Care Home: Clifton Lodge

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What the care home does well Prospective residents have their needs assessed to make sure that these can be met at the home. Residents` health care needs are met through the homes care planning systems. Residents are treated with respect and dignity. Medication is administered safely by trained members of staff. Residents` social, emotional and recreational needs are met through a range of communal and individual activities. Residents are supported to maintain contact with friends and family. Residents` spiritual needs are assessed and action is taken to support these when identified. The home provides a good standard of food. Staff have been trained in the protection of vulnerable adults. Clifton Lodge provides a `homely` and comfortable environment for residents. The home provides sufficient staff to meet the needs of residents. Staff are recruited in line with recruitment legislation. Staff are well trained. The home is well managed and run in the interests of the residents. What has improved since the last inspection? Care plans were found to be up to date and life histories have been developed with residents so as to better meet their social and emotional needs. The home has taken action to ensure that residents know how to make formal complaints in response to its annual quality assurance survey. What the care home could do better: The care planning system could be more concise and user-friendly. All creams prescribed by doctors to manage residents` skin care should be recorded as having been applied where staff undertake this responsibility. Where residents manage their own creams, a risk assessment should be completed to record this. Where hand entries are made to medication administration records, a second member of staff should check and sign that the entry has been made correctly. Wardrobes should be risk assessed as to their likelihood of being pulled over and where such a risk is identified the wardrobe should be bracketed to the wall. Vinyl floors should be sealed to facilitate better cleaning. Key inspection report Care homes for older people Name: Address: Clifton Lodge 16-18 Clifton Road Southbourne Bournemouth Dorset BH6 3PA     The quality rating for this care home is:   two star good 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: Martin Bayne     Date: 1 4 1 2 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 Older People Page 2 of 26 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 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 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Clifton Lodge 16-18 Clifton Road Southbourne Bournemouth Dorset BH6 3PA 01202428598 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: cliftonlodge@hotmail.com Beechrise Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Clifton Lodge is a large, detached property, situated in a quiet residential area of Southbourne in Bournemouth. Local shops are within level walking distance, with the main shopping area of Southbourne and all its amenities about half a mile away. Bus services are available a short walk from the home, providing transport to all parts of Bournemouth, Christchurch and beyond. The home is also situated fairly close to the cliff top where there are a number of pleasant walks. The property is set back from the road and approached via a short driveway with a small parking area for visitors. Additional parking is available on roads in the vicinity of the home. Clifton Lodge is registered to accommodate up to 16 older persons. The accommodation is arranged over two floors, with a passenger lift to aid access between the floors. There are three double and ten single bedrooms. One of the bedrooms provides en-suite facilities. The dining room and two separate lounges are Care Homes for Older People Page 4 of 26 Over 65 14 0 2 3 0 6 2 0 0 9 Brief description of the care home situated on the ground floor, one overlooking the front garden and the other with views over the well-maintained rear garden, with its large lawn and paved patio area, surrounded by mature trees. Twenty-four hour care is provided. Laundering of personal clothing etc is carried out on the premises. Activities and occasional entertainments are arranged. Meals are freshly prepared and cooked within the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out a key inspection of Clifton Lodge between 9:30am and 2:30pm . The inspection was carried out by one inspector, but throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons, and to follow up on two recommendations made at a random inspection of the home in October 2009. The homes last key inspection was carried out in June 2009 when it was given a poor rating. At that inspection four requirements were made and seven recommendations. We found that the home had addressed all of the requirements and recommendations at the random inspection in June. We were assisted throughout this inspection by Mrs Shaw, the Registered Manager of the home. Throughout the inspection we used a sample of two residents personal files to look at the homes record-keeping. These records also provided us with evidence of Care Homes for Older People Page 6 of 26 how residents were cared for and supported within the home. At the time of our inspection there were 13 residents living at the home. We had the opportunity to speak with five of the residents and also with one residents representative who was visiting the home that day. We spoke with two members of staff and also carried out a tour of the premises. Additional information that helped us form the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document AQAA completed by the home. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The care planning system could be more concise and user-friendly. All creams prescribed by doctors to manage residents skin care should be recorded as having been applied where staff undertake this responsibility. Where residents manage their own creams, a risk assessment should be completed to record this. Where hand entries are made to medication administration records, a second member of staff should check and sign that the entry has been made correctly. Wardrobes should be risk assessed as to their likelihood of being pulled over and where Care Homes for Older People Page 8 of 26 such a risk is identified the wardrobe should be bracketed to the wall. Vinyl floors should be sealed to facilitate better cleaning. 