Inspection on 21/09/05 for Carlton House

This inspection was carried out on 21st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Carlton House 26/08/08

Carlton House 03/07/07

Carlton House 04/05/06

Carlton House 11/05/05

Carlton House 12/01/05

Carlton House 11/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Carlton House Carlton House 2 The Avenue Hatch End Middlesex HA5 4EP Lead Inspector Clive Heidrich Unannounced Inspection 21st September 2005 09:20 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 DS0000039315.V252032.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Carlton House Address Carlton House 2 The Avenue Hatch End Middlesex HA5 4EP 020 8428 4316 020 8907 5777 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) Farrington Care Homes Ltd Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th May 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 two vacancies in the home at the time of inspection. The home is owned by the Nathwani brothers of the Farrington Care Homes Ltd organization. The organization owns two other homes in the local London region, and a number of other homes outside of this region. 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 reasonably-sized garden. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across a cool day in September. It lasted until 6:10pm. The inspector met with nine service users who could provide varying amounts of verbal feedback during the visit. Two visitors also provided feedback. Issues were also discussed with staff and the acting manager, some records were checked, care practices were observed, and most of the home’s environment was inspected. The acting manager was present until midafternoon when she had to leave to attend an appointment for enrolment on a management course. After this the shift-leader provided assistance where needed. The inspector thanks all at the home for their patience and helpfulness throughout the inspection. What the service does well: What has improved since the last inspection? The home is now generally up-to-date with the ongoing reviewing of service users’ care plans. A few maintenance issues have been addressed, and many service users are starting to benefit from new furnishings in their rooms. There are additionally now no significant odour control issues. The home has a new cook, in addition to the one already employed. This allows for a cook to be present for seven days a week. There is also a food choice system for service users, and feedback from service users about the food was encouraging. The home is now complying with its responsibilities in terms of fire safety. Carlton House DS0000039315.V252032.R01.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 DS0000039315.V252032.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5. Prospective service users or their representatives may visit the home in advance. Their needs are assessed by members of the management team prior to moving into the home. Contracts are set up with service users or their representatives soon after moving into the home. EVIDENCE: Some service users were able to state that someone, generally a family member, had visited the home on their behalf before they moved in. Individual care files contained pre-admission assessments by management figures within the organisation using the organisations standard assessment form. Some also had external professional assessments. Individual care plans that relate closely to the pre-admission information are set-up once the service user moves into the home. A separate file for contracts was in place. Checks of these found them to be generally signed off by the service user or their representative, and by a senior figure from the organisation. Social services contract details were also available where applicable. Carlton House DS0000039315.V252032.R01.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, 8, 9, and 10. Service users’ needs are, with one exception, adequately set out within a plan of care. Risk management strategies around health issues must be improved on, but health concerns are otherwise addressed. Minor improvements are needed to the medication systems in the home. Service users reported being treated well by caring staff. Observations mostly supported this. EVIDENCE: Service users all reported that staff treat them well, and that privacy is upheld. Many service users were however not able to give clear verbal feedback for reasons of ill-health. Most service users were well-dressed in suitable clothing. Hair and nail care was suitable. Staff were mostly seen to interact in a friendly manner with service users. Some poor practice was however observed. One manual transfer of a dependent service user from a wheelchair to a chair was without the wheelchair brakes being on and was essentially the lifting of the service user. One service user was left from the mid-morning snack until at least after lunch before their food-stained clothing was changed. It is also noted that many staff have not had NVQ training, or other formal training in Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 10 what appropriate values should be for providing care. Management must address these issues. Three care plans, of service users who have moved into the home in 2005, were checked through. Standard organisational formats are used. The plans are mostly adequate in terms of highlighting the key needs of service users and how staff should address them. Improvements are needed in the area of toileting needs and in fully recording about the support to be provided here. Monthly reviews of the plans were mostly taking place as required, and included about any key changes to the care. Risk assessments within the care planning and monitoring process are judged as simplistic and ineffective. The care-planning format prompts only for comments on falls