Inspection on 06/06/05 for Carlton House

This inspection was carried out on 6th June 2005.

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

The inspector 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 24/08/07

Carlton House 06/09/06

Carlton House 01/11/05

Carlton House 19/01/05

Carlton House 26/07/04

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

CARE HOMES FOR OLDER PEOPLE Carlton House 44 St Aubyns Hove East Sussex BN3 2TE Lead Inspector Glynis McLeod Unannounced 6 June 2005 10:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Carlton House Address 44 St Aubyns Hove East Sussex BN3 2TE 01273 738512 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Macleod Pinsent Care Limited Lisa Jane McClintock Care Home 25 Category(ies) of Dementia (DE) 25 registration, with number of places Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users should be aged sixty-five (65) years or over on admission. 2. The service can accommodate twenty-five (25) service users with dementia type illness. 3. The maximum number of service users to be accommodated is twenty-five (25). Date of last inspection 19 January 2005 Brief Description of the Service: Carlton House is registered to provide care for up to 25 older people with a dementia type illness. Most of the care provided is long-term; however, some respite care is also offered. The home does not provide nursing care. The home is a detached property situated close to the main shopping centre in Hove with all local amenities close at hand and is well served by bus and train services. It is a short walk from the seafront and a couple of miles from the South Downs. Accommodation is on four floors accessed by a shaft lift and comprises 15 single rooms and five double rooms, some of which are fully ensuite. There are three lounges, including one that is also used for dining, and another, larger, dining area downstairs. A small patio area lies at the back of the home. Limited parking is available behind the building. The home does not allow smoking on the premises. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection, which was unannounced, took place over six hours and was one of two inspections required over the year. A tour of the premises took place and records relating to care, medication, staffing and maintenance were inspected. Three of the residents, two staff members and the manager were spoken to. The inspector also joined in with a reminiscence quiz that was taking place. Residents were relaxed and happy and clearly had a good relationship with staff. The inspector would like to thank the residents, staff and manager for their hospitality and co-operation during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home needs to look at how it writes and updates care plans so that accurate information for each resident’s care needs is easily available for staff. Checks for new staff must also be completed thoroughly before people start to work at the home to make sure that residents are properly protected. The home also needs to make sure that all areas of the home are safe for residents and that they are not at risk of hurting themselves, for example, from water that is too hot. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 The manager assesses prospective residents appropriately and obtains information from families and other agencies where available. The manager makes a decision based on each individual’s needs to ensure that the home can meet their particular care requirements. Prospective residents and their relatives have the opportunity to visit and talk with the manager before moving in so that they are clear about the services offered. EVIDENCE: Records showed that the manager appropriately assesses prospective residents before admission, either at home or in hospital, and also obtains full assessments from other professionals. Families are also invited to contribute to the process and help with drawing up the initial care plan. Prospective residents are invited to visit the home with their families to meet staff and other residents and are admitted on a month’s trial period to ensure the placement is satisfactory. The home does not take emergency admissions. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The care planning process is confused and information is not readily accessible to staff. This means that important information affecting a resident’s health or well-being could be lost or overlooked. Physical and mental health is closely monitored and the appropriate agencies are contacted when necessary to ensure that residents stay fit, healthy and independent for as long as possible. Medication policies and procedures are clear and comprehensive, and regular monitoring of medication issues means that residents receive their prescribed medication correctly. The home has high standards with regard to staff behaviour and all staff are expected to show respect and courtesy towards residents and all visitors to the home. EVIDENCE: Staff were unclear as to how care plans should be written, reviewed and updated. Information was recorded in a number of files and diaries, contributing to a confusing process where staff were not clearly provided with the up-to-date care needs of each resident; for example, with manual handling Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 10 requirements. Staff record each month any significant issues for each resident but do not fully review all aspects of their care needs. To ensure that residents’ needs are being properly assessed and met, a requirement was made that the care planning process needs to be reviewed and clarified, and that training must be provided to staff to enable them to carry out their roles and responsibilities properly. (Since the inspection, the manager has advised that a thorough review of the care planning process has taken place.) The home has developed good relationships with health care services and is in regular contact with GP surgeries and mental health teams. Records of health professionals’ visits are recorded in individual files and residents have access to a wide range of services including dentistry and chiropody. Medication records were all in order and medicines were properly stored and secured. The pharmacist had recently carried out a three-monthly audit, which was satisfactory, and the manager is currently reviewing policies and procedures. Five staff are currently studying on a medication awareness course. Staff receive training in their induction as to how they should behave towards residents, and this is reinforced during supervision and by the example of senior staff. Staff were observed to be polite, patient and caring towards residents. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The home offers a flexible service and makes positive efforts to involve residents in activities to provide variation and interest. Visitors are welcomed to the home and residents are able to see their friend or relative in private. Staff assist residents to maintain relationships with their families. Meals are nutritious, varied and pleasantly presented with options always available. EVIDENCE: Routines in the home are flexible and residents are able to go to bed when they wish and have their breakfast at a time convenient to them. Staff let residents know daily what activities are on offer and encourage them to participate. There are weekly art therapy and music and movement sessions, and staff lead bingo, quiz and reminiscence sessions. Residents were clearly enjoying the reminiscence quiz on the day of the inspection. The manager is in the process of recruiting a part-time activities co-ordinator for the home. Visitors are welcome at all reasonable hours and can meet their relative either in their own room or in the back lounge. Staff assist residents to keep in contact with families who live at a distance by helping them to write letters, for example. Due to their mental health residents are not able to manage their own financial affairs and are assisted in this by families, solicitors or advocates. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 12 Since the last inspection, the menus have been reviewed and are now displayed in the dining room. A four-week rolling menu operates and fresh fruit and vegetables are provided daily. Residents are asked for their dietary preferences and these are kept on individual sheets easily accessible to all staff. Diabetic, vegetarian and religious diets are catered for and special occasions are marked with celebratory meals. The manager is keen to keep up the fluid intake of residents and, therefore, squash drinks as well as tea and coffee are offered on a regular basis. The kitchen is clean and hygienic and all records are up-to-date and in order. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were assessed. EVIDENCE: Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 26 Residents are able to access all areas of the home and garden and are provided with specialist equipment to encourage them to maintain their independence. The home is clean and hygienic and staff are trained in health and hygiene matters ensuring residents are protected from infections. EVIDENCE: Since the last inspection, the lift has been repaired at considerable cost and residents are again able to access all parts of the building. Specialist equipment, such as bath chairs and grab rails, are provided and a disabled shower has also been installed. The home employs dedicated domestic staff who ensure a high standard of cleanliness throughout the premises. Staff were observed to follow health and safety procedures. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staff numbers are sufficient and ensure that residents have their social and personal care needs met. However, the recruitment procedures are not thorough and could put residents at risk. EVIDENCE: The staff rota showed that there are normally three carers, plus a senior carer and the manager on duty throughout the day. Two waking staff are employed at night. Additional staff are on duty during the afternoons to provide activities in the home for residents and to take them out for walks. As well as the care team, the home also employs a maintenance man, a cook and two domestic staff. The files of new staff were checked and it was found that the necessary recruitment checks, designed to safeguard residents, had not all been undertaken. Some lacked the required two references and others showed that staff had been employed before the Criminal Records Bureau and POVA checks had been returned. Even when staff are recruited through an agency, as in this particular case, it is the manager’s responsibility to ensure that the required checks are carried out. A requirement was made that recruitment checks are properly carried out before staff begin work at the home. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Whilst the home has the necessary health and safety policies and procedures in place, there are still areas of the home where service users are at risk of being injured. EVIDENCE: Risk assessments and policies and procedures relating to safe working practices are in place and staff receive relevant core training, such as fire safety and first aid. Window restrictors have recently been fitted to all windows above the ground floor to ensure residents’ safety. Temperature control valves have been fitted to most of the hot water outlets but two taps, both in residents’ communal toilets, were found to be emitting water that was too hot to keep a hand under, putting vulnerable people at risk. A boiler was also found to be working at maximum capacity without a front cover on it and it was also full of fluff and dust. Pipes in the same room were extremely hot to the touch and were not guarded in any way. The room was Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 17 accessible to residents placing them at great risk. A requirement was made that the pipes were boxed in, that the front was replaced, and that the boiler was serviced. Staff and residents must not have access to the room until the work has been carried out. The maintenance man began work to box in the pipes and replace the front cover during the inspection. A previous requirement that the worn carpet to the lower ground floor, which constitutes a trip hazard, must be replaced had not been met. This requirement is carried forward. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x x x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 2 Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 (1 & 2) Requirement The care planning process must be reviewed and clarified, and training in care planning must be provided for staff. Recruitment checks must be thorough and all documents detailed in the regulations must be otained; staff must not begin work before CRB and POVA clearance has been obtained. The boiler must be repaired and serviced and the hot water pipes boxed in. The room must not be used by staff or service users until the work is completed. The carpet to the lower ground floor must be replaced. (Previous requirement carried forward deadline of 31st May 2005 not met.) Timescale for action 31.7.05 2. 29 19 (1)(b)(c) (4)(b)(c) Schedule 2 13(4)(a,c) 23(2)(c) Immediate 3. 38 Immediate 4. 3 13(4)(a,c) 23(2)(b) 31.12.05 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. Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 20 Refer to Standard Good Practice Recommendations Carlton House H59-H10 S14187 Carlton House V218895 060505 Stage 3.doc Version 1.20 Page 21 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. 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