Inspection on 04/07/08 for Carlton House

This inspection was carried out on 4th July 2008.

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

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

Other inspections for this house

Carlton House 05/07/07

Carlton House 13/07/06

Carlton House 08/12/05

Carlton House 11/07/05

Carlton House 12/01/05

Carlton House 04/06/04

Carlton House 12/01/04

Carlton House 17/11/03

Carlton House 24/06/02

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Carlton House 267 Hainton Avenue Grimsby North East Lincs DN32 0LA Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 4th July 2008 09:00 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 DS0000002911.V366633.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 DS0000002911.V366633.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton House Address 267 Hainton Avenue Grimsby North East Lincs DN32 0LA 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) 01472 360878 Mrs Katrina Peerbux Manager post vacant Care Home 10 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (10) of places Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2007 Brief Description of the Service: Carlton House is registered to take 10 persons with residential care needs; these beds are also registered for people with needs associated with dementia. The home is a detached house situated in a busy residential area of the town; it is close to the town centre and on local bus routes. Accommodation is provided on two floors; there is chair lift access to the first floor. There are four single rooms and three shared rooms; one bedroom is provided on the ground floor. The home has one lounge, one dining room and an outside courtyard. The home has a pleasant, homely inclusive atmosphere. The home is owned by Mrs Katrina Peerbux. The acting manager is Mr A Peerbux. Weekly fees are: £365- £415. The home operates a system whereby the fees may include a third party contribution. Additional charges are made for the following: toiletries, newspapers/magazines, hairdressing and chiropody. Information about the home and its services can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 4th July 2008. During the visit we spoke with some of the people who live at the home, a number of relatives, care staff, a visiting district nurse, the manager and the owner. We looked round the home to see if it was kept clean and tidy. Some of the records kept in the home were checked. This was to see how the people who live in the home were being cared for, that staff were safe to work in the home and that they had been trained to their job safely. We also checked records to make sure that the home and the things used in it were safe and were checked regularly. The manager at the home also completed an annual quality assurance assessment that was requested by CSCI (Commission for Social Care Inspection), which includes information about people who live at the home, the staff that work there, the service provided and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home, their relatives, staff and some health and social care professionals. Three surveys were returned from people who live at the home, five from relatives and three from the staff; the feedback was very positive. Comments from surveys have been included in the main body of this report. We would like to take this opportunity to thank everyone who participated in the inspection process. What the service does well: All of the people living in the home were positive about the home and like living there. Four people said they loved living at the home and the care was very good. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 6 People are confident that the care home can support them, this is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the people working at the home all about them and the support they need. The home has an enthusiastic staff team, who like doing their jobs and learning more about how to do it well. The staff want to make sure that the people who live in the home receive good care. People looked clean, well dressed and had received a good level of personal care. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People said: “The staff are very friendly” “I’m very happy here and very well cared for” “The staff are lovely to me and to others” Relatives said: “ I don’t know how the home could improve on the wonderful work they do already” “ Really look after the people who live there, they’re great.” “We feel they give all the attention that is needed often in very difficult circumstances”. What has improved since the last inspection? The home has improved the recruitment and selection process for new staff by ensuring all required checks on prospective employees are carried out before they start work in the home, this will better protect people who use the service. More redecoration and refurbishment has taken place in the home, which provides people who use the service with a more comfortable and better maintained environment. Storage at the home has improved with the provision of a new shed. Areas around the home were seen to be much tidier which provides a safer environment for people who live and work at the home. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were individually assessed prior to admission to ensure their needs could and would be met. EVIDENCE: Care plans showed that people within the service had been assessed before moving into the home. Risk assessments and a detailed plan of care reflected any specialist interventions. The manager and staff liaised with professionals, the person and their families to find out about people’s needs. The manager visited people and undertook assessments, prior to admission; there had been no new admissions to the home since the previous inspection visit. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 10 People who completed our surveys confirmed that they had received enough information about the home before they moved in. The home does not provide intermediate care support. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the staff performance around recording within the care plans must be made, to ensure the peoples’ health and welfare are protected. People’s privacy and dignity was well maintained. Some medication procedures need improving to ensure that people are protected. EVIDENCE: Three people’s care plans were looked at in order to obtain a picture of what their needs are and how staff support them. The care plans contain information about people’s biography, their personality and their choices and preferences. They also focus on the individual’s abilities as well as areas in which they require assistance. The majority of plans were very detailed and individualised. The care plans are reviewed regularly and there was evidence that some of the plans were Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 12 updated to reflect changes in need however this was inconsistently applied. Daily records detailed that one individual had previously sustained a pressure sore which had healed however there was no records in the care plan to support this, nor the use of any specialist mattresses or cushions or the current care support for the individual’s on going tissue viability needs. However another plan examined clearly showed how the person’s needs had changed and clear plans had been put in place to support areas such as pain control, pressure area support and dietary needs. Risk assessments are carried out to identify any risks to the individual. Where a risk has been identified, a care plan is produced to minimise the risk. Manual handling plans used to identify the support people require with their mobility describe in detail the assistance required so staff are clear about what is expected from them. Nutritional screening records were seen, and the manager said that this is undertaken on admission and subsequently on a periodic basis. The records confirmed this. A record is maintained of people’s weight gain or loss, although some inconsistencies were identified in the records as one individual‘s records seen detailed significant weight loss over a short period of time however this had not been checked or followed up. The person’s weight was checked during the visit which confirmed the previous weight record was inaccurate and the individual’s weight was stable. The registered person confirmed that staff would receive training and support around this to ensure continuity and that future changes/concerns are reported. There was evidence in the records that the home had accessed the support of an individuals G.P. around clearer directions for dietary support given the person’s diabetic needs and continued weight gain. Concerns had been raised to the manager by the community nursing staff and discussions with the staff now evidenced that they clearly understood the meal portion sizes and amount of snacks to be provided. Daily diary records were generally well maintained as were records to support communications with relatives and health care professionals. The records show that care staff work to monitor pain, distress and other symptoms to ensure individuals receive the care they need. Staff working at the home confirmed this. Feedback from relatives confirmed that they believe their relative is well looked after, and that the staff at the home do consult them about aspects of care that is then recorded in people’s individual care plans. Comments included “ We live a long way from the home and the staff always ring me and let me know if my relative is unwell. They let me know if the doctor has been any outcome from the visit”. There is good evidence of regular review meetings taking place, where individuals and their representatives have the opportunity to discuss their current care needs and discuss any issues they may have. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 13 There is good evidence in peoples’ care records to indicate that they are able access health care services, such as the dentist, chiropody, opticians and everyone living at the home is registered with a doctor. People looked clean, well dressed and had received a good level of personal care. From discussions with the manager and staff and from observation there was good evidence to support improvements in the general health of a number of individuals in the home. The manager said how one person’s condition had improved so much in recent weeks that she had gone out with her relatives for two hours one afternoon, which was the first time in three years this had been able to take place. He said that a staff member had accompanied them to the park and how much everyone had enjoyed the visit. Comments from people spoken to during the visit included: ”They look after you really well here” and “ Staff are very good, they are kind and patient with me”. Detailed medication policies are in place however from examination of the records there was evidence that the standards of some of the recording of medication had slipped. Checks on the administration records for controlled medication showed that two staff members were not always signing for the receipt of the medication which is good practice. A more serious issue was identified in that one individual was regularly receiving p.r.n. (as needed) medication for symptoms of sickness however staff had not recording any administration on the medication record, in discussion staff could not account for this. A single capsule was noted to be on the bottom shelf of the medication trolley, out of the monitored dosage system, which is considered poor practice. Other aspects of recording were found to be satisfactory, there were no gaps in signatures on other medication records and receipt and return records were in place. The home has yet to provide secure storage for refrigerated medication, items such as insulin are continued to be stored in the refrigerator in the kitchen. There was no evidence that the manager or senior staff were auditing medication administration procedures however an external audit had been carried out in March by the pharmacy provider, which had been positive. Records showed that all staff who have responsibility for medication administration have completed an in depth accredited course. Staff were seen to respect the privacy and dignity of people in the home, and were seen to respond to people’s individual choices and requests in relation to activities such as requiring drinks, support to get around the home or just having a quiet chat. Observations were that staff were mindful of people’s needs in relation to privacy and maintenance of their dignity and supported people in a respectful manner, they were polite and courteous at all times. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are able to make their own choices about how they spend their time and are offered activities. They maintain contact with their families as they wish and communication between the home and relatives is good. People receive a good quality, varied and nutritious diet. EVIDENCE: People spoken with said they were happy with their lifestyles at the home and that staff support them to engage in activities of their choosing and spend time doing as they wished. They were seen to walk freely around the home, if able. Social needs assessments and care plans have been reviewed and now detail more information about the individual’s past and current interests and their preferences in what activities they enjoy. There is a weekly activity calendar which includes Bingo, manicures, flip chart activity and musical instruments. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 15 New records have been introduced where staff record on a daily basis all activities, outings and social interaction each person has participated in. This is an improvement, however some of the records detail a limited variety of activities, such as “talking about their family and their day”. Discussions were held with the manager and registered provider who accept that further improvements in the variety of activities in the home could be made and that staff still need some support in their approach to individuals in encouraging and motivating them to participate. Records showed that more outings had been arranged; people had enjoyed visits to the International Market, the local park, shops and regular lunch visits to local restaurants/ public houses. One person said how they had enjoyed a BBQ in the garden recently. It is clear from discussions with staff and people who use the service that they continue to enjoy the fortnightly sessions provided by a visiting motivational therapist. During the day people were observed watching the television, having manicures and a number visited a local public house for lunch. All people spoken to said they are very happy in how they spent their time. People’s religious needs are identified on admission and they have the opportunity to attend services held in the local community. Discussions with staff confirmed that none of the current people using the service follow any particular religious observances. Relatives said they were able to visit at any time, were made to feel welcome and always offered refreshments. The staff who are responsible for cooking and serving the meals know each person’s food preferences very well. Everybody spoken with said that the food at the home is very good. Comments included “ The meals are really good here” and “I love all the meals especially the roast dinners”. An observation made at mealtime showed that meals are presented in an attractive manner and that people living at the home were enjoying their food, and being supported appropriately. Staff were seen to interact with people in positive ways, enjoying pleasant conversation and offering people drinks whilst talking about their day. The menu board in the hall displays the week’s menu choices; there is evidence that the menus are now reviewed regularly following discussions with people and changes such as providing more roast lunches and fish dishes have been made. One person said their favourite meal was Haddock and the staff would get them fish and chips when requested. One relative commented on a survey “ The home always provides fresh fruit and vegetables for the meals.” The kitchen was clean and there were good stocks of food in the fridge, freezers and cupboards. The home is currently providing fortified diets and diabetic diets for a number of individuals. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and people and their relatives feel confident that any concerns they voice would be listened to. The home has systems in place to protect people from abuse. People can be confident that their complaints will be listened to and acted upon. EVIDENCE: People and their representatives had been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. This contains details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. People who completed surveys responded ‘yes’ when asked if they knew how to make a complaint. Those people spoken with during the day said that they felt very comfortable in going to the manager knowing that any concerns they may have would be addressed. The home has received one complaint and records seen confirmed that there are good systems in place for the investigation and outcome management of complaints. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 17 There are policies and procedures in place to reduce the risk of abuse. All staff commencing employment have a CRB (Criminal Records Bureau) and a POVA (Protection of Vulnerable Adults) check before starting work in the home. All staff have received safeguarding (adult protection) training which provides information on how to protect people from abuse. After talking with staff at the home, it was clear that they understand the procedures for safeguarding adults. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Carlton House provides comfortable homely surroundings; although some improvements have been made to the facilities at the home in recent months much of the décor and furnishings are now looking tired and worn, some outstanding issues around odour control also impact on the overall quality of the environment. EVIDENCE: People said they were comfortable at the home and they liked their rooms. Generally the décor and some furnishings in the home are worn, tired and in need of refurbishment. There was evidence that improvement work had commenced as the ground floor bathroom had been redecorated and retiled, Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 19 the outside of the home had recently been repainted and a decorator was staining the wooden ramp to the garden during the visit. The registered provider confirmed that significant work to upgrade the décor and furniture throughout the home would be taking place. Because of this no individual requirements concerning the environment have been made instead the owner of the home must provide a maintenance and renewal plan of the fabric and redecoration of the premises for the home to show how and when further essential redecoration and refurbishment work will be completed. The manager has made efforts to reorganise and rearrange aspects of the home’s storage, this was evident from the tour of the building, a new shed for this purpose has been provided in the garden. Bedrooms had been personalised to varying degrees and people confirmed they were able to bring in small items to decorate their room. There was evidence that the management have made some attempts to address the issue of odour control around the home; a bedroom carpet had been replaced and the carpets in the communal rooms had been cleaned more regularly. However odour problems persist in two individual’s rooms and in the sitting room which need to be addressed properly. Laundry facilities are satisfactory. Policies and procedures are in place for control of infection; this is covered in the induction-training programme for new staff and staff confirmed that they have good supplies of protective clothing. All areas of the home were seen to be generally clean and tidy. Seating and shade is provided in the garden, staff said how much one of the people who use the service now enjoys spending time outside, sitting chatting to staff and reading the paper. The outside garden is dominated by a very large apple tree, staff confirmed that they regularly sweep this area to make sure people don’t slip on the fallen fruit. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported by staff who are kind and respectful, however staffing levels are not appropriately maintained which could put people’s health and welfare at risk. Staff generally receive training relevant to their role, although improvements are needed for induction training for new staff. Recruitment practises have improved to afford protection for people in the home. EVIDENCE: People who live in the home said that the staff are ‘wonderful and caring” and that they are ‘well cared for’. A relative said ‘the staff are really kind and polite, we are always welcomed and kept informed of any changes”. People had responded in surveys that staff were “always” or “usually” available when needed. Observation during the day also confirmed this with people receiving support in a calm, paced manner and staff having time to spend with people. The registered provider confirmed that she uses The Residential Staffing Forum to determine the number of staff that are required for each shift at the home. With the current occupancy figure of ten and the current dependency of the Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 21 individuals, staffing levels of three care staff in the morning, two in the afternoon and one waking/ one sleeping at night had been identified. Examination of the staffing rotas identified that a number of the morning shifts had only been covered by two staff members. Staff also have responsibility for the laundry, cleaning, cooking and activity provision. Staff confirmed that it was difficult to manage everything when only two staff were on duty, especially the cleaning. The registered provider confirmed that the home had encountered problems in recruiting new staff however more staff were scheduled to start in the near future which would boost the numbers and ensure the shifts were covered. She also confirmed that she would be recruiting domestic staff to free the care staff to be able to focus on care support and developing the activity programme. Improvements were seen with some aspects of the staff rota; where sickness/ leave cover had been identified the staff member covering had been detailed. The manager’s administration time had been detailed on the rota, usually one day per week, however given staff shortages in recent months this has not always been a true record. The manager explained the recruitment procedure, which was found to be satisfactory and that improvements had been made. He said that two written references are obtained before appointing a member of staff, and any gaps in employment records are explored. Checks on two new staff members’ records confirmed this and show that new staff are confirmed in post only following completion of a satisfactory police check, and satisfactory check of the Protection of Vulnerable Adults register. These checks are necessary to help protect people from potentially unsuitable staff. The home remains committed to providing National Vocational Qualification training for staff. Information received prior to the visit indicated that 75 of the care staff have achieved NVQ level 2 The manager confirmed that new staff would start the course and one staff member had commenced working towards level 3. Feedback from people who completed our surveys and from discussions indicated that they believed that the staff are well trained and