Inspection on 14/02/06 for Carleton House

This inspection was carried out on 14th February 2006.

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

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

Other inspections for this house

Carleton House 11/09/07

Carleton House 10/05/06

Carleton House 29/09/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Carleton House Rectory Road East Carleton Norwich Norfolk NR14 8HT Lead Inspector Ruth Hannent Unannounced Inspection 14th February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 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. Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Carleton House Address Rectory Road East Carleton Norwich Norfolk NR14 8HT 01508 570451 01508 571358 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) Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Gillian Daphne Morse Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 Brief Description of the Service: This is a residential home for up to 27 older people. This original rectory is set in its own grounds with a large well kept garden. It is situated in the small village of East Carleton with a once a week bus service. There is room to park a number of cars in the grounds. The accomodation is on the ground and first floor (accessed by a lift) with bedrooms on both floors. Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over a period of five hours. The Deputy Manager was on duty and assisted the inspector throughout the day. Five members of staff were spoken to along with many of the residents. Records were seen which included care plans, personnel records, health and safety records and medication administration records. A tour of the building took place. Part of the inspection was carried out with the Environmental Health Officer who was also on an unannounced visit. A lunchtime meal was taken with the residents in the dining room. What the service does well: What has improved since the last inspection? What they could do better: Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 6 The storing of files, personnel documents and residents care plans needs to improve and be kept in an orderly manner. The mandatory training for staff is not adequate, especially the training on the protection of vulnerable adults. The choice of meals could be made clearer especially for the residents who take their meals in their rooms. 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. Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not inspected on this occasion. Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 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 the following standard(s): 7, 9 and 10 The care plans are in place but need to be more individual to ensure they are written for the person. The residents are protected by the correct procedure of administration of medication. Residents are treated with respect and their privacy is upheld. EVIDENCE: Three care plans were seen that showed some guidance on what was required for the resident. The difficulty in following the care plan for staff is made by the format used which is stretched over many loose sheets and although reviewed regularly does not give clear individual person centred care. The daily records were informative and details written that had meant any change for someone was highlighted. The observation of the administration of medication was carried out at lunchtime. The correct procedure was used and the recording sheets Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 10 completed appropriately. The liquids were measured at eye level and the tablets were observed swallowed before the charts were signed. The medication stored in the cabinet door were checked to all be with in date and labelled with each persons name. Throughout the day the staff were observed talking and assisting residents in a polite and dignified manner. Doors were knocked on before entry and appropriate conversations were heard. Shared rooms do have a screen to divide the room and doors were closed when any personal attention was given to a resident. Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 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 the following standard(s): 12, 14 and 15 There is a variety of interests for people to participate in that should meet their needs. It is not always evident that everyone can exercise choice and control over their lives. The meals are wholesome and offered in pleasant surroundings. EVIDENCE: On the day of the inspection the residents were having a quiz in the one lounge. In the front lounge one gentleman was reading a newspaper and another was completing a jigsaw. One person was entertaining a visitor and one was stretched out on the settee for, what the staff say, is ‘her after lunch nap’. On the wall in the hall was a printed list of all the activities planned for each afternoon, which gave a wide choice to suit different tastes. Throughout the quiz it was noted lots of laughter and banter to hold peoples attention. The concern shared with the Deputy Manager was the uncertainty of the amount of choice available for residents. Comments such as we know these residents inside out does not always allow for a change of mind or for that person to do something different. An example discussed was the choice of Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 12 meals “the cook knows what they like”, so this meant everyone had the decision made for them rather than the choice be offered. (All had jam in their rice pudding). No one was asked. The menu said an alternative was fruit and ice cream but at the table no one was asked. (Recommendation). The liver and bacon meal itself was a good meal with string beans, broad beans, carrots and mash. Residents said how much they enjoy the meals but again the choice was not obvious, especially to those residents who eat in their room. (Requirement). Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The Home staff are aware of reporting concerns to protect residents but it is unclear if the full understanding of abuse is known. EVIDENCE: The Home has a whistle blowing policy and staff are aware of reporting any concerns to the Management. The Home also checks the POVA register and ensures all staff have an enhanced CRB check before commencing employment. The Home has not had to report or deal with any known abuse. On talking to one staff member she was able to say she would discuss any issues with the Deputy Manager or Senior staff member. The concern shared by the Inspector was the issue of staff training on this subject as no records of any form of understanding of abuse was held. If the staff had not had the training would they recognise what was abuse? (Requirement) Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 24, 25 and 26 The residents do have enough toilets and bathrooms. The majority of the bedroom are safe and comfortable but two need work carried out on the plaster. The Home needs to complete the radiator covers to ensure all areas are safe. The Home is clean and hygienic but effort is needed to find ways to remove the odours that are unpleasant. EVIDENCE: The Home now has three usable bathrooms that are sufficient to care for the residents. One bathroom on the first floor is still unusable and needs to be put to a better use. There are plenty of toilets throughout the building that are easy to reach when in the communal areas or when in the bedrooms (for those who do not have an en-suite facility). Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 15 Many bedrooms were seen with each one being unique in shape, size and colour. Each one was suitably furnished and some empty bedrooms were waiting the arrival of new furniture before any more residents could be admitted. Many of the residents had added their personal touches to the rooms with ornaments, pictures and photographs. Two bedrooms were noted to have damp patches that, was lifting the paper and plaster away from the walls. On discussion with the Deputy Manager this is due to blocked guttering, which on inspecting, could be seen on the outside of the building. Quotes to cover the work were seen that had been written in the summer of 2005 but the work had not been given to any contractor to date. (Requirement) The rooms are suitably lit and warm The water was hand tested in two rooms which corresponded with the records held in the office at the required 43 degrees. Some of the radiators are still without covers and although some have been done this was a requirement to have been completed in December 2005 and must be a priority now. (Repeat Requirement). It was noted that two bedrooms and one lounge had an offensive odour and although the Home has shampooed the areas the problem still remains. (Recommendation) The Home was clean and tidy with all the washing in the correct containers waiting for the washing machine. The water does heat to sluice wash the soiled linen and the service of that equipment had been completed only the week prior to the inspection. The flooring in the laundry now has a suitable covering for easy cleaning. Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Residents needs are met by the a suitable number and skill mix of staff. Residents are cared for in safe hands. The Home follows the policy and procedure for recruiting new staff. Staff are sometimes trained but it is uncertain how much of the training is put into practise and not all staff have received mandatory training. EVIDENCE: The Deputy Manager was able to show a rota that is covered by all the employed staff of the Home. Agency staff were not being used. The Deputy Manager stated how supportive the team had been in the absence of a Manager. On the day of the inspection there were four care staff on duty, one domestic, one laundry assistant, one cook and one kitchen assistant. This was adequate for the twenty one residents at the Home to date. The Home staff were noted to be supporting each other throughout the day. (The laundry assistant joined in the helping of the lunchtime meal and says she enjoys this interaction with residents). The Home has worked hard to get the staff to achieve or begin the NVQ qualification. The result being they have over 50 of the staff either qualified or almost their. A copy of the NVQ assessors report was seen of times and dates of the meetings between staff and at what stage they are at. Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 17 Two personnel files were looked at which held the correct paperwork but all the records were mixed up and difficult to find. (Recommendation) The mandatory training records were also very mixed with evidence of who had completed what, was not easy to find. The most concerning being from the Deputy to the domestic no one had any form of vulnerable adult abuse training. The Deputy Manager had some records of staff who had attended manual handling but through the lunchtime period two staff assisted a resident inappropriately and this situation was discussed with the Deputy as to how suitable or when those two staff members had taken on board the correct methods for transferring residents. (Requirement). Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38 Resident’s finances are safeguarded. The majority of the health, safety and welfare of staff and residents is promoted and protected but risk assessments need to be in place to help promote safe working practice. EVIDENCE: These standards were not inspected fully as the Home is without a Manager at this present time. These standards will be looked at in more detail at the next inspection as the Home has been without a Registered Manager for four months but is aiming to recruit shortly. The Deputy Manager was able to show the full recording of the money held on behalf of the residents. Each one had a recording sheet with all transactions showing two signatures. The resident or family member is given a receipt Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 19 (duplicates seen) for any money handed in to the Home and all purchases hold a receipt. The money is kept locked in the office safe and all records are in a filing cabinet. The Environmental Health Officer arrived during the morning and two recent accidents that had happened in the Home were discussed and records were looked at. The one resident was spoken to, who could not remember the event, and the place where the accident occurred was seen. There was no evidence to say that the accidents could have been prevented and all the correct paperwork had been produced and the relevant agencies who needed to be informed had received the correct completed forms. While talking with some residents it was noted that each one had a long wire that is connected to the call bell system stretching across the bedroom. This appeared a trip hazard and no risk assessments were available to cover this hazard. (Requirement). This type of call bell system is not suitable for any resident who may get up and wander. Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 x x 3 x x 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP25 Regulation 13.4 Requirement It is a requirement that all radiators be covered to ensure safety for residents throughout the building (This is an outstanding requirement). It is a requirement that all residents are offered choice of their meals both in their rooms and at the table and to be able to decide what and how they have that meal. It is a requirement that all staff are trained in the protection of vulnerable adults. It is a requirement that the guttering around the property is cleared and the interior walls damaged by the damp are repaired and redecorated. It is a requirement that staff are able to carry out the correct moving and handling practice and that the training be of a standard that is appropriate to meet the needs of the residents It is a requirement that risk assessments are carried out for all residents who have a trailing flex for their call bell and the DS0000065207.V283729.R01.S.doc Timescale for action 31/03/06 2 OP15 16 31/03/06 3 4 OP18 OP24 18.1 23.2 b 30/04/06 31/05/06 5 OP30 18.1 30/04/06 6 OP38 13.4 a 31/03/06 Carleton House Version 5.1 Page 22 hazard removed and replaced by a safer system if dictated by the risk assessment outcome. 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 Refer to Standard OP24 OP14 Good Practice Recommendations It is recommended that the offensive odours detected in areas mentioned are removed. It is recommended that all residents are made aware of choices at all times to empower them to change their minds if they wish, especially those residents who remain in their rooms. (Do they want custard today, do they want jam in their rice pudding etc). It is recommended that the personnel/training files are place in order and dividers within them to ensure records can be checked more easily. 3 OP29 Carleton House DS0000065207.V283729.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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