Inspection on 03/07/07 for Carlton House

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Carlton House 26/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Carlton House Carlton House 2 The Avenue Hatch End Middlesex HA5 4EP Lead Inspector Clive Heidrich Key Unannounced Inspection 8:10 3rd July 2007 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.V343995.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.V343995.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.V343995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2006 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. The home 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 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 residents 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. It has three interconnecting lounges and a dining room. At the rear there is a well-maintained garden. The service user guide, which details the services provided by the home, was available for viewing within the entrance hall. Copies are available to take away. There was one vacancy at the time of the inspection. Prices for the home range from £505 to £550 a week. Additional charges include for the hairdresser, private chiropody, and personal phone lines within bedrooms. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the previous inspection in May 2006, there has been one change in terms of regulatory activity. This is that the acting manager at the time of that inspection has since been successfully registered with the CSCI in the manager’s role. The service was requested to complete an Annual Quality Assurance Assessment (AQAA) well in advance of the inspection. It was duly returned to the CSCI in good time. In terms of feedback, CSCI surveys were sent to residents, next-of-kin, and health & social care professionals in advance of the inspection. By the requested return date for these surveys, three from residents, thirteen from next-of-kin, and four from professionals had been received. Survey analysis, as recorded about throughout this report, refers mainly to these. A further five surveys were received after the inspection. Their contents have also been considered. The unannounced inspection took place across one day in early July. It lasted just over nine hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector spoke with a number of residents during the visit, most of whom were able to provide feedback about the services in the home. The inspection process within the home also involved observations of how staff provided support to residents, discussions with staff, checks of the environment, and the viewing of a number of records. Feedback was provided to the manager at the end of the visit. An urgent action letter was sent to the provider organization shortly after the inspection, to acquire a more-immediate plan about how some key unaddressed requirements would be actioned. A suitable plan was provided on the same day. The inspector thanks all involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 6 Surveys and feedback provided much in the way of positive comments about the home. Whilst many of these are included within the main body of this report, the following give a sample of the many positive views about the service: “The staff are marvellous”, “the care home has a friendly and warm atmosphere”, that the resident “always looks clean and happy”, and “can’t improve. They are excellent.” Residents and relatives provided good overall feedback about the staff team. The relatives’ survey had the majority of replies noting that the home ‘always’ gives the support or care to the relative that was expected. Comments included, “all the staff appear to care”, “they are accommodating and patient”, and “staff are kindly and reassuring, and give good psychological support to someone with limited grasp of their surroundings.” The inspection visit found that the home appropriately seeks external professional support where difficulties arise, particularly in the area of health care. There is a food choice system for residents. Feedback from them and others about the food was encouraging. Where residents need support to look after any money, the home undertakes this securely and with suitable records. Care staff are supported by domestic and cooking staff. The home is kept suitably clean and hygienic overall. Staffing levels have remained consistent. Finally, the manager demonstrates good management skills that are residentcentred. There was much positive feedback about her from residents and relatives, such as, “she works long hours to ensure the home runs smoothly but is always courteous and polite even after a long shift.” What has improved since the last inspection? Monthly reviews of individual residents’ needs, involving the resident or a relative, are now effective at capturing changes. Record-keeping in the area of health care is also being recorded about consistently now. Quality surveys have been distributed by the home on two separate occasions. They have formed the basis for much in the way of improvements and improvement-planning, for instance in the areas of redecoration, food, and laundry. There have been improvements to the décor, mainly within the lounges which are noticeably brighter. These areas also have new, comfortable chairs and larger televisions. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 7 Training has been further provided to all staff in some key areas, such as for manual handling, emergency first aid, and infection control. There has also been training in dementia care for some staff. The manager has now completed the NVQ level-4 qualification in management, and is close to completing a diploma in nursing. The environmental health department of the local council, at their most recent visit to the home in 2007, noted significant improvements in complying with new legislation in the kitchen. This concerns the recording and actioning of cleanliness, hygiene and maintenance issues. Risk assessments of key hazards around the home have also been undertaken and progressed. What they could do better: There are some requirements that are outstanding from the previous inspection. The improvements needed from these include: • For the kitchen to be refurbished, as it has significant wear and tear to its furnishings. This has additionally been highlighted by the local council’s environmental health department. • Ensuring