Care Home: Clova House Residential Home

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What the care home does well People are offered a good standard of care by suitably trained staff. The environment offers a range of communal areas which are decorated to a high standard. People are offered a range of activities to suit individual needs. People are protected from harm through the staff and manager having a good understanding of different types of abuse. Staff are also aware of the action to take if an allegation is made. What has improved since the last inspection? The home has undergone a major refurbishment which has enhanced the environment for people using the service. The training that staff receive has improved this helps to ensure that people are cared for by competent people. The home have completed a fire risk assessment which helps to protect people from harm. A review of the choice of food offered has improved, along with the whole dining experience due to the refurbishment of the dining areas. What the care home could do better: A review of the staffing levels needs to take place to ensure when the occupancy increases all needs can be met. Staff need to participate in a fire drill so they know what to do in the event of a fire. CARE HOMES FOR OLDER PEOPLE Clova House Residential Home 2 Clotherholme Road Ripon North Yorkshire HG4 2DA Lead Inspector Jo Bell Key Unannounced Inspection 17th October 2007 09:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clova House Residential Home Address 2 Clotherholme Road Ripon North Yorkshire HG4 2DA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01765 603678 01765 690902 clova.house@fshe.co.uk None provided County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd Mrs Jean Morton Collins McAndrew Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2006 Brief Description of the Service: Clova House offers residential care to 40 people over the age of 65 years. The home is a large three storey traditional detached house standing in its own well kept and attractive grounds on the outskirts of Ripon, this has recently been refurbished to a high standard. The town centre and market square are within reasonable walking distance. Service users’ accommodation is on all floors accessed by both shaft and stair lifts. Most service users rooms have either a pleasant garden or rural view. The scale of charges range from £346-£550 per week. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection of the service took place on Wednesday 17th October 2007. Prior to the visit an annual quality assurance assessment was completed and surveys were sent out and returned from people using the service, health care professionals and relatives. One inspector spent five hours at the service. During this time three people using the service were spoken with in detail, along with two relatives and one health care professional. Staff spoken with included, two care staff, the administrator, cook, the maintenance person and the manager. Information was inspected during the day which included :Three Care plans (including the initial assessment) Three Medication charts Risk assessments A selection of Health and safety documentation (which included fire safety) Three Staff training records and recruitment files Discussions took place regarding safeguarding adults and the complaints procedure, the progress made since the last visit, staffing issues and activities. Aspects of the environment were inspected and the previous requirements were also discussed. A major refurbishment of the home has taken place in the last 12 months, the home now has hotel style accommodation which is welcoming, relaxing, and meets the needs of the people living there. What the service does well: People are offered a good standard of care by suitably trained staff. The environment offers a range of communal areas which are decorated to a high standard. People are offered a range of activities to suit individual needs. People are protected from harm through the staff and manager having a good understanding of different types of abuse. Staff are also aware of the action to take if an allegation is made. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good quality outcomes in this area. People have their needs assessed in a detailed and robust manner which helps to ensure individual needs can be met. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People using the service have their needs assessed effectively prior to admission to the home. The manager carries out these assessments and information from the care manager may also have been received. This helps to inform the overall care plan. The three assessments inspected are detailed and comprehensive and contain a range of information to ensure all aspects of individual needs are captured and can be acted upon. The home provides personal care and the manager if fully aware of how staff can meet these needs. The home does not offer intermediate care but can offer a ‘rapid response’ service when needed. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience good quality outcomes in this area. People have their health and personal care needs met in a dignified and safe manner. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The standard of care that people receive is good. People are well cared for and attention is paid to hair, nails, cleanliness of clothes and general appearance. Care plans contain a range of information (three were checked) which includes an initial assessment, individual care plans, risk assessments relating to moving and handling, nutrition, the prevention of pressure sores and information from visiting health care professionals. This information is reviewed and evaluated on a monthly basis, and an audit of this process is carried out as part of the home’s quality assurance system. One person said “the staff really look after me well”. A good rapport was observed between care staff and people using the service and their relatives. Currently staff are able to meet individual needs. There is a clear understanding of how to identify if a person is underweight and the action needed to address this. Staff’s knowledge has been enhanced through recent nutritional training, from the Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 10 community dietician. Evidence in the care plans shows that visits from community nurses, doctors, and