Inspection on 07/06/05 for Candle Court Care Home

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 01/12/05

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 NW2 2TD Lead Inspector Tom McKervey Announced 7th & 8th June 2005 @ 09.15 am 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Candle Court Care Home Address Bentley Drive, off Cricklewood Lane, London NW2 2TD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8731 7991 020 8731 7992 Mr Dolar Popat of Rockley Dene Homes Ltd Robert Titchener N Care Home with Nursing 93 Category(ies) of DE(E) Dementia - over 65 registration, with number MD(E) Mental Disorder - over 65 of places OP Old Age Candle Court Care Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25 November 2005 Brief Description of the Service: Candlecourt 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 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 service users are accommodated on two floors, each with its own staff team. Two passenger lifts service the first floor.Fifty-six service users 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 service users. 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.Candlecourt is situated near a busy junction between Cricklewood Lane and the A41.The home is easily accessed by public transport, and shops and other amenities are within walking distance on Cricklewood Lane.The home’s 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over two days and was completed in ten hours and forty-five minutes. The lead inspector was assisted by Inspector Daniel Lim on the first day, and Inspector Margaret Flaws, on both days. In addition, the Commission for Social Care Inspection’s pharmacist inspected the medication standards. The registered manager was present over the two days of inspection, and fully cooperated in the process. The inspection process included touring the premises, reading service users’ files, and examining documents relating to the management of the home. Ten service users, four relatives and twenty staff were interviewed during the inspection. A regular visitor and an art and crafts therapist were also spoken to. Prior to the inspection, forty-one comment cards were sent to the inspector, from service users, relatives and health/social care professionals, who have regular contact with the home. What the service does well: What has improved since the last inspection? Since the last inspection, new curtains, furniture and bedclothes have been provided. Care plans are now reviewed monthly and accident forms are properly completed. Candle Court Care Home Version 1.10 Page 6 Improvements have been made to the recording of complaints, and service users’ wishes in the event of their death are ascertained and recorded. The staffing levels have been raised to meet individual service users’ needs, and regular fire drills are carried out. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Candle Court Care Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Candle Court Care Home Version 1.10 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 standard(s) 1, 2, 3,4 & 6 Service users and/or their representatives do not have full information on which to assess the suitability of the home. Service users’ special needs are now better provided for by increased staffing levels. EVIDENCE: The Statement of Purpose provides a full description of the service and the range of needs provided for. Although there is a Service User Guide available, relatives who were spoken to, stated that they had not been given a copy. The manager also stated that the guide is not routinely given to service users or their representatives when admitted to the home. A requirement is made regarding this issue. Six case files were examined. The majority of places in the home are funded by block contract with Brent Primary Health Care Trust and Barnet Local Authority. Candle Court Care Home Version 1.10 Page 9 Other places are funded by other Local Authorities or are privately funded. However, none of the contracts seen included the room number allocated, and were not signed by the home or service users’ representatives. A requirement is made regarding this issue. A sample of case files contained comprehensive assessments, including psychiatric assessments. Where appropriate, assessments had also been carried out by social workers. However, the inspector identified three instances where service users exhibited special needs, e.g., challenging behaviours, whose needs were not being fully met. After discussion with the manager, he immediately increased the staffing levels by one carer per shift to provide closer observation of these service users. Standard 6 does not apply, as the home does not provide intermediate care. Candle Court Care Home Version 1.10 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 standard(s) 7, 8, 9, 10 & 11 Care staff treat service users with respect and dignity. There are good care plans to guide staff in achieving goals of care. Service users’ healthcare needs are generally being met. However, in one instance, there was an unacceptable delay in referring to the G.P. There are good systems in place for the administration of medicines, but more care is needed in recording when medication is given or withheld. EVIDENCE: Candle Court Care Home Version 1.10 Page 11 The home operates a key-worker system. The key-worker is responsible for compiling the care plans. Eight care plans were sampled. The care plans covered assessment, goals of care and guidance about the actions to be taken to achieve the goals. The care plans were reviewed every month. The case files contained evidence that service users’ were seen regularly by G.Ps, and a range of healthcare professionals. There were good records of treatment for a service user who had a pressure sore. Advice had been provided by the tissue viability nurse, and there was a policy on the prevention of pressure sores. However, the records of one service user indicated that there