CARE HOMES FOR OLDER PEOPLE
Carl Court Guestland Road Cary Park Torquay TQ1 3NN Lead Inspector
Sharon Goldsworthy Unannounced 21st July 2005 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. Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Carl Court Address Guestland Road, Cary Park, Torquay, Devon, TQ1 3NN 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) 01803 329203 01803 329203 Mr Farzand Mungar Mrs Kim Hioh Mungar Mr Farzand Mungar Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (15), Old age, not falling within any other category (15) Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users with Mental disorder may be admitted from 50 years age 2. Service Users with Dementia may be admitted from 50 years age Date of last inspection 16th November 2004 Brief Description of the Service: Carl Court provides accommodation with personal care to older people (65 ), older people with mental disorder and older people with dementia (from the age of 50). The home is registered for up to 15 service users both male and female. Private accommodation is provided over 2 levels with their being a stair lift in place for those with mobility problems. There are 15 single rooms, 10 of which have en suite facilities. In terms of communal space, Carl Court offers 2 lounges and a dining room. There is also an accessible, secure and attractive garden. The building itself is a large detached property that is almost adjacent to a public park and located in the St. Marychurch area of Torquay. Local shops and amenities are within walking distance of the home, with Torquay town centre a bus ride away. Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Thursday 22nd July 2005 at 9.30am. The Proprietors were present for some of this visit. The Inspector spoke with staff on duty, six residents individually, made a tour of the building, observed care practice and observed some records. What the service does well: What has improved since the last inspection?
The Proprietor has fitted several magnetic door holders to fire doors that are required to be held open during the day. All other fire doors were now found to be closed. Staff training has continued despite ongoing staff recruitment and retention difficulties. Regular senior staff and full staff meetings are now being held and recorded. Four radiators in bedrooms have been replaced with low surface temperature radiators.
Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 6 A new fridge freezer has been purchased for the kitchen. Several bedrooms have been redecorated and re-carpeted in the last year. What they could do better: 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.
Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 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 Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 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) 3, 4 The home admits only residents whose needs have been appropriately assessed and where it is felt these needs can be met. EVIDENCE: A sample of service users files were viewed. These contained all referral documents and care management care plans as well as the home’s own pre admission and admission assessments. These documents are detailed and clear and provide the care staff with a good picture of the resident, and of their care and mental health needs upon admission to the home. The staff currently employed in the home do have experience of caring for older people and were observed giving appropriate care to most residents. However, it was observed that there does appear to be a need for further formal training in relation to working with residents who have dementia and who have specific mental health needs. The Proprietor’s agree that this is an identified need and would like to see their staff team receive such specific training. They hoped to be able to provide this in the next year, should the current staff team remain stable now.
Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 9 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 There is a clear care planning system in place to provide staff with the information they need to satisfactorily meet residents’ needs, although care records are not consistent or complete. The health, social and personal care needs of residents are met, with evidence of multidisciplinary working taking place on a regular basis. Medication in the home is generally well managed. EVIDENCE: A sample of three resident’s files were viewed. Care plans were complete and sufficiently detailed to ensure that the staff team are aware of the care needs and how the care should be offered. They have been reviewed monthly. Care plans demonstrated that residents are receiving appropriate and regular dental and optical care and health care input or advice when required. Risk assessments were present and complete, but are not dated and so provide no evidence of when or how often they are reviewed. One set of daily care records sampled was found to be detailed, provided evidence of sufficient monitoring where a concern was held and was up to date. The other two samples did not. Both were chosen because these residents’ needs were known to have changed recently. In one, the daily care
Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 10 notes recorded recent falls and an increase in care needs, although the care plan did not record or reflect this. The other set of daily records did not follow up on an increased need for monitoring following a fall that resulted in a head injury. In this instance, there were no records made for three days following this accident and then the records were of poor quality and did not evidence an appropriate level of monitoring or care given. It is imperative that care records are maintained to evidence that care and an appropriate level of monitoring is sustained. A discussion was held with one of the Proprietor’s in relation to the care records in general. It is felt by the Inspector that care plans are so focussed on the needs of an individual and what they cant do and daily records in the main are only recording the negative aspects of care. For example, there