Inspection on 25/07/07 for Carl Court

This inspection was carried out on 25th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Carl Court 08/08/06

Carl Court 17/11/05

Carl Court 21/07/05

Carl Court 16/11/04

Carl Court 23/06/04

Carl Court 04/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Carl Court Carl Court Guestland Road Cary Park Torquay Devon TQ1 3NN Lead Inspector Judy Cooper Unannounced Inspection 25th July 2007 10.30 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 Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 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. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carl Court Address Carl Court Guestland Road Cary Park Torquay Devon TQ1 3NN 01803 329203 F/P 01803 329203 carlcourt@btconnect.com 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) 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 DS0000018334.V336993.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users with Mental disorder may be admitted from 50 years age Service Users with Dementia may be admitted from 50 years age Date of last inspection 8th August 2006 Brief Description of the Service: Carl Court provides accommodation with personal care to older people (65 ), older people with a mental disorder and older people with dementia (from the age of 50). The home is registered for up to fifteen people both male and female. Bedroom accommodation is provided over two levels with a stair lift in place for those with mobility problems. There remain four steps that still need to be negotiated, where the chair lift finishes, to allow people access to the home’s first floor. Therefore only those people who do not have severe mobility problems are allocated these rooms. There are fifteen single rooms, ten of which have en suite facilities. In terms of communal space, Carl Court offers two lounges and a dining room. There is also an easily 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. Fees currently range from £327 to £450 per week. The home’s inspection report is contained within the home’s service user guide or can be found on the large sideboard within the home’s entrance hall. It is also available within the home’s office. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place on Wednesday 25th July between 10.30a.m and 6.00 p.m. Opportunity was taken to look at the general overall care given to all the people who live at the home. The care provided for two people was also followed in specific detail, from the time they were admitted to the home, which involved checking that all elements of their identified care needs were being met appropriately. A tour the premises, examination of some records and policies, discussions with the owner, manager, staff, as well as three visitors to the home, also formed part of this inspection, whilst both the people who live at the home and the staff on duty were observed, during the course of the day to determine what care and opportunities are made available. During the visit a period of forty minutes was spent sitting with some of the people who live at the home, observing how they spent their time and the contact they had with staff and others. This approach aims to try to understand the experience of people who live at the home who have difficulty in communicating this verbally, because of their mental frailty. Other information about the home, including the receipt of completed questionnaires from relatives and a telephone call to another, recent feedback from visiting professionals and discussion with all staff employed at the home, during a staff meeting, has also provided information as to how the home performs and all of this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 6 What the service does well: Carl Court provides excellent personal care and support for all the people who live at the home. This includes older people, and those from the age of 50-65 who may have dementia or a mental health need. One of the owners is a qualified mental health nurse (although her nursing registration has since elapsed) and she has completed a national qualification in care to level 4 as required, whilst both have substantial experience in managing a care service, having owned and run Carl Court for the past sixteen years. Both owners are present in the home most days and form additional support to care staff as well as being fully aware of the care needs of the people at the home. Carl Court is well maintained, exceptionally clean and offers accommodation in a comfortable and homely way. Staff are very caring and helpful and treat the people who live at the home with respect which was evidenced by noting that the people who live at the home were relaxed with staff being very attentive towards them and understanding of their individual needs. The owners and staff provide very individual care for all the people who live at the home, some of whom are unable to communicate their needs. Being aware of this, the owners and staff try to ensure the care provided matches the individual needs and personal preferences as far as they are able to ascertain. Due to the categories of the people that are cared for at Carl Court (i.e. many suffer from advanced dementia and/or mental health illness), it means that staff need to take time and use good observational skills to determine what a person may be trying to communicate, and these skills were noted to be an integral part of the staffs’ role within the home. One of the home’s main strengths is the way that the staff upholds the peoples’ dignity and their rights to make personal choices whilst a very caring, comfortable, family atmosphere is maintained within the home, for which the owners and staff should be commended. As well as observing this within the home during the inspection, very positive feedback from both relatives and outside professionals also confirmed this to be the case. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The owners have ensured that the home’s service user guide and statement of purpose has been fully updated to ensure that the details contained within it are current and clearly indicates what services the home can provide. This ensures that any new prospective person and/or their family will know what they can expect from the home prior to admission. The owners have now upgraded all of the peoples’ care plans and have tried to ensure that the person and/or their advocate has also been involved in the drawing up of the plan. This has made sure that either the people who live at the home at the home or their families are fully aware of the care being given and consequently get to have an input into this if desired. This means that care is delivered, as far as possible, in a way that each individual person prefers. The owners have ensured that there is a record kept of the fire training provided for staff at the home, which means that all staff receive this training and are aware of what to do in the event of a fire which protects the peoples’ safety. All radiators have been covered and water temperature regulators have been fitted throughout the home to provide hot water to a safe temperature, which ensures that the risk of a person living at the home sustaining a scald or a burn is minimised as far as the home is able. The owners have increased the security of the home by providing additional key pad locks to all the homes’ doors bar one. This helps keep the people protected from the risk of wandering from the home without staff awareness. The owners have also recognised the need to make the garden area more secure to help minimise the risk from the two people who live at the home, who currently live at the home and who are prone to wander away, if not fully supervised at all times and are in the process of undertaking this work. This will then lessen the need for the high degree of staff supervision currently needing to be provided at all times when the two people want to go into the Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 8 garden and will allow the people to be more freely able to use the garden area when they wish to, rather than having to wait for staff members to escort them there all the time. The recruitment procedures for new staff within the home are completed as required with Criminal Record Checks being undertaken as a part of the recruitment process. This ensures that having suitable staff care for the people who live at the home. This was also evidenced in the very positive comments received from all about the kindness and caring attitude of the staff group within the home. One of the owners, who is also the registered manager, has now completed a nationally recognised qualification in care to level four to complement her other qualifications, including the registered manager’s award, already achieved. The owners have updated their quality assurance questionnaires and have also introduced one specifically for visitors and a separate one for visiting professionals to ensure that the views of all people that have contact with the home are taken into account in respect of any future planning for the home. What they could do better: All medication administered should be signed for by the person responsible for the administration. This to ensure that all records are up to date and the people protected from the possibility of any error occurring (i.e. a dosage being given twice etc). The curtain covering the glass panel to the downstairs communal bathroom should be reinstated to ensure peoples’ privacy when using this room. The owners should have an assessment of the premises and facilities undertaken by a suitably qualified person, including a qualified occupational therapist. This is so that a qualified person could subsequently advise on what aspects of the environment could be improved upon to ensure that the home is meeting the needs of the people in the best manner. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 9 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. The summary of this inspection report can be made available in other formats on request. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 10 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 Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable). Quality in this outcome area is good. The admission process is thorough and well managed with prospective people being made aware, prior to admission, that the staff at the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s service user guide and statement of purpose has been recently further upgraded and now provides very comprehensive and relevant information which is useful to prospective and existing people who live at the home as well as their families and/or carers. Since the last inspection there have been a few new admissions. Two such admissions were inspected in detail during the inspection. Both admissions had been undertaken in such a manner as to allow the two people and/or their families/carers to be aware of what services the home could offer and a letter was forwarded by the home’s management confirming the home could meet the assessed needs of each person prior to both admission. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 12 The manager stated that the home will offer a trail period of a month if requested and all prospective people and/or their families/carers are given the home’s statement of purpose and service user’s guide prior to admission. One person was taking advantage of this having initially come in for a month’s respite stay, which had proved to be beneficial for the person whose next of kin is now considering a more permanent stay on behalf of the person concerned. It was pleasing to note the sensitive way this admission had been handled, with the owners and the person’s next of kin slowly bringing in more personalised items of furniture etc so that the person was able to gradually get used to and become familiar with their new surroundings. All care needs are assessed prior to admission and the manager visits prospective new admissions at their current address whilst they and their families are also able to visit the home to have a look around if this is desired. The home does not provide an intermediate care service. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome area is good. The people who live at the home are looked after well in respect of their health and personal care needs with their privacy and dignity upheld whilst their life style choices are fully respected. A small additional measure needs to be put in place to fully ensure that medication is administered as safely as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were seen in respect of the two people whose care was chosen to be looked at in detail. These were noted as thorough and covered all required care needs as well as the person’s social and psychological needs which helps ensures that the correct care is provided. A comment in one of the person’s care plans stated: “X manages independently regarding personal care needs, but does require prompting and re-assurance from staff”. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 14 Staff confirmed they were involved in the peoples’ care plans and this was evidenced by speaking with them and noting they gave the correct care as was stated within the plan for the person previously mentioned, in particular at lunch time with prompting and support made available to help ensure the person ate a reasonable amount of lunch. As this area is a specifically identified need of the person it was pleasing to see the sensitive and relaxed manner this prompting and support was delivered in which helped maintain a relaxed atmosphere but also ensured that the person’s food intake was noted and encouragement given to increase it. The care seen delivered evidenced that the care plans are up to date and relevant to the needs of each individual person. These and other plans inspected also evidenced that the people who live at the home and/or their families/advocates are as involved as much as possible in the drawing up of the care plan whilst monthly reviews of the plans are undertaken by senior staff members who are familiar with the individual peoples’ needs. Peoples’ health care needs were being fully met, including any specialist needs. Recent professional involvement has included a physiotherapist who came to assess one of the people following their discharge from hospital, after a fall at the home and to advise on mobilisation. It was noted that a handling belt was available to help when helping this person to move. Other recent professional involvement has included the local continence advisor, local G.Ps and the local mental health team dealing with elderly people. One person at the home has very complex mental health needs and it was pleasing to note the support made available from the mental health team who contacts the management twice a week to ensure that they remain confident in delivering what is quite specialist care for a person This helps ensure that the needs of the person are understood, known and met appropriately. The excellent links that the owner and manager forms with specialist services also ensure that the health of the people is both upheld and that they and the staff are made aware of how best to provide any specialised care on a day to day basis. Observations of the care people received and the manner the care was delivered evidenced that the peoples’ individuality and dignity was upheld at all times. Comments received from relatives, residents and staff in relation to the care provided also stated: “The care is excellent. I cannot see how it could improve in any way”. “X has lived in seven different care homes. This is the best! I’ll put my name down for when my time comes”. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 15 “I find it impossible to think of any way in which they can improve further. Whilst I accept that there is always room for improvement, from my perspective, as a relative of a resident with four years experience of this home, this service to my mind is near perfect and for that I thank them”. “I think the quality of care is exceptional” “I can only speak from my personal experience, but X’s needs are always met”. “I am always told when she is put on extra medication and made aware when she is under the weather”. “Having seen other homes you would have difficulty finding better care particularly for the type of clients they have in the home”. “I do not think X could be better placed”. A letter received from the relative of a person who had recently died at the home stated: “With regard to X’s recent death I just want to thank you and your staff for the kindness you showed X and myself during nearly seven years of X’s stay at Carl Court. Living away we were always reassured when we visited X that it was obvious X was well looked after and treated well. It is comforting to know that there are places like Carl Court where, from my personal knowledge, the residents are extremely well cared for and my family and I will be forever thankful to you and your staff for the way you looked after X”. These comments helps evidence that the care given at the home is such that it meets the peoples’ needs and is given in such a manner as to maintain a person’s right to individuality, dignity and privacy. Medications were being stored properly in a locked fixed cupboard. Patient information on each medication being given to individual people is available within each person’s care plan. Only senior and experienced staff administers medication and all have received medication training. Even then the owner will only allow a staff member to undertake medication administration if he is confident that the staff member has the ability and confidence to do so. Currently he is waiting for a staff member to build up this confidence so that they can also undertake this practice. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 16 This evidences that the owner tries his best to ensure that the people who live at the home remain protected at all times. There is a photograph of each person on their medication record so that staff can easily identify who the person is they are giving the medication to. Medication practices were noted to be mostly in order with all necessary records seen and the ‘MARS’ recording sheet for medications administered mostly completed, however it was noted that for one of the people whose care was looked at in detail, there had been an omission made of a medication which had been given in the morning but was not signed for when entries were inspected at 5.00p.m. This could potentially lead to a misunderstanding as another member of staff may note that the medication had not been given at all. Although the home is not currently administering any scheduled controlled drugs at present there were correct records seen of when this last happened. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15 The quality in this outcome area is excellent. The people who live at the home enjoy a peaceful life at the home, with visitors encouraged and welcomed. There is variety of opportunities provided by the home’s interesting and varied activity programme. Staff respect the peoples’ personal choices and the home provides excellent nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a variety of social activities and outings. The activities are provided in-house as well as by different external activities agencies including: Yesteryears, Brixham Occupational Therapy service’, ‘Torbay well-being foundation Tranquil moments and others. There are also regular mini bus trips to local places of interest out using the home’s own people carrier and staff members are also delegated to go to support and provide necessary care for the people whilst they are out. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 18 The home keeps a detailed list of which person has attended which activity to allow them to be able to revue the activities programme and ensure that there is something for everyone. A particular activity enjoyed by the people involves the Occupational Service bringing in several different animals for the people to stroke or just watch. One relative spoken with stated she was pleased that the owner sometimes took X out shopping with her, something that was appreciated and helped the person maintain normal day to day skills. Independence is encouraged and it was noted that one person went out for two walks during the inspection, having been given the numbered code to open the front door. The management stated they also always make sure this person has the name and address of the home to hand in case they need to let a member of the public know this information quickly. This has allowed the person a sense of independence to come and go quite freely and it was quite clear to see this was very much valued. Carl Court has an open visiting policy and families and friends visit regularly which was evidenced by the many varied and differing times recorded in the home’s visitors book. During the site visit three visitors came into the home and all confirmed that they were made welcome and were satisfied with the care their relative or friend received. The management and staff also personally try to help provide all the support and help that both families and the people require to help maintain a relationship, for instance one visitor stated how supportive the manager had been during a difficult time that they were experiencing with the person they were visiting. They stated that they had found the manager to be kind, caring, understanding and sympathetic in this situation, which had helped them feel more confident. It was also noted that the correct day’s newspapers were provided to those people who live at the home and want one. In one case the person enjoyed holding it rather than reading it and a new daily paper was noted as being delivered on each day to the person who clearly got satisfaction from glancing at and enjoying the familiar feeling of holding the paper. The owners stated: “Mr X always had a daily paper and we feel it is important to maintain this practice of ensuring X’s paper is the current up to date one”. Another person also had a daily paper for the same reasons. People continue to be encouraged to express their individuality as far as possible and to this end bedrooms are personalised as desired, in some Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 19 instances in very specific manners and some choose to hold the key to their rooms, some of which were noted as being locked. Having this facility available ensures that people who live at the home are able to retain a sense of personal privacy if they wish and are able to. During the period of forty minutes which was spent sitting with some of the people who live at the home at afternoon tea, observing how they spent their time and the contact they had with staff and others the following was noted: “The people who live at the home all had tea of coffee from china mugs and in one instance a cup and saucer. One person who needed more assistance was encouraged and enabled to do as much as she could for herself and at no time was she hurried or did staff take over what she was doing. Staff were respectful, attentive, kind and quick to meet the peoples’ needs. A calm pleasant atmosphere was maintained throughout this afternoon tea time period”. The home’s cook has been at the home for the past eighteen months and is very experienced with the needs of the elderly having previously owned and run her own home for twenty years. She has undertaken food hygiene training. Menus were seen and it was noted that they were varied and balanced and that choice is always available. On the day of inspection the lunch consisted of a starter course of grapefruit segments or fruit juice (there is always a started course provided), roast chicken with all the trimmings and fresh vegetables, followed by a fresh fruit salad and ice cream. One person had chosen an alternative and could have either fish or quiche depending on her preference. It was noted that everyone had enjoyed the meal with many empty plates! There is also a choice provided at tea time and the home caters for any specific dietary needs, which currently include providing for a vegetarian diet. It was pleasing to note that choice had also been provided to this person with a list of various options provided which the person could then choose daily. The cook also explained how she monitored what came back uneaten as this gave her a good idea of what those people who live at the home, who were now unable to communicate their individual likes and dislikes/preferences, preferred. She also explained how she sought out help and advise from the peoples’ families to help ensure that the meals she provided were ones they would enjoy. This level of involvement has ensured that people who live at the home both enjoy their meals and benefit from good wholesome ingredients. Any support required in helping with feeding is provided in a discreet manner and with due regard for others feelings. Aids such as plate guards are also used if required. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 20 Currently a few people have their food liquidised and it was pleasing to note that each component of the meal is liquidised separately to make the meal still visually appealing. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is good. Arrangements for protecting the people who live at the home and responding to their concerns are such that they should be protected at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaint policy remains displayed and is also contained within the home’s statement of purpose. There are blank questionnaire forms left in the hallway with the Commission’s address included to allow anyone to be able to complain in confidence to the Commission if they so wished. Staff indicated in their feedback that they were fully aware of adult protection procedures and had attended necessary vulnerable adult training. It was also pleasing to note that this training is also made available to ancillary staff and the home’s cook stated that she had nearly completed an in depth training package which had been undertaken over a period of three months. This level of training ensures that all staff are aware of how to identify abuse, which ultimately ensures people who live at the home are safe. The home has not received any complaints since the last inspection in August last year and for some time before that. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality in this outcome area is good. Carl Court is very comfortable, very clean, well maintained and provides a safe standard of accommodation for the people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The tour of the home confirmed that the owners continue to maintain good environmental standards throughout the home by means of good maintenance and upgrading as required. Since the last inspection several rooms have been redecorated and a new carpet provided to one. The kitchen floor and whole kitchen area has also been upgraded. The owners have recognised the need to increase the security within the home and have ensured that all exit doors apart, from one, has a key pad lock in This helps keep the people protected from the risk of wandering from the home. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 23 Those that are able to are given the coded number to ensure that their right to freedom of choice is not hindered and were noted as coming and going as they chose. Regular visitors to the home are also made aware of the coded number so that they can visit easily. The owner confirmed that the key pad locks have all been installed as per the local fire and rescue’s recommendations in ensuring the locks will be deactivated in the event of quick access or escape being needed to and from the home. The home presented as very clean and fresh and this is a credit to the designated cleaner who works very hard to achieve such high standards, which were very noticeable. A feedback comment received from a relative also stated: “The degree of effort that is put into maintaining the property ensures a pleasant and hospitable environment for all”. Staff receive infection control training and are aware of hygiene measures necessary to ensure the people who live at the home are protected from the risk of cross infection. There is a chair lift accessing the first floor, but as there are still four steps to navigate from the lift to the bedrooms the owners ensure that no-one with any mobility problems is accommodated on the first floor. The manager has also made the gardens of the home even more attractive for the people to look at or wander in. The owners are also continuing with their plans to make the garden area more secure to help minimise the risk from the two people who are currently living at the home and who are prone to wander away from this area if not fully supervised at all times. Having a more secure garden area will lessen the need for this level of supervision and allow these people to be more freely able to use the garden area when they wish to. The manager also stated that there are future plans to upgrade the downstairs communal bathroom area. In the meantime the curtain covering the glass panel sited within the existing door, should be reinstated to ensure the peoples’ privacy when using this room. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The quality in this outcome area is good. The home’s recruitment programme is in order and protects people by the appointment of suitable staff. Staff at the home are well trained and supported, and employed in sufficient numbers to meet the peoples’ needs at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection there were fourteen people in the home (and one on holiday). Staffing levels were inspected and it was noted that there is sufficient staff on duty to care for the people at all times and also that staff had sufficient time to spend with the people in a relaxed social manner. All that were verbally able to confirmed that the staff cared for them well and are available as required, as did the relatives/friend spoken to and feedback from other professionals stated the same. Additional training has been undertaken since the last inspection. This has been overseen by an appointed trainer who works with and supports the staff at the home in the undertaking of an intensive training programme recently purchased by the owners, which covers all aspects of care practice. The trainer also helps support the owner and manger in ensuring that staff receive the right level of training, including undertaking further NVQ training in care. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 25 Any new staff member also undertakes the home’s own basic induction training course with the owner or manager. It was particularly pleasing to note that the first two weeks of any new staff member’s employment was spent shadowing other staff to gain familiarity with the very specific needs of the people at the home. An additional in-depth induction training course, which takes several months to fully complete and includes topics such as food and hygiene, basic first aid, fire awareness, risk assessment, diet and nutrition, dementia care, manual handling, infection control, coping with aggression, administration of medication, protection of vulnerable adults and general legislation is now in place and is being undertaken by any new members of staff (currently the recently appointed staff member is undertaking this). She felt this training was very useful as it allowed her to gain confidence in their role. Over fifty percent of the home’s current staff are trained, as required, to a national standard in care and this training continues to be made further available. It was also pleasing to note that an overseas worker was also, at the instigation of the owner, undertaking a national qualification in care to complement the qualification they had obtained within their own country. One staff member is also undertaking her NVQ level four in care having already achieved NVQ level 3 in care. This level of training ensures that staff are both appropriately trained and consequently able to provide suitable care for the people at the home. Since the last inspection the home’s staff group has remained mostly stable with only one staff change noted It is also to the owners’ credit that care staff are only expected to undertake care work, not being required to clean, do the laundry or cook (other than help with the teas). The owner stated that this is so the people can receive the optimum care from designated care workers. The owners are also intending to involve the senior staff more in the management tasks of the home such as undertaking pre-admission assessments, completing records etc. It is to the owners’ credit that they are introducing these extra responsibilities slowly ensuring that the staff involved have the correct skills and knowledge to allow them to be able to both undertake and complete them with confidence. This will ultimately protect the people who live at the home coming into/at the home. When spoken to, the staff on duty felt