Inspection on 29/09/05 for Carleton House

This inspection was carried out on 29th September 2005.

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

The inspector 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

Carleton House 11/09/07

Carleton House 10/05/06

Carleton House 14/02/06

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 NR14 8HT Lead Inspector Ruth Hannent Announced 29 September 2005 9.30am th 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. Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Carleton House Address Rectory Road, East Carleton, Norwich, NR14 8HT 01508 570451 01508 571358 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) Four Seasons Health Care (England) Limited Gillian Daphne Morse Care Home 27 Category(ies) of Old age (27) registration, with number of places Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30/11/04 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 house in on the ground and first floor (accessed by a lift) with bedrooms on both floors. Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place over a period of six hours with both the existing Manager and the new Manager who is about to take over the position at the end of the week. Discussions took place, which included the pre questionnaire, comment cards received, rota’s and menu’s. Residents and staff were spoken to and observations took place. A tour of the building was conducted. Records were seen which included care plans, health and safety, medication and personnel records What the service does well: What has improved since the last inspection? What they could do better: Meals need to offer choice, especially for the midday lunch. Activities and stimulation need to be more evident. Higher priority must be given to the recruitment and retention of staff to ensure more consistency for service users. Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 6 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 I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 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 Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 The Home has a printed pack of information that should enable potential residents to make a choice about the suitability of the home. Potential residents are assessed and basic information is gathered to assess the needs to assure these needs can be met at Carleton House EVIDENCE: Each resident is offered a pack of information for them and their family to read about Carleton House. They are invited to look around the Home and the Manager will assess the required needs at the time of the visit or see the person in their own home or hospital. On choosing a file at random a completed assessment form was read which gave a picture of basic needs. This enabled the Manager to make a decision that the person could have their care needs met at this Home. On talking to one resident she stated she remembered answering questions with her relative on the care she would need before she made her own mind up to stay at Carleton House. (It was also noted in the assessment process that a Social Worker had also contributed to the information required). Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 9 Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Care plans are available on each resident but would be given added value through having a clearer, more person centred format for easier understanding. The service user’s health needs are met by a supportive community health care team who work in tandem with the homes staff team. The administration process of medication is carried out competently and safely. EVIDENCE: The care plans for each person are kept in the bedrooms. Two were looked at in detail during the inspection. The type of format used makes the reading and understanding of the care required very scattered and difficult to ensure all the care is covered as and when required. The daily records stored in the back of the folder offers little information to show the full picture of need has been met and needs to be in more detail. (Recommendation). The Home is supported by a local GP who offers a system of contacting the surgery at certain times to discuss any issues that may not warrant a visit but Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 11 supports the staff in the appropriate health care of the individual. The G.P. will visit the Home on request and the team of district nurses call on a regular basis to attend to dressings. On talking to one lady she told of the “nice nurse who looks after her leg dressings” and another who spoke highly of the GP and that “I only have to ask for the Dr and the staff will do it for me”. The terms and conditions offered to the residents (read) asks for all medication to be handed in to the person in charge of the home and does not offer the opportunity to discuss self management of medication. On talking to the staff member who was administrating medication all residents who are on medication are assisted by staff within the Home. It was uncertain how much the residents would be enabled to be responsible for their own medication and this needs to be reviewed. (Recommendation). The medication administration procedure was overseen at lunchtime. The medication was in a locked trolley and administered from a blister pack system. Each person had their name, photo, medication name, dose and amount on the MAR chart with each administration followed by the staff’s initials. The liquid measure was done correctly at eye level and all medication was swallowed before the recording on the chart. Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, and 15 The residents do not always have their expectations met and are lacking in stimulation that match their interests. Relatives and friends are made welcome and are happy to visit the Home when they wish. Although the meal offered appeared wholesome the fact that there was a fair amount of waste shows a choice of meal may have led to more food being enjoyed and eaten. EVIDENCE: In total four residents were spoken to about their life within Carleton House. (One of these had asked to see the Inspector via a comment card). Each one stated that there was not enough happening throughout the day and each one offered ideas of what they would like to see happening. On walking the building it was noted that five out of the seven residents in one lounge were asleep with the television on but at the far end of the room and not being watched. (It was too far away to be seen) There was nothing else to stimulate residents in the room until a staff member came in to help someone and could offer conversation to the rest of the people in the room. It was the day for the hairdresser so one to one conversation was seen and obviously enjoyed by the banter and laughter that was heard. Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 13 More stimulation needs to be offered (Requirement). Three comment cards from relatives had been received with two praising highly the staff and service offered by a dedicated team in the Home. (One relative handed in the comments while the inspection was taking place and was very complimentary). He and another resident, who has regular visitors, said they were welcome to come and go as they wished and always made welcome. The lunchtime meal was advertised on the wipe board in the lounge but there was no evidence of choice. (Shepherds pie with cabbage then cheesecake). The menu’s sent with the pre questionnaire showed salad or vegetarian option but on talking to residents no one knew what else was on offer. The meal did look appetising but not eaten by quite a few. (One lady arrived late for the lunch stating she was not hungry and could she have soup, which was found for her straight away) More food may have been eaten if there had been a choice on offer. (Recommendation) Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The Home would act and take seriously a complaint and has a full procedure to follow if required. EVIDENCE: There is a complaints procedure, which is offered in the service users guide and is on display in the entrance to the Home but to date the Home has not had a complaint. On occasions concerns have been rectified straight away but no recordings are held on file and the Commission has not received a complaint. On talking to two ladies both said they would talk to the Manager if they were unhappy and felt confident “she would sort it out”. Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 21, 24 and 25 The Home does offer a safe and comfortable environment throughout the communal areas. Due to the unusable baths the number of available, useable bathing facilities needs to be increased. Residents do live in safe, comfortable bedrooms with their own possessions around them. Radiators are still to be covered to ensure the safety of residents within their surroundings. EVIDENCE: A tour of the building took place with approximately ten bedrooms seen. The main areas have two lounges and one dining area. The quiet lounge is light and airy with nice furniture and two large windows looking out onto the grounds. The other lounge/dining room is pleasant but with all the chairs Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 16 placed against the wall did not give it the friendly/homely feel of the other room. The dining area is bright and leads out onto a large, well maintained garden. The bedrooms all vary in size but meet the standards required regarding size. Each one has a hand wash basin with some having a full bathroom. (Due to the type of needs these residents have, none of the actual baths are used). There are two useable bathrooms with another older bathroom to be considered for a walk in shower room. This needs to be completed to ensure the correct number of bathing facilities (1 to 8 residents) is in place. (Requirement). Each bedroom seen had been personalised by the occupant with photos and ornaments, organ/piano and televisions. Some had their own telephones and when discussing the bedrooms with five residents each one was very happy with their own room. Each appeared to be furnished as appropriate with comfortable chairs, bed, table, wardrobe, dressing table and curtains. One room was noted to have an offensive odour but, according to the Manager is about to have the carpet replaced before it is occupied again. (Recommendation). The maintenance staff member is on site throughout the week and has full records (seen) of all the checks carried out on a weekly, monthly, and three monthly basis. Records seen were of fire alarm checks, water temperatures checked and portable electrical checks. Radiators have all been covered in the communal areas but some bedroom radiators covers are still to be completed. (Requirement). Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 The residents are not always able to have their needs met if the staff rota is not covered or the vacancies not filled with permanent reliable staff. The ratio of qualified staff is poor and only the experience of the long term competent staff give any reassurance that residents are in safe hands. The recruitment procedure is clear but the Home must ensure all paperwork is received before commencing with employment to protect resident. EVIDENCE: The Home has a core of dedicated staff, who have worked in the Home for some time and according to them and the Manager often work over their contracted hours to cover vacancies or sickness and annual leave. It was also noted that on the pre questionnaire eleven shifts over eight weeks had been covered by agency. Although the Manager explained she tries to get the same agency staff members this is not always possible and on the day of the inspection a new to Carleton agency carer had arrived on duty. The manager explained the difficulty in trying to recruit staff. On talking to residents one said, “ We have so many strange faces getting us up or putting us to bed that we don’t know who’s who”. Another gentleman had overheard staff having conversations about how poor the pay is for care staff but “must not grumble they do the best they can” At the weekends staff are also covering domestic and laundry tasks as well as care to cover vacancies. For the continuity of care the recruitment of staff and the retaining of those staff must be a priority. (Requirement). Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 18 Only 3 staff members hold the NVQ qualification with one other nearly completed. The staff team total at present is 15 which means the 50 required of qualified staff by the end of 2005 will not be reached. (Requirement). The Manager and two staff members spoken to were able to say they have no incentive to do the course. Two newly recruited night staff have a completed personnel file stored in a filing cabinet in the office. Seen were the application forms, references, form of identification and POVA checks. On talking to the Manager none of these staff members will work alone until the CRB checks have been received. It was noted that only one reference had been returned on one staff member and that hadn’t been dated and signed. (Requirement). Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 19 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) EVIDENCE: Due to the change of management about to take place these standards were not inspected on this occasion. Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION x 3 2 x x 3 2 x STAFFING Standard No Score 27 2 28 1 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 x x x x x x x x x Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 21 No 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 12 Regulation 16m,n Requirement It is a requirement that the home consults and designs a programme of activities which is stimulating and suitable for the residents. It is a requirement that a suitable bathing facility is provided in the bathroom at present not used. It is a requirement that all radiators be covered to ensure safety for residents throughout the building (This was previously a recommendation). It is a requirement that the permanent staffing in the home be increased to ensure continuity of care is available at all times. It is a requirement that the NVQ qualification for staff is obtained by staff employed to the 50 set in the minimum standards It is a requirement that all recruited staff have two suitable signed and dated references. Timescale for action 30/11/05 2. 21 23j 31/01/06 3. 25 13.4 31/12/05 4. 27 18 31/11/05 5. 28 18 31/03/06 6. 29 19 31/10/05 Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations It is a recommendation that the format used for care plans and relevant information be revised to ensure easier reading for the staff member and for easier management of person centred care. It is recommended that residents who would like to manage their own medication have the opportunity to do so once a risk assessment has been completed. It is recommended that residents are made very aware of the choice of meals that are available to them It is recommended that the offensive odour detected in the one bedroom has the carpet removed before a resident is allocated this room. 2. 3. 4. 9 15 24 Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Carleton House I55 s65207 carletonhouse v243426 290905 stage 4.doc Version 1.40 Page 24 - 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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