. All areas of the home are accessible to wheelchair users and there is a lift that provides access to both floors of the building. There are at present no residents who use a wheelchair living at Clifton House. The general condition of the home and of the facilities is good, communal areas and bedrooms are kept clean and odour free. The Proprietor provides a homely touch through supplementary decoration, ornaments and flower decorations and pictures hanging on all the walls. All the refurbishments identified in the last inspection report and that were the subject of a requirement have now been met to a satisfactory standard. Care Homes for Older People Page 21 of 32 Evidence: The Proprietor showed us the fire records for the home and both the requirements issued by the LFEPA in January 2008 have now been met. They were that fire doors should be kept clear so that the self closing mechanisms operate fully and correctly. At this inspection this was so. The second requirement was that staff fire drills be carried out when staffing levels are reduced e.g at night / evenings. The Proprietor showed us evidence that this also has since been carried out. As already indicated above, the home was found at this inspection to be clean, tidy and free from offensive odours. We toured the unit together with the Manager and inspected all areas of the home. Several of the residents bedrooms were seen and were found to be clean and tidy and all the residents spoken to by us said that their bedrooms are decorated and furnished as they would wish. The Manager showed us the homes infection control procedure, which seems to be effective. Staff interviewed confirmed that they are issued with appropriate clothing (disposable gloves and aprons, uniform jackets) and equipment for them to carry out their work appropriately. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and easy cleaning. Care Homes for Older People 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 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.While, generally, the homes residents are being protected by caring and supportive staff, recruitment procedures need to be more robustly applied. Staffing records are not being properly maintained. Staffing records do not evidence that staff are being provided with the necessary induction and training and this may affect their ability to competently perform their work duties. Evidence: We asked for a copy of the staffing rota for Clifton House. The rota shows exactly who is working for the week. The Proprietor said that there are usually 2 care staff on duty for the am shifts and 2-3 care staff for the pm shifts. A senior member of staff is on duty during the day and on call at nights. There is always 1 waking night staff on duty and 1 on call. The rota provided supported this statement. Given that that there are 14 residents living at Clifton House at present the staff: resident ratio mix seems adequate to meet the needs of the residents. The Proprietor told us that no agency staff are used at Clifton House. The Proprietor explained that all the staff group have gained their NVQ level 2s. This Care Homes for Older People Page 23 of 32 Evidence: means that the staff should be able to ensure that the residents are in safe hands at all times. The Proprietor holds an NVQ level 4 qualification. The Proprietor explained that no agency staff are used in the home. Clifton House does have a recruitment procedure that was inspected and seen on the most part to be appropriate for its purpose. As a part of this inspection we reviewed 3 of the staffing files. The Proprietor told us that since the last inspection 2 new staff appointments have been made. Inspection of these files showed that nearly all of the recruitment documents that are required to be held on these staff files were there. The Proprietor said that all applicants are interviewed, application forms completed; two written references gained and enhanced Criminal Record Bureau (CRB) checks undertaken. Documented evidence of the CRB checks was seen at this inspection. However staff contracts and supervision notes were not to be found on the staff files. These documents need to be put on the staffing files. It is therefore a requirement that the Manager draws up and implements a recruitment checklist system to ensure that the appropriate documents are available for inspection. This will help to ensure that recruitment practices meet the required standards. The Proprietor told us that the home has a programme of induction in place. He said it covers staff roles and responsibilities, and key policies and procedures, training to do with fire, manual handling, food hygiene and health and safety. The Proprietor said that staff induction is ongoing for up to a month with observation, shadowing from an experienced staff member and ongoing assessment. At this inspection a review of the 2 new staff members files found satisfactory evidence that the induction training referred to had been carried out as described. Members of staff also told us that they had received this training. With regards to staff competency it is important that all staff are familiar with the homes policies and procedures. At the last inspection we asked the Proprietor if staff are given the opportunity to read and discuss these policies and procedures as a part of the supervision process and whether they are then asked to sign to say that they have read and understood the same policies. The Proprietor said that this practice has been carried out but has not been fully completed. On inspection this was confirmed in that it was found that not all staff had signed to say that they had read and understood all the homes key policies and procedures. So in order for this process to be fully implemented and so as to benefit residents in Care Homes for Older People Page 24 of 32 Evidence: that the staff will know and understand what the stated policies and procedures are, the previous requirement is here repeated. It is that all staff are asked to review the key policies and procedures for the home and then to have a discussion in their supervision sessions over a period of time and then to sign to say that for each individual key policy and procedure that they have read and understood them and have had the chance to discuss them with their supervisor. If the timescale for this requirement is not met then enforcement action may be taken. At the last 2 inspections, concerns were raised to do with staff training. However since the last inspection the Proprietor has prioritised staff training and staff training records and members of staff interviewed indicated that all staff have over the last year completed all the necessary training that was required. This is positive because it helps to ensure a competent and appropriately trained staff team able to best meet the needs of the residents at Clifton House. This essential training includes the following topics: Safe handling of medication Fire safety Manual Handling Health and safety Managing aggression Communication POVA 1st Aid Infection control Food hygiene Care Homes for Older People Page 25 of 32 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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service.Prospective residents