Inspection on 26/08/08 for Carlton House

This inspection was carried out on 26th August 2008.

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

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 03/07/07

Carlton House 04/05/06

Carlton House 21/09/05

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 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Carlton House Carlton House 2 The Avenue Hatch End Middlesex HA5 4EP Lead Inspector Clive Heidrich Key Unannounced Inspection 10:30 26th August 2008 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.V364425.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 DS0000039315.V364425.R01.S.doc Version 5.2 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 Jayaliya Gunatunga Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 24 3rd July 2007 Date of last inspection 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. It is owned by the Farrington Care Homes Ltd organization, a privately-owned company. The organization owns two other homes in the local London region, and is expanding 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 away. 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 residents is provided on the ground and first floors. Access upstairs is by 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. It has three interconnecting lounges and a dining room. At the rear there is an accessible garden. The Service User Guide, which details the services provided by the home, is available for viewing within the entrance hall. There was one vacancy at the time of the inspection. Prices for the home range from £460 to £547 a week. Additional charges include for such things as the visiting hairdresser, private chiropody, and personal phone lines within bedrooms. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place to consider the overall quality of service experienced by people at the home, and to check on compliance with requirements from the last inspection. To enable this process, the service was first requested to complete an Annual Quality Assurance Assessment (AQAA) well in advance of the inspection. This provides the service with the chance to explain how it meets the National Minimum Standards. This pre-inspection paperwork was returned to the CSCI in reasonable time. We also sent the manager a number of surveys to distribute to people involved in the home. We consequently received surveys from six people living in the home, sixteen relatives and advocates, four health professionals, and fourteen staff. The views from surveys were generally very positive. They have been incorporated throughout this report. We were supported by an Expert-by-Experience during part of the inspection visit. An Expert-by-Experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with us to help get a picture of what it is like to live in or use the service. The Expert-by-Experience spent over two hours engaging with residents. They provided a report of their findings to us shortly after their visit, aspects of which we have used within this report as evidence to support our judgements. The inspection visit lasted for seven hours in total. During this period, we met with people who live in the home, staff working there, and a few relatives. Much of the environment was checked, and care practices were observed in communal areas. A number of records were analysed. Feedback was provided to the manager at the end of the visit. We are grateful to everyone involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: We received a lot of positive feedback about the home, from residents, relatives/advocates, and health professionals. Comments include, “There is a very happy atmosphere. The staff are very welcoming”, “Good level of care to patients. Whenever visiting, patients are clean, appropriately managed and cared for”, and “They are so caring and patient. There is nothing they could improve on.” Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 6 The Expert-by-Experience also generally fedback positively. Their report included, “I spoke to many residents who were all very contented with the care and attention they received”, and “One lady told me, ‘I am happy at this home, and the people that care for me are almost like my family’.” We found that the home supports residents well in most areas of care. For instance, staff are respectful and friendly with residents, independence is enabled where possible, and residents can control many areas of their life. We also received good feedback about management, such as “Good leadership from the manager”, and about the staff, such as “The staff are kind and caring.” What has improved since the last inspection? What they could do better: It is of significant concern that there is sometimes a lack of signature on medication records after staff support residents with their prescribed medication. Concerns also arose through a number of one resident’s lookedCarlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 7 after tablets being unaccounted for. The safety of medication processes is therefore insufficient. There were concerns in this area at the previous inspection. We are therefore taking enforcement action to ensure that the necessary improvements take place. This consists of sending a Statutory Requirement Notice about the medication shortfalls. Failure to comply with this notice could result in prosecution. We found that a few areas of maintenance do not sufficiently protect residents. This includes in terms of hygiene practices for both the deteriorating passenger lift carpet that the Expert-by-Experience pointed out, and for those bins in toilets and bathrooms that need to be opened by hand. There are also potential safety concerns with the uneven garden patio that one relative highlighted to us. A full list of requirements and recommendations can be found at the end of this report. 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 DS0000039315.V364425.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 DS0000039315.V364425.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): 3 and 4. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The manager meets prospective residents and their representatives, and assesses needs, before offering a place in the home. Residents’ needs in the home are met wherever possible. EVIDENCE: The manager stated in pre-inspection paperwork that, “service users are admitted only after a full assessment.” At the inspection visit, we found a reasonable standard of recorded assessment by the manager that took place before the person moved into the home. The manager clarified that she always undertakes this regardless of whether or not a social services assessment becomes available to her. We recommend recording the person’s ethnicity as well as religion and preferred communication method within the assessment, so that any needs arising from that can be openly considered. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 10 Written and verbal feedback, from a number of sources, confirmed that residents’ needs are met. Five out of six resident surveys stated that they always receive the care and support they need, one person adding “I am very comfortable at the home.” Similarly, twelve from sixteen relatives and advocates’ surveys stated ‘always’ to this question, the other four rating it as ‘usually.’ Comments included, “This is a very ‘caring’ care home.” When asked about meeting diverse needs, nine relatives and advocates rated this as ‘always’, four as ‘usually’, with three not answering. Health professional surveys were similarly positive to this question. Thirteen out of fourteen staff surveys stated that they always have the right support to meet residents’ diverse needs, one person clarifying that this is an ongoing process for which they receive training. The Expert-by-Experience reported, “Overall the home is well run by the manager and staff who seem to be aware of and have the ability to meet the needs of the residents. One resident said they had ‘moved from another home’ and this one was ‘much better’.” Our observations and checks of records also resulted in recognition that the individual needs of residents are identified and where possible, met. Carlton House DS0000039315.V364425.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 and 10. People who use this service experience an adequate outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents’ health care needs are well met at this home, although procedures for recording medication are sometimes not safely followed which could have significant impact on individual residents. Residents are respectfully and individually treated by staff, with individual needs sufficiently documented about within plans of care. EVIDENCE: All six resident surveys stated that the staff listen to and act on what residents say. Relatives and advocates’ comments included, “Best of all Mum is happy and always looks clean and tidy” and “Manager and staff are very caring & good with residents, always helpful.” The Expert-by-Experience reported, “The atmosphere was warm and friendly and the staff interacted well with each other and the residents who appeared very happy and content.” Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 12 The four health professional surveys stated that the care service ‘always’ or ‘usually’ respects individuals’ privacy and dignity. One such person stated, “The care staff have always knocked on the door before entering the room.” The Expert-by Experience similarly reported, “I did see one lady being woken up to have her lunch and this was done in a very gentle way.” We also overheard the manager apologise to a resident when the manager’s support wasn’t what the resident wanted, and generally saw care being provided respectfully. We checked the care plans of four residents. We found them to be of reasonable detail, in terms of the person’s individual needs and how the service would support these, and covering areas such as personal care, meal support, and leisure preferences. These were signed by management and the resident or their representative. Most files also had a separate health care plan set up by the local GP service following liaison with relevant people. We found that a strength of the service is in the detail of the almost-monthly reviews of the care plans, which reflected very well any changed needs and progress. Ten out of fourteen staff surveys stated that they are always given up-to-date information about the needs of residents, which is sufficiently positive. Five out of six resident surveys stated that they always receive the medical support they need. One rated this as ‘usually’. One relative and advocate survey stated that the home does well at “Prompt attention to medical problems – visits from GPs, nurses, dentist etc.” All such surveys stated that they are always kept up-to-date about important medical issues. The manager stated in pre-inspection paperwork that they do well at, “observing residents closely and reporting all changes to GPs and district nurses.” This was confirmed through records and feedback. We found records of health professional visits within each person’s care file. These were usually of sufficient detail, and produced amended care plans where needed. A range of health professionals is accessed when needed, including speech therapists, eye specialists, dieticians, district nurses, and GPs. Health professional surveys stated in three cases that individuals’ health care needs are always met by the home, the other rating this as ‘usually’. One person stated, “The manager is careful to follow-up all potential problems for clients and get them assessed and treated.” The manager explained that there are now fortnightly meetings with the GP surgery, district nurses and psychiatric nurses organized through the GP practice for their patients who live at this home. This is of great benefit with communication and health support. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 13 We saw that the home’s accident book is used to record instances of any resident having a fall or being found on the floor. Corresponding falls monitoring records were in place for relevant residents, which help to evidence that any concerns in this area are considered. We also saw a record of deciding that a person would benefit from bedsides, a decision recorded as taken through liaison with their relatives and the GP, which appeared appropriate. We noted that bedsides were clearly the exception when looking through a sample of bedrooms. We found the medication in the home to be securely stored. The manager stated that no-one currently self-medicates, although they could if considered safe. Medication is administered to residents by a small number of trained senior staff. We saw a booking form for imminent refresher training for these five staff. We checked the medication of two residents in detail. In both cases we found some gaps in the medication administration records. Most concerning was that for one person’s previous month’s records, the second prescribed dose of an inhaler had not been signed for at all. One tablet of theirs had also not been endorsed on the records for the morning of the inspection, three hours after its administration time, albeit that the tablet had been taken from the blister pack. The other person’s records for the previous month included a set of evening medications that were not signed for on one occasion. All of these gaps have the potential to result in double-doses, or they can indicate that the medication was not given as prescribed and with no explanation. Medication that the service has responsibility for must always be signed for, using the appropriate code, as prescribed. We audited the stock and records of one person’s prescribed paracetamol supply. We found that 26 paracetamol tablets were unaccounted for, which could indicate serious concerns about medication practices in the home. The manager agreed to look into the discrepancy, and explained that she informally audits medication regularly as she is often involved in administration. Formal and recorded medication audits are now required on a regular basis, to provide evidence that residents are receiving their medication as prescribed. We found some anomalies for a newer resident, between their prescription instructions on the medication containers compared with both the instructions written on medication records and the ongoing records of medication offered. For instance, one medication was initially recorded by the home as to be given as needed, without an explanation of why it may be needed, although the manager could explain this verbally. The instruction then changed to three times a day, to match the medication package instructions that had been in place from the start, but without each instance being endorsed by staff across the day that this new instruction had so far applied for. It is concerning that prescribed instructions are not followed. If the instructions are found to be Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 14 contrary to the apparent needs of the resident, or the resident refuses the medication regularly, a review of the medication with the GP should be sought. Where medication is given as-needed, there must be a clear record of why it may be given and how often this can occur, to help ensure that it is given safely. We saw that the typed label on the packet of one medication had been changed by hand, for the medication to be given at night instead of morning. The manager explained that the pharmacist wrote this. Copies of prescriptions were not available, to check that this change matched the GP’s instructions. Copies of repeat prescriptions should be kept by the home, to help ensure that medications are given as prescribed. As we have identified medication shortfalls here, as at the last inspection, we are now taking enforcement action to ensure that necessary improvements take place. This consists of sending a Statutory Requirement Notice, separate but concurrent to this report, about repeated non-compliance with medication requirements. Failure to comply with this could result in prosecution. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 15 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): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents receive a good choice of appealing meals in comfortable surroundings with appropriate support. The home operates in a manner that enables residents to have control over most areas of their lives. Lifestyle preferences and family/friend involvement are recognised, and are supported where possible. EVIDENCE: Nine surveys from relatives and advocates stated that the care service always supports people to live the life they choose. Six others rated this as ‘usually’, with the other respondent not answering. Health professional surveys were similarly positive, one reply stating that the service does well at “promoting service users’ independence.” Four out of the six resident surveys we received stated that there are always activities arranged by the home that the resident can take part in. One reply rated this as ‘usually’, and one stated, “I am able to go out without an escort.” Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 16 We found that the activity folder recorded in good detail the leisure support each resident had received, and was hence evidence of individuality in this area. Recordings included supported walks that usually took place in the garden but occasionally in the local area, sing-a-longs, group chats that we saw to be lively and involving, bingo, exercising, and massage of hands and feet for someone less able to take more active roles. One relative/advocate survey added to this, stating “Efforts are made to make Birthdays special for residents; parties at Christmas; Barbeque in Summer.” The Expert-by-Experience reported, “On the afternoon of my visit an entertainer was coming in to sing songs and play some music, and there was a varied activity programme provided for the residents.” The manager explained that a specific activity worker had been employed but then left, and that a new person had just started in this role. A standard weekly activity program was on display, albeit within corridors and hence not easily accessible for residents. It would be more involving if a program be produced and circulated each week, based on aiming to meet all residents’ preferences across time. The Expert-by-Experience