Inspection on 06/09/06 for Carlton House

This inspection was carried out on 6th September 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 24/08/07

Carlton House 01/11/05

Carlton House 06/06/05

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 Rest Home 44 St Aubyns Hove East Sussex BN3 2TE Lead Inspector Jennie Williams Unannounced Inspection 6th September 2006 11:00 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 Rest Home DS0000014187.V299340.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 Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton House Rest Home Address 44 St Aubyns Hove East Sussex BN3 2TE 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) 01273 738512 Macleod Pinsent Care Limited Vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty five (25) Service users must be older people aged sixty five (65) years or over on admission Service users with a dementia type illness only to be accommodated. Date of last inspection 1st November 2005 Brief Description of the Service: Carlton House Rest Home is registered to provide care for up to twenty-five (25) older people with a dementia type illness. There is no nursing care provided at the home. District nurses will visit those residents requiring nursing input. The home is located in a quiet residential area of Hove. There is limited car parking at the rear of the home and restricted street parking is available on adjacent streets within the area. There are local amenities within walking distance and access to public transport is nearby. Rooms are located over four floors, with two mezzanine floors. There is a passenger shaft lift available at the home to assist those residents who are unable to mobilise on the stairs. This lift services the main floors. There are fifteen single rooms of which six have en suite facilities and five double rooms, of which three have en suite facilities. One single room is below ten square metres. There is one bathroom with an assisted bath, one wheel in shower and six toilets located throughout the home for residents. There is a dining room and good-sized lounge room for residents to use. There is another smaller lounge room at the rear of the building that provides access to the garden. There is a secured small garden area at the rear of the home that is accessible to residents. The weekly fees range between £409 and £600. Additional costs are; hairdresser (£6 - £10), chiropody (£10), papers, toiletries and outings (costing of these varies). This information was provided to the CSCI on 14 June 2006. Copies of previous CSCI inspection reports are available upon request at the home. Prospective residents and their relatives find out about the service through social service referrals, word of mouth or from living in the area. Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Carlton House Rest Home will be referred to as ‘residents’. This unannounced inspection took place over approximately eight and three quarter hours on the 6 September 2006. Sixteen residents over the age of 65 years were spoken with during the inspection, individually and in groups. One care plan was looked at in detail and specific areas of care needs were looked at in three other care plans. The acting manager and six staff were spoken with throughout the inspection process. Nine staff surveys were sent prior to the inspection of which none were returned. Three staff files were inspected. Out of four GP comment cards sent out prior to inspection, one was returned. Ten relative/visitors comment cards were sent to the home of which none were returned. One visitor to the home was spoken with. A comment card was returned from a Community Psychiatric Nurse and a comment card was sent to a social worker, which was not returned. A pre-inspection questionnaire was received prior to the inspection. A tour of the environment was provided and some individual rooms were viewed. Fire records, accident records and medication procedures were inspected. The quality assurance system was discussed and complaint records were inspected. Previous requirements and recommendations at the home were assessed to ensure compliance. The staff rota and menus were viewed. The Inspector ate lunch with the residents and an activity was observed. The procedure for handling residents’ monies was inspected. Apart from fire records, no other health and safety records were viewed as this information has been provided in the pre-inspection questionnaire. A random unannounced inspection was undertaken on the 28 June 2006 following an anonymous complaint made to the CSCI. A report was generated from this visit, but is not published. A copy of the report is available upon request. Any requirements made at the random inspection have been followed up at this inspection to ensure compliance. There were 23 residents residing at the home on the day of the inspection. What the service does well: Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 6 Residents were complimentary about the staff working at the home and felt that their personal care needs were being met. Prospective residents are provided with opportunities to visit the home prior to moving in to ensure the home will meet their needs. Residents felt that their privacy and dignity are respected. Visitors are welcomed at the home and residents may receive visitors in private. Residents were complimentary about the provision of food at the home. Complaints are dealt with appropriately, reassuring those involved that they are being listened to and that action will be taken, if necessary. Residents are happy with their individual rooms and are able to personalise them. Staff receive training appropriate to their roles to ensure their safety and that residents needs continue to be met. Residents’ monies are safeguarded. Residents and staff benefit from supportive and approachable management within the home. What has improved since the last inspection? What they could do better: The reader should be aware that some of the shortfalls noted at the inspection have been highlighted throughout the report, but not reflected as a requirement or recommendation. This is due to an acting manager having commenced employment recently and has provided the Inspector with a list of shortfalls that she has already noted and is taking action to address. Any shortfalls that may have a direct detrimental impact on the safety and well being of residents have been reflected as requirements. Action is required to ensure that the pre-admission assessment is expanded to cover all areas of care needs so that comprehensive care plans can be drawn up using this information. It is an outstanding requirement that