Inspection on 14/06/10 for Carlton Gate

This is the latest available inspection report for this service, carried out on 14th June 2010.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Carlton Gate 17/11/08

Carlton Gate 19/11/07

Carlton Gate 04/01/07

Carlton Gate 27/06/06

Carlton Gate 24/02/06

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for adults (18-65 years) Name: Address: Carlton Gate 10 Florey Lodge Admiral Walk, Harrow Road London W9 3TF     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: Sheila Lycholit     Date: 1 4 0 6 2 0 1 0 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 Adults (18-65 years) Page 2 of 24 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 Adults (18-65 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Carlton Gate 10 Florey Lodge Admiral Walk, Harrow Road London W9 3TF 02072892352 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Westminster Society Name of registered manager (if applicable) Mr Stephen Paul Golden Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Carlton Gate is a registered care home providing personal care and accommodation for two men and four women with a learning disability. Westminster City Council leases the property from the health authority and care is provided by the Westminster Society, a voluntary organisation. The home is well located to enable residents to use facilities in the local community and is close to shops and transport links. The home consists of two flats, Florey Lodge and Barnard Lodge, each for three people. All accommodation is on the ground floor and the home is fully accessible to people using Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 6 1 7 1 1 2 0 0 8 Brief description of the care home wheelchairs. Each person living in the home has a single room. Each flat has an assisted bathroom and accessible shower room. The flat in Florey Lodge contains the staff office. Fees in 2010/11 are £1600.00 per week. Care Homes for Adults (18-65 years) Page 5 of 24 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced visit took place on Monday 14th June 2010 from 10.40am until 4.45pm. The Manager was on duty in Florey Lodge with support staff and the Manager of Barnard Lodge was also on duty. Four residents were at home. One person was at a day service, returning later and one was in hospital recovering from a serious illness. The Manager made himself available throughout the visit and staff and residents were spoken with during the day. Care Homes for Adults (18-65 years) Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: 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 Adults (18-65 years) Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 24 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Clear, up to date information about the service is available in an accessible format. The Westminster Society has a sound admission procedure. Evidence: Copies of the statement of purpose and the service users guide, which had been recently reviewed, were seen. Information is provided in an accessible format, for example photos of staff are included. The service users guide contains a copy of the complaints procedure, which is also in an easy read format. No new residents have moved to the service since the last inspection. The Westminster Society has an established admissions procedure, which fully involves the prospective resident. Residents changing needs are regularly assessed with the involvement of the multi professional Learning Disability Team. Care Homes for Adults (18-65 years) Page 9 of 24 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care plans are comprehensive and show that residents have contributed to the development of their plans. Risk assessments are up to date. Evidence: The Westminster Society has developed an All about me system for care planning, which has been implemented at the service. The files of the two people with the highest needs, one from each flat, were looked at. Care plans are well developed, detailing how the person wishes to be supported in different areas of their life, including personal care, communication and managing money. Residents are supported to contribute to the development of their plans through the use of signs, symbols and photos. Separate support plans are available for night staff, detailing peoples preferred routine at night. The service has achieved a high level of resident involvement, with people supported to take part in all aspects of the life of the house. House meetings are recorded in an Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: accessible format and issues raised brought to staff meetings. As far as possible, residents are supported to manage their own money. . Risk assessments seen on the two residents files were comprehensive and up to date. Care Homes for Adults (18-65 years) Page 11 of 24 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 take part in a range of activities, usually on an individual basis. Staffing levels are sufficient to allow people to maintain a presence in the community. Residents weight and nutrition is carefully monitored and one resident has been successfully supported with PEG feeding for 4 years. Evidence: Residents daily logs and observation show that they are supported to take part in a range of activities both in the community and at home. One person was attending a day service on the day of the inspection but the majority of residents decide their routine on a daily basis. Staffing levels allow residents to be supported individually to go out in the community, for example for lunch or shopping for food. The two care plans seen showed residents interests and the activities they wished to take part in. Discussion with the Manager and records seen show that residents are supported to maintain contact with families and friends, by phone and visits. Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: Residents take part in shopping for meals and are supported with preparing food. The kitchens in both flats were clean and tidy with food safely stored. Residents weight is monitored and recorded, including their BMI. One resident has relied on PEG feeding for the past 4 years. Staff receive advice from the Dietitian and District Nurse who visit regularly. The supplier of the feeds has a 24 hour helpline and the local rapid response nurse can be called to attend. This residents daily logs, which are in an accessible format, are personalised, with a space for the start time of feeds. Staff must ensure this is always completed and signed. Night staff should also confirm that feeds are flowing satisfactorily and note any issues. The Manager stated that all staff have received training in PEG feeding . It is recommended that training is recorded and refresher training provided at regular intervals. Care Homes for Adults (18-65 years) Page 13 of 24 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The staff team works closely with health care colleagues and the multi professional learning disability team to support residents and to ensure their health care needs are met. Evidence: All of the residents need support with personal care. The records of two people looked contained detailed guidance for staff on how they wish to be supported, showing their involvement and also staffs knowledge and understanding of their likes and dislikes. A number of people living at the service have high health care needs and some have a history of mental health problems. Records show that staff work closely with multi professional colleagues to provide residents with good health care and to ensure that their psychological needs are identified and supported. One resident receives regular visits from the Challenging Needs Nurse, who is her care manager. Up to date health action plans were seen on both files looked at. Residents attend hospital, GP and dental appointments with staff and have been supported to have