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 Older People Page 9 of 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their needs being assessed before being offered a placement at the home. Evidence: Since the random inspection in October there have been no new admissions to the home, however a new resident was to be admitted on the day of our inspection. We were told that this person had been referred by word-of-mouth from someone who knew of the home. The prospective residents daughter had come to view the home, at which time they had been given a copy of the brochure and Statement of Purpose for the home. Mrs Shaw, the Registered Manager, had been to see the person referred in their own home and had carried out a pre-admission assessment of their needs, to make sure that the home was able to meet these. We saw that this assessment had been recorded on a template that covered all of the topics detailed within the National Minimum Standards. We also saw that a letter had been sent to the family informing that the home could meet the prospective residents needs and that an offer of a Care Homes for Older People Page 11 of 26 Evidence: placement at the home was to be made. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their health care needs being met through the homes care planning and risk assessment processes, through the staff treating residents with respect and dignity and through medication being safely administered. Evidence: At the key inspection in June 2009 a requirement was made concerning care planning, as the plans were not being updated when needs of residents changed. At the random inspection in October we found care plans had been updated and reflected the needs of the residents at that time. At the random inspection we found that management were still in the process of meeting a recommendation from the key inspection for the development of life histories for each resident. At this inspection we looked at a sample of two care plans. One of the care plans concerned a resident being cared for in bed and we found that the plan had been updated to reflect a recent change whereby the resident was able to spend some time in a chair out of bed. Concerning the other resident we tracked through the inspection, we found that their care plan was also up to date. We saw that life histories had been developed and recorded within the files, and that a photograph of the resident concerned was at the front of Care Homes for Older People Page 13 of 26 Evidence: their care plan, enabling new staff to easily identify residents. We saw that residents or their representatives had signed their plan demonstrating that they had been involved in developing the care plan. We also saw that risk assessments were in place to make sure that care was delivered as safely as possible. Although the care plans were up-to-date and reflected current needs of residents, our view was that the system was overly complicated with it being difficult to find the most up-to-date information. This was discussed with Mrs Shaw. It was agreed that a short summary care plan would be developed for each resident that would allow new members of staff to gain a quick reference on how to meet the needs of residents. Long-term we recommend that the home review care planning and consider changing to a more user-friendly format. There was evidence within the care plans, risk assessments and from speaking with residents that health needs were being met. From speaking with residents and from observing interactions between staff and residents, it was evident that residents were treated with respect and dignity. We looked at how medication was being administered within the home. The home has suitable storage facilities of a controlled drugs cabinet, a medication trolley and a cabinet for surplus stock. The home uses a unit dosage system and we saw that medicines were stored appropriately. We were told that the procedure was to administer and record individually to each person. We saw that there was a sample of staff signatures of those staff who had been trained in safe medication administration. We looked at the medication administration records for all of the residents and saw that there were no gaps in the recording. We saw that there was a photograph of the resident concerned at the front of their medication administration records together with a record of any allergies from which they suffered. We saw that records were being maintained where medicated creams were being applied to residents by staff but not for aqueous cream. We recommend that where residents are able to manage applying their own creams, a risk assessment is completed to reflect this but where staff administer any creams on behalf of residents, records are maintained of this. We saw some examples of where hand entries had been made onto medication administration records and these had not been checked and signed by a second member of staff. We recommend that this practice is adopted where hand entries have to be made to the records. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a range of activities being provided to meet their social and recreational needs, by being able to maintain contact with friends and family and from being provided with a good standard of food. Evidence: As reported earlier, the home has now developed life histories for each resident and these provide better information and a basis for meeting residents social, emotional and recreational needs. We saw that as agreed at the random inspection, a notice board had been put up in the reception area of the home to inform of the activities that were planned for the month ahead. These included Extend exercise group sessions, visiting singers and entertainers as well as Christmas festivities. The returned AQAA informed that the home has allocated additional hours for a staff member to organise afternoon activities for residents. We saw that in the afternoons the staff offer a range of activities including quizzes, boardgames, crosswords, magnetic darts and dominoes. We also saw that the home convenes regular residents meetings at which they have the opportunity to put forward suggestions for any activities. The residents we spoke with told us that they were happy with the activities being provided within the home. Care Homes for Older People Page 15 of 26 Evidence: The representatives of one of the residents with whom we spoke, told us that they could visit at any time and were always made welcome. We saw that part of the admission assessment process was to look at residents spiritual needs. The residents we spoke with told us that the food was of a good standard. We saw that the menu for the day was displayed on a notice board in the homes reception area. During the inspection we spoke with the chef who told us that he was aware of all the residents likes and dislikes. At the time of the inspection a vegetarian diet was being catered for one person and a low fat diet for another resident. When we carried out a tour of the premises we saw that drinks were available within residents rooms. We saw within residents files that nutritional assessments were carried out as part of the assessment process. The home achieved 100 rating of good or excellent from responses in the homes quality assurance surveys concerning the food. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well-publicised complaints procedure, through the staff being trained in the prevention of adult abuse and by the home having all relevant policies and procedures relating to adult protection. Evidence: We saw that the homes complaints procedure was displayed in the reception area, informing residents of how to make a complaint and also providing the current address of the Commission. We also saw that there was a complaints and suggestions book in the reception area. The complaints procedure is also detailed within the homes Service User Guide. We saw that in response to the homes quality assurance survey, (in which it was found that some people did not know how to make a complaint), the management had given each resident an individual copy of How to complain, written in large print. We saw these were available within residents bedrooms. Since the last key inspection there have been no complaints made to the management of the home and none have been brought to the attention of the Commission. The home has all relevant policies and procedures relating to the protection of vulnerable adults. All of the staff have received training in the prevention of adult abuse. Care Homes for Older People Page 17 of 26 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. Clifton Lodge provides a homely and comfortable environment for residents. Evidence: As part of the inspection we carried out a tour of the premises. The home was clean, warm and free from any adverse odours, and was in good decorative order with furniture and fittings in a good state of repair. Residents have access to a well maintained, large garden to the rear of the home. We saw that residents were able to personalise their rooms with their own furniture, however we recommend that the management carry out risk assessments concerning wardrobes. Where there is any likelihood that these could be pulled over they should be bracketed to the wall. We saw that window restrictors are fitted to windows above the first floor and that radiators have been covered to eliminate the risk of any resident getting burnt. We saw that the home has adequate toilets and bathrooms. Within the communal bathrooms we saw that liquid soap, paper towels and bins were provided in the interests of infection control. We tested the hot water temperature of one of the baths in the communal bathrooms and found that this was of a satisfactory temperature. Thermostatic mixer valves have been fitted to regulate the hot water temperature. We recommend that vinyl floors in the WCs are sealed for better infection control and Care Homes for Older People Page 18 of 26 Evidence: ease of cleaning. The laundry facilities for the home are located in an outbuilding to the rear of the home. We saw that the laundry was equipped with commercial machines adequate to meet the laundry needs of the home and that hand washing facilities were available. Staff are provided with gloves and protective clothing as part of infection control procedures of the home. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from staff being deployed in sufficient numbers to meet needs, through staff being recruited in line with the Regulations and through the staff being well trained. Evidence: We were told that between 8am and 8pm there were always two care staff on duty and that during the night-time there is one awake staff member and one member of staff who carries out a sleep in duty. We were shown duty rosters that reflected the above staffing. In addition to the care staff, the home employs a cleaner six days a week between 8am and 2pm. The chef who works six days a week from 8am to 2pm and then from 4pm until 6pm. On the day that the chef is not on duty Mrs Shaw cooks the meals. Mrs Shaw told us that she works in excess of 40 hours in the home every week. Since the last key inspection one new member of staff has been recruited to the staff team. We looked at their recruitment records and found that all of the recruitment checks as detailed in the Care Homes Regulations 2001 had been complied with. The core team of five care staff members have all achieved the qualification of NVQ level 2. The chef has also gained his NVQ level 2 and is about to start NVQ level 3. The housekeeper has an NVQ in health and social care and has started an NVQ in Care Homes for Older People Page 20 of 26 Evidence: domestic cleaning. We were provided with a staff training matrix which showed us that all of the staff have received core mandatory training. Care Homes for Older People Page 21 of 26 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 well managed and run in the interests of the residents. Evidence: Mrs Shaw has managed the home for many years and holds the Registered Managers Award. We looked at the reports on the conduct of the home written by the responsible individual following monthly unannounced visits. These reflected that the responsible individual both knew the residents and took a keen interest in supporting the registered manager in the running of the home. At the key inspection in June 2009 a recommendation was made that systems be put in place to cover the unexpected absence of the manager, to ensure smooth running of the home. Mrs Shaw informed us of the suitable arrangements that had been put in place to meet this recommendation. She also told us that management was hoping to recruit a part-time administrator to assist the Registered Manager. We saw that the home had carried out a quality assurance programme using surveys involving relatives, residents and health and social care professionals. The AQAA Care Homes for Older People Page 22 of 26 Evidence: informed us of where action had been taken in response to the surveys received. We were therefore satisfied that the home is run in the interests of the residents with management seeking to make improvements to the service. We were told that the home does not look after any monies on behalf of residents. The returned AQAA informed us all the data servicing of equipment within the home and the reviewing of policies and procedures. We looked at the fire logbook and saw that tests and inspections of the fire safety system were taking place to the required timescales. Care Homes for Older People Page 23 of 26 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 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 We recommend that in the long-term the home considers reviewing the format of care plans and changes to a more user-friendly system. We recommend that: Where residents are able to manage application of their own creams, a risk assessment is completed to reflect this but where staff administer any creams on behalf of residents, records are maintained of this. Where hand entries have to be made to medication administration records, a second person checks and signs that the entries have been made correctly. 2 9 3 19 We recommend that wardrobes be risk assessed as to the likelihood of being pulled over. Where a risk is identified the wardrobe should be bracketed to the wall. We recommend that the vinyl floors within the communal WCs are sealed to maintain better infection control. 4 26 Care Homes for Older People Page 25 of 26 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. 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