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Clifford House Residential Care Home Good

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Inspection report

Date of Inspection: 27 November 2013
Date of Publication: 4 January 2014
Inspection Report published 04 January 2014 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 27 November 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff and reviewed information given to us by the provider.

Our judgement

Staff supported people in a manner that was sensitive and considerate. However the provider had not taken proper steps to ensure that people were protected against the risks of inappropriate care by means of effective planning and delivery of care.

Reasons for our judgement

People using the service told us they were very happy with their care. One person told us, ‘staff are very kind…they are special people’. Another person said the staff were, ‘very friendly, you couldn’t have better staff’, whilst another stated, ‘they (staff) do all there is in their power to make you happy’.

Staff also told us that tried to support people maintaining their independence. For example, one care worker said, ‘I try to let residents do what they can but just keep an eye to make sure they are managing’. Another care worker told us that despite pressures at times, people using the service ‘always got the best care’. However one care worker told us that she felt there was a risk of care being compromised at weekends. This was because there was no cleaning staff at weekends and this task had to be managed by care workers alongside their other responsibilities which included laundry and providing activities.

During our visit we reviewed seven peoples care records. We saw evidence that the service undertook an assessment of people's needs which took into account their personal circumstances and individual care requirements. We saw that daily care notes were detailed and reflected the care and support people had received during a particular shift. We also saw evidence, that where required, the service effectively communicated with doctors, district nurses and the community mental health team in order to manage people’s needs. For example, staff had identified that one person’s skin integrity was at risk of deterioration. There was evidence that the service had promptly contacted the community nursing team who visited the next day to assess the person’s skin and provide any necessary pressure relieving equipment.

We observed a shift handover meeting during which there was a comprehensive discussion of people’s needs. One care worker told us that she felt handover and the daily communication book were effective tools in providing the information she needed to know about people’s needs. However another care worker told us that she did not feel that she was always informed about changes affecting a person’s wellbeing. For example, she told us that she had noted a bruise on a person she had been supporting earlier that day. She explained that she had later found out that the person had had a fall the previous day, but this had not been handed over to her.

During the inspection we found that some people’s plans of care did not provide sufficient detail about the key risks to their health and welfare and how these should be managed. For example, the care plan for a person with insulin dependent diabetes did not contain comprehensive guidance for staff about the potential signs that might indicate their diabetes was becoming unstable. This person’s care plan also lacked detail about how the care of their suprapubic catheter site should be managed. Staff we spoke to were able to tell us how they looked after the person’s catheter site, but this was not recorded in the care plan. We noted that another person was experiencing on-going problems with catheter care and urinary infections. However their continence care plan simply stated ‘has catheter’. This meant that people could be at risk of receiving inappropriate care and treatment due to care plans not containing sufficient detail about individuals’ needs and how they should be met. This would be of particular concern where care was delivered by less experienced or agency staff.

During the inspection we noted that for one person it was unclear that the delivery of care and treatment followed the guidance given by health care professionals. For example, guidance was available on the Medication Administration Record (MAR) Sheets about a person’s prescribed insulin levels and how to amend these according to recorded blood sugar levels. However, on two consecutive days in November 2013, the person’s blood sugar readings had fallen below the prescribed level there was