Inspection on 05/07/07 for Carlton House

This inspection was carried out on 5th July 2007.

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

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

Other inspections for this house

Carlton House 04/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Carlton House 267 Hainton Avenue Grimsby North East Lincs DN32 0LA Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 5th July 2007 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.V344858.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.V344858.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 Position 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.V344858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th July 2006 Brief Description of the Service: Carlton House is registered to take 10 service users with residential care needs; these beds are also registered for service users 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: £345- £387. The home does not operate a system whereby the fees include a third party contribution. Additional charges are made for the following: toiletries, newspapers/magazines, hairdressing and chiropody. Information on the service is made available to prospective and current service users via the statement of purpose, service user guide and inspection report. Documents are made available prior to and following admission, copies are available on request. Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 1 day in July 2007. • The visit to the home lasted from 9 a.m. until 5 p.m. • • • • • Eight residents spent some time chatting to the inspectors. The inspector also talked to three care staff, one visiting district nurse, one visitor, the acting manager and the owner. Questionnaires about the home were sent to all the residents, staff and relatives. Five relatives questionnaires and four of the staff ones were returned at the time this report was written. The inspector also looked around the home and looked at lots of records including resident care plans, staff recruitment records and other records about the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. The inspectors observed how staff and service users worked together throughout the day. People’s views about the home and what was found during the visit have been used to write the report and make judgements about the quality of care. It was clear at the visit that a number of the management and administration systems had not been maintained properly in recent months; the owner had already identified these problems and is working to make improvements. However if progress is not made then the commission may need to take action. • • What the service does well: The home makes sure that people are only admitted to the home after they have had an assessment of their needs. Staff members also obtain assessments done by the local authority. This helps them decide whether or not people’s needs can be met in the home. Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 6 The staff team clearly enjoyed their jobs and spoke to residents in a nice way. The home generally have a low staff turnover, which means that there is consistency of care and staff get to know the people who live there very well. People spoken to said the staff team were, “lovely”, “very helpful and kind” and a visitor stated “they are so friendly and cheerful, they looked after my wife so well”. All the residents spoken to said that they liked living in the home. Residents said their family and friends are made to feel welcome by staff when visiting the home and that they can visit when they please. Residents liked the food provided, are well fed and encouraged to eat a healthy diet. What has improved since the last inspection? What they could do better: The home produces care plans that state how peoples’ needs are to be met by staff. These must include the full range of needs with clear tasks for staff to ensure residents are looked after properly. When residents have accidents such as falls, it is important that appropriate records are completed to ensure the correct action for the resident has been taken. Staff can then look and see if they can do anything to help reduce the risk of falling. The home needs to make sure there are enough staff on duty so the residents are looked after properly. The management need to talk with the residents more to make sure they are satisfied with and can influence services provided at the home such as care support, meals, activities and if they would like anything to change. Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 7 Carpets and furnishings with stale odours must be cleaned more regularly to ensure that the residents live in a home which is pleasant and comfortable. The supervisory arrangements for the home must improve to provide all the care staff with the necessary guidance, leadership and support to ensure residents living in the home are safe and well cared for. In recent weeks the acting manager has not always followed good practice when recruiting and selecting new staff by not ensuring all required checks on prospective employees are carried out before they start work in the home. This potentially places residents at risk of harm. Hot water temperatures in the home are checked regularly but when records show that the temperatures are too high work must be carried out to reduce them to safe limits, which will better ensure the residents safety. Although staff continue to access a variety of training courses their individual staff training records have not been maintained this is important as the certificates and records demonstrate that the staff have had the training to help them look after the residents properly. 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.V344858.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.V344858.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): 2 and 3. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users had assessments of need completed prior to admission and the home obtained copies of assessments completed by the local authority; this enabled the home to have full information about the service user in order to decide whether they can meet needs. EVIDENCE: The inspector examined four case files during the visit. There was evidence that the home obtained assessments and care plans completed by the social services care management teams and that the acting manager confirmed they visited service users at home or in hospital to complete the homes in- house assessments. The information gathered enabled the home to decide whether they were able to meet the persons’ needs within the home. Examination of Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 10 the documents indicated all needs were identified and the date of completion was prior to admission. Letters were held on file to confirm that the home routinely writes to the service user or representative stating the homes ability to meet assessed needs. Following admission the staff complete a strengths and needs assessment, it is on the basis of both these assessments that the residents’ plan of care is formalised. The written contract/statement of terms and conditions documents were agreed with residents and held on file. Residents spoken to were happy that their care needs were being met. Staff demonstrated a good understanding of the health and psychological needs of the residents. Staff members spoken to had received training for their role and tasks, including dementia care awareness. The home does not provide intermediate care support. Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users health and social care needs were planned for and met in a way that promoted their privacy and dignity, some gaps in care plan formation means that staff may not have all the required information about service user’s needs. Medication systems are generally well managed however recently staff have not always received appropriate guidance to ensure residents receive the medication they need. EVIDENCE: The inspector examined four care files relating to two residents who had lived at the home for some years and two residents who had been more recently admitted. The files contained all appropriate documents with individual sections making it easy to access information, however the quality of the care documentation in a number of the files was inconsistent. A number of the care plans for the existing residents had been in place some years and would benefit from review as the wording in the care support section could more Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 12 clearly and comprehensively detail the support provided to meet the service users current needs. It was noted that some identified needs had not been planned for in all the care plans examined. For example one newly admitted resident who had needs associated with dementia had no plan in place although discussions with the staff, observation during the visit and the daily records indicated that staff were providing a lot of support with orientation, reassurance and behaviour management. Another resident who had recently returned to the home following surgery on her hip had no care plans in place to support pain control, wound management, provision of support stockings and the exercise programme; also the mobility plan had not been amended to detail current needs around anxiety with future falls and increased staff support. This said it was clear from discussions with the staff and the resident that the staff were providing this support and the resident was making good progress. Detailed risk assessments were in place to support areas such as: moving/ handling, tissue viability, nutrition, falls, bed rails and other general areas. The documents were detailed and up to date; although all high risk areas should have an associate care plan in place to minimise or prevent the problem occurring such as “high need” identified on a tissue viability risk assessment, even though the resident had no tissue breakdown. When plans of care were in place they detailed in part what residents could do for themselves and how staff must ensure these skills are maintained. They were written in a respectful way and promoted values of choice, privacy and dignity. The majority of plans had been evaluated monthly with the exception of one resident’s care records. When changes in care needs had been identified in the evaluation section, the care plan had not always been updated, for example one resident had experienced a number of falls and now required constant supervision which had not been detailed on the care plan. In general the standard of daily records was poor; the acting manager completed detailed entries however the remaining staff generally recorded very minimal entries. An entry in one of the residents daily records detailed “large bruise on left forearm” however there was no record of any investigation or follow up action taken which the acting manager must carry out. The home arranges regular review meetings which were evidenced in the resident’s care files. There was evidence that resident’s health needs were monitored and they had access to health professionals and services. One of the District Nurses visited the home during the inspection and confirmed that communication with the home was good, staff were always very helpful and she had observed that they demonstrated a very caring and supportive attitude towards the residents. The Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 13 inspector also spoke with one of the Community Psychiatric Nurses following the visit, who has visited the home regularly; he confirmed that he considered the home managed the needs of the resident’s with dementia very well. Staff members spoken with and surveys received from them indicated that they had a good understanding of how to provide care that maintained privacy, dignity, choice and independence. This was confirmed in discussions with residents, who were observed to be smartly dressed in clean clothes, attention had been paid to hair and nail care and male service users had been assisted to shave. The inspector observed staff members speaking with residents in a respectful, patient and genuinely caring way. Medication was generally well managed; improvements were identified with the standard of recording on the medication administration charts. Storage systems were generally satisfactory although the home was storing insulin in the fridge in the kitchen, which was unlocked. Medicines must be stored securely in a separate fridge and the fridge temperature taken to make sure they are safe to use. One resident was receiving a controlled medication which had been prescribed for pain control; the G.P. had directed the staff to administer this medication on a p.r.n.(when needed) basis however there was no guidance in place to direct staff on how to effectively monitor the residents’ pain control and advice was given to contact the district nurse for specific support in this matter. Carlton House DS0000002911.V344858.