that they performed well together and confirmed that they felt the people who live at the home got the best care available. It was evident that they took pride in their job and felt that ensuring the people who live at the home had a good quality of life, irrespective of need or diversity, was the most important part of their role. A relative’s feedback comment stated: Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 26 “I am very impressed by the range of skills (certificates displayed in the hallway) and the manner in which staff are employed”. Staff members’ comment included: “ I think the home is run in the best way possible for the residents”. “The home allows people who live at the home to be themselves as much as possible”. “We really know the people who live at the home and we care for their individual needs”. The management do not use agency staff preferring to use existing staff as they feel permanent staff know the peoples’ needs well and that the people who live at the home are confident with them. All of the current care staff are well experienced in care. The staffing files for the one newly appointed staff member was inspected and it was noted that all the required information was available including a completed application form, two references and an enhanced CRB check. One of the owner’s sister lives and works in the home and the owners are in the process of obtaining an enhanced CRB check for her. However they had also obtained a Protection of Vulnerable Adult check as well whilst waiting for the return of the CRB check. The owners now ensure that formal supervision is provided to all staff and a record is kept of the content. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,and 38. The quality in this outcome area is good. The home is managed efficiently and well, with the management of the home being easily available and approachable. The home provides a safe environment where peoples’ safety and well being is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the owners, who is also the registered manager, has now completed a nationally recognised qualification in care to level four to complement her other qualifications, including the registered manager’s award, already achieved. Both the owners are well respected by staff, relatives and other professionals. Lots of positive feedback was given about how approachable they both are and how aware they are of the peoples’ needs. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 28 Relatives, visitors or any other professional visitors to the home have now completed annual survey forms (May 2007) the results of which were available for inspection and have been used to form the basis of the home’s annual development plan. The responses from these questionnaires was very positive with all giving the home very complimentary feedback in terms of both the care given and facilities provided. Recent feedback was seen to be really positive with those contacted stating how well they thought the service was run. Examples of comments received included: From a G.P: “Patients well cared for. Staff very pleasant and helpful”. From some care managers: “Carl Court has consistently offered a very high standard of both the physical environment and the individual care that the service users are provided with”. “I have visited Carl Court over the years and the high standard has not altered”. “Carl Court offers an excellent personalised service which is highly respected and valued by the team”. The owners also provide each relative/carer with a statement of the home’s intended quality standards so that they can see what the home is aiming to offer. This ensures that they are aware of how the owners intend for the service to run and are able to have a voice as to whether or not they feel the standards are being met and what if anything can be done to improve the service. Details taken from the Annual Quality Assurance Assessment, required by the Commission prior to the inspection, stated that the home had reviewed the home’s polices and procedures earlier this year. Peoples’ health and safety is being maintained within the home with the owners complying with required health and safety legislation as necessary. The completion of hot water regulation, which ensures hot water is provided to the people who live at the home at safe temperature and the protection of radiators within the home has also further helped ensure that the people remain protected. The owners stated they continue to use the services of an outside agency to undertake their risk assessments of the building and to check the home’s water supply to ensure any risk appertaining to Legionella is minimised. The home’s accident reporting was in order, with necessary details forwarded to Commission as needed. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 29 The process regarding a recent accident was inspected and it was noted that all recording was as required. The families/advocates of the people who live at the home mostly deal with any financial matter appertaining to the peoples’ needs with the home billing the appropriate relative/advocate accordingly for any expenses, which they have paid for initially. Regular staff supervision is now provided and written records were seen whilst staff confirmed that this aspect helps support them in their role. Staff meetings are also held regularly, and on the day of inspection one was being held which all staff had made the effort to attend. Having these meetings operating on a regular basis ensures that there are good and open communications within the home that allow for an exchange of views in a secure and supportive setting. Ultimately this helps ensure that the care provided is to a high standard. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 30 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 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 3 x 3 x x x x 3 Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP9 OP10 OP19 OP22 Good Practice Recommendations All medications administered within the home should be signed for at the point of administration. The privacy curtain to the downstairs communal bathroom door panel should be replaced. The owners should continue with their plans to increase the security of the garden area of the home. 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. Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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 © 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 Carl Court DS0000018334.V336993.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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