was a delay of almost four days between an injury being reported, and the service user being seen by the G.P. A requirement is made regarding this. Administration of medicines was generally satisfactory. However, the medication records on the first floor had gaps where medication had not been signed for, and the temperature of the medication fridge on the ground floor, was sometimes above 8 degrees C. Several service users were having medication disguised. A relative or doctor had recorded agreement to this to maintain the service users’ health. However, administration of covert medication needs to be a recorded agreement, between the doctor, relative and the home manager. A requirement is made regarding this issue. Service users who were spoken to, stated that the staff always treated them with respect, and personal care was provided in private and discreetly. The funeral arrangement of service users was recorded in the case files. Candle Court Care Home Version 1.10 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 standard(s) 12, 13, 14 & 15 There is a good range of appropriate activities provided, and service users, where able, can choose from a menu, which is wholesome and varied. EVIDENCE: Candle Court Care Home Version 1.10 Page 13 The activities coordinator recently left the home, but the manager stated that a member of staff was filling the role until a full-time person is recruited. There is a very varied activities programme, tailored to the needs of service users. The inspector observed arts and crafts sessions taking place during the inspection. 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. Relatives who were spoken to, stated that they were welcomed by staff when visiting the home. Many of the service users have dementia, which limits their ability to communicate choice. However, the case files contain information about service users’ individual likes and dislikes and life histories. This information is used to guide staff in making choices on their behalf. Service users who were able to communicate, stated that they could go to bed and get up at a time of their own choosing and that they chose their meals. A cook and kitchen assistants are employed. An inspection of the kitchen and food stores indicated that there was an ample supply of food available. The menus showed a good variety of balanced and nutritious meals. There was evidence that ethnic dishes are available in accordance with service users’ wishes. An inspection of the well-equipped kitchen, showed that there was plenty of food provided, which was stored safely. The inspectors joined service users for lunch, which was tastefully prepared and presented. Some service users were observed being supported to eat by staff in an unhurried and sensitive manner. New curtains had been recently fitted in the dining rooms. The inspector saw evidence that the old dining furniture was being replaced in the very near future. During the lunch, the noise level in the large dining room was very high, which was not helped by the loud disco-type music being played. The inspector recommended more relaxing, low-volume music to provide a pleasant atmosphere at meal times. It is also recommended to provide low partitions in the dining room to further enhance the service users’ environment. Candle Court Care Home Version 1.10 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 standard(s) 16 & 18 There are appropriate systems, policies and procedures in place to address complaints, and safeguard service users from abuse. EVIDENCE: The complaints log has been amended to include a record of whether the complainant was satisfied with the outcome. Two complaints were being investigated at the time of the inspection. There are appropriate policies and procedures in place regarding protection of service users from abuse. The manager is an accredited trainer for adult protection. Several staff have been trained in these procedures, and an ongoing programme was seen, which showed that all other staff will have received training this year. Service users and their relatives who were spoken to during the inspection, stated that they were satisfied with the care provided. Candle Court Care Home Version 1.10 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 standard(s) 19, 20, 22, 23, 24 & 26. Service users live in a well-maintained and attractive environment. There is a good standard of décor, and bedrooms and communal areas are attractive and comfortable. EVIDENCE: Candle Court Care Home Version 1.10 Page 16 The home employs a maintenance person who is responsible for general maintenance, health and safety issues and minor repairs. An inspection of the premises was carried out. The building is well maintained, with good records of repairs and health and safety checks. Two issues were identified; in Room GB41, one of the door handles needs repair, and in Room GB39, a wardrobe door was missing. A requirement is made to address this. It was noted that new curtains and bedspreads had been provided in the bedrooms and new curtains in the dining rooms, since the last inspection. The inspector saw invoices for new armchairs and dining furniture that had been ordered. There is an attractive central paved courtyard, with raised flowerbeds. This area is accessible by all the service users. A total of twenty bedrooms were visited. They contained evidence of personal possessions and mementoes. All the bedrooms seen were attractively decorated and comfortable. The bathrooms and toilets were equipped with hoists and adaptations. There was evidence that the equipment was regularly serviced. At the time of the inspection, the home was very clean and tidy and there were no offensive odours. Candle Court Care Home Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 There are now sufficient numbers of staff on duty to meet service users’ needs, and there are good systems in place to ensure that staff are appropriately recruited and trained to carry out their roles and