Inspection on 19/12/05 for Carlton Bridge

This inspection was carried out on 19th December 2005.

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 no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Bridge 07/04/08

Carlton Bridge 30/04/07

Carlton Bridge 11/12/06

Carlton Bridge 01/06/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Carlton Bridge 42 Woodfield Road London W9 2BE Lead Inspector Ann Gavin Unannounced Inspection 19th December 2005 10:00 Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 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 Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 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 Adults 18-65. 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. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Carlton Bridge Address 42 Woodfield Road London W9 2BE 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) 020 7286 4032 020 7286 4032 The Westminster Society Ms Mary Josephine Blake Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26.4.2005 Brief Description of the Service: Carlton Bridge is a residential care home for eight men with a learning disability. There are currently 5 older men with complex health needs living in the home. Stadium Housing Trust owns the property with the care and staff provided by Westminster Society, a voluntary organisation who took over as providers in August 2005.The home is located near the Harrow Road. There are local shops and other services close by. Transport links are very good with both tube and buses near by. Carlton Bridge is a modern terraced four-storey property. The accommodation is arranged over the first, third and fourth floor. A lounge/dinning room, kitchen and laundry room with a toilet are situated on the ground and second floor. There is a spacious lift to all floors and all areas are accessible to wheelchair users. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection to look at both those standards not covered in the last inspection and at how the home has adapted into the new provider organisation. The manager and assistant manager were on duty and all the service users were at home. The manager and staff are still adapting to the new ways of working within the organisation and all the change that moving into a new culture and systems involve. This may be helped by time spent in other homes within the organisation along with help to facilitate all the changes. There were 12 requirements made and three recommendations. The inspection took 4 hours involving discussion with the managers, staff, and service users, looking at records and at parts of the home. What the service does well: What has improved since the last inspection? What they could do better: The manager must ensure that new staff have personal care training and that the personal care needs are fully understood and followed by staff. The challenging behaviour training suggested by the specialist nurse needs to be undertaken. The assessment of service users spiritual needs All complaints must be discussed with the staff member involved. There needs to be time spent in organising the records and office to ensure an easier way of working. Attention also needs to be focused on the appearance of the home. Making use of the shift plan could ensure that all staff have appropriate time for service users admin and care of the home. The integration into a new organisation needs to be worked on. The reintroduction of recruiting within the home involving service users may wish to be introduced Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 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. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 Westminster Society have clear guidelines to follow to assess prospective service users needs which are balanced with the needs of the service users in the home. EVIDENCE: Carlton Bridge has been operating with two vacancies for a couple of years. There are now three vacancies as a service user was transferred to a continuing care unit due to a complex medical condition. The home have had some prospective service users visit but there are no plans as yet for any new admissions. The service user has now moved all their belongings so the vacant rooms are available to view. No decoration will be undertaken until the incoming service user makes their choice of colour and decoration. The floor space has been measured ready for new carpets to be ordered once the colour scheme has been chosen. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 Carlton Bridge are working closely with the multi disciplinary team to meet the changing needs of the service users. Staff are aware of the importance of creating and maintaining good risk assessments. EVIDENCE: The care of two service users was discussed with the manager and assistant manager. One service user has been working with the challenging behaviour nurse and the speech and language therapist focusing on helping them to relate in a positive way with staff and other service users. This service user has been weaned off a sedative medication, which they had been taking for years. The challenging behaviour nurse has suggested that all staff complete some specific training to help in managing this service users behaviour. The multi disciplinary team are working together with the staff to build a more structured day using a visual time table which the assistant managers is creating using photographs of the service user carrying out different activities. A desensitising programme involving all the staff is just starting to encourage this service user with their personal care and appearance. The staff were observed relating appropriately with the service users. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 10 There is an ongoing assessment of a service user who could be at risk on the stairs due to their mobility problems. A suggestion of a stair guard was discussed with the local fire service who felt it could hamper an escape route in the case of a fire. There are various other options being looked into to ensure the service users safety. A suggestion had been raised about transferring the service user to another Westminster Society home this must only take place after all avenues have been exhausted and a full review has taken place. The staff will continue to monitor their risk assessment. ‘ He is coming back just for lunch but good to see him’ commented on of the other service users regarding the service user who has recently been placed in a continual care unit locally and their planned visit for Christmas lunch. A discussion was held with the manager and assistant manager about risk assessments and managing the visit both safely and emotionally for all concerned. The assistant manager has already begun plans with the other unit and will complete a risk assessment. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 17 Staff are continuing to develop leisure activities with service users. Service users have choice in menu planning and in where they have their meals. Staff need to formalise the assessment of service users spiritual needs. EVIDENCE: There have been two new members of staff who have widened the leisure activities of the service users. One service user has begun to want to go out more and has travelled more into the centre of London going to the cinema. The staff are working on involving the service users more in the running of the house and encouraging service users to go shopping. The home now has changed, to link more into moving and handling assessments, to two smaller shops rather than one large weekly shop. The menu of the day was that as stated on the planner although some changes had been made to the plan due to lack of availability of the foods chosen. One service user is being assessed regarding their change in eating habits. Staff spoken with told of how they try to manage this situation by ensuring Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 12 that there is always a choice and by constantly encouraging the service user to eat at least a little. The service users at home were eating at different places. Two chose the table and two wished to remain in their comfortable chairs the staff respected their choice. Speaking about service users and their thoughts on death prompted a discussion with the assistant manager about service users spiritual needs. One service user has an identified Christian religion, others it is not known beyond that they are thought to be Christian. The assistant manager has spoken to a local church worker but this needs to be followed through to make sure service users have informed choice over churches/ services available to them. The manager will look into times of various services at Christmas, which service users may wish to attend. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,21 The health needs of the service users have increased. Staff are working together with the multidisciplinary team to assess and meet these needs. Staff need to make sure that they follow service users personal care plans and that they attend the personal care training. EVIDENCE: Three of the current five service users have increased health needs. The home has involved the appropriate professionals for advice and guidance. A recent complaint from the day centre that a service user arrived dressed in trousers, which were too big for them, is unacceptable. These trousers did not belong to the service user and following this incident the assistant manager made sure that the service user was bought new trousers. The assistant manager spoke with the senior on duty on that day. However the staff member concerned was not spoken with directly by the manager investigating the complaint. Each service user has a clear personal support plan which staff must follow. The manager will raise this issue at the staff meeting and will make sure that the staff member involved is spoken with directly. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 14 It was noted that another service user was looking rather unkempt this is the service user who is about to undergo a desensitising programme, which will hopefully enable staff to able to assist the service user more in their personal care. The medication records have been changed in line with the Societies policies. This has meant a change from a computerised system to an introduction of an individual hardback ledger for each service user. The provider may wish to consider maintaining the systems in place which are working rather than introduce a more labour intensive form of record keeping. The medication cupboard was seen. A system to separate the internal from external use creams has been introduced which is a good idea. However the creams must be clearly separated for each service user. The use of the small baskets for medication outside of the blister pack system could be used. The managers spoke of how one service user is speaking to them about their anxiety about dying. Staff are accompanying him to church to light candles and will see if there is any specific support or person who may be able to help. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The complaints system is clear. The manager must make sure that complaints must be discussed directly with staff involved. The home have made appropriate use of the Adult Protection procedures. EVIDENCE: The complaint book was seen and the most significant complaint noted in the previous section. The manager must make sure that staff involved in complaints is spoken to directly by the manager investigating and the necessary training or action implemented. The line manager is currently investigating an allegation of a staff member being asleep whilst on duty this has yet to be concluded. The commission must be notified of the outcome and action. There have been two strategy meetings held since the last inspection one involving a service users challenging behaviour to other service users and staff. These are being monitored and action plan is in place and being carried out. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The home was clean but attention needs to be paid to the appearance of the home. The laundry for the home is situated in the down stairs toilet a timescale for plans to re site must be given to the commission. EVIDENCE: Generally the home was clean though attention needs to be paid to the appearance of the home. For example pictures of service users, which had always been on display had, not been hung again since being redecorated. The new curtains had been hung but had neither been fire proofed or hemmed. The vacant rooms were ready to be seen and will be redecorated for any incoming service user. Christmas decorations were up and the upstairs lounge rearranged to make a distinct dinning room area. The fire officer has assessed the proposed site for the laundry, which is in an upstairs large cupboard. The manager had been concerned as there had been a fire when the laundry was sited there some years ago. The cupboard will require fireproof lagging and new more suitable laundry facilities will be made available. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 17 The down stairs toilet will then revert to being solely for service users use with a new lay out to ensure the safety of service users. The home will consult with occupational therapists. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 The home need to continue to recruit to fill vacancies to ensure continuity of care for service users. Staff need to complete training in challenging behaviour and personal care. EVIDENCE: Since the last inspection two new staff have been appointed. There are still vacancies and the recruitment drive is ongoing. Two short-term contracts one from the bank staff and one from an agency are covering the vacancies. The selection process is now different under Westminster Society and whilst the home previously completed all the selection and interview process with the involvement of the service users this process is now being held centrally with staff allocated from generic interviews. The society is moving towards the homes completing the selection process they may wish to consider carrying on the work carried out with the service users and staff at Carlton Bridge. The manager said that the staff rotas have recently been changed to come in line with other Westminster Society homes. The rota is set at staff working one short week and one long week. The manager and assistant manager are now working shifts to cover vacancies. Discussion with the managers highlighted that more use could be Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 19 made of the shift plans to ensure that they and the care staff had sufficient time for administration The staff rota will be reviewed in the New Year. Staff spoken with said that they received regular supervision and were supported in their roles. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,42,43 Carlton Bridge has had a change of ownership in the summer and the managers of the home are still adapting to the culture, policies and procedures of the new organisation. Direct contact or visits to other homes within the society by the mangers and staff may be helpful in this transition period. The monthly provider visits need to be regular. EVIDENCE: The managers spoke about the transition period and how service users have not been effected by the change though staff have been unsettled. The managers have had various introductory visits into the new culture of the organisation and are in the process of trying to change all their computer led systems into mainly hardback book ledgers. The office is being reorganised and there would appear to be a need to focus for a block time on this task in order to return to a workable order for the home. Some of the viable systems in place might be able to be adopted by the Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 21 Westminster Society if they are seen to run efficiently and effectively in Carlton Bridge. A risk assessment of the building had just taken place and a draft action plan was seen. The fire log books, incident and accident books were seen. Fridge /freezer temperature checks had gaps these need to be maintained regularly. The maintenance cupboard must be locked. The new curtains needed to be fire retard proofed and an immediate requirement was made and the manager advised the commission that the task had been carried out that day. The lock on the inner door of the home has been looked at and a timescale for completion needs to be sent to the commission. The regulation 26 visits are not yet regular with delays before the report is forwarded to the commission. A house book has been introduced which contains name and next of kin details of service users and staff signing in and out. The staff have been asked to leave their home address and next of kin details in the back. This book is kept in the hall to be taken out in the event of a fire to aid the contacting of people. Staff are unhappy at personal information being available in a public place. The managers could consider how best to maintain both the register and the confidentiality of all concerned. Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X 3 X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X 2 LIFESTYLES Standard No Score 11 2 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Carlton Bridge Score 2 X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 X DS0000065284.V273452.R01.S.doc Version 5.0 Page 23 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 2 3 4 Standard YA11 YA18 YA20 YA22 Regulation 12 18 13 22 Requirement The staff must formalise the assessments of service users spiritual needs The manager must ensure personal care plans are followed Medication creams must be clearly separated and stored for each service user Complaints must be discussed directly with the staff members involved and any necessary training identified carried out. The timescale for relocating the laundry must be sent to the commission. The provider must ensure that specified training to manage challenging behaviour and personal care is undertaken. The provider must ensure monthly monitoring visits are carried out regularly The new curtains must be fire proof retard treated-immediate requirement The maintenance cupboard must be locked Fridge/freezer temperatures must be kept daily Timescale for action 28/02/06 31/01/06 31/01/06 31/01/06 5 6 YA30 YA32 16 18 31/01/06 31/03/06 7 8 9 10 YA39 YA42 YA42 YA42 26 13 13 13 31/01/06 19/12/05 31/12/05 31/12/05 Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 24 11 YA42 13 The timescale for putting a lock on the inner door of the home must be sent to the commission 31/01/06 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 YA34 Good Practice Recommendations Westminster society may wish to consider coninuing recruiting of staff with the service users and staff at Carlton Bridge. The Westminster society may wish to consider retaining some of the viable record systems in place in Carlton Bridge The manager could consider how best to maintain both the register of the house and the confidentiality of all concerned. 2 3 YA41 YA41 Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Carlton Bridge DS0000065284.V273452.R01.S.doc Version 5.0 Page 26 - 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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