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 this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although the home had flexible routines and promoted choice and individual decision-making not all the residents were seen to experience a full life with opportunities to take part in varied activities. The home provided well- balanced meals, which met the residents’ nutritional needs. EVIDENCE: The majority of residents’ social, recreational and psychological needs were identified in assessments and care plans; these had not been reviewed and updated in recent times to reflect changes in the needs and circumstances of the residents. The staff develop a weekly activity programme, records evidenced that this had not always been completed. Activity records although completed for each session, indicated that the overall number of sessions provided in the home had significantly fallen since the last inspection. During the morning of the visit the inspector observed that the majority of the residents sat in one of the communal areas and went to sleep; a small number Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 15 of residents returned to bed after lunch and the remainder slept in the lounge. On discussion staff appeared reluctant to wake residents to try and encourage and motivate them to participate in activities, although two residents did join in with a game of dominoes and the inspector was pleased to see one of the staff supporting a resident to write to her son who lives away. The staff do provide one- to one sessions with the residents when they look through old photographs and chat about their lives. Since February the home has arranged for an outside activity provider to visit the home once a month and some of the residents told the inspector that they enjoyed these sessions. One resident told the inspector that he doesn’t usually like to leave the home but earlier in the week the acting manager had taken him shopping as he needed some new shoes and on the way back had stopped for fish and chips for lunch which he had really enjoyed. The registered person should continue, on a regular basis, to consult residents about the programme of activities including trips out on offer at the home and consideration should be given to providing staff with training in planning and organising activities programmes for people with dementia needs. Staff need more guidance and direction to encourage and motivate the residents to take part in the activity programme. Staff spoken to had an understanding of how to promote independence and choice “ we make sure people have choices with clothes, meals, where to sit, leisure and when to get up and go to bed”. Residents confirmed this, one resident told the inspector “ I like to spend time in my own room”. Residents’ religious needs were identified on admission. Staff reported that residents had the opportunity to access local churches or attend services held in the local community; staff feedback identified that none of the current residents followed any particular religious observances, this was confirmed with discussions held with four residents. The staff who are responsible for cooking and serving the meals know the resident’s likes and dislikes very well. Residents spoke positively about the quality of the meals, comments were: “The food is lovely” and “The meals are very good”. The menu board in the hall displayed the week’s menu choices; the menus have not been reviewed for a number of years, which must now take place in consultation with the residents. Resident’s weights are monitored regularly and any concerns are referred to community health services for support, staff were providing two diabetic diets and a fortified diet. There was good evidence that a number of the residents had gained weight and their general condition had improved since their admission to the home. During the visit two of the residents received their meals at different times; all the residents took their meals in the dining room and staff members were observed supporting residents to eat their meals in a patient and sensitive way. Carlton House DS0000002911.V344858.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 this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides an environment where service users and relatives feel able to complain. Current recruitment practices are potentially placing residents at risk of harm. EVIDENCE: The homes complaint procedure was on display and via surveys and discussion staff were aware of how to action and record complaints. No formal complaints had been received by the home since the last inspection; one complaint had recently been received by the Commission and forwarded to the registered provider to investigate, who confirmed that she was in the process of carrying out a full investigation. Issues regarding the complaint were looked into in part during the visit; concerns that staff had on occasion been having cigarette breaks together outside and therefore not always providing adequate supervision for the service users, was confirmed by staff at interview. The registered provider had now addressed this issue and staff were observed to be smoking only during their breaks and not taking their breaks together. The registered provider confirmed that she would be carrying out unannounced check visits to the home to monitor the staff. Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 17 Concerns that a number of the dependent residents were not receiving adequate supervision have also been addressed with an increase in staffing levels. Service users spoken with stated that they would complain to someone if they were unhappy. Surveys completed by relatives detailed that they were confident that issues would be dealt with. All staff complete basic in- house training in safeguarding adults from abuse during induction. The majority of staff have completed the more informative local authority training course. The home had internal policies and procedures in place for safeguarding adults, however the local multi- agency safeguarding adults procedures were not available during the visit. Staff members spoken with were aware of what to do if they suspected abuse had occurred all stated that they would report any abuse immediately to the acting manager and registered provider. The homes recruitment practices were generally robust and ensured via staff selection; interview, references and police checks that only appropriate staff members were recruited. However the inspector identified that a care assistant had started employment that week without the management ensuring that two references and POVA First check were in place. This is unacceptable practice and potentially places service users at risk. The inspector followed this issue up following the visit and the remaining reference and POVA First check were in place the following day to enable the staff member to continue working at the home under close supervision until the full CRB check was in place. Carlton House DS0000002911.V344858.