that all radiators that are accessible to residents have protective covers fitted that can prevent scalding accidents. • That many staff have not had recent formal training in food hygiene. Whilst the manager is actively addressing this, the current shortfall puts residents at risk of poor care in these areas. • For plans to be in place about enabling at least half of the staff team to achieve NVQ qualifications. None of the current team have the qualification, albeit that some are working towards it. This puts residents at risk of receiving care from the staff team that is inconsistent or out-of-date. • For any allegations of abuse to be reported to the CSCI without delay, and to social services as per their borough-wide Safeguarding Adults procedure. One such allegation was identified at the inspection. It was investigated internally. Whilst this process may have been suitably diligent in itself, it lacked the transparency of involving people independent to the organization. There are some other improvements needed. Key amongst these are that: • The service must provide residents with more personalized and varied activities, to better enable residents to have lifestyles in the home that satisfy their recreational interests and needs. Activity provision tended to consistently feature the same options. • Attention must be paid to better enabling residents to have more control over how they experience their meals, to make the mealtimes more satisfying. Some residents experienced delays in receiving lunch, and staffing was stretched in terms of supporting dependent residents. • It is necessary for staff to be provided with formal training on abuse awareness if they do not already have it, so that they are supported to respond appropriately to any abuse scenarios. A number of staff have not yet received this training. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 8 • Appropriate written references must be in place in advance of employment, to help show that the person is suitable and safe to work with residents. A case was found of receiving a reference a few weeks after employment began. A full list of requirements is provided at the end of the 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.V343995.R01.S.doc Version 5.2 Page 9 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.V343995.R01.S.doc Version 5.2 Page 10 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 good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Assessments are appropriately made of prospective people’s needs before offering admission to the home. The home generally meets residents’ individual needs, and does not admit people whose needs they cannot meet. EVIDENCE: There were records of advance assessment of needs before residents were admitted into the home. The manager stated that this is generally undertaken by herself or the area manager. Professional assessment documentation is also acquired where possible in advance. Further assessment is then made upon the person moving in, to help formulate a care plan. There was documentation about placement reviews following admission, that confirmed the placement and fine-tuned any support needs. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 11 From observations, records and feedback, it was apparent that the home only admits people whose needs they can generally meet, and who fit with the registration category. Feedback from residents about the services at the home was highly positive, noting that staff and the manager are very responsive. Friends and relatives’ thirteen surveys had nine people stating that the home always meets needs, two stating ‘usually’, and two blanks responses with positive comments. Comments included, “They are very caring at Carlton House,” and “They are kind and considerate to residents’ needs.” Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 12 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 good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans reflect some of each resident’s individual needs and wishes, however other issues are not captured. Monthly reviews involving the resident or their relative are effective at capturing changes. Residents’ health care needs are well met, including through liaison with community health professionals. The home has reasonable medication systems that support residents with their medicines. Record keeping in this area has minor shortfalls. Staff treat residents caringly and responsibly, providing good general standards of respect. EVIDENCE: The care files of three residents were checked through. Each had a care assessment and plan that was reasonably detailed and up-to-date. Each also Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 13 had monthly summaries that were now updating on key issues for the month, and adjusting the care plans where needed. These updates were being signed by the resident or relative where applicable. All care staff use the care files, and there was no feedback or observations to suggest that staff work contrary to the plans. Improvements with care plans are however identified. The plans lacked information in some useful areas, such as about how each resident’s financial affairs are handled and whether any support is needed by the home, about typical times of getting up and going to bed, pain communication, preferred names, and preferred clothing. Checks of specific residents also showed that the plans lacked sufficient information about a specific medication technique that the service at the home supports, and about a particular skin management issue. These were discussed with the manager, as the lack of this specific information about particular residents within their care plans could cause inconsistent or poor care. The plans should also be provided to residents in their rooms unless not wished for, to enable residents or their relatives where applicable to view the plans whenever they wish. Care files also contained risk assessments of some key hazards relating to the particular resident, personalized manual handling guidance, fall charts, health care summary grids, and daily records that include more detail about any health professional input along with other ongoing records of care. The manager also keeps separate records of the falls experienced by each resident, with notes about what actions have been undertaken. These included about risk assessments