people who deal with wound care are contacted when needed. One health care professional said how good the care was and confirmed that any treatment given is always in the privacy of the persons bedroom. The home is aware of how to report accident or incidents regarding people using the service, this information is audited on a regular basis. The medication system was inspected, people have their medication needs met. Staff complete training prior to administering medication and all three of the medication charts inspected were completed correctly. Controlled drugs are recorded and disposed of and administered correctly, and staff are aware of how to store all medicines. It was noted that one signature on the medication chart did not match the sample signature given, the manager confirmed this will be addressed. Whilst the fridge temperatures were recorded daily this reading was not written correctly i.e. the temperature was either 3.0 or 4.0 degrees centigrade, and it had been recorded as 0.3 and 0.4. Staff are aware that the temperature may affect the medicine stored inside the fridge. Privacy and dignity was inspected. Staff have a good rapport with people, this was evident throughout the day. Staff asked if people were Ok and whether they needed anything. Vacant and engaged signs on bathrooms and toilets are available, and staff put a ‘care in progress’ sign on room doors where personal care is being administered. This helps prevent visitors or other staff walking into someone’s room inadvertently. One person said “the staff are lovely, and very caring”. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience good quality outcomes in this area. A range of activities are provided and people are given choice in their daily life and in the food and drink provided. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home provides a range of activities for people using the service. A designated activities organiser plans each week and clearly documents which activities have been participated in. This is completed for each individual. Some people have visited Ripon Cathedral recently, one man said “I love quizzes, we have them a lot”, another person said “we have a sing song most weeks”. Visits to the local coffee shop take place, and links through the sixth form pupils are made. The activities organiser tries to have one to one sessions with people on a morning and then facilitates an activity during the afternoon. This programme is developing over time. The home have a range of reminiscence pictures on the walls which people discuss and the layout of the furniture in the lounge areas is conducive to socialising. Visitors are encouraged and warmly welcomed. The home have a visitors book which confirms that visitors come and go at a range of times. Two visitors spoken with commented positively on the staff and the care their relative Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 12 receives. Staff are encouraged to maintain people’s independence, though offer assistance where needed. The daily routine is flexible and people are able to come and go as they want to. Observations from the lunchtime meal showed that people have an enjoyable dining experience. There are two dining areas which have recently been refurbished. These are light and airy with suitable chairs and tables. A menu is displayed outside the dining areas but also small menus are located on each table which helps people know what food and drink is to be served when they sit down. Two choices are offered and the menus have been under review since the last visit. Currently staff are having to carry individual hot plates up and down the stairs because the ‘hot trolley’ is out of order. This poses a health and safety risk to staff and the possibility of cross contamination through staff spending time in the kitchen collecting all the plates. This was discussed with the manager who offered assurances that this would be resolved by the end of the following week, however this is not affecting the outcomes for people as they are receiving a hot and appetising meal. The catering staff discussed their role and relatively new cook is in the process of becoming familiar with the system for ordering food within confines of a budget. Currently no fresh vegetables are offered routinely, this was evident at lunchtime. This needs to be addressed to ensure people are having appropriately nutritious food. One of the dining areas whilst the meat part of the meal was eaten some of the frozen broccoli and cauliflower was left. A homemade desert is offered and snacks are available during the morning and afternoon for people to enjoy. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. People are protected from harm and they are able to voice their concerns knowing appropriate action will be taken. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People are aware of how to make complaints or raise any concerns. No formal complaints have been made either to the provider or through CSCI in the last 12 months. The home protects people from harm through staff having a good understanding of different types of abuse, and the whistle blowing and no secrets document enhances this. The manager is fully aware of the vulnerable adults procedure and how to make referrals to the local authority if an allegation of abuse has been made. Staff undertake abuse training as mandatory and in discussions with them they were aware of the action to take if an incident arises. Information in the surveys returned confirmed that people are aware of the complaints procedure and this evidence showed that people are happy to speak to staff about any concerns they may have. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. People live in a clean and well maintained environment where infection control procedures are in place. