Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Carisbrooke House Residential Home 10-11 Sandown Road Great Yarmouth Norfolk NR30 1EY The quality rating for this care home is: The rating was made on: two star good service 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Kim Patience Date: 0 6 1 0 2 0 0 8 Information about the care home
Name of care home: Address: Carisbrooke House Residential Home 10-11 Sandown Road Great Yarmouth Norfolk NR30 1EY 01493855915 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Selvaratnam Balaratnam care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category 0 0 0 Over 65 6 1 22 Conditions of registration: A minimum of three care staff to be on duty during daylight hours. Date of last inspection Brief description of the care home Carisbrooke House is a care home providing personal care and accommodation for up to 22 older people. The registration of the home has just been altered to allow the home to accommodate up to 6 older people who have dementia. The home is located on a street close to the seafront of Great Yarmouth and consists of two adjoining large three storey terraced houses, with small patio areas at the front and back of the building. The accommodation includes 12 single and 5 shared bedrooms, some with en-suite facilities. Three lounges (two on ground floor, one on top floor) and a ground Care Homes for Older People Page 2 of 10 floor dining room make up the communal rooms. Access to the upper floors is by a shaft lift. There is on street parking at the front of the building. The home charges from £268 to £325 for shared rooms and from £281 to £338 for single rooms. Additional charges are payable by residents for hairdressing, chiropody, toiletries and newspapers/magazines. Care Homes for Older People Page 3 of 10 What we found:
This inspection was a random unannounced site visit and took approximately 4 hours to complete. During the site visit we completed a tour of the premises, spoke to some residents, spoke to some staff, looked at the way in which medicines were being managed, looked at some care plans and other records and made observations of daily life in the home. We found that the premises were generally clean and tidy. However, in some bedrooms odours could be detected and in some areas carpets were stained. Some communal facilities need to be updated and in one bathroom the bath panel was in need of repair. We found that hazardous substances such as bleach were accessible in a bathroom and there were several large containers propping a fire door open. The fire door led to a step staircase down into the cellar of the home. This was pointed out to the staff who took action to remove the products during the visit and closed the fire door. We also found that some radiators in the communal parts of the home did not have covers on them. However, the handyman said they had been removed for repainting. The television in the lounge had a fuzzy picture and could not be seen clearly. The handyman said the Ariel had been disturbed in the high winds and they were awaiting the repair man to fix it. We looked at the care records relating to two people living in the home and found some shortfalls. For instance, a nutritional screening tool stated that the person was at low risk yet they had been refusing to eat and drink. a pressure care assessment said the person was at medium risk but there was no care plan setting out how the risk should be minimised. Records appeared to contain the care and health assessments but were not followed up with care plans setting out how care staff should support people in meeting their needs. We did not see monthly weight checks even though people had been identified at risk of weight loss. We also found in one case that there were no records relating to medical contacts. When we looked at the way in which medication is managed we found some areas of concern. The home uses a metered dosage system (MDS) with pre-printed charts supplied by the pharmacy. There were no resident identifying photographs or other relevant information. When we examined the charts we found gaps in the records where it could not be determined if the medicines had been given or not. We also found the use of X in the box which was not defined as having any meaning. Some medicines prescribed for use on a when required basis were being given consistently without proper care planning or justification and some medicines prescribed for regular use were being given on a when required basis. When we cross checked the medicines in stock with the charts we found that in some cases there were surplus or deficit medicines. One resident said there had been a problem with her medicines being out of stock and the charts showed some evidence to support this. The fridge contained some creams that were not labeled with the persons name and there was no way of monitoring the temperature to ensure it is within the required limits. In addition, the fridge was not locked and could be easily accessed. We did not see any activity during the visit and on arrival several people were asleep in the lounge areas. Care plans lacked detail about interests and hobbies and what Care Homes for Older People Page 4 of 10 activity had taken place. The senior care assistant said the activities person previously employed had left and not yet been replaced. We observed lunch and spoke to the cook. The dining room was nicely laid out for lunch and looked comfortable. The dining room seats 16 residents, however it appeared there was only sufficient space for 12 people and this raised