care plans need to reflect actual current practice, ensuring that all needs of an individual are being met at the home. Urgent action is required to ensure suitable risk assessments are in place, with particular attention to prevention of falls, to ensure any activity that poses a risk is identified and eliminated so far as is practicably reasonable. Care notes provide limited information on the health Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 7 status of an individual and do not refer to the mental health needs to assist staff in monitoring the well being of residents. This remains an outstanding requirement. It remains an outstanding requirement that hot water is delivered around the recommended 43°C to ensure residents are safeguarded. Action is required to ensure that all parts of the care home and equipment in use are kept clean and in a good state of repair. Action is required to ensure that residents, visitors and staff are protected and safeguarded by staff participating in regular fire drills. Good practice recommendations have been made for medication procedures that will better safeguard staff and residents. It has been recommended that hot and cold taps be clearly marked to avoid confusion for residents. The home needs to continue to work towards the recommended ratio of staff with National Vocation Qualifications to ensure that there are suitably qualified staff on duty. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carlton House Rest Home DS0000014187.V299340.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 Rest Home DS0000014187.V299340.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 & 6 “Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home, however inadequate pre-admission assessments place some residents at risk of their needs not being met. EVIDENCE: The home has a Statement of Purpose and Service User Guide that provides prospective residents with information about the facilities and services provided at the home. These documents are available upon request at the home. A copy of the Statement of Purpose was observed to be located by the front door of the home. All prospective residents are assessed prior to moving into the home. Relatives/representatives are involved in this process wherever possible. These assessments have limited information available about the needs of the resident. Thorough pre admission assessments are required to be undertaken to ensure the home can evidence that all needs can be met. Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 10 The acting manager confirmed that there was no one residing at the home from any minor ethnic community or social/cultural groups with any specific needs or preferences. Prospective residents and their relatives are encouraged to visit the home prior to moving in. The first four weeks is a trial period. There is no dedicated accommodation to provide intermediate care. Respite care is available if there is a spare room. The home does not take emergency admissions. Carlton House Rest Home DS0000014187.V299340.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 “Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service.” There is a risk of residents needs not being met due to care plans not being completed and reflecting actual current practice. Suitable risk assessments are not implemented, posing a greater risk to the well being of residents. Residents are safeguarded by the medication procedures in place. EVIDENCE: The Inspector viewed care plans with the acting manager. Some care plans had limited information about the care needs of residents. The acting manager has identified this shortfall and is currently in the process of changing the care plan format. Staff spoken with feel that the new care plan format is very good. The acting manager confirmed that she has completed about a third of residents care plans onto the new format. There is a key worker system in place that provides continuity for residents and staff and one to one time spent with the individual is recorded. At the visit to the home in June 2006, it was noted that specialist advice had not been followed up nor incorporated into the care plan. This shortfall has Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 12 now been addressed. The GP comment card demonstrated that when they give any specialist advice it is incorporated into the resident’s care plan. Care plans need to be kept under regular review and ensure that current actual practice is reflected. The reviewing process in place was discussed with the acting manager, who will review the current practice. Some residents spoken with confirmed that staff discuss their care with them. Some risk assessments were observed to be in place, however these are not consistent for all residents. There was no clear risk assessments in place paying particular attention to falls. On reading the accident book, it was noted that an individual had numerous falls in a short period of time. A falls risk assessment was not located for this individual. There were no risk assessments or clear guidance in place for residents who had previously or are at risk of absconding. Risk assessments were not being dated nor identifying who had undertaken the risk assessments. Care notes written on individuals do not provide sufficient information to monitor their health. It is important that the mental health status of residents is recorded and provides a clear picture of the status of an individual in order to assist staff in the early detection of behavioural changes and any deterioration in health. Writing ‘no problems’ or ‘is fine’ does not provide suitable information. The acting manager confirmed that she is proposing to book a training session for staff on record keeping and report writing. A form has been implemented to record when a visiting health professional visits any resident. The reader can clearly see when health professionals have visited. A GP and visiting health professional comment cards received confirmed that staff demonstrate a clear understanding of the care needs of residents and they are satisfied with the overall care provided to residents within the home. A resident observed to be wearing glasses confirmed that they have regular eye checks. The majority of residents that were asked confirmed that they felt that their privacy and dignity are respected. Staff were heard to be calling residents by their preferred term of address and were observed to knock on room doors prior to entering. One resident advised the Inspector that they did not like staff calling them ‘darling’. The acting manager needs to ensure that terms of endearment are only used with the agreement