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home has undergone a large refurbishment in the past 12 months. The communal areas are decorated to a high standard and the home has a welcoming and pleasant feel, and areas are well maintained and mostly free from unpleasant odours. In one room only there was a smell of urine, however staff were aware of this and plans were already in place to address this. The maintenance person is responsible for security in the home and ensuring the grounds are kept safe and tidy. The home can accommodate wheelchairs and the grounds are accessible. There is a refurbished conservatory for people using the service and visitors have access to a range of both public and private areas. Some bedrooms have been refurbished and those viewed are in a hotel Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 15 style accommodation, with excellent views. Some rooms need to be upgraded and this is an ongoing process. One lady said “I love my new room”. Staff usually undertake infection control training, though not all staff spoken with could confirm this, staff training files did not contain certificates to confirm this training had taken place. However, staff were observed wearing protective clothing, which includes gloves and aprons, and hand washing techniques were in place. The home has sufficient sluice rooms and whilst the laundry is down in the cellar staff were still able to carry out their job effectively. People have clean clothes which are regularly washed and ironed, and put back in their room. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience good quality outcomes in this area. People are cared for by competent, well recruited staff who are currently in sufficient numbers to meet individual needs. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People are currently cared for by sufficient staff who are competent and know how to meet individual needs. The home have twenty seven people using the service and on a morning there are four care staff, during the afternoon and evening three staff, and overnight two staff. Whilst people using the service felt their needs were being met, the home is large and located on different floors. Overnight one member of staff has to look after approximately thirteen people. This needs to be reviewed as anyone needing two people to assist them then leaves the other twenty six people having to wait for assistance. As the occupancy increases people’s needs may not be consistently met. Staff are encouraged to complete NVQ Level 2 or 3 and specific training is offered regarding care practices. This is covered in the detailed induction programme. One person confirmed that they have completed this process. This helps to ensure that staff have a standard of care which they have to meet, and people receiving the care can have their needs met. People are cared for by staff who are effectively recruited. The staff file shave been re-organised and the manager is clear regarding the process to follow. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 17 Three staff files show two written references are obtained, a police check and a protection of vulnerable adults check takes place prior to the person starting work at the home. This all helps to protect people form harm. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People who use the service experience good quality outcomes in this area. The home is run in the best interests of people living there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home is run in the best interests of the people using the service. The manager is supernumerary and has support form a deputy and an administrator. The manager is registered with the CSCI, and has many years experience as a registered nurse caring for older people. A robust quality assurance system has been developed which includes an audit of systems including care plans, accidents, medication, health and safety and the food and drink provided. Remedial action is then taken when an issue has been identified. Customer surveys are sent out each year and people are informally asked about their views regarding the service. A range of risk assessments are in place which help to protect people from harm. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 19 People who use the service can ask the home to deal with their finances. Three records show that effective record keeping is in place to ensure the amount of money kept is the amount of money recorded. The new administrator who has been in post for a few months is extremely well organised and efficient and is in the process of updating the home’s administrative systems to ensure there is a clear audit trail and records can be easily found. The manager has found this very supportive and clearly this person is an asset to the home. People spoken with discussed what happens when they visit the hairdresser or chiropodist and how that is paid for. Health and safety in the home was discussed with the manager and maintenance person, some information was obtained through the annual quality assurance system. Regular checks are made to moving and handling equipment, bed rails, the call bell system and fire safety equipment. This was evidenced in well maintained records at the home. The issue regarding staff carrying hot plates of food was discussed as there is a health and safety risk. Water temperatures are tested and these were found to be within normal parameters (38-43 degrees centigrade). The home has a fire risk assessment in place and staff undertake fire training, moving and handling training and health and safety training on a regular basis. Records confirm this. There is always a qualified first aider on duty and staff are aware of their responsibilities. The home has weekly fire alarm tests, but has not had a fire drill for over twelve months. The manager was aware of this and appropriate action will be taken. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 Requirement A review of the staffing levels must take place to ensure the home has sufficient staff when the occupancy increases. A fire drill must take place as part of the homes fire safety procedure, to ensure staff are aware of what action to take in the event of a fire. This will help protect people from harm. Timescale for action 17/11/07 2. OP38 23 17/11/07 Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The initials on the medication charts should match the sample initial/signature given by staff administering medication. The fridge temperature needs to be recorded accurately. This will ensure staff are aware when items stored may be at risk. 2. OP38 The equipment for keeping food warm at mealtimes should be in full working. This will ensure staff are not put at risk when having to carry hot plates of food up and down the stairs. Clova House Residential Home DS0000007883.V333770.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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