Inspection on 15/09/08 for Carlton Hall Residential Home

This inspection was carried out on 15th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Hall Residential Home 30/10/07

Extracts from inspection reports are licensed from CQC, this page was updated on 01/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Carlton Hall Residential Home Chapel Lane Carlton Colville Lowestoft Suffolk NR33 8AT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kevin Dally     Date: 1 5 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Carlton Hall Residential Home Chapel Lane Carlton Colville Lowestoft Suffolk NR33 8AT 01502513208 01502567643 carlton_hall@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Shirley Baxter Type of registration: Number of places registered: Carlton Hall (Lowestoft) Limited care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Staffing levels within the home must be reviewed together with the regulatory authority 6 months from the date of the certificate of registration. Date of last inspection Brief description of the care home Carlton Hall is a registered care home for older people, providing residential care for up to forty-two residents, with up to 11 places for people who may have dementia. Carlton Hall is a large detached country house, situated in its own grounds. The home opened several years ago, as a small home. Over the years the property has been extended, and the numbers of registered care beds have increased. An extension was added during 2006, which increased the number of beds from thirty five to forty two. The home is situated in the village of Carlton Colville, on the outskirts of Lowestoft, north Suffolk. The accommodation for service users is situated over two floors, with Care Homes for Older People Page 4 of 30 Over 65 11 31 0 0 Brief description of the care home the majority of residents accommodation located at ground floor level in the extensions that have been added to the house over the years. The home is set in attractive grounds which include a long driveway, visitors and staff car parking areas, mature gardens and grassed areas, patios and decking, a fenced off ornamental pond, and paddocks used for animal grazing during different periods of the year. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection of Carlton Hall, which took place on the 15th September 2008. Mr. and Mrs. Baxter, the owners, were present for the inspection and provided us with information that was relevant to the inspection. A tour the premises was completed and we were able to spend time with some of the residents and staff, and talk with 3 visiting relatives. This gave us information about the home including what people thought about the quality of the service provided. We also observed staff serving the lunch and we followed a medicines round. A selection of residents care plans and medicine records; staff records, maintenance and training records were also checked, as were a selection of other documents, including the staff duty rotas and the menus. Care Homes for Older People Page 6 of 30 Surveys were sent to the home to distribute to residents, relatives and staff before the inspection took place. One resident and three relatives responded to our questions. A selection of their views and opinions about the home are included within this report. The manager also completed the CSCI annual quality assurance assessment form (AQAA), which provides key information about the home, and allows them to say what they do well, what they could do better and any plans to improve the service. The report has been written using some of the information gathered before, or during the inspection. On the day of inspection the residents were seen relaxing in various parts of the home including a sunny conservatory area, or in one of the three lounges in main. People in the dementia unit had their own lounge and courtyard area, which they could easily access and were observed using these facilities throughout the day. Staff were seen supporting the residents and undertaking their care duties throughout the day in a calm and respectful way. What the care home does well: What has improved since the last inspection? What they could do better: This inspection showed that the home continued with the provision of a service that usually met the needs of the residents. One key concern was around excessive hot water tap temperatures found in two kitchenettes, which the home must ensure are delivered at a safe and acceptable level. This is to ensure that residents have hot water provided to facilities and that this is at a temperature that is useable, safe and does not put them at risk of scalding. During the inspection, the owner did immobilise these and made arrangements to have safety valves installed. Although improvements were noted to the care plans, these must provide more detail around all aspects of a residents health care needs (including their mental health i.e. dementia and falls prevention). This is to ensure that residents personal and social care needs are met. Employment records checked, showed some shortfalls in obtaining a second reference for new employees, which was required, to ensure staff are suitably checked and cleared to work with vulnerable adults. Staff induction and foundation training to Skills for Care requirements must be provided for new care staff, and the staff training plan must be reviewed to identify staff training shortfalls. This is to ensure that the staff group have the skills to meet peoples care needs. Recommendations included Additional hot water tap temperature outlets should be tested weekly to ensure wider monitoring of all outlets against mechanical failure. This is to ensure that the residents are kept safe. Care Homes for Older People Page 8 of 30 Staffing levels should be reviewed to ensure there is sufficient staff available to meet the needs of the residents. The home should consider how it proposes to meet the Skills for Care recommendations of 50 percent staff qualified to NVQ Level 2. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect that they will have their basic care needs assessed prior to moving into the home, however they cannot be assured that the staff group is sufficiently trained to meet all their care needs. This judgment has been made using available evidence including a visit to this service. Evidence: The home has a statement of purpose and service user guide, which they make available to residents on admission, or upon request from the office. This included information around the range of care needs that the home can provide, and how to make a complaint to the home, should this be necessary. New residents and their families can visit the home to view the premises, before moving in. One CSCI residents survey returned said they had received enough information about the home before moving in. Care Homes for Older People Page 11 of 30 Evidence: The care records for two residents were checked and each included a brief assessment of the needs they had prior to admission. The assessment included information around the residents personal details, a dependency profile, areas of personal care needed, a brief past medical history, any current medicines, and a social contact section. The home would combine this information in their residents long term needs assessments or main care plan. The information was very brief and could be more detailed to ensure that the home is better informed about key care information. The home was able to show us that they had provided some training for the staff group that would assist them to support the needs of the people who lived at the home. (Please refer to Standard 30) Some specialized training, for example dementia training, had been provided for some staff. Feedback received from staff (3) informed us that they had received training, which they considered was relevant to their role. Examples they gave included induction training, dementia care, and completion of their national vocational training (NVQ level 2 & 3) courses. The information provided by the home (AQAA) told us that around 34 of the care staff (14 of 41) had achieved a national vocational care qualification (NVQ) level 2 or above, but that there were no further staff members currently working towards this award. Therefore the home needs to consider how it proposes to meet the Skills for Care recommendations of 50 staff qualified to NVQ Level 2. The following is a selection of feedback received from residents and relatives about the care provided by the home. I think the staff are very patient, and treat the residents with respect. I am happy here and am treated well. I think the staff are first class, are never rude and are very kind and helpful. Most of the carers are very good and caring but some of the young carers dont have a clue, and definitely need more training. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can usually expect to have their health care needs met including receiving their medicines. Their plan of care would not always provide adequate detail of the care required. People would be treated with respect and dignity. This judgement has been made using available evidence including a visit to this service. Evidence: The home uses the Standex system that records key information about the residents care needs, and this is based on assessments and regular reviews of the care needed. The records for two people with more complex care needs were checked to see if the information in the care plan matched with the care given. Sections were provided around personal care, eating and drinking, breathing, mobility, elimination, skin, history of falls, psychological assessment and activities. One residents care plan checked provided quite basic information although it did give some insight into their care needs. For example, under psychological assessment the records said, Gets up Care Homes for Older People Page 13 of 30 Evidence: at 6.30am, enjoys participating in activities, and likes the company of others. Other key sections, for example, history of falls, the information only recorded yes, but did not give any further background information or guidance for staff on what to do, or how to prevent these falls. The pre-assessment information had identified that the resident falls regularly, and on the morning of the inspection, it was evidenced that they had sustained a fall. A second care plan checked identified another resident as having dementia. The care plan said, can become very anxious and distressed, but did not say why, or how staff should help them reduce their anxiety. Further, under sleeping the care plan said, Can be very disturbed, restless, or anxious, but again did not say why this was or how staff should support the resident, or approach the problem. Positively care plans provided some nutritional and moving and handling advice under the risk assessment information. This had been regularly reviewed by staff and provided information on the residents progress. The moving and handling risk assessments also included a monthly record of the residents weight, so this could be monitored by the home. Feedback from residents and relatives were usually satisfied with the overall care provided by the home and made the following comments. Generally I am very pleased with the care my relative receives, and they seem to be happy here, or I think my relative is always well cared for, or They attend to my relative well, and I think that this is one of the best places I have been to. However one person raised some concerns about the care provision. They said, The older carers are very good but a young carer said, you can wash yourself, but the resident was partially paralyzed. Feedback from staff told us they had been recently concerned where a residents continence care had not been properly managed. One issue the previous shift had been referred to the management, who were now investigating the issue. The homes accident records showed us that there had been 52 falls within the last 3 months, with most residents only experiencing minor one off falls. Four people, who were more prone to falls, were more closely monitored, and there was evidence that advice had been sought from the falls prevention team at the local NHS. Strategies were implemented to reduce these and to try to prevent further falls. An example of this was reviewing one residents medicines to stabilize their condition. Care records showed that there was access to a variety of health care professionals including the doctor, district nurses, opticians and chiropodists. The district nurse had called on the morning of the inspection to apply a new dressing for a resident. The Care Homes for Older People Page 14 of 30 Evidence: home