Inspection on 24/08/07 for Carlton House

This inspection was carried out on 24th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Carlton House 06/09/06

Carlton House 01/11/05

Carlton House 06/06/05

Carlton House 19/01/05

Carlton House 26/07/04

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

CARE HOMES FOR OLDER PEOPLE Carlton House 44 St Aubyns Hove East Sussex BN3 2TE Lead Inspector Jennie Williams Unannounced Inspection 24 August 2007 10:30 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 DS0000014187.V345930.R01.S.doc Version 5.2 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 DS0000014187.V345930.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton House 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 01273 738512 Karenhoweone@yahoo.co.uk Macleod Pinsent Care Limited Karen Howe Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: The maximum number of service users to be accommodated is twenty five (25) Service users must be older people aged sixty five (65) years or over on admission Service users with a dementia type illness only to be accommodated. Date of last inspection 06 September 2006 Brief Description of the Service: Carlton House Rest Home is registered to provide care for up to twenty-five (25) older people with a dementia type illness. There is no nursing care provided at the home. District nurses will visit those residents requiring nursing input. The home is located in a quiet residential area of Hove. There is limited car parking at the rear of the home and restricted street parking is available on adjacent streets within the area. There are local amenities within walking distance and access to public transport is nearby. Rooms are located over four floors, with two mezzanine floors. There is a passenger shaft lift available at the home to assist those residents who are unable to mobilise on the stairs. This lift services the main floors. There are fifteen single rooms of which six have en suite facilities and five double rooms, of which three have en suite facilities. One single room is below ten square metres. There is one bathroom with an assisted bath, one wheel in shower and six toilets located throughout the home for residents. There is a dining room and good-sized lounge room for residents to use. There is another smaller lounge room at the rear of the building that provides access to the garden. Work is being done to the small garden area at the rear of the home to make this a safer and more user friendly area for residents. The weekly fees range between £417 and £677. There are additional costs for hairdresser, chiropody, newspapers, clothing and toiletries. This information was provided to the CSCI on 24 August 2007. Copies of previous CSCI inspection reports are available upon request at the home. Prospective residents and their relatives find out about the service through social service referrals, word of mouth or from living in the area. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. The Registered Manager confirmed that they use the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place over seven and a half hours on the 24 August 2007. Evidence obtained at this site visit and information that the CSCI have received since the last inspection forms this key inspection report. Eighteen residents were briefly spoken with at lunchtime and three were spoken with individually throughout the inspection process. Two care plans were viewed and specific areas of care were looked at in a further two care plans. The Registered Manager and five staff were spoken with throughout the site visit including; deputy manager, cook, maintenance person and two carers. Three staff files were viewed and training records inspected. Two visitors were spoken at the site visit. A tour of the environment was provided and some individual rooms were viewed, with the resident’s permission. Medication procedures were inspected. The quality assurance system was discussed and recent results viewed. Complaint records were viewed. Copies of the staff rota and menus were viewed. The procedures for dealing with residents personal allowances was checked. An Annual Quality Assurance Assessment (AQAA) was sent to the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. Health and safety records were not viewed as this information has been provided in the AQAA. There were twenty-two residents residing at the home on the day of the site visit. What the service does well: The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. Prospective residents are provided with opportunities to visit the home prior to moving in to ensure the home will meet their needs. Residents were complimentary about the staff working at the home and felt that their personal care needs were being met. Residents felt that their Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 6 privacy and dignity are respected. Routines of daily living are to the individual’s choice and preference. Activities are provided at the home that is within an individual’s choice, interest and ability. Visitors are welcomed at the home and residents may receive visitors in private. Residents were complimentary about the provision of food at the home and confirmed that an alternative is provided if an individual does not like the main meal on offer. Residents feel comfortable to make complaints, reassuring them that they are being listened to. Residents found their rooms to be comfortable and the home was clean and free from offensive odours. Staff receive training appropriate to their roles to ensure their safety and that residents needs continue to be met. Staff were observed to have a good