may be assured that the home is well run and managed by a person who is fit and able to be in charge of the day to day operations of the unit. They will benefit from the leadership and management approach taken in the unit.The quality assurances processes now need to be fully implemented so as to ensure that it is being run in the best interests of the residents and residents financial interests are safeguarded.Staff are supervised regularly however the process being used needs some regularisation and improvement. The health and safety of staff and residents is being promoted and protected. Evidence: The Proprietor has been in the management role at Clifton House for over 2 years and holds the necessary experience and management qualifications to undertake this role. Care Homes for Older People Page 26 of 32 Evidence: The Proprietor told us that since the last inspection a number of surveys have been sent out requesting information from residents and their relatives and from visiting professionals seeking information about the quality of different aspects of the services being provided at Clifton House. While some feedback forms have been returned to the Proprietor he has not yet been able to analyse this information received and it is now time to undertake a new survey for 2009. He explained to us that a new set of questionnaires will be issued and that this feedback information together with information gathered from the complaints and accident records and the residents weekly room safety checks will be analysed for a report and action plan on the findings. The Proprietor agreed that this will be a useful tool for service improvement. It is a requirement that a fully operational quality assurance process is established within the given timescales in order to ensure that the home is run in the best interests of the residents and of the staff. The general feeling within the home was warm and congenial; both staff and management were open and communicative and little sense of anxiety was apparent with residents. The Proprietor told us that Clifton House does not look after residents monies directly and therefore this Standard was not inspected. The Proprietor told us since the Deputy Manager left at the end of last year the frequency of staff supervision had reduced and staff have not had the required levels of supervision. Care staff should receive formal supervision at least once every 3 months. Some supervision records were seen in the staffing files inspected and they did not reflect the frequency stated by the Proprietor and they had not been signed off by staff in agreement with the record made by their supervisor. The records were also quite varied in their recording content, some not covering sufficient detail to form a useful record. Records should include the monitoring and review of all aspects of care practices, the philosophy of care in the home and also career and training development needs. Areas of discussion should also cover the monitoring and review of any individual work objectives that the staff member is expected to carry out. The supervision record should detail any agreements made, revised work objectives, key areas of discussion and should be signed off by both the member of staff and the supervisor. Staff who are supervised should be given a copy of the supervision record which they may keep in their staff handbook file. Care Homes for Older People Page 27 of 32 Evidence: The care staff interviewed confirmed that they had not received regular supervision on an individual basis. Staff said that they had not received copies of their supervision records. The Proprietor told us that he will undertake all staff supervision from now onwards and that he will ensure the correct frequency will be maintained and that records will be made of the discussions had with staff. It is therefore strongly recommended that following the inspection of this standard the Proprietor ensures: A supervision recording format is used that covers the areas outlined above in sufficient detail to ensure a useful record is maintained for both the staff and the management if the need arises in the future. That all staff should be given a copy of their supervision record following the supervision meeting. The Proprietor showed us the maintenance record for the home which details all the maintenance requirements and how and when they have been resolved. The home is maintained to a reasonable standard. Certificates were checked and seen for the following services that are installed in the home, certificates which state that these systems have been checked by appropriate professionals since the last inspection and found to be satisfactory and fit for purpose in that they help to ensure the safety of the residents. Fire protection and alarm system - 24.12.08 Fire Extinguishers - 12.3.09 Emergency Lights - 9.6.08 Fire extinguishers - 13.3.08 Boiler and gas - 14.2.08 Electrical systems check - 12.5.08 Checks on the hot water outlets are also now being regularly checked and temperatures recorded. The records were seen and checked to 26.3.09. All recorded temperatures came within the prescribed limits. Fridge and freezer temperatures are also checked daily and records taken, these were seen to date. Care Homes for Older People Page 28 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 19 23 The LFEPA?s second 01/05/2008 requirement regarding fire drills should be carried out as requested as soon as possible since the timescale given by the LFEPA was 18.3.08. Care Homes for Older People 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 29 18 Appropriately completed (signed and dated) staff contracts and supervision notes need to be put on the staffing files. It is a requirement that the Manager draws up and implements a system to ensure that all the appropriate documents are gained and are available for inspection. This will help to ensure that recruitment practices meet the required standards. In order to meet the NMS. 01/09/2009 2 30 18 That all staff are asked to review the key policies and procedures for the home and then to have a discussion in their supervision sessions over a period of time and then to sign to say that for each individual key policy and procedure that they have read and understood them 01/06/2009 Care Homes for Older People Page 30 of 32 and have had the chance to discuss them with their supervisor. In order to meet the NMS. 3 33 24 That the Quality Assurance process is fully established for the home. In order to meet the NMS. 01/09/2009 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 36 That following the inspection of this standard that: A supervision recording format is used that covers the areas outlined above in sufficient detail to ensure a useful record is maintained for both the staff and the management if the need arises in the future. That all senior staff who provide supervision should receive staff supervision training and that this should be completed within the next 6 months. This should help to ensure consistency in the delivery of supervision. That all staff should be given a copy of their supervision record following the supervision meeting Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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