reported, “I asked one resident if there was a vicar or a priest that visited and was advised that there was. One lady told me that ‘occasionally she was taken to church on a Sunday morning as she enjoyed it so much’.” The manager, and one resident independently, explained that Holy Communion is provided every Friday. The manager added that a vicar visits sometimes for those with Church of England faith. However one relative’s surveys stated, “The care home advertises communion for Anglican worships but it has never been offered” and one resident told us that their faith needs were not being met. Consideration should be given to checking that the faith needs of all residents are addressed. Nine surveys from relatives and advocates stated that the care home always helps the resident to keep in touch with them. One person noted that, “Messages are passed on.” Four other surveys rated this as ‘usually’. Three stated ‘not applicable’ with one adding, “I visit my mother regularly and she has a telephone in her room.” We additionally overheard staff inform one resident about a message from a family member. The manager stated in pre-inspection paperwork that they do well at “giving choices with food, meal times, assistance with eating, and providing special diets.” We saw afternoon tea being served at around 2:15 via a trolley. There was discussion with each resident about what they wanted. Five resident surveys reported that they always like the meals at the home, the other rating it as ‘usually’. One resident told us during the visit that the “food is especially good.” Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 17 The Expert-by-Experience reported, “Lunch looked very appealing and was well presented on the plate. Those residents that needed help eating were given the relevant assistance in a polite, unhurried way.” We checked a typical week’s menu from August, and found four occasions of roast dinners being served, although there was usually a non-roast option such as cottage pie also available. We saw that a separate vegetarian dinner was prepared where requested, and that the specific dietary needs of certain residents are recorded in the kitchen. Discussions with the cook confirmed that meals and mealtimes are flexible, to aim to meet individual resident’s needs. Menus also confirmed a choice of nutritious and warm evening meals. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 18 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): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be very confident that concerns and complaints are acted on appropriately. The service at the home takes reasonable precautions to ensure that residents are protected from abuse. EVIDENCE: The Expert-by-Experience reported, “I did ask some residents who they would complain to if they was a problem and every one of them said they would speak to the manager. They all knew she would get something done about it.” Fifteen out of the sixteen surveys from relatives and advocates stated they know how to make a complaint if needed. Twelve stated that the service had always responded appropriately, with one rating as ‘usually’ and three blank replies. Health professional surveys were similarly positive, whilst all staff surveys stated that they know what to do if a concern is raised. The manager stated in pre-inspection paperwork that they do well at “maintaining records for complaints and responding within the timescales.” We checked the complaint records that the manager looks after. We found six entries since the last inspection; just one of those was from 2008. One was an issue raised through The Commission, anonymously, about standards of care, which we passed to the provider to investigate. Their detailed response was Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 19 that appropriate care was being provided in most areas, with the only shortfall being something they had already recognised. The other complaints included about missing items, upsetting behaviour from a resident, and inappropriate behaviour from carers. Records showed appropriate investigation of each complaint, and a prompt outcome plan regardless of whether the complaint was upheld or not. The manager explained that she and some other staff attended update training on abuse-prevention through a local training provider recently. She planned to sit with other staff to go through a training DVD on the subject, for which questionnaires to prove knowledge were available. Checks of the training files of a number of staff revealed that nearly all had received training in this area within the last few years. We also saw that the first day of induction for new staff includes a component about abuse-prevention. We did not observe any concerns about how staff work with residents whose behaviours can challenge the service. Standard 10 explains positive outcomes for residents in terms of respect from staff. Additionally, one resident told us that staff deal with the situation calmly when residents argue, and one relative/advocate surveys stated that the home does well at having a “positive approach to residents even if at times many have high demands or short fuses.” Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 20 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, 20, 23, 24, 25 and 26. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a generally well-maintained environment that has had recent redecoration to some areas. Bedrooms are comfortable and safe, and with ability for individualisation. The home is kept clean at all times, and infection control standards are mostly appropriate. EVIDENCE: The manager stated in pre-inspection paperwork that they do well at “maintaining a safe and well-maintained environment.” The Expert-by-Experience reported, “The passages and stairways around the home were clean and although there were some scuff marks on the walls overall they were well decorated and had recently been fitted with new carpet.” We also found that the kitchen has been completely refurbished and Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 21 was hence easier to use and keep clean. This all helped to generally give the home a comfortable and well-maintained feel. The Expert-by-Experience also reported, “The carpet in the lift was dirty, sticky and unpleasant and in need of fairly urgent replacement.” We checked that this was the case, and agree that deep-cleaning or replacement is needed. The patio, accessible from the lounges, had paving slabs that were not at a consistent height and angle throughout. This was raised by a relative in their survey, stating, “Patio in back needs repair – very dangerous for residents”, and by the Expert-by-Experience. The worst slab was approximately an inch higher than the next at one corner. The manager explained that nearly all residents need encouragement and support to come into the garden. However, to better enable independence, the patio needs to be re-laid to allow it to remain consistently level. The Expert-by-Experience reported, “The chairs in one of the lounges are very close together and there are very few, if any, occasional tables between them for people to put their drinks on. This lack of space between chairs also makes it impossible to stand beside the chair to assist someone to get up if they need help.” Consideration should be given to this. The Expert-by-Experience reported, “Every bedroom that I saw was bright, clean, pleasantly decorated and free from odour and some had recently been fitted with new carpet. Most of the bedrooms had personal belongings on the walls e.g. picture, photographs etc.” This matched what we saw from the six bedrooms we viewed with the manager. None additionally had lingering odour, and all had radiator covers and window restrictors. All six resident surveys returned to us reported that the home is always fresh and clean. A relative/advocate similarly stated in their survey, “The environment and inside the home is very clean.” This matched what we saw overall. We saw from records that the home employs two cleaners. We saw that all four of the industrial washing and drying machines in the laundry area were working. Disposable gloves and aprons were readily available. Training records showed us that most staff have had infection control training. We saw that waste bins in toilets and bathroom generally did not open without the use of hands to lift lids. Better infection control principles would enable such bins to be pedal operated. This must be addressed. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 22 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): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met overall by there being enough staff at the home. Staff generally have appropriate skills, capability, and training. Recruitment processes are sufficient to help protect residents. EVIDENCE: The manager stated in pre-inspection paperwork that they do well at having “the right mix of staff, teamwork to get best outcomes, using only our own staff.” Surveys from relatives and advocates stated that care staff, ‘always’ or ‘usually’, have the right skills and experience to look after people properly. Comments included, “Staff seem to have the skill and experience to offer a high level of care” and “Staff always cheerful.” Health professional surveys were similarly positive. Five of the six resident surveys we received stated that staff are always available when needed. The other survey rated this as ‘usually’. Twelve of the fourteen staff surveys we received stated that there are always enough staff to meet the individual needs of residents. The rosters for the current and previous week were checked through. They essential upheld appropriate staffing levels, occasionally being one person Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 23 down in the mornings, although the manager would usually be present to assist. The roster also showed a consistent presence of domestic support staff. We checked the recruitment records of three staff who started working at the home since the last inspection. We found that two appropriate references, copies of identification, application forms, and work permit details where applicable, were all in place. One person had a Criminal Record Bureau (CRB) disclosure in place. The other two people had cleared POVA-First checks from the CRB, the minimal sufficient check to start work, with the manager adding that she had seen a recent CRB for one of these people. All of these checks were dated as having taken place in a timely manner. Staff surveys praised the training at the home highly. All surveys stated that the induction covered everything they needed to know very well, and that they are given relevant and up-to-date training. We saw that for a newer staff member, the national induction framework booklet was used in a timely manner. For an established staff member, they had recent training certificates that included continence management, dementia care, and infection control by a qualified nurse. The manager explained to us about National Vocational Qualifications (NVQs) at the home. Training records and certificates were seen. The overall evidence suggested that the National Minimum Standard, of 50 of care staff being qualified at NVQ, would shortly be achieved, taking into account those working towards it. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 24 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): All of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The home is run by an appropriately qualified and experienced manager, to the benefit of residents and with due support of staff. The views of people involved in the home are considered. Reasonable safeguards are in place for looking after small amounts of applicable residents’ money. Health and safety standards mostly protect people in the home. EVIDENCE: The home’s manager has been in the role since the autumn of 2005. She has previously had a number of years’ experience as a senior staff member within the home. She has completed the NVQ level 4 in management and care. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 25 The Expert-by-Experience reported, “Residents spoke very highly of the manager.” This matched the survey feedback we received. For instance, one resident survey stated, “The manager is wonderful. She has a very difficult job and should be given a very big pay rise.” A health professional survey reported, “The manager does a really good job leading/managing the team.” 12 of the 14 staff surveys we received stated that the manager regularly gives enough support. One person added, “The manager is always very helpful and supporting.” Similarly, 12 staff surveys stated that the ways information about residents is passed between staff work well, the other two stating ‘usually’. The manager told us that senior management visit the home regularly. We could not find any of the required reports of their 2008 visits during the inspection, however these were made available to us afterwards. The reports included a number of care checks and recommendations, discussions with residents and relatives, and showed good awareness of the ongoing issues at the home. It is recommended that copies of the reports are always kept available within the home, for reference by relevant people. We saw that a summary of results from a residents’ satisfaction survey dating April 2008 were displayed on one hallway notice board. 16 people responded, with strengths such as staff and food noted, along with four points for improvement raised by individuals and what the service was doing about this. It is encouraging that the overall findings of the surveys are made available, and that no significant issues arose. We saw that the manager looks after small amounts of money on behalf of some residents. Detailed records of this are kept for each applicable resident, approximately ten people at the time of the inspection. The manager told us that representatives are asked to check and sign these records, when passing on further money, and that the home does not look after bank accounts for anyone. We found that receipts matched the records being kept. We found that ongoing checks of temperatures and cleanliness are recorded within the kitchen. We saw that the home achieved a 3-star rating (5-star maximum) from a food hygiene audit by the local authority’s environmental health department in February 2007. This pre-dates the kitchen refurbishment. We checked the water temperature from hot water taps in one bedroom and a bathroom. Both had thermostatic controls that prevented the temperature from becoming too hot. Appropriate records of monthly checks of the hot water temperatures from all outlets in the home were also seen. We noted that a number of bedroom doors had a plastic container fixed to the back of them, containing documents for night-staff to sign once they had completed ongoing checks of the resident. Some of these containers were partially broken, with some jagged edges, from where they had probably been Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 26 pushed against the walls when opening the door fully. As these are unsightly and present minor safety risks, we recommend their replacement. We saw fire safety records that encouragingly included monthly fire training by the manager for small groups of staff. We also saw that that the local fire authority had visited the home in July 2008 and found fire safety matters to be satisfactory. We checked a sample of professional inspection certificates. We found these to be up-to-date for the passenger lift, mobile hoists, and legionella-prevention within the hot water systems. Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 2 3 X X 3 3 3 2 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 3 3 3 X 3 X X 2 Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 10/10/08 suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Previous timescale of 1/8/07 not met. Enforcement action is being taken. Deep-cleaning or replacement of 01/12/08 the carpet in the lift is needed, to uphold standards of hygiene and appearance. The patio in the garden must be 01/12/08 re-laid to ensure that it remains consistently level throughout. This is to better enable residents’ independence and safety in the garden. The waste-bins in toilets and 10/10/08 bathrooms must be operable without the need to touch them by hand. This is to help control the potential spread of infection. Requirement 2 OP19 23(2)(d) 3 OP19 23(2)(o) 4 OP26 13(3) Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 29 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 OP3 OP7 Good Practice Recommendations It is recommended to record the person’s ethnicity within pre-admission assessments, so that any needs arising from that can be openly considered. To assist residents and their representatives to be clear on their current care plans, consideration should be given to making the care plans available within each person’s room unless they expressly refuse or it would cause anxiety to the resident. If prescription instructions are found to be contrary to the apparent needs of any resident, or the resident refuses the medication regularly, a review of the medication with the GP should be sought to help clarify appropriate medications. Copies of repeat prescriptions should be kept by the home, to help ensure that medications are given as prescribed. It would be more involving for residents if an activity program be produced and circulated each week, based on aiming to meet all residents’ preferences across time. Consideration should be given to checking that the faith needs of all residents are addressed. Consideration should be given to providing more space between chairs in lounges, to allow tables for drinks to be placed there and to help staff to position themselves better when helping anyone to move. It is recommended that copies of the provider representative’s monthly regulation-26 reports are always kept available within the home, for reference by relevant people. The broken plastic containers behind some bedroom doors should be replaced, to uphold safety and appearance standards. 3 OP9 4 5 6 7 OP9 OP12 OP12 OP20 8 OP33 9 OP38 Carlton House DS0000039315.V364425.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 DS0000039315.V364425.R01.S.doc Version 5.2 Page 31 - 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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