professional rapport with residents and were heard to be calling them by their preferred term. Some of the comments received from residents were the staff are ‘very good’, ‘they are kind and nice’ and ‘wonderful’. Residents and staff benefit from supportive and approachable management within the home. What has improved since the last inspection? What they could do better: Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 7 There have been no requirements made at this inspection. Any minor shortfalls noted have been highlighted throughout the report of which the Registered Manager is already addressing or will address. The AQAA received from the home evidences that the home is working to improve the quality of the service provided at Carlton House Rest Home. It provides CSCI with information on areas that have been improved in the last twelve months and what their plans for improvement are within the next twelve months. The AQAA identifies that management have already identified areas in 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. The summary of this inspection report can be made available in other formats on request. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 8 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 DS0000014187.V345930.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 & 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: The home has a Statement of Purpose and Service User Guide that provide prospective residents with information about the facilities and services provided at the home. These documents are available upon request at the home. A copy of the Statement of Purpose was observed to be located by the front door of the home. All prospective residents are assessed prior to moving into the home. Relatives/representatives are involved in this process wherever possible. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 10 The pre admission assessments undertaken identifies good information on the assessed needs of the individuals and evidences that only those residents whose needs can be met are admitted. Information from other health professionals is obtained wherever possible. The deputy manager confirmed that there was no one residing at the home from any minor ethnic community or social/cultural groups with any specific needs or preferences. Prospective residents and their relatives are encouraged to visit the home prior to moving in. The first four weeks is a trial period. Some residents/visitors spoken with confirmed that they had visited the home prior to moving in. There is no dedicated accommodation to provide intermediate care. Respite care is available if there is a spare room. The home does not take emergency admissions. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the information provided in the care plans on the assessed needs of individuals and residents/representatives are provided with an opportunity to be involved in the reviewing process to ensure choice and preference is taken into account. Residents are generally safeguarded by the medication procedures in place. EVIDENCE: The care plan format has been amended since the last inspection. Care plans viewed provided clear guidance for staff on how to meet the assessed needs of the individuals. Staff felt that these were easier and clearer to understand. Specific areas of care were noted to be reflected in the care plan such as diabetes etc. Nutritional assessment and individual risk assessments for fire evacuation were included in the care plans. There is also a quick clear summary provided on an Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 12 individuals’ usual routines in relation to bed times, meals, activities, bathing preferences etc. Monitoring forms are in place for those residents where there may be concerns identified with their diet. There is evidence of residents/representative input into care plans. Signatures are obtained where possible and a form is signed advising if a family member does not wish to be involved in the reviewing process. Visitors confirmed that they or another representative are involved in the reviewing process of their relative’s care plan. There is a key worker system in place and any activities undertaken between key workers and residents are recorded. The Registered Manager confirmed that there is a daily routine rostered for carers that include one to one time with residents they are the key worker for. There were improvements noted in the daily records for residents, however further work is still needed. The Registered Manager confirmed this is an ongoing training need for staff. This has not been reflected as an outstanding requirement as work is continuing to be done to address this. A new form has been implemented for use when an individual needs to be transferred to hospital. This has received positive feedback from hospitals and ambulance crew. It was confirmed that advice is sought from specialist health professionals when the needs arise. A resident observed to be wearing glasses confirmed that they have access to an optician when the need arises. On viewing the quality assurance results undertaken by the home, it was noted that a GP survey had written ‘what I like is that your home is warm and friendly and kindness is shown to my patient’. The Registered Manager confirmed that there are policies and procedures in place for all aspects of dealing with medicines. The content of these were not read. Residents photos are on the front of each Medication Administration Record (MAR) chart to assist staff in the identification of each resident. Records are kept on incoming and outgoing medicines into/out of the home. A