Mr Roopesh Ramful
Clifford House Residential Care Home
Clifford House Residential Care Home Good
Date of Inspection: 27 November 2013
Date of Publication: 4 January 2014
Inspection Report published 04 January 2014 PDF
Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)
People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)
People should be protected from abuse and staff should respect their human rights (outcome 7)
People should be cared for in safe and accessible surroundings that support their health and welfare (outcome 10)
Staff should be properly trained and supervised, and have the chance to develop and improve their skills (outcome 14)
The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)
Not met this standard
We checked that people who use this service
Where they are able, give valid consent to the examination, care, treatment and support they receive.
Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
Can be confident that their human rights are respected and taken into account.
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
The provider had not made suitable arrangements to make sure staff acted in accordance with legal requirements where people who used the service did not have capacity to consent to their care and treatment.
Reasons for our judgement
Where people had capacity they were asked for their consent before they received any care and treatment and staff acted in accordance with their wishes. People using the service told us they felt involved in decisions about their care. One person said, 'you have the right to your own mind'. Another person told us he felt staff 'always respected his wishes'.
Staff we spoke with were aware of the need to seek the consent of people using the service before they provided care and support. For example, one care worker told us that she would always ask the person 'do you mind if I begin assisting you'. She added that if a person was declining care, she would respect this and leave, but would try again later. Another care worker said she always respected people's wishes to decline care, but would try and encourage people to accept support so that their care needs could be managed effectively.
The service provides support to some people with varying degrees of dementia or poor cognitive function. Our observations on the day indicated that some of the people using the service would have difficulties giving valid consent to complex or significant decisions about their care, treatment and support. We viewed seven care plans; each of these contained a judgement about the person's mental capacity. In three of these plans the person had been assessed as lacking capacity, but there was no evidence that these decisions had been reached in line with the principles of the Mental Capacity Act (MCA) 2005. The mental capacity judgements were non-specific and there was no assessment in care plans about the person's ability to make particular decisions about their care and support. We also did not see any guidance for staff as to when and in what circumstances best interest decisions might be needed for those people that lacked capacity. For example, where a person needed to make a more complex or significant decision or were perhaps being resistive to care that was required to maintain their wellbeing.
When we spoke with the manager about this, he told us that he reached decisions about a person's capacity by talking with them and asking questions before forming a view. The manager told us that he did not use a specific tool to assist in assessing capacity. Staff we spoke to told us that that they had not received training in mental capacity and the manager confirmed that this was not currently offered to staff. This meant that the provider did not have suitable arrangements in place to ensure that at all times; staff were aware of and followed in practice the requirements of the MCA (2005).
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