Inspection on 01/12/05 for Candle Court Care Home

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Candle Court Care Home 04/06/07

Candle Court Care Home 23/05/06

Candle Court Care Home 07/06/05

Candle Court Care Home 25/11/04

Candle Court Care Home 06/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Candle Court Care Home Bentley Drive Off Cricklewood Lane London NW 2 2TD Lead Inspector Tom McKervey Unannounced Inspection 1st November 2005 10:00 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 Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 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. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Candle Court Care Home Address Bentley Drive Off Cricklewood Lane London NW 2 2TD 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) 0208 731 7991 0208 731 7992 Rockley Dene Homes Limited Mr Robert Titchener Care Home 93 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0), Old age, not falling within any other category (0) Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2005 Brief Description of the Service: Candle Court Care Home is a nursing home for people with mental health needs and dementia. The home is owned and managed by Rockley Dene Homes Limited, a company based in Harrow, Middlesex. The company also owns three other care homes elsewhere in the U.K. The home was registered with the Commission for Social Care Inspection in April 2004. The home provides nursing care and support for 93 service users over the age of 65, who have a mental disorder, and/or dementia. The residents are accommodated on two floors, each with its own staff team. Two passenger lifts service the first floor. Fifty-six residents live on the ground floor and thirty-seven on the first floor. Each floor is sub-divided into three named wings. The two-story building has a rectangular structure with an attractive central courtyard, which is accessible by all the residents. Each floor has its own bathrooms, toilets, lounge, dining room and small kitchen areas. There are 59 single and 17 double bedrooms with en-suite facilities. The basement of the premises contains a large and a small kitchen, a laundry area, staff changing facilities and a staff training room. Candle Court Care Home is situated near a busy junction between Cricklewood Lane and the A41. The home is easily accessible by public transport and there are shops and other amenities within walking distance on Cricklewood Lane. The homes stated aims are to provide long-term personal and nursing care, to 93 older people of both genders, over the age of 65 suffering from dementia, enduring mental health problems and physical disability. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of six hours. A new manager who had recently taken up post, was present during the inspection, and fully cooperated in the process. A new deputy manager who had also been appointed recently, was not on duty at the time of the inspection. There were six current vacancies in the home. This inspection focused primarily on the requirements that arose at the last inspection. The process involved touring the premises, reading residents’ files, and examining documents relating to the management of the home. Ten residents, four relatives and six staff were interviewed during the inspection about their views and experiences of the service. What the service does well: What has improved since the last inspection? What they could do better: Three requirements from the last inspection have been restated. These refer to distribution of the Service User Guide to residents and relatives, provision of detailed contracts for residents, and the need to implement a programme of staff supervision. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 6 All staff must attend training in adult protection procedures, and staffing levels need to be reviewed to ensure that sufficient staff are available to meet residents’ needs at busy times. Requirements have been made regarding safe storage of medication. The manager must review the practice of staff wearing disposable gloves when supporting residents to eat, and provide evidence that residents who are able to, can choose what they prefer to eat. 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. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 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 Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, & 3 Prospective service users and/or their representatives are not provided with a Service User Guide, which should have full information on which to assess the suitability of the home. Service users are properly assessed prior to being admitted to the home. EVIDENCE: The manager who had just recently been appointed, stated that she was currently updating the Statement of Purpose and Service User Guide to include information about herself and the new deputy manager. At the last inspection, a requirement was made that the Service User Guide be given to new service users on admission to the home. There was no evidence that this had been complied with. Therefore, this requirement is restated. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 9 A sample of residents’ contracts did not include the room number allocated, and were not signed by the home or service users’ representatives. This was a requirement at the last inspection, and is restated in this report. The case files of recently admitted residents contained comprehensive assessments by placing authorities and the home. These included psychiatric assessments. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, & 9 There are individual care plans for residents, but they are not reviewed at least monthly to ensure that staff are aware of residents’ changing needs . Residents’ safety and welfare could be at risk if medication is not stored safely. EVIDENCE: Four residents’ care plans were examined. The care plans covered assessment, goals of care and guidance about the actions to be taken to achieve the goals. However, the care plans were not being reviewed every month, which is the required standard. A requirement is made to address this. The case files contained evidence that residents were seen regularly by G.Ps, and a range of other healthcare professionals. However, a recommendation is made that these records are better structured for ease of reference. There was one resident who had a pressure ulcer, which was improving, and residents’ weight and blood pressure was being monitored regularly. Four relatives, who were visiting residents during the inspection, were spoken to. Three of the relatives were very satisfied with the service. One said; ” the staff are wonderful, nothing is too much trouble”. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 11 However, one relative was concerned that the resident had not had been having baths according to the agreed care plan. The inspector examined the bath book and found that the records substantiated this relative’s complaint. The manager agreed to address this matter immediately, and a requirement is made in this report about this issue. The medication standard was examined. The home has a contract with a clinical waste company for the disposal of unused medication, which complies with the new regulations. The administration of medicines records were in order and residents’ consent to medication forms was signed. However, the following issues were identified: • The medication policy did not make reference to covert administration of medicines. • The fan in the first floor clinic room was dirty and the room temperature was too high. • The temperatures in both clinic rooms were not being recorded each day. These issues could affect safety of the medication, and a requirement is made to address this. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 There are some appropriate activities provided for residents, but these are limited at present until the vacant activities organiser post is filled. It is not clear how residents are consulted about their choice of meals, and the practice of staff wearing disposable gloves when assisting residents to eat should be reviewed. EVIDENCE: The manager stated that the post of activities organiser has still not been filled, but intends to re-advertise in the New Year. In the meantime, a member of staff was delegated to this task. Two sessions of arts and crafts and music are provided and some residents were seen being supported by staff in one-toone activities. The home has an open visiting policy, and the visitors’ book showed frequent visits to the home at various times of the day and evening. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 13 Relatives who were spoken to, stated that they were welcomed by staff when visiting the home. Improvements had been made to the general ambience of the dining rooms, which were attractively decorated and provided a relaxed atmosphere. One resident who was articulate, said that although the food was plentiful, there was no choice about the menus. The menus that were seen were varied, but it was not clear whether or not any residents had an input into the content of the menus. A requirement is made that evidence of choice about food is available to residents. The inspector observed staff supporting residents who needed help with eating their meals. The staff wore disposable gloves when carrying out this task. It was not apparent why this practice existed, and it seemed rather undignified. The manager was asked to review this practice and take steps to preserve the dignity of the residents at mealtimes. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 There are appropriate systems in place to protect residents from abuse, but not all staff have received training in adult protection. EVIDENCE: There is an appropriate complaints procedure in place. The complaints record showed that two complaints were currently being investigated. There are policies and procedures in place regarding protection of service users from abuse. Some staff stated that they had attended training in adult protection, but records to confirm this were not available for inspection. A requirement is made to ensure that all staff attend this training. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23 & 26 Residents live in a clean and pleasant environment. There is a good standard of décor, and bedrooms and communal areas are attractive and comfortable. EVIDENCE: A tour of the property was carried out. The building was well maintained and there were good records of repairs and health and safety checks. New armchairs and dining room furniture had been purchased since the last inspection and the home appeared attractive and comfortable. Requirements made at the last inspection relating to residents’ rooms had been complied with, and the home was very clean and tidy. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 Proper staff recruitment procedures are carried out to protect residents welfare and interests. Staffing levels need to be reviewed to ensure that sufficient staff are available when residents’ needs are highest. EVIDENCE: The staff rotas showed that a registered nurse is always on duty on each floor during the day and night. The home meets the minimum staffing levels according to the London Guidelines. However, in discussion with some staff, it appeared that there was an imbalance between the workload and the number of staff available at times when the needs of residents were most demanding. A requirement is made for workload and staffing levels to be reviewed. There were thirteen staff trained at National Vocational Qualification, (NVQ) level 2 or above, and the NVQ training programme for all other staff is ongoing. The records of four new staff were examined. There was evidence that Criminal Records Bureau, (CRB) checks had been made and references had been obtained. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36 & 42 The new management team has made a good start in running the home and staff morale has improved. A programme of supervision for staff needs to be implemented to support them in their work with residents. EVIDENCE: Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 18 The new manager had only been in post for three weeks at the time of the inspection. She is a registered nurse and was recently a care commissioner for a local authority. She had also previously managed health services in New Zealand. The manager has already applied to be registered with the Commission for Social Care Inspection. A new deputy manager was appointed in the last four months, who is also a registered general nurse. Staff who were spoken to, said they were happy with the new management in the home and that their morale had improved. At the last inspection, a requirement was made for a programme of staff supervision be implemented. This had not taken place and the new manager intends to begin this task in the near future. In the meantime, this requirement is restated. The accident book was properly completed. There were good records of health and safety checks and fire alarm testing and drills. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 19 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 2 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 1 X 3 Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 5(2) Requirement The registered person must provide service users and/or their representatives with a copy of the Service User Guide. This requirement is restated from the last inspection. The previous timescale for this requirement was 31/08/05. The registered person must ensure that service users’ contracts are signed by the home manager and the service user or representatives, and include the room number allocated. This requirement is restated from the last inspection. The previous timescale for this requirement was 31/08/05. • The registered person must ensure that; There is guidance about the covert administration of medicines in the medication policy. • The fan in the clinic room is cleaned and the room temperature is maintained below 25ºC, and the DS0000053368.V261358.R01.S.doc Timescale for action 28/02/06 2. OP2 5(1)(b) 31/03/06 3. OP9 13(2) 31/01/06 Candle Court Care Home Version 5.0 Page 21 temperatures in both clinic rooms is monitored daily. 4. OP15 12(2) The registered person must provide evidence of choice for those residents who are able to choose their meals. The registered person must review the practice of staff wearing disposable gloves when supporting residents to eat. The registered person must ensure that all staff in the home attend training in adult protection. The registered person must review staffing levels to ensure that sufficient staff are available when residents’ needs are highest. The registered person must ensure that staff receive at least six formal supervisions a year, which supports them in their roles as carers. This requirement is restated from the last inspection. The previous timescale for this requirement was 31/08/05. 31/01/06 4. OP15 12(4)(a) 31/01/06 5 OP18 13(6) 31/03/06 6 OP27 18(1) 31/01/06 7 OP36 18(2) 31/03/06 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 OP8 Good Practice Recommendations The manager should structure residents’ health records so that the information is more clear and accessible. Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Candle Court Care Home DS0000053368.V261358.R01.S.doc Version 5.0 Page 23 - 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!