Inspection on 16/08/05 for Carlton House (30)

This inspection was carried out on 16th August 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Carlton House (30) 27/04/06

Carlton House (30) 05/12/05

Carlton House (30) 02/11/04

Carlton House (30) 21/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOMES FOR OLDER PEOPLE Carlton House 30 Chatsworth Road Croydon Surrey CR0 1HA Lead Inspector James Pitts Announced Inspection 16 August 2005 9:30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Carlton House Address 30 Chatsworth Road, Croydon, Surrey, CR0 1HA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8688 7801 020 8688 7801 Dr Emmanuel Akuffo Mrs Celia Akuffo Mrs Celia Akuffo Care Home 15 Category(ies) of Learning Disability - over 65 registration, with number of places Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Up to seven (7) residents may be 50 to 64 years of age. Date of last inspection 6 May 2005 Brief Description of the Service: Carlton House is a privately owned home for 15 people with learning disabilities, at present there are twelve service user’s residing at the home whose ages range from fifty upwards. Carlton House comprises of two large houses made into one with connecting corridors. It is situated in a residential area a few minutes walk from the centre of Croydon and the main railway station. There is off street parking for a number of cars. There are eleven single rooms and two twin rooms. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An additional visit to the home took place on 6th May 2005 in order to check on progress for the 15 requirements that had remained outstanding for some time. It is positive to note that most of these have now been achieved and the home has shown steady signs of improvement in the last year. This report covers standards that were inspected both at the additional visit and at this inspection. Other visits have also occurred where the inspector was able to talk with the service users. This inspection visit also involved service users, conversations with the management team, looking at policies and records as well as reviewing the questionnaires from service users, relatives and a local GP who has contact with the home. What the service does well: What has improved since the last inspection? The home has taken the appropriate steps to try to secure independent advocacy for service users. There are still some difficulties in obtaining an advocate but it is good to note that the staff team are now more aware of how important this is. The staff are also now much more aware, through training, of what they need to do to protect vulnerable people from abuse. It is good to note that four staff have now done this and that the manager agreed that all staff would eventually have this training when places on the course become available. A professional Occupational Therapy assessment of the home has now been completed and the home is able to ensure that furnishings have been assessed Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 6 as being safe in the event of fire. The safety of the hot water and heating around the home has also greatly improved which will also help to keep the service users safe from harm. It is positive to see that action has been taken to improve the professional training of staff and that the home is taking more steps to ensure that this continues. A Quality Assurance system is now in place and this includes questionnaires that are given to service users, relatives and other people who have contact with the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 & 6 Service users and other people are told what the home does and how it will do it. The service user guide should, however, be written in a clear way so that everyone can understand it. The service users can feel confident that the home will only care for people that the staff are trained and able to care for. EVIDENCE: The home has a statement of purpose, which tells people what the home does and how the staff will care for the service users. The Statement of Purpose has all of the things included in it that have to be there. The home also has a service user’s guide, which tells the service users what the home is like and what the staff will do to help the people who live here. This guide could still be clearer and include things like pictures that can help more people to understand it. The inspector recommended at the last inspection that the home should make this guide more understandable for service users, and this is still to be done. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 9 Each person who lives here has something called a contract. This tells the service user, their family and the local authority about what care the staff will provide and how much this will cost. New service users do not come to live at the home unless the staff get all of the proper information that helps to decide if the person can be properly cared for here. No one new has come to live at the home since the last time that the inspector came to visit. The inspector told the home that they must write into the statement of purpose that they sometimes do have people come to live here for short periods of time. This is known as respite care. This has now been done. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 The Service users can feel confident that their personal care needs and physical and emotional health needs will be well met by this home. This ensures that the service users have the opportunity to maintain their dignity, have their rights respected and continue to enjoy a good quality of life. Service users can also have confidence that their health care needs will be attended to and that will receive the support and treatment that they need. EVIDENCE: All of the service users continue to have a detailed care plan. The care plans tell the staff in a lot of detail about the best ways to support each person who lives here. It also tells the staff about what each service user likes to do each day, the things that they like and how the staff should do the best things to help in the right way. A senior member of staff looks at the care plans each month to make sure that each of the service users is being supported in the right way. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 11 All of the people who live at the home usually go to see a local GP if they are not feeling well. The service users can see any local GP but most see the same one. The staff are still very good at writing down anything that happens if anyone becomes unwell. If any of the service users have an illness or something else is wrong with them then the staff do know what this is and how to help them to get the treatment that they need. If anyone needs to take medicine then the staff help him or her to do this. None of the service users can do this without help and the staff have written down why this is so on each of the care plans. The staff are very good at making sure that people take their medicines so that they can stay well. The staff are also good at making sure that no one can get hold of any medicine that they should not have and so they keep medicines locked away. The service users who spoke with the inspector and who sent back their comments all said that they feel as if the staff treat them well and that they are respected. Two service users have passed away in the last year, which were very sad times for everyone who lives and works here. One of these people was able to stay at the home until they passed away. The staff were very good at doing the right things to make sure that this person was made as comfortable as possible and to stay in their own home amongst familiar people and friends. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Service users can feel confident that the staff of the home will provide opportunities to engage in activities and will have support to develop and maintain personal and family relationships. Service users can also be confident that they can enjoy a varied, nutritious and healthy diet. EVIDENCE: The majority of service users continue to attend day activities, for example Norbury Pop-in centre. There had been a problem last year about how much money it was costing for service users to pay for taxis to go to the centre, but this has now been worked out. Some of the service users are able to get out and about without needing staff to help them or go with them. The home organises day trips to places of interest. Fairfield Halls in Croydon is a renowned concert hall visited by service users when a particular show sparks interest. An activities coordinator is employed by the home every Tuesday to come in to organise activities with service users who may not be able to get out and about very often. The staff are very good at helping each service user to keep in contact with their families and friends. Family and Friends are made very welcome when Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 13 they visit the home. Service users can see their family and friends in either their own bedroom or in the other parts of the house that everyone shares. Each of the people who live at this home is allowed to make choices about what they want to eat. The staff are good at making sure that healthy food is always on offer. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 The service users can feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances. EVIDENCE: The service users, and others, are given clear information about how to complain and what happens when they make a complaint. The Inspector investigated a complaint that was made by the relatives of one of the service users earlier this year. The home was not found to be at fault but there were some useful lessons that came out of the complaint that would help to ensure that a miss understanding could not occur in the future. The Inspector advised the home about some changes that they can make about how they share information when anyone goes into hospital. It was encouraging to note that the manager of the home accepted that the suggestions were helpful. At the last inspection the manager of the home was asked to make contact with an advocacy organisation. This was to see if an independent advocate could be provided to any service user who does not have close contact with their family or friends. The manager did this and was told that there is a shortage of advocates, but that the home would be put onto the waiting list. The Inspector suggests that the manager keep in regular contact with the advocacy organisation to remind them about the home wanting an advocate for service users when one becomes available. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 15 The staff team are good at making sure that all of the service users are protected from abuse (this means that the staff at the home do everything that they can to stop any of the service users from being hurt by someone else). There is also clear written information for staff about what to do if they think that a service user is being hurt or abused by another person. The staff know what they then have to do to keep people safe. None of the service users who spoke with the inspector said that they are being hurt by anyone else. The Inspector told the home that they must ensure that the staff have training about protecting vulnerable people from abuse. It is good to note that four staff have now done this and that the manager agreed that all staff would eventually have this training when places on the course become available. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 24, 25 & 26 Service users can feel confident that they do live in a comfortable, clean and well maintained house that meets their needs. The premises have also now been properly assessed by a qualified occupational therapist. EVIDENCE: It was required at the previous annual inspection that there needed to be a professional Occupational Therapy assessment of the home. This was done on the 21st April of this year. All but one of the service users is physically mobile. The one person who needs to use a wheelchair has their bedroom on the ground floor and the home is big enough to allow this person to get around in their wheelchair. At the last inspection the Inspector was concerned that not all of the furniture is service users bedrooms was able to resist fire. The manager was asked to carry out a risk assessment about this, which has now been done. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 17 Heating, lighting and ventilation are adequate (a number of rooms had windows open on the day of the inspection). The Inspector was concerned at the last Inspection that the hot water in some of the bedrooms and bathrooms might be too hot. It was required that the home fit appropriate thermostatically controlled mixing valves, which the manager has said has now been done. The Inspector checked some of the hot water taps in the home and all were found to be at a safe temperature. The inspector noted at the previous unannounced inspection that some of the radiators in communal areas of the home had been covered, but that this work had still to be completed throughout the home, or to provide radiators with low temperature surfaces. This has also now been done. The home remains clean and tidy and is free of any unpleasant odours. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 & 30 The home is mostly good at the way in which staff are recruited and trained. However, the management team must remain aware that if they do not ensure that all the required background checks on staff are always carried out then this could place service users at risk. EVIDENCE: The manager provided details of staff that had completed their NVQ level 2 training. Four have now done this, three are currently doing it and two more will start this training once the current group have finished. The deputy manager of the home started their NVQ assessor training on the same day as this inspection visit. It is good to see that the home has taken action on this, as it had been a requirement at the previous unannounced inspection. The staff files for new staff at the home were looked at to see if they were properly recruited and that all of the correct checks had been done before they started work. The Inspector found that one member of staff had no CRB Disclosure certificate and yet was being allowed to work at the home. This is unacceptable as it places service users at possible risk. The Inspector reminded the manager that the Commission views it very seriously if the home does not carry out all of the checks that are required by law before any new staff begin working here. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 19 All staff have an individual training and development profile, which is included on their staff files. This covers the National Training Organisations workforce training targets and shows that staff are fulfilling the aims of the home and are able to meet the individual and changing needs of service users. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 36, 37 & 38 Although much of the management and administration of the home has improved the management team should be mindful that they risk undermining the good direct care work of the home if further progress is not made. However, the service users can feel confident that the home carries out all of the necessary health and safety checks to make sure that the house is a safe place in which to live. EVIDENCE: It was required at the previous inspection that there needed to be a specific Quality Assurance system in the home. A Quality Assurance system is now in place and this includes questionnaires that are given to service users, relatives and other people who have contact with the home. One concern that the Inspector has is that minutes of service users monthly house meetings could Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 21 still be better at showing how the staff tell service users about the progress on things that have been talked about. To assist open and specific future planning for the home, a Business and Development Plan has now been put into place. This was a requirement at the last inspection and it is positive to see that this has been done. Service users’ own money is kept in wallets in the safe: the inspector examined all of those that are kept and found the amounts tallied with the records. Personal allowances are kept in these tins the limit of which should not usually exceed £100. Money from savings accounts would only be withdrawn for specific reasons, for example paying for new clothes or paying for a holiday. However, it was noted at the previous annual inspection that where the money that was withdrawn for service users was then paid to a company providing a holiday, this had not been entered through the service users financial records at the home. This must be done in all cases, and as no further monies have since been withdrawn this requirement will not again appear in this report but service users financial records will be checked at random again at a future visit. The home has got better at carrying out staff supervision or appraisal (Staff supervision is a time that each member of staff can meet individually with the manager to discuss how they are progressing in their work and to resolve any employment and training matters). The proprietor / manager previously informed the inspector that regular supervision sessions with staff are taking place, but there remain very few records to show that this occurs at least six times each year, which is required. It was reported at the previous annual inspection that not all of the records required by Schedules 3 and 4 of the Care Homes Regulations 2001 for the protection of service users and for the effective and efficient running of the business are not entirely appropriately maintained, or being kept up to date and accurate. The proprietors have clearly continued to make a number of positive strides in this direction; however, it is still necessary for staff to sign the records showing that they have read and understood the policies and procedures that are in use at the home. The following health and safety checks have been carried out within the last year: Fire Alarm System: 28/09/04 Fire Extinguishers: 06/05/05 Gas Safety Check: 26/11/04 Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 22 Electrical Installation: 17/07/04 Legionellosis: 25/07/05 Portable appliances: 29/07/05 On the 12th May an environmental health officer also visited. The report that this person sent to the home did not show any cause for concern. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 N/A 15 3 COMPLAINTS AND PROTECTION N/A N/A N/A 3 N/A 3 3 3 STAFFING Standard No Score 27 N/A 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 N/A N/A 2 3 3 1 1 3 Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 29 Regulation 19 (5) (d) Requirement The home must ensure that all staff have a satisfactory CRB check in place prior to commencing their work at the home. The minutes of service users monthly house meetings must show how the staff tell service users about the progress on things that have been talked about. As required at the previous unannounced inspection, staff supervision must occur at least six times each year. As required at the previous unannounced inspection, staff must sign the records showing that they have read and understood the policies and procedures that are in use at the home. Timescale for action with immediate effect 16/10/05 2. 33 24 (3) 3. 36 18 (2) with immediate effect with immediate effect 4. 37 18 (4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 25 Carlton House 1. Standard 1 The As recommended at the previous unannounced inspection, the servie user guide should be made to be more understandable for service users. Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 26 Commission for Social Care Inspection 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carlton House G53 S25763 CarltonHouse V187247 160805 stage4.doc Version 1.40 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!