of the residents involved. Medication Administration Record (MAR) charts inspected demonstrated that medication is being signed for at the time of administration. It was noted that eye drops had not been signed for two days. The acting manager will address this shortfall with the individuals involved. All MAR charts have photos of the residents on them to assist in the identification of individuals. All staff Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 13 administering medication have received medication training. Some staff have undertaken a 12-week distance-learning course on medication. It is recommended as good practice that all hand written prescriptions are double signed by two staff who are medication trained and any hand written amendments are signed. The MAR charts need to provide clearer guidance on the use of prescribed creams eg. where the cream is meant to be used. The acting manager confirmed that there are policies and procedures in place for all aspects dealing with medication. The content of these were not read. Records are maintained of all incoming and outgoing medication. There are clear records being maintained for any controlled drugs that may be used in the home. There was no resident self-medicating on the day of the inspection. Carlton House Rest Home DS0000014187.V299340.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 “Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents’ lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. EVIDENCE: Residents spoken with confirmed that their lifestyle within the home is their choice. They are able to choose when to get up and when to go to bed etc. Residents spoken with felt that there were enough activities provided at the home if they choose to be involved. Ten residents were observed to be participating in a reminiscence activity on the day of the inspection. Visitors are welcomed at the home and there are no restrictions for them. Residents are able to receive visitors in private. There is a visitor’s book located at the entrance of the home that all people must sign upon entering and leaving the home. A visitor came to the home on the day of the inspection and confirmed that they had arrived unannounced, as they are currently viewing homes for a friend who requires care. It was confirmed that staff were welcoming. Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 15 The Inspector ate a tasty lunch with the residents. Lunchtime was noted to be a social time and unhurried. Staff were nearby to offer discreet assistance if required. The majority of residents eat in the dining room, however five residents ate at a table in the lounge area, by choice. The menu provided to the Inspector demonstrates that there is a choice of food offered. Carlton House Rest Home DS0000014187.V299340.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 “Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Complaints are dealt with appropriately, reassuring those involved that they are being listened to and that action will be taken, if necessary. Protection of Vulnerable Adults procedures ensure residents are safeguarded. EVIDENCE: The home has a complaints procedure in place. There have been four complaints made to the home in the last 12 months. One anonymous complaint was made directly to the CSCI and this was followed up as a random unannounced inspection and a report generated. This report is not published but is available upon request. Any requirements made at the random inspection have been followed up at this inspection. The concerns raised were as follows; specialist advice on care needs were not being followed up, smoking practices within the home, heating and ventilation within the home, lack of working bathing facilities, lack of staffing numbers on duty and the lack of accessibility to the rear garden. The complaints made to the home were: one resident not wanting a single room, two residents in a double room being incompatible in relation to lighting and heating being on/off, one resident complaining their room was cold and one resident commenced having difficulties with the stairs. All concerns were substantiated and suitable action was taken. Clearer records of complaints and the action taken need to be maintained. The acting manager has already identified this shortfall and will be implementing a new complaints recording Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 17 format. This is not reflected as a requirement as action is being taken to address this shortfall. There is a suitable Protection of Vulnerable Adults (POVA) procedure in place and staff have received POVA training. There have been no POVA investigations made since the last inspection. Carlton House Rest Home DS0000014187.V299340.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Residents live in a homely environment and are provided with suitable indoor and outdoor communal facilities, however additional work is required to ensure all parts of the home and equipment used is kept clean and in a good state of repair. EVIDENCE: Rooms are located over four floors, with two mezzanine floors. There is a passenger shaft lift available at the home to assist those residents who are unable to mobilise on the stairs. This lift services the main floors. The Inspector viewed some individual rooms that were seen to be personalised to reflect the personality of the individual. There is a small garden area at the rear of the home and this is accessible to residents. There is a steep ramp that residents need to negotiate to access all areas of the garden. The registered providers have already identified that Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 19 unsuitability of the steep ramp and confirmed that they will be taking action in the future to address this. The home has previously had problems with the heating and hot water provisions within the home. This was one of the concerns that the complainant had raised with the CSCI. A new boiler has been purchased and the acting manager confirmed that the central heating was currently in the process of being flushed around the time of the inspection. Additional fans had been purchased in the heat to assist in ventilation of the home and there is an air humidifier available at the home. There were creams, labelled and unlabelled, and personal items found located in communal bathrooms. Under the bath hoist seats need to be cleaned and some of the covering on these hoist seats need a thorough clean or be replaced. The acting manager confirmed that all hot water taps have had regulators installed, however the shower was noted to be delivering water at 58°C. Hot water pipes are being covered to