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 this service experience adequate 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 improvements have been made to the facilities at the home in recent months outstanding issues around odour control impact on the overall quality of the environment. EVIDENCE: The home provides comfortable facilities. The home was in reasonable decorative order. Furnishings and fittings are of reasonable quality, although some furnishings and the décor of some rooms particularly the communal rooms are showing signs of age. Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 19 Three of the bedrooms have been redecorated and new carpets provided. Redecoration of the ground floor bathroom (identified at the previous inspection) was in progress. A new wooden ramp had been fitted to the back door which provided residents and visitors with mobility problems improved access to the garden. The maintenance programme identified further refurbishment and redecoration to the communal rooms will take place. A tour of the home was carried out and all areas were generally clean however more attention is needed with tidiness and storage should be reviewed. A mattress was stored on the first floor landing, items stored in a disused shower on the first floor bathroom, a number of service users toiletries left in the bathrooms and sections of coving to be used for the work to refurbish the bathroom were stored in the downstairs hall way. Bedrooms had been personalised to varying degrees and residents confirmed they were able to bring in small items to decorate their room. Residents and relative surveys indicated that they were very happy with the home in general and the bedrooms, “the staff keep the home nice and clean”. One bedroom had an odour of stale urine and also a stale odour was noted downstairs which the registered provider confirmed she was looking into. Work was in progress to tidy the garden areas; the acting manager had pruned many of the existing shrubs in preparation of planting more flowers, which one of the residents had requested. There is seating provided outside and a number of residents told the inspector how much they enjoyed sitting out when the weather was nice. The fire escape must be kept clear and storage provided for the tins of paint currently stored there. Carlton House DS0000002911.V344858.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 this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a group of staff who demonstrate a very caring manner however shortages of staff in recent months has meant that residents have been put at risk of not receiving all the care they need and staff have felt overstretched. Recruitment procedures do not afford sufficient protection for service users. EVIDENCE: The home had ten residents at the time of the visit. In line with the previous registration authority the care workers also have responsibilities for laundry, domestic work and preparation of the meals. Evidence from examination of a selection of staff rotas for the last three months identified that the home had not maintained adequate staffing levels to meet the dependency of the residents. At the previous inspection visit the home had begun recruiting more care staff to provide three staff on the morning shift, evidence from the rotas confirmed that this had taken place but a number of staff had subsequently left the home and the home was now generally providing only two care staff on the morning shift and struggling to provide enough staff on night duty. Current dependency Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 21 levels would also indicate that the staffing levels needed to be increased to cover the tea time period. Examination of the rotas also identified some other issues: the rotas themselves were not an accurate record of the hours staff worked, a number of shifts were not detailed; the acting manager was working the majority of his shifts “on the floor” which included night duty and sleeper duty and there was no identified management time on the rota for the acting manager. A number of “half” sleeper duties were rostered; discussions with the acting manager confirmed that staff would share this role working up to or from 2a.m.; this is considered an unacceptable shift pattern for staff work especially when it is alongside their day duty shifts. Staff spoken to and in surveys detailed that they had struggled at times to provide all the supervision and support many of the residents now needed. The inspector discussed the above issues with the registered provider, who confirmed that the home had experienced problems in recruiting suitable staff however would immediately review the staffing levels and rota management. Following the inspection, the registered provider confirmed that the staff rotas had been reviewed: three staff were now rostered until 5p.m. each day, the night staff were commencing work at 8 p.m. and also that the night staff were no longer sharing any sleep in duties. The core staff group at the home has remained very stable and it was clear that staff have developed very positive relationships with the residents and their families. Comments from service users and relatives included “ the staff are lovely and kind”, “I’m well looked after”, “I like all the staff” and “the staff take very good care of Mum”. The inspector observed the staff talking to people in a friendly and courteous way, they were supportive at mealtimes and had time to sit and chat to people. The atmosphere was relaxed. The home had a training plan and there was evidence that mandatory, general and service specific training was covered. Examination of staff training records in some of the staff personal files identified that they had not been maintained; there were few certificates in place to support recent training courses the staff had accessed. Induction records for a staff member recruited in 2006 identified that the skills for care induction programme had been fully completed by the care worker but had not yet been signed off by the acting manager. Three staff in the home have achieved NVQ level 2 or above and six staff are currently working towards level 2 or above which demonstrates that the management at the home are committed to achieving the target of having at least 50 qualified at level 2. Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 22 Generally the home operated a robust recruitment process. References and criminal bureau checks were obtained and checks made against the protection of vulnerable adults register. Care staff members were selected via an interview process with records maintained. As detailed in a previous section of the report the home had recruited a new care assistant who had started work even though one of the references and the POVA First check had not been obtained. This is unacceptable practice and potentially places service users at risk. The inspector followed this issue up and the remaining reference and POVA First check were in place the following day to enable the staff member to continue working under close supervision until the full CRB check was in place. Another staff file examined during the visit contained all appropriate documentation with the exception of the CRB check; the registered provider confirmed that the staff member had received their copy however the home had not yet received the documentation from the CRB department, it is important that this is followed up and a current CRB check is in place. Carlton House DS0000002911.V344858.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): 31,32,33,35,36 and 38. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. In recent months the acting manager has not always demonstrated effective management of the home which has not always safeguarded the welfare and safety of the residents; this said residents were satisfied that the home was well managed and they had appropriate support. EVIDENCE: The acting manager has been in post for eighteen months, he is a qualified nurse and has considerable experience in managing the care of older people. However it was evident at this visit that a number of the systems which support effective management of staff and operation within the home had Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 24 deteriorated, for example appropriate record keeping, recruitment, rota management, staff supervision and the management of health and safety. This said the service users, staff and the majority of relatives were very complimentary about the management and how the home was run. All the service users spoken to commented on how friendly and supportive the manager was. Staff confirmed that moral was good and commented that there was a good team approach to the care delivery at the home. Evidence from staff interviews indicated that the staff consider the acting manager to be very approachable. Comments received from relative surveys included “We feel the staff really care about our mother, especially Ali the manager, even telephoning when my mother has had a good day.” The registered provider told the inspector that she feels the management of the home had slipped in recent months whilst she had been on sick leave and not able to carry out her regular supervisory visits. The registered provider had carried out a full audit of the management systems the previous week and had developed action plans to address the deficiencies identified, these action plans had been forwarded to the commission prior to the inspection; she confirmed that this work would commence the following week. As detailed earlier in the report, the staffing levels were reviewed the day after the inspection to ensure enough staff were rostered to meet the current dependency levels of the residents. The registered provider has recently developed a formal quality assurance programme and is now in the process of fully implementing it. Surveys have been issued to residents, relatives and stakeholders, the results have been analysed and published; formal meetings with residents and relatives have yet to be arranged. Staff confirmed that they had access to regular meetings, although minutes for recent meetings had not been produced. The registered provider now needs to prioritise the work identified in the action plans from audits and surveys, and set clear timescales for the work to be achieved. The homes policies and procedures manual had been reviewed and up dated recently. The registered provider had produced an annual development plan for the year. There were accurate and up to date records relating to any personal allowances the home keeps on behalf of residents; although two of the records checked were in a negative balance and efforts should be made to obtain more regular funding from the residents’ representative. Supervision records for some staff were very good and showed a real commitment to the supervision process however not all care staff had received the required amount of sessions. Staff appraisals had been completed in June. The majority of staff were up to date with mandatory training; moving/ handling training was completed in June, fire safety had been arranged for the Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 25 following month, seven staff had completed food hygiene training in 2005 and eight staff had completed first aid courses. One of the service users had recently sustained a minor injury during a transfer using the hoist; advice was given to the manager to provide further specific training in moving/ handling to the staff members involved. Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment and checks were all in place and up to date however the fire risk assessment document had not been updated since 2003 and the last fire drill had taken place in July 2006. General environmental risk assessments had been reviewed in November 2006. The kitchen area was visited; the two work tops and a number of wall tiles need replacement where the surfaces could potentially compromise infection control management. Records of fridge, freezer and hot food temperatures were up to date and maintained; refrigerated and frozen food stocks were all labelled and dated appropriately. It was identified that the general management of aspects of health and safety in the home had slipped since the previous visit, these included: • Hot water temperatures are checked at all outlets each week, however when recorded temperatures were higher than the maximum temperature permitted which is 43 degrees centigrade, there were no records of action taken by the management to reduce the temperature to an acceptable level. Staff had not always completed accident/ incident forms following residents falling or “lowering themselves to the floor”. Audit records had not been maintained to demonstrate review of further action taken to reduce risk of re-occurrence. Environmental audit records identified that the self-closing door device had not been repaired for six months; this work was carried out in June. The repair /maintenance book for the home was not available. • • • Carlton House DS0000002911.V344858.