CARE HOMES FOR OLDER PEOPLE
Carlton Hill Care Home 398 Carlton Hill Carlton Nottingham NG4 1JA Lead Inspector
Mary O`Loughlin Unannounced Inspection 13th September 2005 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 Carlton Hill Care Home DS0000026424.V249337.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 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. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Carlton Hill Care Home Address 398 Carlton Hill Carlton Nottingham NG4 1JA 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) 01159619959 01159873889 Mrs Josephine E Flavill Mrs Catherine Flavill Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (28), Terminally ill (1) of places Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. For one Service user aged 59 requiring Nursing To admit one named Service user under 65 years Date of last inspection 20th October 2004 Brief Description of the Service: Carlton Hill Care Home provides 28 places for Older people requiring Nursing or residential care and for one person with a Terminal Illness. The home was opened in 1988 and consists of a two -storey building with a newer purpose built extension. There are 16 single rooms and 8 double rooms; one single and one double room provide en-suite facilities. There are suitable adaptations and equipment including a passenger lift which ensures that the home is suitable for the client group accommodated. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted unannounced over four hours. The main method of inspection used was to case track, this means that the care plans of 4 residents were examined to ensure that the home are able to meet their assessed needs and that documentation meets the National Minimum Standards. 6 residents and one relative were spoken with to obtain their views on what life was like in the home. The manager and Proprietor were present and provided all the required information to the inspector. The home was clean, warm and very well maintained. All those spoken with confirmed that they were very happy with the care they receive and felt that all of the staff were very caring and helpful. What the service does well: What has improved since the last inspection?
Regulators have been fitted to all hot water outlets to maintain the hot water at safe levels to prevent scalding. All staff now receive annual updates in Moving and Handling practice.
Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 6 Residents are now asked to give their signed consent for photographs to be taken, which are held on their records as an aid to identification. The homes activities worker is supplied with a uniform to enable residents to identify her. Staff are now undertaking training in adult protection issues and there has been commendable work undertaken to provide staff with comprehensive guidance in the home on protecting people from abuse. Residents are now asked for their views on the home through a questionnaire form. There is a programme of redecoration in place and evidence that continuous improvements are undertaken to the fabric of the building. New purchases include, specialist beds and hoisting equipment. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 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 Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 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): 3-4-5-6 Prospective residents are provided with appropriate information on which to make an informed choice about where they live. No resident moves into the home without having had their needs assessed and been assured that these will be met. EVIDENCE: The records of two recently admitted residents demonstrated that the manager gave prospective residents the opportunity to visit the home with their relatives. If the prospective resident wishes to stay at the home the manager then obtains an appropriate Nurse or social worker assessment as required. Where people are privately funded the manager undertakes an assessment of their needs prior to agreeing the admission to determine that the home are able to meet their needs. Throughout the process prospective residents and relatives are kept fully informed and the manager ensures that where required, all the necessary
Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 9 equipment is obtained before a resident is admitted. A statement of purpose and service user guide is also made available. The resident and relative participate in the assessment and care planning, wherever possible signing the plan before it is implemented. Good practice was seen in that the resident is asked if they are happy with their room following admission and records of this are held within their file. Intermediate care is not provided at the home. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 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 the following standard(s): The standard of assessment and care planning ensures that all residents receive appropriate care in accordance with their wishes. Residents can be assured that the staff promote and maintain their health, ensuring access to health care services to meet their needs. EVIDENCE: Care plans were in place for all four residents case tracked. The care plans are based on the activities of daily living and reflect relevant clinical guidelines in the care of older people. The plans are reviewed at least monthly and as needs change. Plans are drawn up with the involvement of the resident or their relative wherever possible. The manager is presently implementing a client review meeting where resident and relatives are invited as required to review the care the resident is receiving. This gives the resident and relatives the opportunity to discuss any areas of the care plan that they are not sure about and provide good feedback to the manager on whether the home is meeting its stated aims and objectives in the care of the resident.
Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 11 One resident with nutritional needs was case tracked; the records seen demonstrated excellent monitoring of the person’s needs and appropriate intervention of the Dietician. The resident was weighed monthly and a nutritional risk assessment was completed using a nationally recognised nutritional risk assessment tool. Treatments prescribed were administered and the resident was showing improvement. One resident with a long-standing pressure sore was case tracked, the records were comprehensive and demonstrated excellent management of the risks. The person had access to the tissue viability specialist and the care they were receiving was evidence based. The records contained a wound assessment and records of the dressing changes, which is good practice. The resident was sat on a pressure-relieving cushion and examination of the person’s room demonstrated that an appropriate pressure-relieving mattress was in place. Each care plan contains an overview of the residents’ mental state and cognition, which informs a plan of care where necessary. There is appropriate assessment of the resident’s risk of falling and staff refer people to the occupational therapist if assessment of the risk requires their specialist assessment. Access to regular chiropody, dentistry, and ophthalmology is supported and recorded within plans. The medicine records of those case tracked show that they receive medicines as prescribed by the doctor. The medicine record sheets are signed and witnessed each month, one record of a mid month prescription change was not individually signed and witnessed. The receipt, storage, administration and waste disposal are all compliant with the Medicines and Environmental laws. The manager also includes within each care plan environmental risk assessments to ensure that people are safe within the building and that any necessary safeguards can be identified and put in place. During the inspection staff were respectful to the wishes of individual residents and demonstrated a good knowledge of the person’s preferences in regard to their privacy. Residents are able to have a key to their door if they are assessed as safe to operate these. Residents spoke of how staff are polite and friendly with them, always respectful and aware of their wishes. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 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 the following standard(s): 15 Residents receive a wholesome, appealing and balanced diet in pleasing surroundings. Individual preferences and special diets are considered to ensure residents receive a diet that is suitable to their individual assessed need. EVIDENCE: During the inspection the meal of the day was a traditional lunch of chicken and fresh vegetables. The dining room was nicely prepared and the residents had good access to the tables to allow the manoeuvring of mobility aids. The meal of the day was displayed on a notice board within the dining room. Residents receive a diet that is appropriate to their assessed needs. There was consideration to the type and quantity of the meal prepared for each resident. People were assisted to take their meal by staff that sat with them and carried out the support sensitively.
Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 13 All residents were happy with the food provided. Nutritional plans demonstrated good practice in ensuring that foods rich in calcium or other therapeutic feeds were provided as required. One resident spoke of the opportunity to discuss favourite cultural recipes with the cook, who will then provide these special meals as desired. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 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 the following standard(s): 16-18 Residents are safeguarded from abuse in accordance with local adult protection guidelines. Residents can be confident that their concerns will be listened to and addressed in an appropriate timescale. EVIDENCE: The home has a complaints procedure in place. The record of the proposed client review meetings also includes reference to if the resident and relatives are aware of how to complain, this is good practice and ensures that people are fully informed of their right to have their concerns taken seriously and investigated as necessary. The manager is enrolled on an Adult Abuse Awareness training course in October 2005. Staff are also receiving training in adult abuse awareness. The manager has produced an excellent reference/training book, which is supplied to individual staff and informs them of the issues around abuse and the local procedures in the event of an allegation or suspicion of abuse. The home’s practices regarding residents’ money and financial affairs ensure that residents’ have access to their personal financial records and there is safe storage of money and valuables.
Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 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 the following standard(s): 19-20-22-23-24-25-26 A comfortable and safe standard of accommodation is provided for the residents. Residents have access to appropriate equipment to maximise their independence. EVIDENCE: The home is suitable for its stated purpose, having a range of adaptations and equipment necessary to support older people. The Fire and Environmental offices inspect the premises. A programme of routine maintenance is held and this was available for inspection. The gardens were well maintained and provided a safe enclosed rear garden or an open plan front garden for residents to access.
Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 16 The home was clean, warm and well maintained. Individual residents rooms were personalised and homely. Residents were supplied with a key following assessment. Shared rooms had appropriate screening in place to allow for privacy. Each room was fitted with good quality furniture and had a lockable drawer in which people could keep their valuables. There was provision of nursing beds as required and suitable bed linen, laundered to a good standard. Wash hand basins had hot water regulators fitted to prevent people from scalding. Radiators were fitted with covers to prevent accidental burns. A nurse call system was in operation. The laundry room was fitted with appropriate facilities that allowed washing temperatures to control infection. Staff had access to protective equipment and areas of infection risks were supplied with clinical waste disposal units. One qualified nurse and one carer attend Infection control link nurse meetings, which provide them with all up to date information on infection control practice. This information is then cascaded to staff at the home and informs practice accordingly. Residents said they felt safe in the home and found their rooms met their individual preferences. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 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 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): Residents are protected by the homes’ recruitment practice and they can be assured that there are appropriate numbers of staff on duty to meet their needs. EVIDENCE: Staff duty records demonstrated that sufficient and appropriately skilled staff were employed over the 24hr period to meet the needs of the residents at this time. Three staff files examined show that the homes’ recruitment practice safeguards the residents from people who may be unsuitable to work with vulnerable adults. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 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 EVIDENCE: The home manages the personal monies of two residents. Personal allowances are paid directly from the appointee to the homes pooled account. Good records are held of all transactions and receipts are retained. They are however advised to contact the appointee to ensure that appropriate management of these funds are in place. The present account is none interest bearing, which is not recommended. Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 19 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 4 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 20 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. 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 Refer to Standard 35 Good Practice Recommendations The registered person should ensure contact the appointee for those residents who are unable to manage their own finances to ensure that individual interest bearing accounts are put in place. The registered person should ensure that all medicine records, which are hand written, are signed and witnessed. 2 9 Carlton Hill Care Home DS0000026424.V249337.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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