CARE HOMES FOR OLDER PEOPLE
Carlton House Rest Home 44 St Aubyns Hove East Sussex BN3 2TE Lead Inspector
Glynis McLeod Unannounced Inspection 1st November 2005 09:45 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 House Rest Home DS0000014187.V249570.R02.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 House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Carlton House Rest Home Address 44 St Aubyns Hove East Sussex BN3 2TE 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) 01273 738512 Macleod Pinsent Care Limited Lisa Jane McClintock Care Home 25 Category(ies) of Dementia (25) registration, with number of places Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users should be aged sixty-five (65) years or over on admission. The service can accommodate twenty-five (25) service users with dementia type illness. The maximum number of service users to be accommodated is twenty-five (25). 6th June 2005 Date of last inspection Brief Description of the Service: Carlton House is registered to provide care for up to 25 older people with a dementia type illness. Most of the care provided is long-term; however, some respite care is also offered. The home does not provide nursing care. The home is a detached property situated close to the main shopping centre in Hove with all local amenities close at hand and is well served by bus and train services. It is a short walk from the seafront and a couple of miles from the South Downs. Accommodation is on four floors accessed by a shaft lift and comprises 15 single rooms and five double rooms, some of which are fully ensuite. There are three lounges, including one that is also used for dining, and another, larger, dining area downstairs. A small patio area lies at the back of the home. Limited parking is available behind the building. The home does not allow smoking on the premises. Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection, which was unannounced, took place over five and a half hours and was one of two inspections required over the year. A tour of the premises took place and records relating to care, medication, staffing and maintenance were inspected. The inspector spoke to staff, residents and the manager. Residents were relaxed and happy and clearly had a good relationship with staff. The inspector would like to thank the residents, staff and manager for their hospitality and co-operation during the inspection. What the service does well: What has improved since the last inspection?
The home has completely revised its care plans since the last inspection and they are now easy to understand and provide useful information for staff to help them care for residents. There has also been improvement in the health and safety issues noted at the last inspection. The boiler has been serviced and is now enclosed in a separate room. Pipes have been boxed in and water temperatures have been regulated so that residents are not at risk of hurting themselves from hot water. A new carpet has also been ordered for the ground floor and the downstairs area, so that residents will no longer be at risk of tripping on worn areas. Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 6 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 House Rest Home DS0000014187.V249570.R02.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 House Rest Home DS0000014187.V249570.R02.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): The key standards were assessed at the previous inspection. None of the other standards were assessed at this inspection. EVIDENCE: Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Residents’ health, personal and social care needs are clearly identified in their care plans and staff have detailed up-to-date information that enables them to meet residents’ needs. EVIDENCE: Since the last inspection, the manager has put considerable effort into completely revising the care plans. They are now clear and accessible to staff, providing them with accurate and detailed information on how to care for each resident. Families are invited to help draw up the plans, which are reviewed monthly by senior staff. Each resident has been assessed for slips, trips and falls and guidelines are available instructing staff on how to assist residents moving around the home or transferring from bed to chair. Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 10 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): The key standards were assessed at the previous inspection. None of the other standards were assessed. EVIDENCE: Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 11 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 and 18 Policies and procedures ensure that residents are protected from abuse and that complaints are properly listened to and investigated. EVIDENCE: The home has a clear complaints policy that gives families information on how to make a complaint and details how the home will respond to it. There were no complaints recorded in the home’s complaints book, and no complaints had been made to the Commission regarding the home. The manager tries to respond to residents’ concerns at any early stage before they become a complaint. The manager has undertaken adult protection training as part of her Registered Manager’s Award course, and an external trainer visited the home earlier in the year to provide training for other staff. The manager was aware of how to respond to an allegation of adult abuse, and the relevant policies to protect residents were in place. A recommendation was made that the manager attends the local authority adult protection training so that she is aware of local guidelines and the particular social work team she needs to contact if she has any concerns. Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 12 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 The home is safe, well-maintained, clean and hygienic. Residents live in comfortable, well-decorated surroundings and have access to all parts of the building and the garden. EVIDENCE: Since the last inspection, the home has made the boiler safe and ordered a new stair carpet for the ground floor and downstairs area. The carpet will improve the look of the building and also help prevent any trips that could injure residents. A number of bedrooms have been completely redecorated and look fresh and attractive. Furnishings and décor throughout are homely and comfortable and there is an on-going plan of renewal to improve the premises. A maintenance man is employed and any work undertaken in the home is recorded. Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The home employs sufficient numbers of staff to ensure that residents’ needs are properly met. A full training programme ensures that staff are qualified and competent to carry out their duties. At the last inspection, a requirement was made that staff files must contain all the required information and that all the necessary checks must be made before staff begin working at the home. At this inspection, it was found that the necessary checks on staff are still not being made before staff begin work. This puts residents at risk and is also in breach of the Care Standards Act 2000 regulations. EVIDENCE: There are normally four staff plus the manger on duty throughout the day and an extra person comes in between eight and nine pm to help with getting residents to bed. Two waking staff are on duty during the night. The home also has two domestic staff who keep the home clean and hygienic. The home has met the target of having more than a minimum of 50 trained staff and 60 of the care team are qualified to NVQ2 or equivalent. In addition, two members of staff are undertaking their NVQ3 training. There is a full staff training and development programme and the manager puts great emphasis on ensuring that staff are properly trained and capable of providing a good standard of care. Training needs are identified during supervision, and a record of all training undertaken is kept in each staff member’s file. Recent
Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 14 training has included: first aid, safe handling of medication, basic food hygiene, managing challenging behaviour and understanding dementia. At the last inspection, it was found that not all staff files were up-to-date or that they were lacking certain required information. Although work on updating the files is in progress, it was found that there were some references either missing or not acceptable. An immediate requirement was made that staff must not be employed at the home until all the necessary checks are properly completed. A further requirement was made that staff files must be brought up to date and include all the required information by 31.12.2005. Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 15 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): 31, 33 35 and 38 The manager is experienced and competent and runs the home professionally. The home ensures that residents, their families and other professionals are invited to comment on how the home is run. The management team also regularly monitor and review the service they are providing to ensure that it is run in the best interests of the residents. The home ensures that residents’ finances are properly safeguarded by its policies and procedures. EVIDENCE: The manager has nearly five years’ management experience and has been in her current post for two and a half years. She is a registered general nurse and has obtained her NVQ4 and Registered Manager’s Award. She and her senior staff are experienced in working with older people and are aware of the particular care needs of people with dementia. Both the manager and her staff undertake regular training to keep up-to-date with current practice.
Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 16 There is a comprehensive quality and assurance system in place and the manager and owner complete an annual development plan looking at staff levels and training needs, and the maintenance and improvement of the property. The manager has recently completed an audit on falls in the home, which has led to changes in care practices aimed at reducing the number of falls. She is also in the process of reviewing and rewriting all the policies in the home to ensure they reflect current practice. Records showed that residents’ personal allowances are kept and managed properly. Health and safety policies and procedures were seen to be in place, and records showed that all appliances had been serviced and passed as being in good order. Fire safety tests and drills are carried out regularly and recorded, and all incidents and accidents are properly recorded and filed. Care staff undertake a two-part induction programme, which includes relevant information regarding health and safety issues around the home and which is designed to protect both them and the residents. Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X x STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19(1bc) 4(bc) Sch2 Requirement Staff files must contain all the required information, including suitable references, before starting work at the home. (Outstanding requirement from previous inspection) Timescale for action 31/12/05 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 OP18 Good Practice Recommendations The manger should attend the local authority adult protection training. Carlton House Rest Home DS0000014187.V249570.R02.S.doc Version 5.0 Page 19 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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