Inspection on 04/05/06 for Carlton House

This inspection was carried out on 4th May 2006.

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 03/07/07

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 4th May 2006 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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.V293057.R01.S.doc Version 5.1 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 Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2005 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. There were two vacancies at the home at the time of inspection. 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 service users 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. The home has three interconnecting lounges and a dining room. At the rear there is a well-maintained garden. The scale of charges, as at the time of the inspection, was £485 to £505 a week. Additional charges include for the hairdresser, private chiropody, and personal phone lines within bedrooms. 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. The home did not have a registered manager at the time of writing. A manager, Mrs Gunatunga, has been employed at the home since the late summer of 2005. She has applied to the CSCI for registration in this role. This is referred to further under standard 31. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across one and a half days in early May. It lasted almost ten hours. Its focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspection process involved meeting with a number of service users individually to discuss the services provided in the home. The inspector also discussed aspects of the service with a few visitors present during the visits, with staff who were working during the visits, and with the manager. Additionally, care practices were observed across the first day, aspects of the environment were checked on, and a number of records were sampled. A few months prior to the inspection, the manager was requested to send out comment cards to involved people, and to complete an inspection questionnaire. Consequently information from four service users’, eleven friends/relatives/visitors’, and four health & social care professionals’ comment cards, along with the completed inspection questionnaire, have been included in this report. Feedback was almost entirely positive. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: What has improved since the last inspection? Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 6 A number of requirements from the last inspection report have been addressed. These include that: • Refurbishment of a bathroom and the shower room has taken place. • There is better recording and analysis of continence support. • All previous medication issues have been addressed. • The complaints procedure has been strengthened, to ensure that complaints are appropriately addressed. • Recruitment checks have been brought up to standard. • The manager is addressing her role fully. • Service user meetings and quality audits are happening. • Staff supervision systems have been set up. • Service users’ looked-after money in the home is appropriately documented and safe. Additionally, there has been some redecoration of the dining room and the lounges, a further domestic staff member is generally rostered to work during the week, a maintenance worker is now employed on a part-time basis, an activities schedule is displayed and worked towards, and a weighing chair has been purchased. This all represents significant improvements since the last inspection. What they could do better: There are a few requirements that are outstanding from the previous inspection. The key improvements from these are: • 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. • To ensure that radiators that are accessible to service users have protective coverings fitted that can prevent scalding accidents. • For plans to be in place about enabling at least half of the staff team to achieve NVQ qualifications. There is currently a small shortfall in numbers. • For there to be recorded risk assessments of the key potential hazards around the home and about how risks from these will be reduced. Additionally, the following points must also be addressed: • Medication must not be left with service users unless risk assessed as safe, as there was a case during the inspection of finding an unused pot of tablets in one service user’s bedroom. • Many staff have not had recent formal training in food hygiene, manual handling, and emergency first aid. Whilst the manager is actively addressing this, the current shortfall puts service users at risk of poor care in these areas. Please contact the provider for advice of actions taken in response to this Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users’ needs are suitably assessed in advance of moving in. The home meets the needs of the service users, and appropriately seeks external professional support where difficulties arise. EVIDENCE: A copy of the service user guide, which provides details about the home’s services, was available within the entrance hall. It was updated in January 2006 to reflect the changes of management in the home. It complies fully with expectations on the information provided. Records showed that appropriate admission assessments are made of people who may be moving in. These are made by the manager or the local area operations manager, through visiting the prospective service user and their representatives in advance of offering a placement. Reports of other health and social care professionals are also obtained. If a placement is offered, a care plan is then promptly set up. It is also signed by the manager and the service user or their representative. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 10 Records and feedback showed that the home does not admit people whose needs are too great. When the needs of a service user living in the home become too great, external professional support is acquired, and consequently formal and appropriate procedures for a service user to move into a nursing home are occasionally followed. The overall feedback received from service users, relatives, and health professionals found that everyone was satisfied with the care provided. One service user said that they are treated like family in this home, another that the care is very good. The manager and staff were able to explain about how they meet the needs of individual service users, and no concerns arose from this. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Strengths are with accessing appropriate health professional support, upholding generally good systems of medication, and treating service users respectfully. Improvements are needed to keep manual handling assessments of service users up-to-date and effective, and to ensure that medication is always given to service users safely. EVIDENCE: The care files of three service users were checked through. These showed that care plans of reasonable detail, in respect of support needs and how these will be addressed, are in place for each service user. They are supplemented by monthly reviews that are mostly kept up-to-date. In terms of effectiveness, it is recommended that these reviews capture any significant events in the service user’s life that month, such as the outcomes of health professional visits, clearly state any changed support needs, and record any planned objectives for the coming month. It was noted positively that a number of care plans and monthly reviews have been signed by both the manager and the service user or their representative. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 12 An improvement is needed with the daily records kept about each service user. Whilst suitable detail was sometimes in place about what had occurred for the service user across the shift, in many cases the entry made by staff was very short and uninformative. The inspector also found that the significant support provided to one service user during one morning was not later recorded about. The manager agreed to address this, noting that such information is needed to provide a complete picture about each service user’s needs. Each service user had a moving and handling risk assessment on file. Those seen dated from October 2005. A few were found from feedback and observations to be out-of-date due to changes in approach. The assessments additionally did not clarify what needs to be in place for each applicable manoeuvre, rather that the same staff support and equipment be in place for the service user whatever the manoeuvre, which is not always the case in practice. Additionally, the environment of the manoeuvres was not considered, which could put people at risk through such things as tripping hazards in bedrooms. The manager must address these issues. It is additionally recommended for one staff member to be trained as an inhouse manual handling expert. This would allow them to provide expert training promptly to new staff, and to provide advice and support to all service users and staff in that respect. The home uses a separate file for recording the toileting support provided for each applicable service user. This was seen to be kept up-to-date. A senior staff member then records a review of each service user’s needs and support weekly. This is good practice. The manager noted that the advice of the health authoritys continence advisor is sought where needed, and that training and reviewing of the home’s systems in this respect is being sought. The monthly weight records of services users were audited. The manager and staff were able to suitably explain about appropriate actions being taken in the few cases of recent weight loss, such as with changing diet and acquiring food supplements through a GP review. The home has also acquired a weighing chair since the last inspection to assist with weight monitoring. The health records of service users generally showed recent chiropody and optician support. It was found from feedback that individual service users have acquired suitably recent support in other areas such as dentistry, continence management, and medication reviews. The records of this were not always up to date, which can prevent appropriate treatment from being sought. The manager must ensure that each service user has separate health records that capture all professional input and which also explain the key advice of such input. The manager explained that they acquire district-nursing support where needed, such as for pressure sore prevention and treatment. She noted that Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 13 appropriate equipment is acquired where needed, and explained a recent successful treatment of one service user in this respect. Feedback received from GPs and nursing professionals was entirely positive. They noted that they receive appropriate referrals from the home, and that their advice is followed by the home. There were good records of accidents involving service users. These focussed mainly around falls and their prevention. The manager undertakes monthly recorded audits of falls. She explained about how she identifies further action from this process, such as with contacting health professionals that may for instance result in changes of medication. The home provides a significant amount of support to service users with their prescribed medications. Appropriate storage of medications was seen, including through a medication trolley that can be taken around the home where needed. Sample checks of the medication storage and records raised no concerns. Signatures of staff providing medications were generally up-to-date. There were records of the receipt of each medication, and of their return to the pharmacist where applicable. The four requirements about medication from the last inspection had all been effectively addressed. The only improvement with medication is for staff to safely ensure that service users take their medication or that the medication is returned for disposal. During the late-morning tour of the home, some tablets in a pot were found on the dressing table in one service user’s room. It was established that these were tablets that had been left with the service user in error, and who had consequently forgotten to take them. The manager addressed the situation appropriately, noting that staff should not be leaving tablets for service users to take. The inspector observed service users generally being treated respectfully by staff throughout the inspection. Service users fedback positively about staff in this respect, noting also that they are well-cared for. Service users, visitors, and health professionals all noted that service users are provided with privacy as needed. There were no concerns about service users’ appearance during the inspection. Service users wore appropriate clothing, and their hair and nails were presentable, which shows that staff provide suitable support in this respect where needed. One service user noted that the home’s laundry systems work fine. Another was seen to be helpfully provided with their glasses when a staff member recognised that they had come downstairs without them. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Strengths are with improved provision of activities, the welcoming of visitors, and the provision of varied and nutritious meals. Improvements are recommended only with keeping suitably up-to-date records. EVIDENCE: Service users spoke generally positively about the activity provision in the home. One person said that activities are fine, and that they can choose whether to join in or not. Another pointed out the poster of weekly activities on display and noted that staff try to stick to it. The activity poster aims at afternoon activities that are staff-led. During the inspection, staff engaged service users in music and singing. Records showed that activities include exercise and reminiscence, such as with discussing Remembrance Day. The home also regularly welcomes a visiting hairdresser, musician, and priest. The manager spoke of acquiring a designated activities worker who would provide occupation of service users in both mornings and afternoons. Recruitment will shortly take place. This is partly in response to feedback from a quality audit report, which is encouraging. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 15 It is recommended that the activities record to be kept up-to-date, to show what the variety of activities were, as there were only six entries across the previous four weeks. A recent service user meeting established that none of the service users wished for any day trips at that time. Service users reported being content with family members taking them out, as confirmed at this visit by one service user. The manager noted that support is provided where requested for local walks and visits to shops, which one service user regularly takes. Where assessed as safe, service users can also go out independently. All visitors reported being welcomed into the home at any time. Observations confirmed this, for family members and a priest, during the inspection. Service users are supported to be independent within the home where possible. One service user was seen to make decisions about what to watch on television in one of the three separate lounges, whilst classical radio was being played in another lounge. Staff responded to requests for support as needed. Service users generally reported positively about freedom and choices within the home. One said that you can do what you like, another that they can go to their room whenever they want. A third said that staff support is unhurried. Service users all reported positively on the food provided. One noted that they can go to the kitchen at anytime to get a cup of tea, and most felt that they are provided with a choice of meals. The home operates a system of asking service users about their choice of two main meals, two deserts, and two evening meals, before the meals are prepared. Analysis of the meals provided across the previous week showed reasonable variety and suitable nutrition around traditionally-English meals. It is recommended that these food records include the vegetables actually provided with the meals, to show suitable matching and variety in this area. A menu was written on a display board before lunch. The main meal for the day centred around roast chicken and beef stew. A sample of the vegetables used, cabbage, cauliflower, peas and roast potatoes, found them to be of a softer texture but with a clear and pleasant taste. Presentation and support during the meals was seen to be suitable. Cooks are rostered for both main meals across all seven days of the week. On the day of the inspection, an experienced care staff member was covering for the absence of the cook through illness. This did not appear to cause difficulties in the preparation and provision of the meals. There was guidance on display in the kitchen about the specific dietary requirements of individual service users. The main cook has a certified and relevant NVQ qualification. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Strengths are that the home has tightened its complaints processes to ensure that complaints are appropriately addressed, and that challenging behaviours of service users are addressed calmly. Improvements must be made to ensure that the CSCI is notified about allegations of misconduct, and to keep appropriate records of any challenging behaviours of service users. EVIDENCE: Service users reported that they know who to speak with if they are unhappy with their care. They generally noted that staff listen and respond to their concerns. Many noted that nothing needs changing with the home. Only 5 of the 11 friends’ and relatives’ comment card noted awareness of the home’s complaints procedures. It was recommended to the manager that these systems be clarified to friends and relatives. There were four entries in the complaint file for 2006. Two were from a service user about poor treatment by staff, and two from relatives about missing items. Records, and feedback from the manager, showed that appropriate action had been taken in all cases, including outcome letters to the complainants. Staff disciplinary procedures had been followed where appropriate, and the manager explained other suitable measures taken to prevent a reoccurrence. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 17 The manager must ensure that any allegations of misconduct by staff towards service users is reported to the CSCI, to show openness about the home’s responses and to help ensure that these responses are suitable. Feedback from service users included that they feel safe in this home. Observations during the inspection included a verbal altercation between two service users that was calmly diffused by the manager through redirecting the attention of one of the service users. There were no concerns about how staff were seen to treat service users. Appropriate recruitment checks of new staff take place. Training for staff on the prevention of abuse has been booked for all staff to attend by the end of June. Whilst there were no practical concerns with how staff responded to any challenging behaviours of any service users, it was found that there was insufficient recognition about such behaviours in applicable service users’ records. Care plans must clarify the behaviours and explain how staff should respond, and daily records must make brief reference to incidents of such behaviour and staff response. The need for such plans is a repeated requirement. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Strengths are that much refurbishment of bathrooms and the shower room has recently taken place, that the home is kept clean and hygienic, and that service users are satisfied with the environment. Improvements must mainly be made to the kitchen in terms of refurbishment, as its furnishings have significant wear and tear. EVIDENCE: Service users commented positively on the environment overall. One said that the home is kept clean and warm. One visitor noted that several improvements have been made over the last few months such as to decorations and furnishings, all of which makes the home more welcoming. It was found that virtually all of the refurbishment requirements of the last inspection had been addressed. The bathrooms, shower room, and toilets were consequently found to be well-maintained and pleasantly decorated. The manager also reported amongst other things that the dining room and first lounge have been redecorated, and that new lino has been installed in some Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 19 toilets and bathrooms. This is all very beneficial to upholding a pleasant appearance. Only a small amount (approximately a meter in length) of ripped off borderpaper in the third lounge, the installation of further radiator covers, and refurbishment of the kitchen, remains to be addressed. These are for reasons of homeliness, safety, and general wear and tear respectively. A recent Environmental Health visit from the local council also identified the refurbishment of the kitchen as their only necessary action. The manager noted that plans have been made to address all of these issues. The home now employs a maintenance worker three days a week. The worker was installing fire-release devices to hold a number of communal doors open, during the inspection. Their employment is seen as a good investment for the home. A written maintenance request file was also seen to be in use, which allows big and small issues to be addressed quicker. There were no concerns about appearance and facilities within individual service users’ bedrooms, from those seen during this visit. Maintenance issues from the previous inspection had been addressed. One issue for consideration is that the hallway carpet from the lounge to the laundry area is losing its colour and showing signs of wear. It should be considered for replacement. The inspector observed one service user attempting to pass across the slight ramp from the dining room to the second lounge. They could not get their frame to traverse the slight incline. This may cause others to fall. A method of levelling the connection between the two rooms must be found. The home has a store of wheelchairs for general use by service users where needed. There were recent professional checks of these for faults, and those in storage were seen to be kept clean. The home has a passenger lift between floors, and a number of hoists for manual handling purposes. Professional checks of these were all found to be up-to-date. The home has a staff-call alarm system within each service users’ bedroom and within toilets and bathrooms. A test of one found staff to respond quickly. The manager gave a good account of the infection control precautions in place in the home. This includes re-enforcement of procedures at staff meeting and through a recent team discussion with an infection control nurse from the health authority. Staff showed awareness of the correct procedures. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 20 The home has two industrial washing machines and two tumble driers in the laundry room. Clothing systems were seen to work. The home aims to employ two cleaners and one designated laundry worker each day. The home was suitably clean during the inspection, except for ingrained staining in the kitchen as referred to above. There was additionally no malodour within communal areas of the home. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Strengths are that the home has a staff team who are committed to service users’ care, that the manager is pro-actively attending to team training needs, and that recruitment practices are generally suitable. Improvements however must be made to ensure that further NVQ training is provided to meet standards, and that team training needs are fully addressed. EVIDENCE: Service users commented positively about the staff working in the home. One said that staff do what they can, another that they are wonderful. One visitor said that the staff seem friendly and helpful whenever they visit or phone. All health professionals said that staff show a good understanding of service users’ needs. Observations and records confirmed this. Nine out of eleven friends and relatives stated on comment cards that there are sufficient staff working at all times. One person said that this was not the case, and one service user noted that staff can be very busy at times. During this visit, the home was operating two staff short overall, due to covering training and an unexpected absence. There was little adverse effect on service users noted. Analysis of the roster actually worked for the week found that sickness had meant that the home was one staff member short in the mornings