used specialist equipment including hoists, and staff were observed using this during the morning period. The senior carer was followed on the medicines round during the lunchtime period, and good practice was observed. Medicines were checked and audited and found secured in the medicine trolley. The senior spoken with had a good understanding of the homes medicine procedures and confirmed they had received medicine training. The medicines for three residents were audited and found to be correct. The medication administration records were correctly completed with the correct codes being used. Feedback from one resident said they always received the care and support or medical care they needed. Feedback from three relatives said that the home always or usually met the needs of their relative, and that they give their relative the support and care they expected. One resident spoken with said I think the care and support is very good. Staff were observed to be hardworking throughout the inspection, and were polite and caring towards the residents. Residents dignity was maintained during care sessions. One resident told me, The staff are extremely patient. Staff were seen to knock on doors, and to ask residents what they wanted. One relative said, I have nothing but praise for the home. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect the home to meet their social and leisure needs, and provide a varied diet. Their individual choices, participation and inclusion at the home would be encouraged. This judgment has been made using available evidence including a visit to this service. Evidence: During the day we saw positive examples where people were being encouraged to exercise their choices, join in with social and leisure activities, and meet with friends and family. Time was spent in the dementia unit (known as the yellow unit) during the later afternoon and we found this to be a relaxed and calm area with two staff in attendance. The staff were seen positively supporting and talking with the residents during the afternoon. They also provided personal care, when this was needed. The home provided an activities coordinator in the unit from 10 to1pm and she was seen providing support activities and therapy to some vulnerable residents. One visiting relative confirmed they had often seen activities provided for these residents. There Care Homes for Older People Page 16 of 30 Evidence: were also interest points within the unit including a budgie in a birdcage or television for the residents to watch, access to a safe enclosed outdoor courtyard, and a kitchenette area to make a cup of tea. Several residents were seen in the courtyard, relaxing and enjoying the afternoon sun. One resident told us the evening team are very good. During the lunch period in the main dining room, residents were seen talking with friends and catching up on the days events at the home. Three residents told me that the meal was very tasty, and this looked and smelt appetizing. They also told me that it was served in good portions, which met their dietary needs. Residents said the staff are nice and helpful. The meal at lunchtime was a mince hotpot or quiche and salad, and vegetables and potatoes. This was followed by banana custard desert. Records checked provided some information about the residents preferred activities and choices, so staff were aware of peoples interests. One example of this read, Rises at 8am, wash and dress before breakfast. Enjoys walks, memory games, scrabble and skittles, and most things. Enjoys socializing and the company of others. During the day two activity coordinators were seen providing support and working with individual residents. One coordinator told us that during the morning they had provided skittles and exercises for the residents. They told us previous activities had included quizzes, cards, and individual time with residents in their rooms, DVDs, television, films with popcorn, and walks in the garden. During the morning, several residents were seen accessing the garden areas. The coordinator told us that a boat trip had been arranged for some residents. During the day we spoke with two relatives who told us they often visited the home. One said, The staff are friendly to visitors, and they listen and try to address any concerns we have. The home is always clean and tidy and the grounds are very good. Another said, I am always made to feel welcome. My relative is always in his or her own clothes which are kept clean. The meals are excellent although the teas are a bit light. Another relative said, The home has a good provision of activities and entertainment. It is a very clean environment, and offers good home cooked food. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could usually expect to have their concerns listened to and would usually be kept safe from harm, although they cannot be assured that recruitment processes and staff training are as robust as they could be. This judgment has been made using available evidence including a visit to this service. Evidence: The home has a complaints procedure in place, which was included within the service users guide. The complaints book was checked and this showed that two complaints had been received and investigated by the management. One was about a personal care issue, which was upheld, and a letter of apology had been sent to the resident. Another was about a lost piece of clothing, which was eventually found. The survey received back from a resident said that staff listen and act on what they say and that they know how to make a complaint. In the survey to relatives we asked Has the care service responded appropriately if you or the person using the service has raised concerns about the care. Two relatives said always, the other did not say. Comments received from the relatives included the following. I have not said anything as I would not want to make it difficult for my relative/friend, and Whenever I speak to anyone in authority I always feel listened to and generally receive a satisfactory response within 24 hours. Care Homes for Older People Page 18 of 30 Evidence: Staff records showed that they had usually received training in safeguarding, although some had yet to receive this, so some staff may not know what to do in the event of suspecting abuse. Staff records also showed that when recruited a criminal records bureau (CRB) check was made including a protection of vulnerable adults (POVA 1st) check, and a check of their identity. However, the home had not obtained a second reference for some staff members, so could not completely assure itself of these staff members were suitable to work with vulnerable adults. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Carlton Hall provides a good quality environment that is well maintained, although residents were put at risk of scalding due to a lack of some hot water temperature controls. This judgment has been made using available evidence including a visit to this service. Evidence: Carlton Hall is a large detached country house, situated in its own grounds. Over the years the property has been extended, and the numbers of registered care beds have increased. In 2006 a new wing to accommodate 10 people with dementia was registered, so taking the total number of places to 42. The 10 new bedrooms added in the Yellow wing all conform to the environmental standards of size with additional en suite. Each room has the required furniture, fittings, carpet and curtains. All this is new and of good quality and light and airy. The en suites include a toilet and wash hand basin. Weekly temperature checks and records were in operation although the number of outlets tested meant that it would take some time to routinely test all outlets. There is sufficient storage in the form of cupboards and a large walk in cupboard. The main living area is a combined lounge and dining room with a kitchenette in one corner. This will serve drinks, tea and breakfast. Care Homes for Older People Page 20 of 30 Evidence: The kitchenette hot water tap temperatures in the pink lounge (main) and yellow lounge (dementia lounge) were found to be around 50 degrees Celsius, and this could place vulnerable residents at risk. The management had overlooked this area in their risk assessment, and agreed that this needed immediate attention. The owner therefore immediately turned these taps hot water supply valves off, to make them safe. These were rechecked and confirmed as safe. The owners told us that the plumber would be called the following day to install thermostatic valves to ensure appropriately regulated temperatures. There are 3 assisted bathrooms with toilets. There is a toilet near the communal area. The temperature of the assisted bath was taken and found to be within the safe limits range of 40 to 42 degrees Celsius. The remainder of the home was well maintained and attractively decorated in keeping with the homes style. Furnishings in the home were well maintained and comfortable. Residents spoken with confirmed that the home was well maintained and comfortable. The home was very clean and hygienic throughout with no offensive odors in the home. The first floor bedrooms were visited and found to have restrictors on the windows to prevent a person from falling. The previous inspection identified that an industrial washing machine with sluice wash was required for dealing with foul linen. This had now been installed although the laundry staff told us that they had only needed to use this on a few occasions. The laundry was found to be very well organised, with appropriate baskets for various types of linen, and peoples personal clothing. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect that they are usually supported by adequately trained staff, and are usually protected by the homes recruitment procedures. This judgement has been made using available evidence including a visit to this service. Evidence: The home continues to operate a fixed roster that rotates every two weeks. Staff have the same pattern of working and any changes are then made by the manager or her assistant. Any sick or annual leave is recorded on a separate absents record, but it was difficult to see at a glance, who had previously been on duty. At our request the owners provided a list of the staff who had covered absent duties during the period from 18th August to 15th September 2008. In discussion with the owners, it was agreed that they would provide a copy of the duties worked, including replacement staff, on a contemporaneous record. The roster showed all staff working at the home. Shifts are normally 7am to 3pm, 2.45 pm to 10pm, and 10pm to 8am, so allowing some overlap on the busy morning and afternoon shifts. There are 5 care staff on duty including two staff in the yellow unit. In addition there are staff who come in as breakfast staff and tea staff (08.30 to 13.30 and 16.30 to 20.00) there are also 3 activities staff, a cook and assistant cook, cleaners each day, a laundry person and the handy man. At night there is 4 care staff Care Homes for Older People Page 22 of 30 Evidence: one of which is a senior. During the week there is also the manager and the assistant manager on duty 09.00 to 17.00. Feedback from the relatives, the staff group and records checked told us that during July and August there had been a moderately high absence leave, but the manager had covered these shifts. Comments about staffing included, Since adding the extra beds for the dementia patients, there never seems to be enough staff at nights, so always short. I would definitely think more staff are required. We are sometimes shorted staffed which impacts on our work, or, We are expected to help cover. Some staff feedback expressed concerns about how shortages impacted on their work. This included an example where the resident had been found incontinent, but had not been appropriately addressed by a previous shift. This was reported to the manager, who fully investigated this matter. Staff records showed us that when staff are recruited a criminal records bureau (CRB) check was made including a protection of vulnerable adults (POVA 1st) check, and a check of their identity. However, the home had not obtained a second reference for some staff members, so could not completely assure itself that these staff members were suitable to work with vulnerable adults. The home was able to show us that they had provided some training for the staff group that would assist them to support the needs of the people who lived at the home. For example, staff training records checked generally included records of fire training, moving and handling training, medicines training, and safeguarding training, although one staff members records