being updated, and GP referrals. Manual handling guidance has been updated as previously required. The guidance now gives good personalized information about the support and equipment needed for each manoeuvre. Updates take place where changes in need occur. However, the new guidance methods tended to lack a record of the assessment of need, in terms of the resident, the environment, and the staff. This was discussed with the manager, as this lack of recorded assessment could fail to highlight specific issues that could consequently cause accident or injury. Assessment details must be recorded about. Records in the accident book and the wound charts file were up-to-date and written with detail. It was noted that, relative to the accident book, individual falls charts within files are not kept up-to-date. To help keep information accurate, fall charts within individual care files should be up-to-date. A separate continence-monitoring file is kept for applicable residents. It included regular reviews of continence support. It was clearly used regularly, however in the early afternoon of the inspection, the latest entries were from the previous evening. Some days also had limited information. This lack of Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 14 information can cause inaccurate analysis and hence inconsistent care, which should be addressed. There was otherwise little to suggest that continence was not being managed appropriately for individuals, for instance as there were no lingering offensive odours, and as staff were observed to sometimes prompt certain residents to move to the toilet. Health records generally indicated that residents receive standard health checks from chiropodists, dentists, and opticians, and specific health professional input where needed from GPs, district nurses, psychiatrists, and physiotherapists for instance. One resident for example received prompt physiotherapist support, and different walking equipment, following a fall. Records showed that for another person requesting the GP for a sore throat, an appointment had been made by staff that day, the GP visited that day, and antibiotics were acquired by the following day, all of which is very prompt. Feedback from residents confirmed that the home is responsive to requests for GPs, and the three resident surveys noted that they always receive the medical support that they need. Regular weight checks are kept of each resident, using the home’s weighing chair. These records showed that there were some people who had experienced weight loss. This had been identified and addressed through internal monitoring such as with nutritional intake records, or with external professional input. Consequently, there had then been weight gain for these people. The manager explained that nutritious snacks are provided to residents such as ham sandwiches and hot chocolates, to assist in this area, and that build-up drinks are also acquired from GPs. The manager stated that no-one at the home has a pressure sore. There was strong evidence from records and feedback about good liaison with the local district nursing team. Preventative equipment was in place for some residents, with details about use within care plans. Medication was seen to be securely stored overall, in an organized and hygienic manner. It was being given out to residents at the start of the inspection in a conscientious manner by two staff. Medication is supplied by a local pharmacist using blister-packs where possible. Checks were made of the medications for four residents. These showed that all bar one medication was in place. The exception had just run out. A further supply was acquired that day. There were four missing signatures within the checked records. Checks of the medications themselves established in each case that the medication had been taken from the supply and so was likely to have been given. However, gaps in records have the potential to cause doubledoses, and so must be eradicated. Records are generally kept for medications coming into the home and those being returned. However, there were occasional pages of administration sheet Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 15 where the medications had not been signed in. Failure to check could result in mistaken discrepancies in quantity not being discovered, which may later result in the medication running out before further delivery. Records of medications coming into the home must be fully kept. Records showed that eight staff have had formal training on medication, and that only these staff dispense medications to residents. The manager noted that refresher training was being planned for. Staff were seen to treat residents respectfully and patiently. For instance, staff always talked respectfully to residents before and during support procedures such as manual handling manoeuvres or offering medications. Discussions with staff found that they are aware of support needs for individual residents, which some residents were also able to confirm. Residents’ surveys and feedback were highly positive about staff. For instance, all three surveys stated that staff listen to and act on what the resident says. Friends & relatives’ surveys generally stated that care staff always have the right skills and experience to look after people properly. Comments included that, “the staff all seem very caring and gentle with the seniors in their care”, “she is always clean”, and “they are very caring and attentive to residents.” Similarly, professional surveys generally stated that the care service always respects individuals’ privacy and dignity. Residents were seen to be generally well-presented from the start of the inspection. One resident confirmed that they only receive their own clothes back from the laundry processes in the home. Clothing appeared well-fitting, clean, and appropriate to the individual. There were no concerns observed with hair or nail care. Glasses were seen to be in place and clean on relevant residents. Records showed that consultation processes had highlighted clothing care as an area for improvement. There were also records of the improvements being implemented. Observations here suggest the improvements have taken effect. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 16 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 adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home aims to provide activities that suit residents, but in practice the regularly-provided activities are not sufficiently varied and personalized. Visitors are welcomed at all times, and are generally kept up-to-date about key issues where applicable. A good standard of nutritional and tasty food is provided to residents. The service aims to empower residents through staff willingness to provide support where needed. However there are barriers to this through, for instance, poor independent access in some areas of the home, and insufficiently planned support for more-dependent residents at mealtimes. EVIDENCE: There was varying feedback about the activity provision in the home. Some residents expressed satisfaction in this area, others that provision is sometimes available. Friends and relatives’ survey comments were however less encouraging. There was acknowledgement of the hairdresser who visits Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 17 regularly at additional cost, a fortnightly occupational therapist visit, and people who come in to play music and provide art workshops. There were also many comments about what else could be done, rather than the “daily routine of sitting around with the TV on.” Suggestions of much more music, quizzes, acquiring specific films or musicals on DVD, day trips, and tactile interactions for more dependent residents, were all made. The manager noted that, following consultations with residents and relatives, activities are taking place every afternoon. Records generally backed this up, however there was little variety therein beyond music exercises, ball games, and walks. The manager also noted that an activities co-ordinator has been recruited, and should start work shortly pending recruitment checks. Their acquisition should make a significant difference in providing residents with more personalized activities regularly, which is the improvement needed. Within this, occasional day trips to places of interest to residents as a whole are specifically recommended. Relatives’ surveys showed encouraging feedback about maintaining contact. Five out of eight stated that the home always helps their relative to keep in touch, with non-respondents generally explaining that they visit frequently. One person noted that, “Staff have made good efforts in the past and still try to assist communication when you visit.” Similarly, seven out of ten respondents reported that they are always kept up-to-date with important issues affecting their relative, with the remainder clarifying this as ‘usually.’ Visitors were welcomed during the inspection, and individual resident records noted about who had visited. It was also seen that residents can have largebuttoned phones supplied in their rooms, albeit at an additional cost. In terms of diversity and equality, survey feedback was reasonably positive. Relatives and friends noted that the service ‘always’ or ‘usually’ meets the different needs of people, and similarly supports people to live the life they choose. Professional feedback included that, “Carlton House are very empathetic in assisting clients to make lifestyle choices.” The manager noted that staff have had training in equal opportunities and diversity. There was feedback about regular visits from local church ministers, which covers the faith needs of all residents according to the records supplied. The manager also noted that holy days and saints’ days are celebrated. In terms of visit evidence, staff fedback appropriately about providing support to residents at an appropriate level, for instance prompting when the resident is capable but needs overseeing to wash and dress appropriately. Residents were free to come and go within the home, and some facilities such as the main downstairs toilet were clearly accessible to people using zimmer-frames. Feedback and observations showed that staff are clearly responsive to resident requests. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 18 Shortfalls in enabling choice and control to residents are however identified in two areas. In terms of independently getting around the house, the steps in the upstairs hallway and at the entrances, the steps used to access the home by either of the front doors, and the relatively uneven garden patio outside the lounge, present difficulties to some residents. There was feedback about the worst patio slabs having been levelled, but the overall design is very difficult to retain at an even level. Discussions with the manager found her to be keenly aware of residents who wish to move downstairs so as to get around more easily and hence avoid the hallway steps upstairs. There was no evidence however of a written plan to address access issues throughout the house, as is recommended through The Disability Discrimination Act 2005. This should consequently be set up. The other area for improvement came from observing lunch in one lounge where more-dependent residents eat. One staff member ended up having to support two people to eat, as well as encourage a third person. This followed some residents being supported to sit at the table but then wait for fifteen minutes before meals were served, during which time they made comments about the wait and appeared generally anxious. One resident in that room also tried unsuccessfully to remove a cloth apron placed around them to help preserve clothing, again following waiting a little while with no food arriving. So in terms of more-dependent residents, the evidence suggested that support needs to be provided when meaningful rather than well in advance, and that sufficient staff need to be made available to support more dependent residents. The manager noted that non-care staff are trained in providing extra support at key times. It was also observed that the meals were provided ready-prepared, to the extent of gravy having already been poured. This denies residents the opportunity of choosing how to have their meal, in terms of such things as portion size and how foods and sauces are mixed. Attention must be paid to better enabling residents to have more control over how they experience their meals. The day’s main meals were written about on a board in the main dining area from the start of the inspection. Staff explained that residents are asked about their choices the day beforehand, and records consequently enabled the cook to judge the amount of each meal to prepare. There are two main choices, plus other dietary requests such as for vegetarian options are enabled. So it is clear that residents do have choice and control over what the meal is, which is encouraging. Feedback from residents and relatives was also very positive about the food itself. Comments such as, “The food always seems balanced and varied”, and “The food is very good” were typical. The inspector sampled the day’s main meal, of lamb steaks or beef stew with mashed potato, broccoli and cauliflower plus gravy. It all tasted fine, with the meat components in being of particularly Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 19 succulent. Food is another area where the manager has stated that there has been recent consultations with residents and relatives. Different foods have been added to the menu as a result of this. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 20 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 and 18. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has procedures that enable residents and others to make complaints and aims to ensure appropriate responses. Complaint records do not however always fully capture complaint information. Residents receive partial protection from abuse through the home’s systems. Some staff lack training in abuse awareness, and the home does not yet follow the local borough’s guidance on safeguarding adults. EVIDENCE: It was clear from surveys that residents know who to speak with if they are not happy about services, and that they know how to make a complaint. The manager was generally cited as the person to speak with, reflecting her approachability. Relatives and friends’ surveys were similarly positive about knowing how to make complaints, and about concerns being responded to appropriately. The complaints process is explained within the service user guide. There have been no complaints or allegations reported directly to the CSCI about this home since the last inspection. A check of the home’s secure complaints file found that two complaints have been made directly to the manager during this timeframe. Both were responded to in writing within the Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 21 expected 28-day timeframe. One was from a resident, the other from a staff member, both about care practices. Neither were upheld. The manager was able to explain the investigation processes, however it would be more transparent if there was a written record of how conclusions were drawn. Improvements are needed in some respects of complaint handling. There was a separate record in the communication book about one resident complaining about treatment from another resident. This had not been recorded about in the complaints book, despite the home’s complaints policy stating that complaints can be made verbally. Use of the complaints book would show greater transparency about how issues of concern are addressed. All complaints must therefore be recorded about within the complaints file. It was also apparent that one of the logged complaints was an allegation of abuse. It was a previous requirement for abuse allegations to be reported to the CSCI, as this is clearly stated within legislation. Additionally, the current borough-wide safeguarding adults procedure expects allegations to be reported to social services for independent consideration. This procedure was not available in the home at the time of the inspection, and so must be acquired promptly. Failure to notify the appropriate independent bodies about allegations of abuse could lead to the allegations being inappropriately addressed. It is noted however that in this instance, the evidence suggests that the allegation was taken seriously and duly investigated internally. Records showed that seven of the overall staff team have received formal training in abuse-awareness. Certification showed that this was from a neighbouring local authority. This however leaves thirteen staff, including noncare workers, who have not received such training, and who might not respond to fully protect residents should an abuse scenario arise. Discussions with staff found that whistleblowing principles would be followed, although possibly not with due promptness. It is consequently necessary for remaining staff to be provided with formal training on abuse awareness. The home has to deal with an amount of challenging behaviour from a few residents. Observations of how this took place showed staff aiming to be patient and calm. Staff feedback confirmed these principles. Care plans referred to the behaviours briefly, guiding staff on appropriate approaches. Referrals to health and social care professionals were also apparent where appropriate. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 22 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, 21, 24, 25 and 26. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is kept in a good state of repair in some areas, but a few other areas have become tired-looking. Redecoration has taken place in some areas, which has for instance enabled lounges to be brighter. Outstanding requirements for kitchen refurbishment and completing the covering of radiators have yet to be fully addressed. The home generally has suitable facilities. Suitable cleanliness is upheld by trained staff. There is however no written plan on how to enable suitable independent access under the Disability Discrimination Act 2005. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 23 EVIDENCE: It was encouraging to find that some areas of the home had been pleasantly redecorated since the last inspection. This particularly applied to the lounges and some corridors, which appeared much brighter. One survey confirmed this, stating that, “the atmosphere of the home in terms of brightness and light has improved considerably.” The manager noted also that there are generally new comfortable chairs in the lounges, and new plasma televisions in two lounges. Three relatives’ surveys raised the point that the hallway carpet from the lounge to the lift was in need of replacement. The carpet was found to be discoloured and worn, which is insufficiently homely, and as per one survey, “makes the atmosphere depressing.” It must be replaced. The manager noted that this is within the planned maintenance program. It was twice previously required for the kitchen to be refurbished due to progressive wear and tear. There