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 3 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 X 2 Carlton House DS0000002911.V344858.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 Requirement The registered person must ensure that all care programmes detail all service users needs and associated care interventions, Where necessary care plans must be revised and updated. Timescale of 21/12/05 and 31/07/06 not met. NEW TIMESCALE. The registered person must ensure that carpets with offensive odours are cleaned more regularly or replaced. Timescale of 15/08/06 not met. NEW TIMESCALE. The registered person must ensure that when service users sustain bruising/ injuries the incident is formally documented on the appropriate documentation and fully investigated to ascertain the cause of the injury and any follow up action to be taken. The registered person must ensure that service users with DS0000002911.V344858.R01.S.doc Timescale for action 31/08/07 2. OP26 16(2)k 20/08/07 3. OP8 OP18 13(4)(5) and(6) 05/08/07 4. OP7 OP38 13(4) 15/08/07 Carlton House Version 5.2 Page 28 5. OP9 13(2) 6. OP8 OP9 12(1) and 13(1)b 7. OP12 16(2)m and n 8. OP15 12(3) and 16(2)i 19 9. OP18 OP29 10 OP38 23(2)l 11 OP27 18(1)a identified risks of developing pressure sores have them planned for with clear steps in how to minimise the risks. The registered person must ensure arrangements are made for the safe storage of medication requiring refrigeration. The registered person must consult with the community health team to provide the necessary guidance for staff in monitoring the identified service user’s pain control to ensure it is managed effectively. The registered person must ensure that service users are provided with adequate meaningful activities, which are suited to their needs and preferences. The registered person must ensure that the menus are reviewed to reflect the current preferences of the service users. The registered person must ensure that new staff do not commence employment at the home until two written references and a pova first or CRB check have been obtained. When a pova first check has been obtained stringent supervision arrangements must be put in place until the criminal bureau check has returned. The registered person must ensure that storage in the home is reviewed to provide appropriate storage areas for items such as: decorative materials and mattresses to better promote residents safety. The registered person must ensure that appropriate numbers of care staff are employed and rostered to meet the dependency DS0000002911.V344858.R01.S.doc 31/08/07 15/07/07 31/08/07 15/09/07 06/07/07 15/08/07 06/07/07 Carlton House Version 5.2 Page 29 12 OP37 17(2) 13 OP32 10(1) 14 OP30 OP37 18 (1) 15 OP30 18 16 OP33 24 17 OP36 18(2) 18 OP26 13 (4) and 16(2)g 13 (4) 19 OP38 20 OP38 13 (4) and 17(2) needs of the service users. The registered person must ensure that the staff rota is a clear and accurate document which identifies the staff member working on each shift and hours worked. The registered person must 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. The registered person must update the individual staff training records, providing evidence that staff have participated in training. The registered person must ensure that staff who have completed the skills for care induction programme have had their work assessed and signed off. The registered person must ensure that the systems to monitor the quality of the service are now fully implemented. The registered person must ensure consistency with supervision to enable all care staff to receive at least six formal sessions per year. The registered person must replace the worktops and a number of wall tiles in the kitchen to maintain the health and safety of staff and residents. The registered person must ensure that hot water temperatures at outlets accessible to residents do not exceed 43 degrees C. Records must detail action taken to reduce the temperature. The registered person must ensure that appropriate DS0000002911.V344858.R01.S.doc 15/08/07 15/08/07 31/08/07 31/08/07 15/09/07 15/09/07 15/09/07 15/08/07 15/08/07 Page 30 Carlton House Version 5.2 accident/ incident documentation is completed following all accidents/ incidents in the home. 21 OP38 13(4) The registered person must 15/08/07 ensure that accident management is reviewed to record all further action that staff take to further reduce risk of reoccurrence. The registered person must ensure expedient action is taken to repair broken or faulty equipment in the home such as the self-closing door devices. The registered person must update the home’s fire risk assessment which must identify the frequency that staff fire drills take place. 15/08/07 22 OP38 23 (2) 23 OP38 23(4) 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP28 OP37 Good Practice Recommendations The registered person should ensure that the 50 of the care staff have achieved NVQ level 2. The registered person should ensure that all reports to support formal monthly visits to the home are sent in to the Commission on a regular basis. The registered person should ensure that a copy of the local multi- agency safeguarding adults procedures are kept in the home at all times. The registered person should provide further moving and handling training to the staff when service users sustain injuries during moving/ handling transfers. The registered person should provide training to staff to improve the quality of the daily records of care. DS0000002911.V344858.R01.S.doc Version 5.2 Page 31 3. 4. 5. OP18 OP38 OP7 Carlton House 6. OP12 The registered person should provide training for the staff to improve the quality of the activity provision in the home. Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carlton House DS0000002911.V344858.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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