is no records made of activities/outings enjoyed or time spent enjoying the company of other residents or staff or where improvements have been identified. It is essential that care staff recognise the importance of resident’s social and emotional health and well-being and see them as individuals with feelings and emotions. The medication was found to be administered and recorded appropriately. However, there was one bubble pack of a drug required to be treated as a Controlled Drug stored amongst all other medication, instead of in the Controlled Drugs cupboard. There was large surplus stock of medications found in the Controlled Drugs cupboard that had not be disposed as required following a residents discharge, death or change in medications. Staff were observed with residents throughout the day of this inspection. They were observed responding to residents’ needs promptly and spending time with residents offering reassurance. Staff on duty were observed responding and caring particularly well to a resident who had two seizures on the day. They dealt with the situations calmly and monitored appropriately following each. Residents spoken with confirmed that staff are very caring and attentive. One resident was observed to be walking around a lot looking for something to do, and found it very difficult to settle. Staff did spend a little time with her, but mainly to bring her back to the lounge of dining area or taking her away from residents whom she was annoying by not settling herself. Staff spoken to recognise that this person needs and wants to keep busy, but were not seen to take initiative in finding something for her to do. Upon talking to this resident, she stated that she likes to be of help – and as such there would be no reason why she couldn’t be involved in domestic tasks within the home. The Proprietors recognise this need also, and stated their intention to raise this with staff again. This issue would also be addressed in a good dementia care course. Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 11 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 The level of activities offered in this home could be improved. However, residents’ are enabled to maintain good links with relatives and friends outside of the home. EVIDENCE: The home does not have a displayed “activity programme”. Some records held do evidence that regular activities, entertainment and outings are arranged. Current regular activities include; a relaxation group, music and singing, gentle exercises (run by an Occupational Therapist) and outings. There is no evaluation process and no detail of the actual activity, with the exception of the exercise classes, where records are completed by the Occupational therapist. The Proprietors agreed to look at this following the last inspection. On the day of this inspection no activities with groups or individuals were observed. Two residents went out of the home, one with a relative, and the other independently. Given that the majority of the residents at Carl Court have very specific mental health needs, there is little in the way of innovative, good practice or specialist activity programmes that reflect individual’s needs or wishes. As mentioned earlier, there is a resident who wanders aimlessly looking for something to do, whilst others were sat looking at newspapers or the TV. When talking to residents, with the exception of two, they stated they were happy to do this. However, this is not acceptable and does not reflect good practice in dementia care or mental health care.
Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 12 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 The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. Staff have little knowledge of Adult Protection issues. EVIDENCE: The home has a Complaints procedure in place and this document is included in the Service User Guide and Statement of Purpose. There is a complaint form, which is held on service users files for completion when required, although none have been completed since the last inspection visit. Residents stated that should they have any concerns they would complain to the Proprietors. They confirmed that they see them often and felt happy that their complaints would be dealt with effectively. None of the residents were aware of the CSCI, although this could be to do with their memory loss and the fact that it has been some months since the Inspector visited the home last. None of the staff have received any training in relation to the Protection of Vulnerable Adults from Abuse, and as such do not have sufficient knowledge and skills to recognise and deal with any observations or allegations of abuse according to local policies and procedures. Their initial induction programme does cover this topic in brief. The Proprietors acknowledge that this is a shortfall, and were able to confirm at this inspection visit, that this training has now been booked with the local council in January and February 2006. The home does have Adult Protection policies in place and available to staff should it be required. Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 13 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, 26 The home is safe, clean and well maintained. EVIDENCE: The home is comfortable, safe and well maintained with a homely feel. There is an attractive garden that is accessible and has been designed with safety in mind. The garden also contains an aviary and fishpond. The Proprietor has fitted several magnetic door holders to fire doors that are required to be held open during the day. All other fire doors were found to be closed. Four radiators in bedrooms have been replaced with low surface temperature radiators. A new fridge freezer has been purchased for the kitchen. Several bedrooms have been redecorated and re-carpeted in the last year. The Proprietors reported that the continuation of the replacement of radiators to low surface temperature radiators and the refurbishment of the first floor bathroom would continue in the next few weeks. They explained that they have been without a handyman for some weeks now due to sickness.
Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 14 The home has a variety of aids and adaptations fitted throughout, such as grab rails, raised toilet seats, a hoist, and a hoist to one of the three baths. There is a ramp and access to the rear of the home. The home has not met the Recommendation to obtain an assessment of the premises and facilities by a qualified person such as an Occupational Therapist. The Proprietors have now agreed to obtain this assessment. Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 15 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) 29 Whilst having improved, recruitment procedures still need to be improved. EVIDENCE: At the last inspection, staff personnel records were viewed, in particular the three most recently recruited staff. All files contain CV’s/application forms, contracts etc. All appropriate records are in place for the overseas staff that was obtained via an agency. The Proprietor was reminded that CRB’s should have been obtained for these two members of staff and stated their intention to obtain these. However, these have not been applied for to date, and neither have another two newly recruited members of staff. The Proprietor was able to demonstrate that forms for completion were in his possession, and that one member of staff had started to complete a form, but had made several mistakes. The Proprietor did approach the two members of staff on duty on the day of this inspection visit, to request that they complete an application form. The practice of recruiting members of staff without obtaining either POVA first checks and leaving staff unsupervised without CRB’s is potentially dangerous and could place residents at risk of abuse. Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 16 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) 36, 38 The system for induction and appraisal of staff is good, however, staff are not appropriately supervised/monitored. The health, safety and welfare of residents and staff is promoted and protected. EVIDENCE: Staff receive a good induction and foundation training package when they first start work in Carl Court. They then receive bi-annual appraisals with the Proprietors. Records of both systems have been inspected on previous inspection visits and found to be detailed and up to date. The Proprietors report that they meet with staff individually sometimes several times during a month; to discuss work related issues and abilities. They were also able to tell the Inspector about disciplinary matters that they have dealt with. However, none of these meetings with staff are recorded. Staff supervision meetings and disciplinary meetings must be recorded and produced as evidence of these meetings having taken place and evidence that the Proprietors are dealing with issues of concern appropriately.
Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 17 A sample of health and safety records maintained in the home were viewed on the day of this inspection visit. All were found to be complete and up to date with the exception of the accident book. The last recorded accident was in November 2004 and no other accident book was found. However, from reading care records, observations and residents and talking to staff and the Proprietors it is evident there have been several accidents in the home since November 2004. The home’s accident policy states, “record all accidents however trivial”. The Proprietors stated their intention to look into this. One of these accidents resulted in some hospital treatment, but this was not reported to the CSCI. It is a requirement under the Care Homes Regulations 2001 that all serious accidents should be reported to the CSCI and should be in future. Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x 2 x 2 Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 19 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 4 Regulation 18(1) Requirement All staff receive training in caring for residents with dementia and any specific mental health needs. In addition, all staff need to be trained in Food Hygiene, Manual Handling, First Aid and Health and Safety Daily care records must be maintained to evidence that care and an appropriate level of monitoring is sustained. Controlled medications must be stored in a locked metal cabinet and administered and recorded as required All unused medications must be returned to the pharmacist or disposed of according to the homes medication policy An appropriate activity programme must be provided that meets the needs, abilities and wishes of residents. All staff must receive training in the Protection of Vulnerable Adults from Abuse. Radiators must be guarded or have guaranteed low temperature surfaces POVA and enhanced CRBs must be applied for and obtained for Timescale for action 30/03/06 2. 7 17(1) Immediatel y Immediatel y Immediatel y 30/9/05 3. 9 13(2) 4. 9 13(2) 5. 12 16(2)(m) 6. 7. 8. 18 19 29 13(6) 13(4) 19(1) 28/2/05 30/12/05 Immediatel y
Page 20 Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 all new staff. 9. 10. 11. 36 38 38 18(2) 17(1) 37(1) All staff must receive supervision at least times six a year and this must be documented All accidents must be recorded in full in the accident book The CSCI must be informed of all serious accidents, illnesses, deaths, theft and allegations of misconduct in the home 30/10/05 Immediatel y Immediatel y 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. 2. 3. 4. Refer to Standard 7 12 19 22 Good Practice Recommendations Care plans and risk assessments should reflect the current needs of residents and be dated to evidence review of such documents. Record in more detail the activities that have occurred, as well as some level of evaluation, and a list of those who participated. Refurbish the first floor bathroom as planned. The registered person should be able to demonstrate that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist. Continue as planned to develop the homes Quality Assurance system through questionnaires and surveys. A policy should be implemented for all staff in relation to the need to report all accidents, deaths, illnesses, theft and misconduct to the CSCI. 5. 6. 33 38 Carl Court D54-D07 S18334 Carl Court V213439 210705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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