Random inspection report
Care homes for adults (18-65 years)
Name: Address: Ann Charlton Lodge Eden Hall Grove Redcar TS10 4PR three star excellent service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Katherine Acheson Date: 1 1 0 6 2 0 1 0 Information about the care home
Name of care home: Address: Ann Charlton Lodge Eden Hall Grove Redcar TS10 4PR 01642480660 F/P01642480660 anncharltonlodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Maureen Ireland Type of registration: Number of places registered: Conditions of registration: Category(ies) : Trustees of East Cleveland M S Homes care home 25 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 25 The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Physical disability - Code PD, maximum number of places: 25 Date of last inspection Brief description of the care home Ann Charlton Lodge is a detached, single storey, purpose built facility, which is situated in a residential area of Redcar. The building is set back from the road and occupies its own grounds. The home is near to bus routes and within reasonable distance of community facilities. Ann Charlton Lodge is registered to provide personal and nursing care to a maximum
Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home number of twenty-five people with a physical disability. Internally the home is well maintained and offers accommodation to people in the form of twenty-five single rooms. All bedrooms offer ensuite facilities, toilet and hand washbasin. All bedrooms meet the size requirements of national minimum standards. There is a central spacious lounge/dining room. A hatch serves the dining area from the commercial kitchen and portable screens provide some privacy and separation from the main communal area. There is a second smaller lounge and a conservatory, which, is used by those people who wish to smoke. There is another conservatory overlooking the rear gardens. The home also has a hairdressing room and physiotherapy room. The cost of care at the time of the inspection visit ranged from £622.01 to £735.71 a week Care Homes for Adults (18-65 years) Page 3 of 13 What we found:
This unannounced random inspection took place on 11 June 2010. The reason for this inspection was to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. The manager completed and returned an Annual Quality Assurance Assessment, (AQAA). The AQAA is the services self assessment on how they think that they are meeting National Minimum standards. This information was received before the inspection and was used as part of the inspection process. Before this inspection visit we looked at all of the information that we have received since last inspection of the service in April 2007. Numerous records were examined including care records of people living at the home, risk assessments staff recruitment and training records and a sample of health and safety records. Medication systems and practice were examined. People living the home and staff working there were also spoken to. Discussion also took place with the manager. Before the inspection surveys for people that use the service and staff were sent out to the home for the manager to distribute . Surveys for people that use the service asked for comments on care received. Surveys for staff asked for comments on what it was like working at the home and training received. We received seven surveys from people that use the service and seven from staff. Comments in surveys received can be read in the main body of the report. Individual needs and choices The care files of two people that use the service were looked at during the visit. Care files contained a detailed assessment of needs for the person, evidence of nutritional screening, risk assessments, moving and handling assessments and care plans. Care plans are record used by care services to show what sort of help each person needs and how staff will provide that care. Assessments looked at during this inspection contained good detail. Care plans provided guidance to staff about how to meet the needs of the person and included evidence of personal choice. Risk assessments were evident on care files looked at during the visit and included intervention required to minimise the highlighted risk. One care file looked at highlighted that a person had been assessed as needing bed rails to maintain safety. Although this care file contained a risk assessment to determine if bed rails were the safest option, it was insufficiently detailed. The use of bed rails had not been discussed by a multi disciplinary team. Risk assessments need to be updated to include best practice safety measures that need to take place prior to using the bed rails and safety checks that need to take place on a regular basis whilst the bed rails are in use.