has also been a requirement dating back to 2004 about completing the process of covering the radiators in the home to prevent possible scalding accidents, as the radiators remain too hot to the touch. As neither of these issues had been addressed, and feedback from the inspection failed to provide sufficient evidence of imminent action, an urgent action letter was sent to the provider organisation shortly after the inspection requiring a written plan of action in respect of these areas. This was supplied immediately. An order to cover the radiators would be placed within two weeks. Kitchen refurbishment has involved negotiations with both the local environmental health department and the home’s neighbours, but the finalizing of a contract for the refurbishment is planned for August. These issues must be promptly addressed and completed. One relative noted that the layout of chairs in the lounges is depressing as they are too close together. The inspector also noted that the closeness of chairs, with no space between them, prevented staff from supporting some residents with getting in and out of the chairs appropriately. Consideration should be given to providing space between lounge chairs where this benefits individual residents. There is a recommendation made under standard 14 for a written plan to be set up in respect of achieving compliance with the Disability Discrimination Act 2005. There are currently a number of areas of the home that compromise independent access, including the steps outside the home and in the corridor upstairs. Conversely, one resident was positively observed to access the main toilet off the lounge independently with a frame. The home has a fixed-alarm-call system within each bedroom. A random check of the system found it to work fine. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 24 Residents fedback reasonably positively about the environment of the home. One resident confirmed that the home is kept clean, including at the weekend. Surveys confirmed that standards of cleanliness are generally upheld. Two staff were seen to be attending to cleaning duties from the start of the inspection. Rosters confirmed this as standard for weekdays, with one person undertaking weekend cleaning duties. Care staff were also seen to attend to cleanliness issues. For instance, at one point, a staff member noted that the cloth apron they were about to provide to a resident was not clean, and so they acquired another one. Checks around the home during the visit found the home to generally be suitably clean. There were no lingering offensive odours. Checks of mobile rails around toilets found them to be clean, including underneath the rails. There were records of daily cleaning of the kitchen. The kitchen was reasonably clean, but there were some areas of built-up grease such as on top of high-fridges, which could be improved on but which also tie-in with the need for refurbishment of the kitchen. The home has two industrial washing machines and tumble-driers. Disposable gloves and aprons were seen to be available and in use. A designated laundryperson works daily to assist with the flow of laundry items. Records showed that fourteen staff have received training in infection control, which is a significant majority of the staff team. This training has generally been provided in the last year, which is encouraging. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 25 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 adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff generally treat residents appropriately. Residents generally experience their needs being met through staffing provision. Staffing levels are generally sufficient. Recruitment standards do not always protect residents sufficiently, through gaps in some checks and delays in receiving checks before allowing people to begin employment. Training has been provided to staff in a number of key areas including emergency first-aid, infection control, and through an induction that meets standards. However, food hygiene has yet to be provided to the staff team overall, and none of the current staff team have an NVQ in care. EVIDENCE: The feedback about the staff team was generally positive. Resident surveys noted that staff are ‘usually’ or ‘always’ available when needed, albeit that most also noted that staff often appear busy. One resident stated that the staff team are marvellous, and noted that if a staff member didn’t understand them, that staff member would find someone who did. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 26 The majority of friends and relatives’ surveys noted that the care staff ‘always’ have the right skills and experience to look after people properly. Comments included that, “the staff all seem very caring and gentle with the seniors in their care”, and “the staff seem to genuinely enjoy their jobs.” Professional feedback found that staff at the home ‘usually’ or ‘sometimes’ have the right skills and experience to support residents’ social and health care needs. Observations from the inspection found no basic concerns with the ability and attitude of staff. The rosters for the week of the inspection and the previous week were analysed. They showed that staffing levels are upheld. Four carers work the morning, three the afternoon and early evening, with two working at night. Additionally there are cleaners, a cook, a laundry person, and the manager working. It was noted that the manager provided cover for some sickness, including at weekends. Recruitment records from two staff employed since the last inspection were checked. One had a suitable Criminal Record Bureau (CRB) disclosure in place. The other had the PoVA-First component of the CRB in place, and was working under the supervision principles needed pending receipt of the full CRB. Both had suitable identification and work permit information. However only one had suitable references in place. The references for the other person were at head office and were supplied after the inspection. One was found to have been requested and received after the staff member had started working in the home. Appropriate written references must be in place in advance of employment, as one source of evidence that the person is suitable and safe to work with residents. Additionally, one person had a recent year’s employment gap with no documentation about it but