responsibilities. EVIDENCE: At the time of the inspection, the staff numbers were insufficient to meet the needs of the service users, particularly the needs of three service users on the first floor, who required close observation. The manager immediately increased the staffing levels by one carer per shift to address this. The staff rotas showed that a registered nurse is always on duty on each floor. There were thirteen staff trained at National Vocational Qualification, (NVQ) level 2 or above, equating to 23 of the care staff. This is a decrease from last year. The manager explained that some staff who had the qualification, had left the home. However, the NVQ training programme is ongoing. Eight staff records were examined. They showed that staff had been appropriately recruited, with proof of identity and Criminal Records Bureau and Protection of Vulnerable Adults checks being made. There was evidence that staff who are not fluent in English, are provided with English language courses. The records showed that all staff receive an induction and foundation training, and it was noted that training in the English language is provided for staff whose first language is other than English. Candle Court Care Home Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 & 38 There are good systems in place to safeguard the health and welfare of service users. Staff need to have a broader range of one-to-one supervision to better support them in their work. At the time of this inspection, no criticisms of the manager were made by staff. However, following previous concerns about the manager’s style, an independent investigation into this matter was commissioned by the proprietor, and the outcome of this investigation is awaited. EVIDENCE: Candle Court Care Home Version 1.10 Page 19 The registered manager has been in post for approximately three years. He is a registered nurse in general and mental health and has a MSC in management. The manager stated that a deputy manager post was vacant on the first floor. It is also planned to appoint a head of care as part of the management structure in the home. Both posts were currently advertised. The manager’s duties were not recorded on any of the staff rotas, which was a requirement from the last inspection. This requirement is restated. During this inspection, service users, relatives and staff who were spoken to, expressed satisfaction about how the home was managed. However, following two previous inspections, when concerns were expressed about the management style, the provider appointed an independent consultant to investigate this matter. At the time of this inspection, the investigation had not been completed. An independent agency carried a quality assurance audit of the home 2004. The manager stated it is planned to repeat the audit this year. Monthly unannounced visits are carried out by a senior company executive, and the reports of these visits are sent to the Commission for Social Care Inspection. A business and financial plan for 2005/6 was available for inspection. Money is held on behalf of one service user in the home. The records of cash transactions were examined and found to be in order. The staff supervision records were sampled. It was evident that the type of supervision being provided was solely task and performance related, which although important, is not broad enough in scope to provide the support intended by Standard 34. The supervision records were not securely stored. A requirement is made to address these two issues. The manager agreed to provide more secure facilities for these records. There is a comprehensive portfolio of policies and procedures at the home. The prevention of pressure sores policy was examined and seen as appropriate. Certificates of safety were seen for gas, fire and electrical installations. There were good records of health and safety checks and fire alarm testing and drills. Candle Court Care Home Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 2 3 3 3 2 3 3 Candle Court Care Home Version 1.10 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 5(2) Requirement The registered person must provide service users and/or their representatives with a copy of the Service User Guide. 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 30/10/04. The registered person must ensure that any injury to a service user is reported to the G.P within 24 hours. The registered person must ensure that; !. All medication given is signed for. 2. The administration of covert medication is a tripartite, recorded agreement, between the doctor, relative and the home manager. 3. The medication fridge on the ground floor, is maintained at a maximum of 8 degrees C. Version 1.10 Timescale for action 31/8/05 2. 2 5(1)(b) 31/8/05 3. 8 12(1)(a)( b) 13(2) 31/8/05 4. 9 31/8/05 Candle Court Care Home Page 22 5. 19 23(2)(b) 6. 32 23(3)(a)(i ) 7. 36 18(2) The registered person must ensure that the door handle in Room GB41,is repaired, and the wardrobe door is replaced in Room GB39. The registered person must ensure that the managers duties are recorded so that staff are aware of his whereabouts. This requirement is restated from the last inspection. The previous timescale for this requirement was 31/1/05. The registered person must ensure that: 1.Staff receive at least six formal supervisions a year, which supports them in their roles as carers. 2. Staff supervision records are kept confidential and stored securely. 31/8/05 31/8/05 31/8/05 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 15 Good Practice Recommendations The registered person should provide more relaxing, lowvolume music to provide a pleasant atmosphere at meal times. It is also recommended to provide low partitions in the dining room to further enhance the environment for service users. Candle Court Care Home Version 1.10 Page 23 Commission for Social Care Inspection 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. 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