on a Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 22 number of days. However, the total staff complement has increased from the last inspection with the addition of a second cleaner across the week. The manager was aware of her responsibilities to manage the staffing levels. It is therefore recommended that bank (as-needed) staff be employed to cover at short notice, to support those permanent staff who provide similar cover. The manager should also ensure that the time-keeping record of staff is always kept up-to-date. Checks of three staff employed since the last inspection took place, including one non-care staff member. It was found that suitable application forms, identification checks, and reference checks are undertaken. It is however recommended that the manager or owners of care establishments are used as referees, not senior staff, to ensure that the reference is from a professional and not personal perspective. Following discussion with the manager, and the viewing of further records, it was established that new staff do not now start work until a suitable Criminal Record Bureau disclosure is received in respect of the staff member’s proposed employment with the organisation. This is the expected standard. Records and feedback from the manager found that five care staff have qualifications at NVQ level 2 or above, including many at level 3. Two other staff are pursuing the qualification, as evidenced by their NVQ assessor being at the home during the inspection. A further few staff must still achieve the qualification, or have their nursing qualification confirmed as equivalent with the national training organisation, for the home to be considered to have a sufficient component of staff as suitably qualified. The manager must address this. The organisations standard induction form was seen to have been used by each of the sampled staff members within two weeks of starting work. It is recommended that the forms be checked for compliance with the national training organisations standards. The manager noted that she would shortly be attending a conference in this respect, and also on dementia care. The manager has organised and audited training certificates, and has recently planned and booked team training in medication and abuse awareness. She is planning further training in manual handling and emergency 1st aid. From a sampling of a number of staff training records, food hygiene training is also required. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Key improvements have been made with the managing of the home, the supervision of staff, and the auditing of service users’ and their representatives’ views. Further improvements are needed to make reports on quality auditing process and with updating a few professional health and safety checks. EVIDENCE: The home’s manager has been in the role since the autumn of 2005. She has a number of years’ experience as a senior staff member within the home. She has been undertaking the NVQ level 4 in management and care since her appointment to the role, and was at the time of the drafting of this report about to complete registration with the CSCI as the legally registered manager. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 24 One service user commented very positively about the manager, noting for instance that the manager knows where to sit service users to ensure that there are no arguments. Records, observations, and discussions with the manager, showed that the manager is fully and effectively taking on board the responsibilities of her role. The manager explained how she has undertaken a quality audit of service users’ and relatives’ views in early 2006. Records showed that the organisation’s standard forms were used, and that the manager had extracted and addressed the key issues from those ten or so replies received. She explained that she had fedback the findings to people personally, which is good practice. A written and distributed report of such audits is also required, to summarise the process and make it available to anyone involved in the home. Records of a recent service user and relatives’ meeting were seen. The feedback was very complimentary towards the home. The meeting was also used to re-enforce safety procedures, which is encouraging. Further meetings are planned. It was previously required for the monthly proprietors’ reports about the home must be sent to the CSCI. This was only once achieved since the last inspection, the report of which was the only record on file in the home. It is accepted that the local operations manager has a significant presence in the home. However, the proprietors must ensure that monthly reports about the operation of the home, including service users’ and visitors’ views, are undertaken for their and CSCI overviewing purposes. The service looks after the money of four service users. Checks of the records of two of these people found that suitable and clear records of expenditures, with receipts, are being kept. Service user or family signatures were acquired where possible. The manager explained that family or the service user themselves look after their own money in other cases. Records and feedback found that the manager implemented a system of individual employee supervision from April 2006. She plans to provide such supervision at least every two months. Supervision records covered support, performance and training issues, and so are seen as suitable. Records of recent staff meetings, handovers, and a communication book were also in place. There were no observations of health and safety concerns during the visit. For instance, it was found that the tea served from the tea trolley was of a suitable but safe temperature. All baths have temperature probes attached to them, to help prevent scalding. All taps are additionally thermostatically-controlled. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 25 Suitable in-house health and safety check records were in place. This includes for water temperatures, staff-call alarm systems, and fire bells. A monthly standard health and safety audit is carried out. Written risk assessments are in place for kitchen practices, however there are none for other areas of potential hazard in the home. This was discussed with the manager, who agreed to make records of significant hazards identified and actions to reduce associated risks. This requirement has been made in previous inspection reports. There were certificates of professional checks in respect of the lift, hoists, wheelchairs, and for the water systems against legionella. The manager reported that an update for the portable electrical appliance testing was being undertaken at the time. There were no up-to-date certificates in place in respect of the gas systems and of the electrical wiring, at the time of drafting this report, which leaves the home vulnerable to possible faults with these systems. Further professional checks must be undertaken in respect of these two areas. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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 3 X 3 3 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 2 Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 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. Standard Regulation Requirement The manager must ensure that daily records about each service user capture all significant events involving the service user. The manager must ensure that each service user’s manual handling assessment is up-todate in respect of the support provided, clarifies what staff support and equipment is needed for each manoeuvre, and assesses about environmental hazards. The manager must ensure that each service user has separate health records within their care files that capture all professional input and which also explain the key advice of such input. The manager must ensure that staff observe service users taking their medication unless risk assessed as unnecessary for any given service user. The manager must ensure that any allegations of misconduct by staff towards service users is promptly reported to the CSCI. DS0000039315.V293057.R01.S.doc Timescale for action 01/07/06 1 OP7 17(1)(a) s3 pt3 2 OP7 13(4), 15 01/08/06 3 OP8 17(1)(a) s3 pt3(m) 01/07/06 4 OP9 13(2), 18(1)(a) 22/05/06 5 OP18 37 22/05/06 Carlton House Version 5.1 Page 28 6 OP18 15, 17(1)(a) s3 pt3 7 OP19 23(2)(d) Care plans of applicable service users must clarify any challenging behaviours and explain how staff should respond. Daily records must make brief reference to any such incidents and about staff responses. Lounges and hallways must be redecorated where wallpaper has been torn, to ensure that the environment remains homely. Previous timescale of 1/12/05 partially addressed. All radiators in the home must be covered or replaced with lowsurface temperature models. Previous timescales of 1/11/04 partially met. The kitchen requires general upgrade due to wear and tear. 01/07/06 01/07/06 8 OP19 13(4), 23(2)(n) 15/06/06 9 OP19 23(2)(b) Previous timescale of 1/2/06 not met. A method of levelling the connection between the dining room and the second lounge must be found, to uphold safety and to fully enable easy access for service users. 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. 01/08/06 10 OP19 23(2)(n) 01/08/06 11 OP28 18(1)(c) 01/08/06 12 13 OP30 OP33 18(1)(c) 26 Previous timescale of 31/12/05 partially addressed. The manager must ensure that all staff receive formal and upto-date training in food hygiene, 01/10/06 manual handling, and emergency 1st aid. Monthly proprietors’ reports 31/05/06 DS0000039315.V293057.R01.S.doc Version 5.1 Page 29 Carlton House about the home must continue to be sent to the CSCI without undue delay. Previous timescales of 15/3/05 and 1/11/05 partially met. Management must provide an open report, available to all service users and their representatives, of the fullyaudited feedback about the care in the home and how any shortfalls will be improved. A copy of the report must also be sent to the CSCI. Previous timescale of 15/12/05 partially met. The manager must ensure that up-to-date and valid professional checks of the gas system and the electrical wiring are in place. Risk assessments must be carried out on all safe working practices and significant findings of the risk assessment recorded. Previous timescales of 31/1/04 and 1/8/05 partially met. 14 OP33 24 01/09/06 15 OP38 13(4), 23(2)(c) 15/07/06 16 OP38 13 15/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP7 Good Practice Recommendations It is recommended that each service user’s monthly care plan reviews capture any significant events in the service user’s life that month, such as the outcomes of health professional visits, clearly state any changed support needs, and record any planned objectives for the coming DS0000039315.V293057.R01.S.doc Version 5.1 Page 30 1 Carlton House 2 OP7 3 4 5 6 7 8 OP12 OP15 OP19 OP27 OP27 OP28 9 OP30 month. It is recommended for one staff member to be trained as an in-house manual handling expert. This would allow them to provide expert training promptly to new staff, and to provide advice and support to all service users and staff in that respect. It is recommended that the activities record to be kept upto-date, to show what the variety of activities were, as there were only six entries across the previous four weeks. It is recommended that the food records include the vegetables actually provided with the meals, to show suitable matching and variety in this area. The hallway carpet from the lounge to the laundry area is losing its colour and showing signs of wear. It should be considered for replacement. It is recommended that bank (as-needed) staff be employed to cover at short notice, to support those permanent staff who provide similar cover. The manager should ensure that the time-keeping record of staff is always kept up-to-date. It is recommended that the manager or owners of care establishments be acquired as referees of prospective employees, not senior staff, to ensure that the reference is from a professional and not personal perspective. It is recommended that the home’s induction forms be checked for compliance with the national training organisations standards. Carlton House DS0000039315.V293057.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 DS0000039315.V293057.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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