new form has been implemented to ensure that seniors check the MAR charts on a daily basis. MAR charts viewed demonstrated that medication is generally being signed for at the time of administration. Where it is written to administer one or two tablets, staff are not writing how many were administered. Two tablets were observed not to have been administered, however no information written to advise why these had not been given. No requirement or recommendation has been made in relation to these shortfalls as the Registered Manager can identify who was responsible for these errors and address this directly with the individual/s involved. There was no clear Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 13 information in place if prescribed creams were still in use or where these needed to be applied. The Registered Manager confirmed that she will address this. It is recommended as good practice that any handwritten prescriptions be double signed by two staff who have undertaken medication training. This is to safeguard staff and residents from errors occurring. The Registered Manager confirmed that all staff administering medication has received medication training and some staff are doing a 12 week long distance course on medication. Of the residents that were asked, all confirmed that they felt their privacy and dignity are respected. Staff were observed to have a good professional rapport with residents and were heard to be calling residents by their preferred term. Residents were observed to be clean and well dressed. Visitors also confirmed that their relative is always well kept and clothes are clean. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. EVIDENCE: Of the residents that were asked, all confirmed that they felt their lifestyle within the home is their own choice. Residents were observed to move freely within the home. Of the residents and staff asked, all felt there were sufficient activities provided at the home. Visitors spoken with confirmed that they felt there were enough activities at the home. A mini bus van is used to take residents out into the community. A list of resident’s names was noted to be on display in the two lounge rooms identifying which lounge residents prefer to sit in. It was confirmed by the deputy manager that this is just as a guideline for staff, however residents are able to move freely within the home. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 15 Visitors are welcomed and encouraged to visit the home. There are no time restrictions imposed for visitors. Visitors spoken with confirmed that they are always welcomed at the home. Residents are able to receive visitors in private. New menus have been devised between the Registered Manager and the cook, using information obtained from when observing residents meal times over a period of time to ascertain individual preference. Residents are provided with a choice in meals. The Registered Manager confirmed that there are no restrictions to the provisions of food. A couple of residents, who due to their dementia type illness may forget that they have eaten. When these residents claim they have not eaten, another meal is provided for them. The Registered Manager confirmed that it is better for staff to provide an extra meal, than cause distress for the residents. Residents are weighed at least monthly and nutritional assessments are undertaken for all residents. Residents were complimentary about the food provided at the home. Comments ranged from ‘good’ to ‘food fantastic’. Residents were observed to be enjoying their lunchtime meal. Lunchtime was observed to be a social time, with discussions and laughter heard between residents and with residents and staff. Staff were observed to be nearby to offer discreet assistance if needed. The cook confirmed that they have a list of residents’ likes and dislikes in relation to food. Residents confirmed that they are provided with a choice in meals and a comment received from a resident was that ‘the food is fantastic’. A visitor commented that there appears to be a lot of food on offer for supper. Another visitor confirmed that they have not eaten at the home, however commented that meals looked fine. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents feel comfortable to complain, reassuring them that they are being listened to and that action will be taken, if necessary. Safeguarding Adult procedures and the training of staff ensure residents are safeguarded. EVIDENCE: The home has a complaints procedure in place. The AQAA identifies that there have been five complaints made to the home in the last 12 months. Four were complaints and one was dealt with through the Safeguarding Adults procedures. Records are kept of complaints and copies of correspondence are maintained. Complaints are dealt with in an unbiased procedure. The Registered Manager has implemented a complaints summary page to easily monitor the number and outcome of complaints. The complaints received were regarding a resident saying that they had not had breakfast, relatives not happy with their relative remaining in bed and another resident not attending church. All were unsubstantiated. Records demonstrate that appropriate action was taken to address these issues. Of the residents that were asked, all confirmed that they would feel comfortable to make a complaint. Visitors spoken with confirmed that they would feel comfortable making a complaint and feel that action would be Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 17 taken. One relative confirmed that any problems they have identified have been immediately addressed. There has been one Safeguarding Adults