and handling, which are consequently only recorded about very briefly and with little exploration of individual needs and actions to reduce risks. A number of staff have attended detailed risk-assessment training but this is not evident from the care records. During the visit, there were generalised risks to service users from such things as heavy doors, slight changes in the floor level, and a lack of staff presence in any lounges earlier in the morning, as well as specific risks to certain service users from such things as loose wires from a pressure care mattress. More generally, these standards specifically also recommend the use of nutritional and activities-of-daily-living assessments. Management must ensure that there is evidence of more detailed risk assessing of service users’ needs on an ongoing basis, so that appropriate preventative actions can be taken. Some useful monitoring systems are in place in addition to individual daily records and a handover book. These include individual records of falls within care files, elimination support records, and records of visits of health professionals. There was evidence with all of these to suggest that they are not always used when they should be. This must be addressed, to make their monitoring use accurate. Monthly weight records of service users are being kept. Where any service user is not able to weight bear and so be weighed, it is recommended that alternative methods of gaining weight, such as through a weighing chair, be considered. Records, observations and feedback did suggest that service users’ health needs are addressed, including through the acquisition of community health professionals where needed. The home’s medication systems were briefly sampled. Records of administration were generally up-to-date. Storage was appropriately secure. A few issues are highlighted for improvement within the requirements list below. The home has also benefited from a number of senior staff completing a distance-learning medication course. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, and 15 Recreational and religious needs of service users are not sufficiently supported by the home. Contact with friends and family is however encouraged and supported. Service users fedback positively about the food provided. Choice is provided. Nutrition is sufficient. EVIDENCE: Service users generally spoke highly of the food provided in the home. They reported that they receive enough food, that they are asked what their choice is from the choices on offer, and that they receive regular snacks and drinks. Snacks were provided during the inspection, and a number of service users had cold drinks available within arms’ reach for a lot of the time. One visitor noted that a lot of fruit is used for snacks. Observations and records showed that the individual needs of service users are catered for, for instance in terms of diet restrictions, support with eating, and having meals blended for ease of swallowing. Service users also now benefit from there being a designated cook working seven days a week. One service user mentioned that the menus are bland. On checking the previous weeks choices, it was found that there is little variation from certain set meals, despite the choices available. The evening meal in particular was Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 12 too often a choice of soup and sandwiches or a grilled convenience food with baked beans. Checks of the kitchen found fresh fruit and vegetables being used within the cooking, hence it is felt that the meals are nutritionally sufficient. Management are hence recommended to audit the views of service users about what they like about the meals, what could be improved, and what additional meals they would like to be served, so that this feedback can be incorporated into the menus. Service users spoke positively about how welcome their visitors are made to feel. Privacy is provided for these visits. Some service users go out with the support of their family, whilst one service user is judged as safe to go out by themselves. Service users benefit from the regular visits of three different activity people. However, on other days of the week, activities are judged as scarce according to feedback and records. There appear to be few care staff who undertake activities with service users. The management must ensure that activities are provided daily for service users, regardless of whether external or through care staff. Care staff may benefit from receiving specific training in this respect. Evidence of attempting to meet service users’ religious needs is also required, as there was no record of the active involvement of any faiths in the home. From the start of the inspection, the home felt very warm. Throughout the morning in particular, it was noticed that many service users were dozing. As above, there was little in the way of stimulation for service users during the morning. The management are recommended to consider whether heating levels adversely affect service users. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 13 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 Minor improvements are needed to ensure that evidence points towards complaints being taken seriously. EVIDENCE: Feedback from service users found that they were confident that their complaints would be listened to and acted upon by staff. A complaints notice was on display on the notice board in the entrance hall. The shortfall refers to the half-filled-in complaint form that was within the complaints folder, as the form does not show how this minor issue raised by a service user was addressed. It also remains for the complaints policy on file to include page 4 of its procedure. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. The home is kept adequately clean and hygienic. Communal living areas are generally well-maintained. Most bedrooms are safe and comfortable. A number of concerns arose about the maintenance of the bathrooms and toilets, as there was only one bathroom available to service users at the time of the inspection. Some other maintenance issues were also present. Additionally, some work previously required to minimise risks to service users remains to be addressed. Service users are in general supported to have the specialist equipment that they need for their mobility. EVIDENCE: The acting manager pointed out two major maintenance issues during the inspection. One bedroom’s radiator was leaking, making the carpet sodden and causing a small part of the wall in the bedroom underneath to be wet. The shower room was closed off from use due to part of its panel ceiling having caved in, also due to a water leak from the bathroom upstairs. Additionally, Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 15 the poor décor issues of these two rooms, as highlighted at the last inspection, remained to be addressed. All of these issues were put to the directors of the company by letter straight after the inspection, and their response at this stage has been co-operative. Service users raised little concerns about the environment, all finding their bedrooms for instance to be sufficient. One service user enquired about having their bedroom furniture moved around to better meet their mobility needs, which the acting manager agreed to look into. Many items of bedroom furniture were seen to have been recently updated, and a few rooms were seen to have been redecorated. There were no significant concerns about offensive odours during this visit. Standards of cleanliness during the visit were adequate. It is recommended that the yellow bin system be improved by the addition of bins with pedals, so that hand contact to open the bin becomes no longer necessary. This would minimise infection control risks. Lounges and hallways were seen to be in a pleasant but worn state of repair. There are too many areas where wallpaper has been torn off. This must be addressed, to ensure that the environment remains homely. A majority of radiators in the home lacked guards. Whilst some were at low temperatures, others were scalding to the touch. It remains for this to be addressed, to minimise risks to service users. The step to the main entrance of the home lacked a number of tiles and a secure rim, which may cause injury to anyone using the step. This must be addressed. Other maintenance issues include: • For there to be a soap dispenser, or loose soap, at the handwashing sink in the laundry room. • The kitchen requires general upgrade due to wear and tear. In particular, the cold tap at the handwashing sink in the kitchen must be fixed and made workable again, and the missing cupboard doors must be re-fitted. • For the loose hot tap in room 6 to be made secure. • For the floor in the downstairs toilet opposite the office to be levelled, have the stain removed, and be sealed around the base of the toilet. • For the blind in the downstairs bathroom to be re-fitted as it had fallen off. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 16 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. Reasonable staffing levels are mostly provided in the home. Minor improvements are needed. A number of staff have many years’ experience of working in the home, which enables them to provide established care routines for individual service users. Training improvements are needed, principally in ensuring that the majority of staff have the overall care knowledge that NVQs provide. Some improvements are needed to ensure that the recruitment procedures are sufficiently robust. EVIDENCE: Feedback about the staff, from service users and some visitors, was positive. Staffing levels were reported by service users to be sufficient. The roster for the week showed that reasonable levels are upheld except in two minor respects. These are that the acting manager continues to work senior care shifts throughout the week (instead of another carer working these shifts and the acting manager doing management work), and that there are some shortfalls in terms of people rostered to clean the home, both through sickness and at weekends. These two issues must be addressed, so that appropriate numbers of all grades of staff are present to enable service users’ overall needs to be fully met. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 17 Due the amount of significantly dependant service users in the home, it is recommended that management use a professional assessment form to justify, or adjust, their staffing levels. The roster shows a low level of staff turnover. Many staff have worked in the home for a number of years, which is to the benefit of service users in terms of these staff members’ overall knowledge of how the home operates and what individual service users’ routines are. One staff member has started work at the home since the last inspection. The acting manager confirmed that recruitment, to fill the small amount of identified staffing vacancies, is ongoing. Checks of a couple of recently-appointed staff member’s recruitment files were made. One file has appropriate pre-employment checks. The other lacked a second written reference and a clear Criminal Record Bureau (CRB) outcome for this employment. This was put in writing to management for immediate action. Management must ensure that all recruitment checks required under law are in place before staff start working in the home, to ensure that service users are protected from the potential for unsuitable workers from being employed. It was not possible to audit the training files of staff on this visit. Feedback from staff found that some staff have attended in recent years lengthy courses in medication, protection of service users from abuse, and risk assessment, and that all staff received refresher moving and handling training this year. A few staff were due to attend an infection control course shortly. Feedback found that only a few staff have qualified, or are pursuing, the NVQ level-2 (or above) in care. This would not meet the national minimum standard of 50 of care staff having such training, a standard that provides documented evidence of the staff team having knowledge of good care practices. Management must address this. It is further recommended that the training records of staff be audited, to ensure that they have up-to-date training in key areas (1st aid, health and safety, moving and handling, fire safety, food hygiene, protection of adults from abuse, and the needs of older people) and to take action where there are shortfalls. The acting manager was aware of the need for further staff training. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. This home is currently not being appropriately managed, as there are many shortfalls in areas where clear management from a permanent manager would have addressed issues. Service users are not benefiting from any clear leadership in the home, despite the good intentions of the people working there, and hence service users’ best interests are not always being served. Record keeping in respect of money kept within the home on behalf of service users is poor. The home is therefore unable to fully demonstrate that they are safeguarding service users’ financial interests. There was insufficient evidence of staff being appropriately supervised. Standards of record keeping and of health and safety do not fully safeguard service users’ best interests. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 19 EVIDENCE: The home appointed an acting manager from within the staff group in late August. The acting manager was present during the first half of the inspection, then had to leave to enrol onto an NVQ management course. She has already worked as a senior in the home for a number of years, and has almost completed the necessary training to become a registered nurse. This represents good experience and a plan to gain appropriate qualifications. There were a number of issues within the home that suggest that its management is yet to have a sufficiently influential effect on improving the standards of care for service users. For instance, the significant amount of maintenance issues (see standards 19-26), whilst reported, had not been addressed. There was little evidence of staff supervision except for within the minutes of the couple of team meetings held in the last six months. There was evidence, from feedback and records, that communication between staff does not always occur sufficiently well. The owners must ensure that the acting manager is given a full induction into her responsibilities, that she works mainly in addition to the care staff rostered, and that she is supported to undertake the necessary training for the role. Additionally, it remains for the monthly reports into the care being provided in the home, a legal requirement on all care homes, to be formally sent to the CSCI. The acting manager was not able to provide much evidence under the quality assurance standard (#33). The home clearly operates a lot on verbal feedback from service users, and their friends and relatives, in this respect. However, there does not appear to be any formal procedure for auditing and reviewing the overall feedback, particularly when standards of communication amongst staff need improving. Management must provide an open report, available to all service users and their representatives, of the feedback about the care in the home and how any shortfalls will be improved. A similar but separate project amongst the homes staff team, that also looks at employment issues, is highly recommended in terms of staff communication and morale. As noted under standards 7-11, there were some shortfalls in record-keeping, in terms of ensuring that sufficient records are kept. It must also be ensured that private information, such as those referring to service users’ toileting support, are kept sufficiently confidential and not close to the visitors’ book in the entrance hall. The records of service users’ money as held within the home were found to need improvements. This was put to the owners by immediate action letter after the inspection. Their responses have been very robust, and whilst acknowledging the necessary improvements to records within the home, have also shown good standards of records keeping about service users’ money within the head office. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 20 Standards of fire safety were generally strong. The fire records showed that fire checks are undertaken by staff weekly, emergency lighting monthly, fire drills quarterly, and that there are now regular internal training sessions. The fire risk assessment was updated in March 2005. It is recommended that it also consider about service users’ needs, and about fire doors, in the event of a fire. Professional checks of the fire systems were up-to-date. The local fire authority visited in August 2005 and found standards to be satisfactory. Hot water temperature checks are internally recorded about monthly. Suitable equipment for this purpose was seen. Thermostats are fitted to these taps to ensure that hot water is released from taps at a suitable temperature. The thermometers in the fridges were however reading very high temperatures and may be broken. It is recommended that they be replaced by equipment approved by the local environmental health department. The cupboard that holds cleaning liquids was not locked during the tour of the home. To minimise risks of service users inappropriately using these liquids, it must be kept locked at all times. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 21 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 1 3 1 2 X 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 2 1 2 1 Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 22 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. Standard Regulation Requirement Risk assessments of service users individual needs lacked detail and ongoing review. This must be addressed. (Previous timescales of 1/3/05 and 1/7/05 not met). Plans for providing individual continence care to service users must be written (as part of each applicable service users’ individual plan). Timescale for action 1 7 13(4), 15 01/07/05 2 8 12(3), 13(1)(b) 01/08/05 3 8 17(1)(a) schedule 4 4 9 13(2) (Previous timescales of 1/10/04 and 1/8/05 not met). Individual care monitoring records, such as falls summaries, elimination support records, and 01/11/05 summary records of the visits of health professionals, must be kept fully up-to-date. Opened liquid medicines must have a date of opening recorded on them so that they can be disposed of after an appropriate 01/07/05 time. (Previous timescales of 1/3/05 and 1/7/05 not met). Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 23 5 9 13(2) The homes medication policy must include about how to manage service users who have swallowing difficulties. (Previous timescales of 1/8/04 and 1/8/05 not met). Excess prescribed creams must be returned to the pharmacist, not left stored in the office. The signatures used by staff to sign for the medication must tiein with those on the list of staff that give medication. Management must ensure that all staff receive refresher training in appropriate care practices, values training, or care NVQ training, to evidence that care staff have had appropriate training in providing care. Management must ensure that service users are treated respectfully at all times. Management must ensure that activities are provided daily for service users, regardless of whether through external people or care staff. Activity book records must support this. Evidence of attempting to meet service users’ religious needs is required, as there was no record of the active involvement of any faiths in the home. All complaints at the home must be fully recorded about and addressed, not left half recorded about. The complaints policy in the office must be completed by the inclusion of page 4. The radiator in room 8 must be repaired to prevent any further leakage of water. DS0000039315.V252032.R01.S.doc 01/08/05 6 9 13(2) 01/11/05 7 9 13(2) 01/11/05 8 10 12, 18(1)(c) 01/05/06 9 10 12(4) 01/11/05 10 12 16(2)(n) 01/11/05 11 12 16(3) 01/12/05 12 16 22 01/11/05 13 19 23(2)(b, c) 01/10/05 Page 24 Carlton House Version 5.0 14 19 23(2)(d) 15 19 13(4), 23(2)(b, o) 23(2)(b) 16 19 17 19 23(2)(b) 18 19 23(2)(b) 19 21 23(2)(b) 20 21 13(4) 23(2)(n) Any damage issues for the carpet and the walls affected by the leak (including in the room below) must be suitably and promptly addressed. Lounges and hallways must be redecorated where wallpaper has been torn, to ensure that the environment remains homely. The step to the main entrance of the home lacked a number of tiles and a secure rim, which may cause injury to anyone using the step. This must be addressed. The kitchen requires general upgrade due to wear and tear. In particular, the cold tap at the handwashing sink in the kitchen must be fixed and made workable again, and the missing cupboard doors must be refitted. The loose hot tap in room 6 must be made secure. The floor in the downstairs toilet opposite the office must be levelled, have the stain removed, and be sealed around the base of the toilet. The lock and door for the upstairs bathroom must be replaced to ensure privacy and ensure that it can be overridden in case of emergency. (Previous timescales of 1/9/05, and of 1/11/04 for the lock, not met) The plastic cover on part of the upstairs bath is now significantly flaked and torn. It must be removed, and any underlying cause of its presence promptly addressed. The upstairs bathroom has a large part of the bath and the DS0000039315.V252032.R01.S.doc 01/12/05 10/10/05 01/02/06 01/11/05 15/10/05 01/11/05 01/09/05 21 21 23(2)(b and d) 23(2)(b) and (d) 23/09/05 22 21 27/09/05 Page 25 Carlton House Version 5.0 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. (Previous timescales of 1/9/05, and of 1/11/04 for the plastic sheeting, not addressed). The bath itself is not fully draining this water, as the plughole stays slightly overflowing. This must also be addressed. The shower room downstairs has had parts of its ceiling fall in due to a leak from the upstairs bathroom. 23 21 23(2)(b, c, and j) Both of these rooms were unavailable for service users’ use at the time of the inspection. These issues must be fully addressed. 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. 01/11/05 The room must be redecorated to provide a pleasant and safe setting. (Previous timescales of 1/11/04 and 1/9/05 not met). The downstairs bathroom needs refurbishment around the toilet sill area. (Previous timescale of 1/9/05 not met). Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 26 27/09/05 24 21 23(2)(b) and (d) 25 21 23(2)(b) 01/11/05 26 21 23(2)(b) 27 22 13(1)(b) 23(2)(n) The blind in the downstairs bathroom must be re-fitted as it had fallen off. Visibility strips must be stuck to the areas of the home where there are sudden changes in flooring levels. (Previous timescales of 1/9/04 and 1/7/05 not met). All radiators in the home must be covered or replaced with lowsurface temperature models. (Previous timescales of 1/11/04 not met). There must be a soap dispenser, or loose soap, at the handwashing sink in the laundry room. The care and senior staff roster must ordinarily be staffed by care and senior staff. The manager must ordinarily work superfluous to these rosters. Minimum levels of domestic staff must be adhered to, including at least one such staff working at the weekend and for long-term sickness to be covered. 