which the manager explained the reason for. Regulations require that there be documentation exploring the reason for the gap, in case the gap relates to reasons that could put residents at risk. Records and feedback established that none of the current staff team have an NVQ qualification in care. Four have started the course, with a further three enrolled. Completion of all these would almost meet the 50 standard of qualified staff. The manager noted that other staff have completed the award but have then left the home, and that a non-care worker in the home has a level-3 qualification relevant to their work. Nonetheless, the current scenario is that the home lacks a suitable proportion of qualified staff, which could put residents at risk of inappropriate care. Every effort must be made to ensure that the 50 standard is reached without further delay, and a written training plan for the home is recommended to show the organisation’s commitment to achieving training standards. Overall training records showed that all staff have had manual handling and emergency first-aid training within the last year, as previously required. Staff have also had training on infection control within the last year. About half of Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 27 the staff team have also had training on dementia care. Bookings were seen for five staff to attend distance learning on nutrition and health, with two others to do the same for health & safety. This is encouraging. A previous requirement to ensure all staff have received food hygiene training was yet to be addressed, with just four staff noted to have had such training. This was put to the providers by urgent letter following the inspection, with a reply that most courses are only available from September, and that this would be arranged. The requirement is repeated, as failure to address it puts residents at risk of poor hygiene practices in relation to support with food and drinks. There were records to show that new staff work through an initial induction process with senior staff before starting to work on their own. The records were signed by both parties, and showed promptness in working through the topics. There were also records of four different staff working through documentation about the national induction standards, including writing responses to questions about the learning. The manager noted that she oversees this process, and plans to start it with a few other staff, which is encouraging. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 28 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 and 38. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager demonstrates good management skills that are resident-centred. Quality assurance systems are operated in the home and make a difference to the lives of residents. Residents’ money is suitably looked after by the home where applicable. Health & safety systems suitably protect everyone in the home. EVIDENCE: The home’s manager has been in the role since the autumn of 2005. She previously has had a number of years’ experience as a senior staff member Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 29 within the home. She has completed the NVQ level 4 in management and care since her appointment to the role, and had become registered as the manager of the home since the last inspection. She noted additionally that she is close to completing a Higher Education Nursing diploma. There was evidence of her managing the staff team effectively in respect of guidance about meeting residents’ needs. Feedback about the manager was encouragingly positive. Every resident spoken with spoke positively about her, one noting that the manager is, “marvellous, as she knows everyone and is always around.” Relatives’ feedback was similarly positive, for instance that she is, “extremely helpful, kind, calm and efficient.” Resident and relatives’ surveys have been distributed twice since the last inspection, at approximately 6-month intervals, using the organisation’s standard written form that enquires about the care in the home. Seven replies were received the first time, thirteen the second. The manager wrote a short summary of each set of replies, noting both strengths and areas for improvement. She explained that she discussed findings verbally and individually with residents and relatives. The reports were not sent to the CSCI as previously required, but evidence shows that the findings were addressed. It would be good practice to augment the verbal feedback with a open summary that is available for all involved people or which is distributed, to help show that the surveys are taken seriously. Conversely, it is positively noted that the surveys have clearly formed the basis for the pre-inspection paperwork requested by the CSCI, and that action has been taken with areas identified for improvement. The manager noted that proprietors’ reports continue to be written monthly following visits from the area manager to the home. It was previously required for these to be sent to the CSCI, to help provide ongoing information about the services at the home. However, the last report received was in May 2006. As there are some key areas of improvement needed within the home from this visit, the proprietor reports must be sent to the CSCI to help provide updates. The manager explained that most residents have family that look after their finances. A few residents look after their own, and the service at the home looks after small amounts for four people. This money was seen to be securely stored. Records and receipts showed clear documentation and appropriate spending, including sometimes for family members to sign that further money had been provided. A separate hairdressers’ record is also kept, for which relevant people are invoiced. Health & safety risk assessments were in place for key hazards around the home, for instance about slight changes in flooring levels between rooms, the garden, steps, and storage of flammable liquids. These all explained what had Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 30 been done to contain the risk, assessed the risk, and identified if further action was needed. The record of a visit from the local council’s environmental health department on 28th February 2007 was seen. There were no overall judgements, but they noted for instance that the service has, “much improved since the last inspection” regarding kitchen records. Only one issue was highlighted, about replacing a freezer, for which there was feedback during this visit about it having been addressed. The last fire authority visit was in 2005, from which ‘satisfactory standards’ were noted. The home’s fire-safety risk assessment was reviewed and updated in January 2007. A sample of professional checks of systems in the home were considered. These were seen to be up-to-date for the prevention of legionella and for the electrical wiring. Records noted that the gas systems and the portable appliances had last been serviced in May 2006, and were hence due, which the manager stated that she was addressing. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 31 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 3 3 X X 3 1 3 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15 Requirement Care plans must include information about the following areas: • how each resident’s financial affairs are handled and whether any support is needed by the home, • typical times of getting up and going to bed, • pain communication, • preferred names, • preferred clothing, • any specific medication technique that the service at the home supports, and • any skin management issues. The lack of this specific information about particular residents within their care plans could cause inconsistent or poor care. Individual manual handling records must include an assessment of need, in terms of the resident, the environment, and the staff. A lack of this could fail to highlight specific issues that could consequently cause accident or injury. DS0000039315.V343995.R01.S.doc Timescale for action 15/10/07 2 OP7 13(4) 01/10/07 Carlton House Version 5.2 Page 33 3 OP9 13(2) 4 OP9 13(2) 5 OP12 16(2)(m, n) 6 OP14 12(3) 7 8 OP16 OP18 17(2) s4 pt11 37 9 OP18 13(6) 10 OP18 13(6) Medication records must always be appropriately signed for once the medication has been offered to a resident. Gaps have the potential to cause double-doses. Records of medications coming into the home must be fully kept for each resident. Failure to check could result in mistaken discrepancies in quantity not being discovered, which may later result in the medication running out before further delivery. The service must provide residents with more personalized and varied activities, to better enable residents to have lifestyles in the home that satisfy their recreational interests and needs. Attention must be paid to better enabling residents to have more control over how they experience their meals, to make the mealtimes more satisfying. All complaints must be recorded about within the complaints file, to show due transparency. The manager must ensure that any allegation, of misconduct by staff towards residents, is promptly reported to the CSCI. Previous timescale of 22/5/06 not met. The current borough-wide safeguarding adults procedure must be acquired for use in the home, to help protect residents should any allegations of abuse arise. It is necessary for staff to be provided with formal training on abuse awareness if they do not already have it, so that they are supported to respond appropriately to any abuse scenarios. DS0000039315.V343995.R01.S.doc 01/08/07 01/09/07 01/09/07 01/09/07 15/08/07 01/08/07 15/08/07 01/11/07 Carlton House Version 5.2 Page 34 11 OP19 23(2)(b) 12 OP19 23(2)(b) 13 OP25 23(2)(n) 14 OP28 18(1)(c) 15 OP29 19 s2 pt3 16 OP29 19 s2 pt6 17 OP30 18(1)(c) 18 OP33 26 The hallway carpet, from the lounge to the laundry area, must be replaced as it is discoloured and worn. The kitchen requires general upgrade due to wear and tear. Previous timescales of 1/2/06 and 1/8/06 not met. All radiators in the home must be covered or replaced with lowsurface temperature models. Previous timescales of 1/11/04 and 15/6/06 partially met. The manager must ensure that the home actively plans for 50 of care staff to have achieved the NVQ level-2 (or above, or equivalent) qualification in care within the prescribed timescale. Previous timescales of 31/12/05 and 1/8/06 not fully met. Appropriate written references must be in place in advance of employment, as one source of evidence that the person is suitable and safe to work with residents. There must be documentation exploring the reason for any employment-history gap, in case the gap relates to reasons that could put residents at risk. The manager must ensure that all staff receive formal and upto-date training in food hygiene. Previous timescale of 1/10/06 not met. Monthly proprietors’ reports about the home must continue to be sent to the CSCI without undue delay. Previous timescales of 15/3/05, 1/11/05, and 31/5/06 not met. 01/11/07 01/10/07 01/09/07 01/10/07 01/08/07 01/09/07 15/10/07 01/09/07 Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 35 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 3 4 5 6 7 8 9 Refer to Standard OP7 OP8 OP8 OP12 OP14 OP16 OP20 OP30 OP33 Good Practice Recommendations Care plans should be provided to residents in their rooms unless not wished for, to enable residents or their relatives where applicable to view the plans whenever they wish. To help keep information accurate, fall charts within individual care files should be up-to-date. The continence-monitoring file should be kept fully up-todate, to help ensure that analysis is correct and hence prevent inconsistent care. Occasional day trips to places of interest to residents are recommended, to help to meet recreational needs. A written plan, to address access issues throughout the house in respect of the Disability Discrimination Act 2005, is recommended. It would be more transparent if there were a written record within the complaints file explaining how conclusions were drawn for each complaint. Consideration should be given to providing space between lounge chairs where this benefits individual residents. A written training plan for the home is recommended, to show the organisation’s commitment to achieving training standards. It would be good practice to augment the verbal feedback about quality surveys with an open summary that is available for all involved people or which is distributed, to help show that the surveys are taken seriously. Carlton House DS0000039315.V343995.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 3rd 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. 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