investigation undertaken in the last 12 months. The Registered Manager confirmed that this was unsubstantiated, however identified the importance of how staff relay information to relatives/representatives. Staff spoken with confirmed that they have received training in the Safeguarding Adults procedures. The AQAA identifies that there are policies and procedures in place for Safeguarding Adults. The content of these were not read. A resident sitting in a lounge room was observed to be trying to move a table that had been put in front of her. She was unable to do this. This was discussed with the Registered Manager on the day of the site visit. It was confirmed that the table was placed there to assist the individual to easily access her tea/coffee and is usually placed to ensure that residents are able to move them. It was discussed that she remind staff to be conscious of how these tables are left in position, as it may be seen as a form of restraint. The AQAA identifies that there no incidents of restraint needed in the last 12 months. The home has been pro active and has commenced obtaining information and training for the changes within the Mental Capacity Act. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. EVIDENCE: Rooms are located over four floors, with two mezzanine floors. There is a passenger shaft lift available at the home to assist those residents who are unable to mobilise on the stairs. This lift services the main floors. The Inspector viewed some individual rooms that were seen to be personalised to reflect the personality of the individual. Work is currently being done to the small garden area at the rear of the home to make this a more pleasant and safer environment than previously. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 19 The home had previously had problems with the heating and hot water provisions within the home. The Registered Manager confirmed that a new boiler system and central heating system has been installed. There is a full time maintenance person employed at the home and the home and equipment in use is regularly checked to ensure they are kept clean and in a good state of repair. The maintenance person confirmed that he has enough equipment to undertake his duties effectively. The Registered Manager confirmed that equipment is replaced where necessary. There is a hoist available at the home, but the Registered Manager confirmed to the Inspector following the site visit that they have been advised by a moving and handling trainer not to use this. A staff member spoken with confirmed that if a resident was to have a fall, they call the ambulance service. The home needs to be aware that ambulance crew must follow the home’s policies and procedures in relation to manual handling. The Registered Manager confirmed that they will be purchasing a new hoist, however are obtaining information to ensure that correct type is purchased. Work has been done since the last inspection to improve the standards of furnishings and cleanliness within the home. Some areas were noted to have new curtains, flooring and furniture in place. The Registered Manager confirmed that brochures were shared with the residents to choose their own furniture and provided with an opportunity to choose their own color schemes for their individual rooms. The home was clean and free from offensive odours on the day of the site visit. The home has placed alcohol gel by the front door to encourage people to use this on entering and leaving the home to assist in promoting infection control. The Registered Manager confirmed that this has received positive comments from visiting health professionals. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the skill mix of staff on duty and are safeguarded by the recruitment procedures in place. The recruitment of additional staff will assist in ensuring staffing numbers are consistent. EVIDENCE: Residents were complimentary about the staff working at the home and most felt that there were sufficient numbers of staff on duty. Comments received about the staff were ‘very good’, ‘they are kind and nice’ and ‘wonderful’. Staff spoken with confirmed that at times they feel there are not enough staff on duty. This may be due to staff holidays, illness or staff vacancies. It was confirmed that the home is currently recruiting two additional staff member from overseas to assist in ensuring staffing numbers are more consistent. There are sufficient numbers of domestic staff employed at the home. The Registered Manager confirmed that the staff currently working at the home are very supportive, however there are problems with recruiting and retaining staff. Visitors spoken with confirmed that they find the staff friendly, knowledgeable and in their opinion feels that there are enough staff on duty at the times they Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 21 visit. Visitors were complimentary about the staff in how they support residents and have noticed a good rapport between the staff and residents. On viewing the home quality assurance system results, some comments written about the staff from relatives were; ‘I’ve always found the staff very helpful and they always have the time to talk to you’ and ‘We couldn’t ask for more. Staff are excellent and we hope mum doesn’t ever have to move from the home. Everything well organised, very friendly staff who care for the patients’. The deputy manager confirmed that there is usually three carers working in the morning, two to three in the afternoons. There is a senior carer also working on both these shifts. There are two carers that work a waking night. The AQAA identifies that there