provide very good standards of care. The manager keeps an overview of the staff training programme to assist him in the planning of training in the home. Generally the home provides a very good staff training programme with staff accessing annual updates in statutory courses and a variety of general and service specific courses however there were a number of gaps in the induction training of new staff. Records evidenced that staff are up to date with mandatory courses in fire safety, moving/ handling, first aid and food hygiene. All staff have completed safeguarding courses and updates in health / safety and infection control. Senior care staff have all completed the safe handling of medications course Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 22 and the manager is currently arranging for further staff to enrol. Courses have been provided on diversity and the Mental Capacity Act. Checks on induction records for three staff showed that there were no records to support the in- house induction training for two staff members and that the Skills for Care induction training booklets had not been fully completed or signed off for the three staff members. Records to support training in this area must be completed to ensure staff have received all the appropriate information, training and have been assessed as competent to manage the care of individuals. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 23 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): 31,33,35,36 and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence a visit to this service. The acting manager does not always demonstrate effective management of the home which does not always fully safeguard the welfare and safety of the people who use the service; this said individuals are satisfied that the home is well managed and they have appropriate support. EVIDENCE: The acting manager (and joint owner) Mr Ali Peerbux has now been in post for over two years. He is a qualified nurse and has many years experience in providing care for older people. Mr Peerbux is keen to promote and provide Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 24 good quality care to vulnerable people. He has an excellent rapport with people living at the home, who speak very highly of him, one person said “ We love Ali, he’s the gaffer, he looks after things really well”. This said it is clear that the acting manager’s focus and expertise lie in providing and directing good standards of care rather than the maintenance and development of the management and administration systems. At the previous inspection visit in November improvements had been noted to aspects of the management systems however at this visit it was clear that standards of records and management of areas such as care plans, medications, training, supervision and the quality assurance system had slipped. Discussions were held with the manager, the registered provider and the inspector on how important the continued maintenance of these systems were in protecting the health, welfare and safety of the people residing in the home and how the registered provider needed to ensure a more robust and consistent approach in how she oversees the management of the home. The acting manager must receive regular formal, documented supervision to make sure his performance has been discussed and any support or direction needed has been identified. The quality assurance system has not been adequately maintained to demonstrate that continued improvements have been made and the home is run in the best interests of the people who live there. Meetings have been held with people who use the service and areas such as activities and meals were discussed. Surveys had been sent to relatives in December, comments received by two of the families prompted the manager to arrange meetings to discuss the issues however there were no records to support any follow up. Surveys have been issued to people who use the service and these need to be analysed. Some auditing of the facilities has taken place. An annual development plan was produced in June 2007 this now needs to be reviewed to assess improvements made over the last twelve months and identify new areas of focus. The home has good policies and procedures in place, and the manager explained that they review and update these as and when required. The records confirmed this. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Two peoples’ finances were checked during the visit and were found to be correct. A staff supervision programme is in place however records show that many of the sessions are group ones which really constitute a team meeting. Staff need to access at least six individual sessions per year and any “group” ones would be supplementary to this. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 25 The home’s quality assurance assessment indicates that routine maintenance and servicing of equipment takes place. The home carries out weekly fire safety checks and these are recorded and staff are involved in fire drills periodically to ensure they know what to do in the event of a fire. An up to date fire risk assessment is in place. Safe working practices are maintained by risk management and the provision of training to staff in the form of moving and handling, basic food hygiene, first aid at work, infection control and fire safety. Accident records are completed and records show that all individual incidents/ accidents are followed up by the manager. Advice was given to audit accidents in the home monthly to identify any trends that may be apparent. Hot water management at the home has been problematic for some time. At the last inspection visit the weekly records to support hot water temperature monitoring were unsatisfactory in that many of the temperatures were too high and no record of action taken in respect of this was detailed. There are records to support visits by plumbers to resolve this issue however checks of the records during the visit evidence that again a number of them were too high. Feedback from people who completed our surveys and from discussions indicated that they feel safe living in the home, and that they believe it is well run. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 26 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 27 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(1) Requirement The registered person must ensure that people’s care plans set out in detail the action staff must take to meet all aspects of health and personal care needs of the people using the service. Information within the plans must be up to date reflecting the care being given. This will ensure that people receive the right care to protect their health and wellbeing, and their wishes, choices and rights as individuals are promoted and protected. The registered person must put in place a robust system to monitor that people’s weights are completed consistently. A record of weight gain or loss must be kept and appropriate action taken when needed. So the nutritional health of people using the service is promoted and protected. 3. OP9 13(2) The registered person must ensure that safe systems are in DS0000002911.V366633.R01.S.doc Timescale for action 31/08/08 2. OP8 12(1)a 31/08/08 31/08/08 Page 28 Carlton House Version 5.2 place for the recording of all medication administered in the home. So the health and welfare of people using the service is promoted and protected. The registered person must ensure arrangements are made for the safe storage of medication requiring refrigeration. Timescales of 31/08/07 and 01/01/08 not met. NEW TIMESCALE The registered person must produce a maintenance and renewal of the fabric and redecoration of the premises plan for the home to show how and when essential redecoration and refurbishment work will be completed. This will enable people using the service to live in a pleasing and well-maintained environment, which meets their needs and the outcomes of the statement of purpose. 6. OP26 16(2)k The registered person must ensure that carpet/furnishings with offensive odours are cleaned more regularly or replaced. This will enable people using the service to live in a clean and comfortable environment which meets their needs and safeguards their dignity. Timescales of 15/08/06, 20/08/07 and 01/01/08 not met. NEW TIMESCALE. 31/08/08 4. OP9 13(2) 31/08/08 5. OP19 13,23 16/09/08 Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 29 7. OP27 18(1)a The registered person must 15/08/08 ensure that appropriate numbers of care staff are employed and rostered to meet the dependency needs of the people who use the service. This is to ensure that people receive the care they need in a timely fashion, that individuals are adequately monitored and supported and staff do not feel overstretched. Timescales of 06/07/07 and 15/12/08 not met. NEW TIMESCALE The registered person must ensure that the induction process is robust and that all staff are competent to carry out their work tasks before the induction book is signed off. The booklets, or copies must be held in the home. So that people can be assured that competent individuals with the skills to meet their needs are looking them after. The registered person must ensure that the acting manager’s management performance is effectively monitored which must include regular formal supervision. This will ensure that the management and administration systems in the home will be improved to further protect people who use the service. The registered person must ensure that the acting manager applies for registration with the commission. This will ensure their fitness for 8. OP30 18 16/09/08 9. OP31 OP36 9,18(2) 31/08/08 10. OP31 9 31/10/08 Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 30 11. OP31 10(1) 12. OP33 24 the role and protect people who use the service. The registered person must 20/08/08 ensure that the acting manager is provided with adequate management time to effectively manage the home and that this is clearly identified on the staff rota. Timescales of 15/08/07 and 01/01/08 not met. NEW TIMESCALE. The registered person must 16/09/08 ensure that the systems to monitor the quality of the service are fully maintained. So the home can demonstrate that it is offering a quality service and value for money to the people using the service, and is listening to their views and opinions and taking action to meet its aims and objectives and produce favourable outcomes for people. 13. OP36 18 The registered person must ensure the manager increases the frequency of staff supervision so care staff receive at least six individual supervision sessions per year. So staff can receive feedback and support around their work practices and career development needs, and people using the service receive care from competent and experienced people who understand their roles and responsibilities. 30/09/08 14. OP38 13 (4) The registered person must ensure that hot water temperatures at outlets accessible to people who use the service do not exceed 43 degrees C. Records must detail DS0000002911.V366633.R01.S.doc 15/08/08 Carlton House Version 5.2 Page 31 action taken to reduce the temperature. This will ensure the health, safety and wellbeing of people living or working within the home is protected and maintained. Timescales of 15/08/07 and 15/12/08 not met. NEW TIMESCALE. 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. Refer to Standard OP9 OP9 OP12 Good Practice Recommendations The registered person should ensure that all medication is safely stored in the medicine trolley or cupboard. The registered person should ensure that two staff signatures support receipt of controlled medication. The registered person should provide training for the staff to improve the quality of the activity provision in the home. Carlton House DS0000002911.V366633.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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