Care Homes for Adults (18-65 years) Page 4 of 13 Care plans and risk assessments looked at during the visit had been updated on a three monthly basis. Lifestyle Files of people that use the service that were looked at during the inspection contained a care plan about what they liked to do in their leisure time. It was evident following discussion with people that use the service that they are encouraged to live life to the full and enabled to take responsible risks. People that use the service are supported to go out independently. The home has its own transport to take people to all appointments, on shopping trips and to visit family and friends. The home also has a small vehicle, which is available and insured to cover family members over the age of twenty five. Family and friends are able to use the vehicle to take people that use the service on social outings. One person spoken to said, I join in all of the activities in house and regularly go out. We have an excellent entertainment committee. We have quiz nights every six weeks. We go out to the pub every six weeks. We regularly go out for lunch. We have bbqs, chinese takeaways and bingo. Everything is spaced out at regular intervals so there is always something going on. The home benefits from a visiting library service. This service also offers talking books and large print books. People are encouraged and supported to practice their religion. Two people visit the local Gospel Church to attend services and a coffee morning. A representative from the local Church of England Church visits the home on a weekly basis to give communion. There are computers with Internet access available in the lounge area of the home, however many of the people that use the service have their own lap top. Family and friends are made to feel welcome. A discussion took place with the manager regarding equality and diversity. The manager demonstrated through discussion an in depth knowledge. She informed how she does and would support relationships in the home. Holidays are encouraged for those people who are able. Staff had supported one person on a recent holiday in Blackpool. When interviewed this person said, I went to The Bond Hotel in Blackpool with a staff member. The hotel is adapted for disabled people and there are hoists in the bedrooms. We had a great time. I visited the zoo, Sea life Centre and The Waxworks. I plan to go again in October. People spoken to during the visit complimented the home and chef on the food provided. Comments made included, The food is wonderful. Today is a fish day, we can have scampi, poached fish or battered fish another person said, The food is brilliant. The chef has a secret way of doing his batter and its lovely another person said, The food is first class. Personal and Healthcare Support During the inspection arrangements for receiving, storing, administering, recording and
Care Homes for Adults (18-65 years) Page 5 of 13 disposing of medication were observed and examined. In general record keeping was good and medicines were appropriately stored, however hand written entries of medication on Medicine Administration Records (MAR) did not always contain the signature of two staff. Two staff should check and sign a MAR for handwritten entries to make sure the medication has been written up correctly to avoid any errors. In general nurses are responsible for the administration of medication, however a discussion with a nurse that works at the home highlighted that on occasions senior care staff have administered liquid medication to people that use the service via a peg tube. Further discussion highlighted that some of these people were receiving nursing care. The nurse said that liquid medication is drawn up by nurses working at the home and given to the senior carer to administer, this is secondary dispensing of medication. The manager and nurse were spoken to during the visit was advised that this practice must stop. Those people that use the service that are receiving nursing care must have their medication administered by a nurse. The manager and nurse was informed that secondary dispensing of medication must stop. The nurse that prepares/draws up the medication must administer it. Concerns and Complaints Last inspection of the service in April 2007 highlighted that the complaint policy/procedure should be updated to include peoples rights to complain to commissioning agencies such as Social Services and the Primary Care Trust. Examination of records confirmed that the complaints policy/procedure had been updated. This policy/procedure was available in large print on the notice board in the entrance to the home and in the care files of people that use the service. Information in the AQAA indicated that the home has received one complaint in the last twelve months. Environment Ann Charlton Lodge is a detached, single story, purpose built facility that is situated in a residential area of Redcar. The home is registered to provide personal and nursing care to a maximum number of twenty five people. Internally the home is well maintained with appropriate furnishings. The manager said that since last inspection most of the furniture in the main lounge/dining area has been replaced. Some carpets in both communal and bedroom areas have been replaced. All bedrooms are single and have ensuite facilities, which consist of a toilet and hand wash basin. There is a central spacious lounge/dining room. There is a second smaller lounge and conservatory to the front of the home and a conservatory to the rear. There is also a hairdressing room and physiotherapy room. The home ensures the provision of environmental adaptations and specialist equipment. All of the bedrooms are fitted with ceiling hoists. The manager said that all manual hoists have been replaced by electric hoists and that people that require to use a hoist have a sling identified. The manager said that all hoists and slings are serviced on a six monthly basis. Records were available to confirm that this was the case. A number of people that use the service have an environmental control system called a possum. A possum is a device that gives people the control and independence to do simple tasks like drawing the curtains, making a phone call, switching on the lights or