are 14 permanent care staff employed at the home of which five have National Vocation Qualification (NVQ) level 2 or above and a further seven staff are working towards achieving these qualifications. Staff files viewed identified that there are robust recruitment procedures in place. The Registered Manager confirmed that a new application form is currently being implemented. References are obtained and a Protection of Vulnerable Adults (POVA) First check is obtained prior to a carer commencing employment. The Registered Manager confirmed that staff commencing work prior to a full enhanced Criminal Record Bureau (CRB) being received are supervised. New staff work three to four days shadowing another worker and are not counted in the numbers of staff working with residents. Staff spoken with confirmed that they are provided with training relevant to their roles and are generally kept up to date with all mandatory training. Where mandatory training may have lapsed, there was evidence that updated training is being arranged. There was evidence that new staff undertake an induction programme that complies with the Common Induction Standards set by Skills for Care. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff and residents benefit from a well managed home and the quality assurance system in place ensures the home is run in the best interest of residents. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. EVIDENCE: The Registered Manager has been working at the home since approximately August 2006 and is registered with the CSCI. The Registered Manager has had managerial positions throughout her working career in a variety of care settings. She has obtained the NVQ level 4 in care and has completed the Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 23 Registered Manager Award course. Staff spoken with found the manager to be approachable and supportive. It was confirmed that changes she has made within the home since commencement have all been positive for the benefit of the residents and staff. The Registered Manager was very complimentary about the registered providers and stated ‘couldn’t ask for better employers’. It was confirmed that they are very supportive and there are clear lines of accountability within the home and with external management. The Registered Manager should be commended on the effort she has made to develop and implement a clear structured quality assurance and quality monitoring system to enable all people within the home to have their say. Surveys for residents have been implemented that are user friendly. Cartoon facial expressions are on the surveys to assist residents in answering questions about the care they are provided with at the home. The Registered Manager confirmed that different residents on a monthly basis complete these. The Registered Manager confirmed that she proposes to vary the survey every six months and that residents have enjoyed in participating in this process. Feedback is sought from relative/visitors and visiting health professionals. An analysis of surveys for the past six months is displayed by the front door so all people interested in the home can view the results. Written comments provided to the home have been used in the various sections of this report. Records are kept of who has been offered a survey for completion. Staff surveys have been developed and implemented and the AQAA identifies that the Registered Manager has taken action on issues identified in the staff feedback. There is a suggestions box located within the home that allows anyone to raise any issues anonymously. Staff meetings are held every three months. Meetings are held with the residents, albeit these are not formal. The Registered Manager has implemented forms and delegated some regular monitoring within the home to staff. The Registered Manager stated that every month she undertakes a health and safety audit and an audit of individual rooms. The Registered Manager confirmed that she is being proactive in developing other audit forms to assist in the monitoring of the running of the home for use next year to assist in completing the annual AQAA that will be required by CSCI. The financial viability of the home was not assessed on this occasion, however the registered providers have given no cause of concern regarding the financial viability to date. The Registered Manager confirmed that she manages the budget for Carlton House Rest Home. No representative of the home is an appointee for any of the residents. Residents/representatives have made their own arrangements for dealing with Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 24 residents finances. The home securely holds the personal allowances for residents. There are clear records kept of individual’s monies and receipts are kept of any financial transactions. Personal allowances checked evidenced that accurate records are being maintained. Health and safety records were not viewed. Staff confirmed that they have received fire training and that regular fire drills are undertaken. As previously mentioned, each individual resident has a risk assessment in place to assist people with information if the evacuation of the home is required in an emergency. The AQAA identifies that equipment in use has been tested or serviced as recommended by the manufacturer or other regulatory body and that all relevant policies and procedures are in place. Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 25 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Carlton House DS0000014187.V345930.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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