surgery, including a cataract operation. Records and discussion show that the health care needs of residents, a number of whom have deteriorating health, are given a high priority. Medication is kept in locked wall-mounted metal cabinets in each flat. Medication and Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: storage at Barnard Lodge was seen and was safely stored in a newly installed cabinet. The Boots monitored dosage system is used. Medication administration records were up to date and fully completed. Medication is checked as part of the Westminster Societys regular audits. The Commission has been notified of some medication incidents, including missed medication and the wrong dosage given since the last inspection. The Westminster Society investigates each incident, providing additional training where necessary. Care Homes for Adults (18-65 years) Page 15 of 24 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The home has a clear, accessible complaints procedure. Staff work with the local safeguarding team to ensure residents welfare. Evidence: The home has a well designed complaints procedure, which is given to each resident. The complaints record shows that residents feel able to make complaints, which are taken seriously. The number of complaints, which mostly relate to one persons behaviour, have reduced as a result of steps taken, though concerns remain. Issues raised by staff were investigated earlier this year and action taken. Safeguarding issues have been referred to the local safeguarding team in line with local procedures and the Commission has been informed. Training records show that all staff have received training in safeguarding vulnerable adults. Care Homes for Adults (18-65 years) Page 16 of 24 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 two flats provide pleasant accommodation, which is fully accessible, close to public transport, shops and services. The flats are generally well maintained and are kept clean and tidy by support staff. Evidence: The service consists of two ground floor flats in a private development off the Harrow Road. The flats are situated in attractive grounds. Both flats are fully accessible to residents using wheelchairs. A very small staff office is located at Florey Lodge and plans for another small office at Barnard Lodge are in hand. Three residents bedrooms were seen, which contained a range of personal possessions reflecting their interests. The flats are generally in a good state of decoration. flooring has recently been replaced and new furniture purchased. Each flat has an assisted bathroom and separate shower room. Individual hoists are available for residents who need them. Bedrooms do not have have wash basins. It is recommended that the provision of wash basins is considered to provide residents with more privacy and to give staff handling PEG feeds easy access to hand washing. The flats are kept clean and tidy by support staff. Care Homes for Adults (18-65 years) Page 17 of 24 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Steps have been taken to improve staff cohesion and communication. Staff have access to regular training and support. Evidence: Since March 2010 staff have been deployed as two teams, allocated separately to each flat. The change was in response to conflict and poor communication within the team, which was investigated by the Westminster Society following complaints from staff. The Registered Manager and acting Manager at Barnard Lodge confirm that the arrangements are working well. The change has resulted in higher staffing levels and increased management oversight. Quality monitoring reports from the Society indicate that staff sickness is high, which was confirmed by the Manager, who stated that sickness absence is being looked at individually by the Societys Occupational Health staff. Vacant shifts are covered by staff from the Societys bank, who are known to residents. Staffing levels are good, allowing residents one to one support in the community and enabling the high physical needs of a number of residents and challenging behaviour to be managed. One member of staff is on waking night duty in each flat. Staff are recruited by the Societys HR team together with local managers. Residents are involved in all staff selection. Recruitment checks are undertaken by HR staff. Staff undertake a structured induction. All new staff are given a list of tips from Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: residents about how they expect staff to treat them and to behave. Staff have access to NVQ level 2 training and the Societys training programme. A number of staff have achieved NVQ level 3 which they have self-funded, with the Society allowing time for study. Training records show that all staff attend mandatory training, with regular refresher training. Mandatory training is monitored by means of a spreadsheet and the Manager stated that training was up to date with the exception of a member of night staff who had been booked on refresher training. Staff are supported by regular staff meetings, which are recorded in detail and by supervision. Care Homes for Adults (18-65 years) Page 19 of 24 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 service is managed by a competent and experienced Manager, who himself receives good support from senior staff. The Westminster Society has a range of consultation and involvement initiatives which support service users to contribute to the development of the service. Evidence: The Registered Manager has worked at the home for a number of years, is a qualified Social Worker and has completed NVQ level 4. The Manager of Barnard Lodge is also an experienced Manager, with NVQ level 4. The Manager was observed to have very good communication skills with residents, acting as an excellent model for staff. He plays a leading role in the Societys user involvement programme, developing ways of supporting service users to contribute to service development. A member of support staff spoken with stated that she received good support from the Manager, who made himself available to discuss any concerns. Service users views are regularly sought and conveyed to the Societys adult services committee, which includes users in its membership. Health and safety records seen were up to date, including fire safety records. Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: Additional equipment has been purchased to ensure that residents can all be evacuated quickly and safely in the event of a fire. There is good support and management overview of the service. Records show that the Service Manager visits regularly and completes reg 26 reports. An annual audit also takes place by a senior manager, who produces a detailed report, with action to be taken. A range of management information, including any complaints, is forwarded monthly to line managers. Care Homes for Adults (18-65 years) Page 21 of 24 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 Adults (18-65 years) Page 22 of 24 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 1 17 13 The start time for PEG feeds 30/06/2010 must always be noted and signed. Night staff must record whether the feed was flowing normally or whether there were any problems. To ensure that the procedure is accurately recorded. 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 2 17 26 Records of staff training in assisting with PEG feeding should be kept and refresher training regularly provided. Consideration should be given to providing wash basins in residents bedrooms to enhance privacy and to provide handwashing facilities for staff handling PEG feeds. Care Homes for Adults (18-65 years) Page 23 of 24 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 non-commercial 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 24 of 24 - 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. 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