checked did not provide evidence of safeguarding training. Gaps in some training records were noted around staff members having received health and safety training, infection control, and food hygiene training. Staff records checked showed us that the home had a staff induction list which some staff had completed. The home showed us a new induction, foundation and training record that covered many of the requirements of Skills of Care. However, this had yet to be implemented, and three new staff members records checked did not provide evidence of induction training. Some specialised training, for example dementia training, had been provided for some staff. Feedback received from staff (3) informed us that they had received training, which they considered was relevant to their role. Examples they gave included induction training, dementia care, and completion of their national vocational training (NVQ level 2 & 3) courses. The information provided by the home (AQAA) told us that around 34 percent of the care staff (14 of 41) had achieved a national vocational care qualification (NVQ) level 2 or above, but that there were no further staff members Care Homes for Older People Page 23 of 30 Evidence: currently working towards this award. Therefore the home needs to consider how it proposes to meet the Skills for Care recommendations of 50 percent staff qualified to NVQ Level 2. One relatives feedback said, I think the new girls need more training. I think they should be assigned to an older one so they can see how things are done. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will benefit from an appropriately run home that seeks their views about the service provided but cannot be assured that their health, safety and welfare is always protected.This judgement has been made using all the available evidence including a visit to this service. Evidence: Mr. and Mrs. Baxter are joint owners of Carlton Hall. Mrs. Baxter is the registered manager and has achieved a NVQ level 4 combined care and management award. Mrs Baxter is supported by her deputy manager in her absence. Residents and staff spoken with said the management team were approachable, and would deal with their concerns. Mrs Baxter has experienced a period of illness and notified the Commission of the management arrangements that she put in place to cover this absence. She has now returned to work. The home had a new quality assurance process in place and surveys had been given to Care Homes for Older People Page 25 of 30 Evidence: residents, their families and the staff group during March 2008. The home had complied a summary of the feedback received and made a comprehensive action plan to resolve some of the issues raised within the survey. There was a complaint process in place should a resident wish to raise any concerns. The home maintains maintenance and service records and the fire and the hot water tap temperatures records were checked. The home had undertaken a fire risk assessment in accordance with the local fire service requirements. Fire training was provided for new staff members. The information provided by the home (AQAA) showed that home continued to maintain equipment including hoists, fire detection equipment, call bells, the heating system, soiled waste and gas appliances. The home confirmed they have a written assessment around the control of substances hazardous to health. The home has a range of policies and procedures for staff, which includes health and safety, and financial procedures, which are regularly reviewed. Staff records show that some staff have received health and safety training including moving and handling and fire procedures, although some new staff had yet to receive this training. The tour of the premises showed that the building was well maintained. The home maintained fire check records and undertook checks on hot water temperature checks to ensure that these remained safe for the residents. A sample of hot water tap temperatures taken during the inspection showed that hot water tap temperatures are usually maintained at around 40 to 42 degrees Celsius, with the exception of the kitchenettes, where hot water tap temperatures were delivered at an unsafe level. (Please refer to standard 25) Feedback from staff said that they were supported by their manager who would meet with them to discuss how they were working. One staff members records checked showed evidence of recent supervisions. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must provide more detail around all aspects of a residents health care needs (including their mental health i.e. dementia and falls prevention). This is to ensure that residents personal and social care needs are met. Hot water must be provided from hot water outlets that is useable, safe based on the guidance from the Health and Safety Executive / Local Authorities Enforcement Liaison Committee (HELA) Local Authority Circular Number: 79/5 recommends the following temperatures;Wash hand basins 41 degrees Celsius, Showers 41 degrees Celsius Baths 44 degrees Celsius This is to ensure that residents have hot water 10/12/2008 2 25 13 13/11/2008 Care Homes for Older People Page 28 of 30 provided to facilities and that this is at a temperature that is useable, safe and does not put them at risk of scalding. 3 30 18 Staff induction and foundation training must be provided for new care staff. This to ensure the home can evidence that they have the skills to meet peoples care needs. 4 30 18 The staff training plan must be reviewed to identify staff training shortfalls, and additional training sessions provided for staff. This is to ensure staff have the skills to meet peoples care needs. For example, food hygiene, infection control or safeguarding training. 10/12/2008 10/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 25 Additional hot water tap temperature outlets should be tested weekly to ensure wider monitoring of all outlets against mechanical failure. This is to ensure that the residents are kept safe. Staffing levels should be reviewed to ensure there are sufficient staff available to meet the needs of the residents The home should consider how it proposes to meet the Skills for Care recommendations of 50 percent staff qualified to NVQ Level 2. 2 3 27 29 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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