questions about whether all residents had a choice to take their meals in the dining room if they wished. The food served on the day was cottage pie and it did not look appetising. One resident said that the food was not good but was improving slowly. They said there was little choice and the menu was predictable. The cook said there was a choice of two meals some days but this did not appear on the menu. She said if anyone wished for an alternative it is provided if possible. The home maintains records of peoples choices and daily dietary intake. At least two people needed some support with their meals and did not receive it resulting in the meals not being eaten in full. There were three staff on duty during the inspection and were caring for 17 residents, 5 of whom were said to have dementia. The numbers appeared to be sufficient and there was nothing to indicate that peoples needs were not being met. However, one resident said that they did not always think there were enough staff to support people properly. The resident also said that staff start to get people out of bed from 5 oclock in the morning and like to have people in bed before 9 oclock in the evening. When we looked at the reports written by night staff we could see that staff started to get people up at 6 oclock in the morning and sometimes there were 12 people up before the day shift started, again this raises questions about whether people have a choice about the times they wish to get up and go to bed. We spoke to staff about training and they said they had recently been provided with training in moving and handling, dementia care and fire safety. However, the cook said she had not received any training since starting at the home but had done basic food hygiene previously. All the findings will be followed up in greater detail at the next key inspection. What the care home does well: What they could do better:
Some improvements are needed to enhance the environment, such as replacement of some carpets and repair of some of the facilities. Some areas are also in need of redecoration. The home must ensure that all hazardous substances are stored in accordance with COSHH procedures and that fire doors are kept closed in line with good fire safety procedures. Care plans must be written for all needs and risk assessments must be completed with action plans describing how risks should be minimised. Medication management must be reviewed and improvements need to be made to ensure that people receive their medicines as prescribed. People must have their dignity and choice promoted at all times. The home should Care Homes for Older People
Page 5 of 10 seek to find out what peoples preferences and expectations are and meet those individual needs. Activities should be provided so that people have sufficient stimulation and occupation. The mealtime experience must be enhanced and people must be provided with the support they need to maintain a good diet. The home must seek peoples views on what they like to eat and incorporate this into the menu planning. Providing the cook with further training on the dietary needs of older people will support the process of improving the meals provided and ensuring they are of good nutritional value. Staffing levels must be reviewed to ensure that people receive the support they need at all times. This is with particular reference to getting up, going to bed and at mealtimes. 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 Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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 7 15 Care plans must be written 06/02/2009 for all health and care needs, with a plan of how those needs should be met. So that peoples health and well being is promoted. 2 8 13 Risk assessments must be written for all risks with an action plan stating how the risk should be managed. So that peoples health and welfare is safeguarded. 06/02/2009 3 9 13 The home must have 06/02/2009 systems in place for the safe management of medicines. So that peoples health and welfare is safeguarded. 4 14 12 People must be supported to 06/02/2009 make their own decisions in respect of daily life in the home and their dignity must be promoted. So that peoples health and well being is enhanced. 5 15 16 The home must provide a wholesome appealing diet 06/02/2009 Care Homes for Older People Page 8 of 10 based on the likes, dislikes and preferences of people living in the home. So that peoples health and well being is promoted. 6 19 22 The premises should be kept 06/02/2009 odour free and in a good state of decor and repair. So that peoples health and well being is promoted. 7 38 22 Fire safety procedures must 06/02/2009 be followed and all fire doors must be kept shut. So that peoples health and welfare is safeguarded. 8 38 13 Hazardous substances must be stored away safely and securely. So that peoples health and well being is safeguarded. 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 06/02/2009 1 15 The home should consult with residents about their likes, dislikes and preferences in respect of meals and this should be incorporated in the meal planning process. Staffing levels must be reviewed to ensure that peoples needs are met at all times of the day and that choice is promoted. All staff must be provided with adequate training to do their job effectively. 2 27 3 30 Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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 Older People 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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!