Care Homes for Adults (18-65 years) Page 6 of 13 just turning on the television. Each person that uses the service is provided with a infra red buzzer that allows them to call and speak to staff wherever they are in the home. Staffing At the time of the inspection there were twenty four people using the service. Duty rotas looked at during the visit confirmed that there are seven to nine care assistants on duty in the morning and afternoon and between three to four care assistants on an evening. On night duty there are three care assistants on duty. There is a nurse on duty twenty four hours a day. Duty rotas showed that three to four times a week there is an additional nurse on duty during the day. The manager of the home works full time and is supernumerary. On occasions the manager works to cover sickness and holidays. Duty rotas looked at did not contain hours worked by the manager. Records were available to confirm that the manager follows good recruitment procedures. Three files of staff working at the home were examined. Appropriate references were on file as was evidence of Criminal Record Bureau checks. People that use the service are involved in the interviewing of new staff. One person that uses the service said, We do all of the interviewing with the manager and administrator. We dont only interview new staff, we interview those staff working at the home who are applying for promotion to make sure that they are suitable. Records were available to confirm that staff working at the home receive induction training. Staff files examined during the visit contained certificates to confirm that staff had recently attended training in Moving and handling, fire, infection control, emergency aid and dementia awareness. Records were available on files looked at during the visit to confirm that regular supervision takes place. Staff surveys received informed that regular training is provided to staff and that staff are given the support that they require. Conduct and management of the home A sample of health and safety records were examined and found to be in order. Records were available to confirm that the homes gas boiler, emergency lighting and fire alarm had been serviced in the last twelve months. Water temperatures are taken and recorded to ensure that they are within safe limits. Regular testing of the fire alarm takes place. What the care home does well:
Ann Charlton Lodge provides people that use the service with a with a purpose built,
Care Homes for Adults (18-65 years) Page 7 of 13 spacious, friendly and comfortable environment. The home has a welcoming atmosphere and people that use the service are well looked after. Staff are well trained and communication is good. It is evident following discussion with people that use the service, staff and indirect observation, that staff know the people they are caring for extremely well and that there is a mutual respect between staff and people living at the home. People are supported to make decisions and choices about their lives and are encouraged to express their views. Activities are varied and plentiful and those people who are able have regular planned holidays. People that use the service are supported to go out independently. People enjoy regular visits to the pub, shops, theatre and visiting family. Food provided is enjoyed. People spoken to during the visit spoke highly of the chef. Records were available to confirm that the manager follows good recruitment procedures. People that use the service are involved in the interviewing of new staff. People that use the service spoke positively about the home and care received, comments made included; The entertainment is very well organised and the food is superb This is a very good home with staff that care. We have regular meetings and we make our own choices and decisions Staff are brilliant and the food is excellent Everyone is really helpful. Staff look after us very well What they could do better:
The use of bed rails should be discussed with a multi disciplinary to confirm that bed rails are the safest option for the person. Risk assessments for people using bed rails need to be updated to include best practice safety measures that need to take place prior to using the bed rails and safety checks that need to take place on a regular basis whilst the bed rails are in use. This inspection highlighted that some improvement is needed with medication recording and administration practice. Hand written entries of medication on Medicine Administration Records (MAR) did not always contain the signatures of two staff. Two staff should check and sign the MAR to make sure the medication has been written up correctly to avoid any errors. In general nurses are responsible for the administration of medication, however discussions highlighted that on occasions senior care staff have administered liquid medication to people (receiving nursing care) via a peg tube. Discussions also identified that liquid medication is drawn up by nurses working at the home and given to the senior care staff to administer, this is secondary dispensing of medication. The manager was spoken spoken to during the visit and advised that this practice must stop. Those people that use the service that are receiving nursing care must have their medication administered by a nurse. The manager was informed that secondary dispensing of
Care Homes for Adults (18-65 years) Page 8 of 13 medication must stop. The nurse that prepares/draws up the medication must administer it. 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 2. Care Homes for Adults (18-65 years) Page 9 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 10 of 13 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, 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 20 13 Those people that use the 12/06/2010 service that are receiving nursing care must have their medication administered by a nurse. To ensure safe practice. Secondary dispensing of 12/06/2010 medication must not take place. To avoid the risk of errors or harm to people that use the service. 2 20 13 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 9 The use of bed rails should be discussed with a multi disciplinary to confirm that bed rails are the safest option for the person. Risk assessments for people using bed rails need to be updated to include best practice safety measures that need to take place prior to using the bed rails and safety checks that need to take place on a regular basis whilst the bed
Page 11 of 13 2 9 Care Homes for Adults (18-65 years) 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 rails are in use. 3 20 Hand written entries of medication on Medicine Administration Records (MAR) should contain the signatures of two staff. Two staff should check and sign a MAR for handwritten entries to make sure the medication has been written up correctly to avoid any errors. Duty rotas should be updated to include the managers working hours. 4 33 Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