50 of care staff must have achieved the NVQ level-2 (or above) qualification in care within the prescribed timescale. 15/10/05 01/07/05 28 25 13(4), 23(2)(n) 01/11/04 29 26 16(2)(j) 01/11/05 30 27 18(1)(a) 15/10/05 31 28 18(1)(c) Where this is no longer possible in practice, a written plan to address the issue must be made available to the CSCI. The owners must ensure that no staff start work until both written references are suitably in place, the CRB check is sent off, and the POVAFirst check is received. The incoming manager must attend necessary training to be suitably qualified. DS0000039315.V252032.R01.S.doc 31/12/05 32 29 19(1)(b) schedule 2 23/09/05 33 31 9(2) 10(3) 01/08/05 Page 27 Carlton House Version 5.0 She must apply for registration to the Commission for Social Care Inspection. (Previous timescales of 1/8/04, 1/1/05, and 1/8/05 not met) The owners must ensure that the acting manager is given a full 01/11/05 induction into her responsibilities. Monthly proprietors’ reports about the home must be sent to the CSCI without undue delay. 01/11/05 (Previous timescales of 15/3/05 partially met) Service user meetings, as per the homes Statement of Purpose, must be held. (Previous timescales of 1/10/04 and 1/8/05 not met). Management must provide an open report, available to all service users and their representatives, of the fullyaudited feedback about the care in the home and how any shortfalls will be improved. A copy of the report must also be sent to the CSCI. For any money that is looked after on behalf of service users within the home, clear and transparent records of dates and amounts involved in receiving any money, spending any money, and returning any money to the service user or their representatives, must be kept in an appropriate format. An ongoing balance must also be kept, that must tally with the amount of money actually being stored. Formal recorded supervision must be given to staff at least 6 DS0000039315.V252032.R01.S.doc 34 32 9(1), 10(3) 35 33 26 36 33 12(3) 16(1) 01/08/05 37 33 24 15/12/05 38 35 17(2) sch 4 part 9 01/11/05 39 36 24 01/07/05 Page 28 Carlton House Version 5.0 times a year. (Previous timescales of 31/1/04 and 1/7/05 not met). It must be ensured that private service user information, such as the book referring to service users’ toileting support, is kept sufficiently confidential and not close to the visitors’ book in the entrance hall. Risk assessments must be carried out on all safe working practices and significant findings of the risk assessment recorded. (Previous timescales of 31/1/04 and 1/8/05 not met). 40 37 17(1)(b) 01/10/05 41 38 13 01/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard 7 Good Practice Recommendations Ensure that the current main needs of each service user, and how these will be addressed, are clearly available and easily accessible within care plans (and hence are not just available within other sections of the care files such as pre-admission records or daily records). That each service users’ individual plan highlights a few key and individual objectives that are to be pursued by each service user and staff across coming months, and that this is regularly reviewed for effectiveness. The use of assessment forms for such things as nutrition and activities-of-daily-living is recommended. Where any service user is not able to weight bear and so cannot be weighed, it is recommended that alternative methods of gaining weight records, such as through a weighing chair, be considered. Key care staff may benefit from receiving specific training in respect of providing activities to service users. An advertised weekly plan of activities, for service users, is DS0000039315.V252032.R01.S.doc Version 5.0 Page 29 1 2 3 4 5 6 7 8 8 12 12 Carlton House 7 12 8 15 9 10 11 26 26 27 12 30 13 33 14 15 16 38 38 38 recommended. Management are recommended to consider whether heating levels in the home adversely affect service users’ alertness. Management are recommended to audit the views of service users about what they like about the meals, what could be improved, and what additional meals they would like to be served, so that this feedback can be incorporated into the menus. It is recommended that the yellow bin system be improved by the addition of bins with pedals, so that hand contact to open the bin becomes no longer necessary. This would minimise infection-control risks. That the laundry room would benefit from being repainted, to address the blistering paintwork on its walls. Due the amount of significantly dependant service users in the home, it is recommended that management use a professional assessment form to justify, or adjust, their staffing levels. It is recommended that the training records of staff be audited, to ensure that they have up-to-date training in key areas (1st aid, health and safety, moving and handling, fire safety, food hygiene, protection of adults from abuse, and the needs of older people) and to take action where there are shortfalls. It is recommended that management audit the views of the staff team, both from a care service and from an employment perspective, report the overall findings to the staff team, and plan to make improvements. It is recommended that the fire risk assessment also consider about service users’ needs, and about fire doors, in the event of a fire. It is recommended that the thermometers in the fridges be replaced by equipment approved by the local environmental health department. The monthly written health and safety checks that have been discontinued should be restarted. Carlton House DS0000039315.V252032.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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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