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Inspection on 11/05/05 for Carlton House

Also see our care home review for Carlton House for more information

This inspection was carried out on 11th May 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Positive feedback was given by a visiting GP about the stability of the staff group and the commitment and interest of the staff group with the welfare of the residents. Positive comments were also received from residents about the quality of the food and enjoyment of activities provided. The Inspector also observed a substantial lunch being provided. Residents seemed well looked after.

What has improved since the last inspection?

Progress is being made gradually to improve the decoration of the home and plans are advanced to make further improvements and the home feels welcoming and homely. Improvements have been made for the safe provision of medication.

What the care home could do better:

The appointment of a manager is imminent and is needed as over the last two and a half years no manager has been in place. The manager needs to ensure that the concerns set out below are met. Some of these concerns go back to 2003. Supervision is needed for all members of staff. Assessment, care planning and risk assessments must all improve so that it is clear that staff know what the plan is for each service user. Residents need to be party to these plans and be more involved in contributing to the running of the home. Risk assessments of the home need to be comprehensively undertaken particularly around fire risk; fire drills must be reintroduced. Whilst redecoration and improvements to the building have taken place, further work is needed to ensure that the home is safe and more comfortable for residents.

CARE HOMES FOR OLDER PEOPLE Carlton House 2 The Avenue Hatch End Middlesex HA5 4EP Lead Inspector Richard Adkin Unannounced 11 May 2005, at 11:15hrs th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Carlton House Address 2 The Avenue, Hatch End, Middlesex, HA5 4EP. 020 8428 4316 020 8907 5777 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Farrington Care Homes Ltd CRH PC Care Home Only 24 Category(ies) of OP old Age registration, with number of places Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 12/1/2005 Brief Description of the Service: Carlton House is a large detached property situated in a residential area within the Royston Park estate in Hatch End. This home is currently registered for the provision of personal care for up to 24 older people. The group of people living at the home at the time of inspection were of mixed gender. There were three vacancies at the home at the time of inspection. The home is owned by the Nathwani brothers of the private Farrington Care Homes Ltd organization. The organization owns two other homes in the local London region, and two further homes nationally. The home is about five minutes walk from a superstore, bus routes, and a local-line railway station. The Hatch End shopping parade is about ten minutes walk from the home. The home has a forecourt with parking space for about eight cars. There are no parking restrictions on the road outside the home. Accommodation for the service users is provided on the ground and first floors. Access upstairs is by the lift or stairs. The home has two double rooms and 20 single rooms. Three single rooms have en-suite facilities. The home has a large number of toilets available. the home has three interconnecting lounges and a dining room. At the rear there is a well-maintained garden. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 4 and a half hours to follow up the large number of requirements and recommendations from the inspection 12 January 2005. The Inspector looked around the building and a number of records and policies and procedures were inspected. The Inspector had the opportunity to speak to three of the Senior Care Assistants, seven of the residents and the Service Manager who kindly made herself available during the course of the inspection. What the service does well: What has improved since the last inspection? Progress is being made gradually to improve the decoration of the home and plans are advanced to make further improvements and the home feels welcoming and homely. Improvements have been made for the safe provision of medication. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 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 G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards were assessed on this occasion. EVIDENCE: Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 11 Limited progress has been made around the planning process. Without this there is no guarantee that the planned care needs of residents will be met. Some marked progress has been made around the safe provision of medication. One resident’s health care needs need to be more fully met. EVIDENCE: The Inspector looked at four sets of records of residents. The process of individual resident’s plans setting out the action which needs to be taken to ensure that all aspects of care is beginning to happen. This has happened for fourteen of the twenty-four residents. A number of requirements arose that had not been met at the previous inspection. Plans of care need to be signed off by a senior person within the home. These plans need to be signed by the resident and/or their representative. Risk assessments of residents’ individual needs lacked detail. Plans of care for anyone moving into the home need to be signed and dated. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 10 Though records of individual continence care are kept; these records do not seem to be used as a trigger for prompting for check ups with key health professionals. The issues arising around medication are being tackled such as medication storage; the signing and recording of giving of medication, the returning and storage of disused medicine, and the training of staff. The medication policy, however, needs to be integrated to capture about self-medication and how to manage service users who have swallowing difficulties. Opened liquid medicines need to have a date of opening recorded to monitor the disposal date. The spiritual needs of residents needs to be further addressed and recorded and acted upon Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 Residents need to be more actively contributing and have a voice in the running of the home. Meals seem nutritious and balanced and offer a healthy and varied diet for residents. Activities on offer were stimulating. EVIDENCE: Residents’ meetings, as per the home’s Statement of Purpose, need to be held so that residents can make a contribution and have a stake in the home. Residents spoken to were positive about the quality and variety of the food provided. Appropriate support was provided to residents where needed with eating. During the inspection a craft activity was taking place. Residents were looking forward to a singer/songwriter performing at the home on the following day and were satisfied with the range of activities now being offered. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The complaint procedure must be given greater prominence. The lack of procedure does not ensure that people living in the home and their representatives have a means to voice concerns or complaints. Individual plans must detail actions to manage challenging behaviour. EVIDENCE: The complaints policy was not in the procedures manual or displayed. The brief procedure kindly forwarded to the Inspector referred to the National Care Standards Commission as opposed to the Commission for Social Care Inspection. The verbal feedback received from residents spoken to was positive about all aspects of the running of the home. Individual plans did not detail appropriate staff responses to challenging behaviour, and incidents were not being properly recorded. This needs to be rectified. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21, 22 and 26 Some improvements to the décor have been made. There are a number of further improvements outstanding which put residents at risk of harm and do not provide safe and comfortable surroundings in which to live. The home must be free of offensive odours. EVIDENCE: Since the last inspection the home’s redecoration programme has gone forward. A number of areas however require attention including: • • • • The downstairs shower-room is in a poor state of repair with exposed plumbing work. Likewise the upstairs bathroom has exposed plumbing work and needs a number of areas of repair. There was a strong offensive odour on entering the home initially and this needs to be managed. Visibility strips must be stuck to the areas of the home where there are sudden changes of flooring levels. This remains a requirement though G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 14 Carlton House some action has been taken and needs to be fully implemented to lessen the risk of tripping and prevent accidents. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 A cook needs to be employed part-time to deliver nutritious meals and ensure that care staff are free to undertake their role. EVIDENCE: There have been difficulties in employing a part-time cook; but this must be prioritised so that care staff can focus on delivering care rather than covering the domestic side of work. Positive comments were received from a visiting GP about the commitment of staff to residents in maintaining their well being to keep them at the home, and the stability of the workforce. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 and 38 The home needs leadership to establish routines, sound risk assessments and fire procedures to safeguard the health, safety and welfare of the people using the service. EVIDENCE: The manager is due to start within the next few weeks and needs to be registered at the earliest opportunity and put into practice a number of requirements to ensure a better quality of care. Formal recorded supervision must be given to staff at least 6 times a year. Handover records signed by senior members of staff need to be fully passed over and recorded. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 17 Risk assessments for safe working practices must be developed, implemented and significant findings recorded and acted upon. Fire drills must be reintroduced and the fire risk assessments must be reviewed. This is all essential for the health and safety of people in the home. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 2 COMPLAINTS AND PROTECTION x x 1 2 x x x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 2 x x x 2 x 1 Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Plans of care must be signed by a senior figure from the home. Service users, or their representatives where applicable, must also be asked to view, agree or alter, and sign the plan. (Previous timescale not met). Risk assessments of residents individual needs lacked detail. This must be addressed. (Previous timescale not met). Plans of care for anyone moving into the home must be signed and dated. (Previous timescale not met). Plans for providing individual continence care to residents and for prompting for check-ups with key health professionals must be written . (Previous timescale not met). The homes medication policy must include self-medication, and how to manage service users who have swallowing difficulties. (Previous timescale not met). Opened liquid medicines must have a date of opening recorded on them so that they can be Timescale for action 1/7/05 2. OP7 13(4) 15 1/7/05 3. OP7 15(1) 1/7/05 4. OP8 12(3) 13(1)(b) 1/8/05 5. OP9 13(2) 1/8/05 6. OP9 13(2) 1/7/05 Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 20 7. OP11 14(1)c 15(1) 8. OP14 12(3) 16(1) 22(5) and (7) 9. OP16 10. OP18 11. OP21 13(7)(8) 15(2) 17(2) Schedule4 Pat 12 c 13(4) 23(2)(n) disposed of after an appropriate time. (Previous timescale not met). Service users must be given the opportunity to discuss their wishes regarding terminal care, including their spiritual needs, during the settlement into the home. Key points should be recorded. (Previous timescale not met). Service user meetings, as per the homes Statement of Purpose, must be held. (Previous timescale not met). The complaints policy was not in the procedures manual or displayed. The brief procedure forwarded referred to the National Care Standards Commission as opposed to the Commission for Social Care Inspection. This needs to be rectified. Individual plans must detail appropriate staff responses to challenging behaviour. (Previous timescale not met). The lock and door for the upstairs bathroom must be replaced to ensure privacy and ensure that it can be overriden in case of emergency. The light bulb must be replaced in the downstairs toilet. The shower-room has large areas of wall covered in torn lining paper where tiles have been removed. The ceiling tiles were stained and damaged. Plumbing work was exposed. The lighting has no cover. Refurbishment must be addressed. (Previous timescale not met). The upstairs bathroom has a large part of the bath and the 1/9/05 1/8/05 1/8/05 1/8/05 1/9/05 12. 13. OP21 OP21 16(2)(j) 23(2)(b) and (d) 1/6/05 1/9/05 14. OP21 16(2)(j) 23(2)(b) 1/9/05 Page 21 Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 and (d) 15. OP21 23(2)(b) 16. OP22 13(1)(b) 23(2)(n) 17. 18. 19. OP26 OP27 OP31 16(2)(k) 18(1)(a) 9(2) 10(3) bidet continuing to be covered by a plastic adhesive sheet for reasons which are unclear. The toilet roll dispenser is collapsed and needs repairing; the side of the bath exposing the stopcock needs to be replaced. A washer is needed for the dripping tap. The downstairs bathroom needs refurbishment around the sill area, bath panel and radiator shelf. Visibility strips must be stuck to the areas of home where there are sudden changes in flooring levels. (Previous timescales not met). The premises must be free of offensive odours. The manager must ensure that a part-time cook is employed. The incoming manager must attend necessary training to be suitably qualified. She must apply for registration to the Commission for Social Care Inspection. (Previous timescale not met) It is necessary for senior staff to ensure that handover records of the key points of the previous shift are kept and signed off by both the people involved. (Previous timescale not met). Formal recorded supervision must be given to staff at least 6 times a year. (Previous timescale not met). Risk assessments for safe working practices must be developed. (Previous timescale not met). Risk assessments must be carried out on all safe working practices and significant findings of the risk assessment recorded. (Previous timescale not met). 1/9/05 1/7/05 (with immediate effect) 1/8/05 1/8/05 1/8/05 20. OP32 12 18(1)c 1/7/05 21. OP36 24 1/7/05 22. OP38 12 1/8/05 23. OP38 13 1/8/05 Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 22 24. OP38 23(4) Fire drills must be reintroduced - 1/7/05 the last documented fire drill was 2002. The fire risk assessment must be 1/7/05 reviewed from the August 2002 version. (Previous timescale not met). 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. 2. Refer to Standard OP19 OP38 Good Practice Recommendations The kitchen remains in a tired state of repair. The planned refurbishment should take place. Monthly health and safety checks that have been discontinued should be restarted.. Carlton House G62-G11 S39315 Carlton House V226201 110505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex HA1 BH1 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. 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