reduce any risk of injury to residents. Some commodes being kept in individual rooms were noted to be old and in need of being thoroughly cleaned or replaced. The acting manager confirmed that it is in the ‘pipeline’ to being addressed. Some toilet roll holders were noted to be broken and toilet paper was being sat on the cistern behind the toilet. Some residents may be unable to reach the toilet paper behind them, hence possibly losing their independence and dignity by requiring assistance to the toilet. There was a toilet frequently used by residents that is need of decoration and there was no overriding lock on the door if staff needed to access the room in an emergency. The hot and cold taps were not clearly marked in a number of rooms. The home needs to reassess the type of door locks that are in place, as when doors are shut properly, the individuals’ door will lock. There were individual rooms and areas throughout the home that are in need of additional cleaning. Some carpets were old and stained and should be thoroughly cleaned or replaced. Screening is provided in shared rooms, however it was noted that there were dentures in the shared rooms en suite that were not labelled. Any minor points noted throughout the inspection were discussed with the acting manager on the day. There were no offensive odours noted on the day of the inspection. Carlton House Rest Home DS0000014187.V299340.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 “Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents’ needs are being met with the number of staff on duty and staff are provided with relevant training to ensure residents needs continue to be met. EVIDENCE: Residents were complimentary about the staff working at the home. Comments about the staff ranged from ‘they are alright’ through to ‘they are wonderful’ and ‘admirable’. Residents and staff spoken with confirmed that there were sufficient numbers of staff on duty at all times. The rota provided to the Inspector demonstrates that there are usually three to four staff working in the morning, plus management, three carers during the afternoon and two waking night carers. A new shift time has recently been introduced from 7am to 11am to ensure there are additional numbers of staff on duty at peak time. Staff were observed to interact well with residents. The Inspector observed staff providing assistance to a very ‘demanding’ resident during lunch with understanding and patience. There is a photo board at the entrance of the home with staffs’ names to assist residents and visitors to be orientated to who is who. On inspecting staff files, there was evidence that the home generally follows a robust recruitment procedure, however one staff file was noted not to have a written reference from her most recent employer, which was relevant to care work. POVA First checks are undertaken and Criminal Record Bureau (CRB) Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 21 checks are obtained on all staff. Gaps in employment had not been explained. Interview notes are recorded. The acting manager will address this shortfall. Staff spoken with confirmed that they are kept up to date with all mandatory training and are provided with sufficient opportunities to attend training sessions. Staff files inspected demonstrated that some recent training undertaken are: Fire training, manual handling and dementia etc. There are 14 care staff employed at the home, of which four have obtained National Vocation Qualification (NVQ) level 2 or above. The home needs to ensure that work is continued to meet the recommended 50 ratio of staff with NVQ qualifications. Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 22 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, 33, 35, 36 & 38 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The home is generally run in the best interest of residents, however a more structured quality monitoring system would enable management to monitor the success of the home in meeting its aims and objectives. EVIDENCE: The home has been without a manager for a period of time. There is now an acting manager in place who has just recently commenced employment. She has had managerial positions throughout her working career in a variety of care settings. The acting manager has obtained the NVQ level 4 in care and has completed the Registered Manager Award course. Priority should be given to submit an application with the CSCI to commence the registration process. Staff spoken with confirmed that they find the management of the home are supportive and approachable. Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 23 It was discussed with the acting manager that a structured quality assurance and quality monitoring system be developed and implemented. The acting manager was advised that an analysis be undertaken of the surveys and results be made available for people involved with the home. The acting manager has already noted that the questionnaires in place for residents are not satisfactory and will be ‘revamping’ the whole quality assurance system. There is a suggestion box at the home, which provides anyone connected with the home an opportunity to express any ideas or concerns anonymously. The home is not an appointee for any resident, however does hold personal allowances at the home. There are clear records maintained of residents monies and receipts are obtained for any financial transactions. The monies checked evidenced that there are clear records of financial transactions being maintained. Staff confirmed that they receive regular supervision. Due to no manager being available at the home, supervision dates have fallen behind. The acting manager is taking action to address this shortfall. The pre-inspection questionnaire demonstrates that the last fire drill was undertaken on 01 August 2005. Staff should be provided with regular fire drills. The acting manager, the pre-inspection questionnaire and staff all confirmed that regular fire training is provided at the home. The acting manager confirmed that the fire risk assessment for the home is being updated in the near future. No other health and safety records were inspected as this information was provided in the pre-inspection questionnaire, which were found to be satisfactory. There are suitable records maintained for accidents/incidents that occur within the home. Any other shortfalls noted in the health, safety and welfare of residents have been noted in the relevant sections of the report. Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 24 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 2 3 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 Standard No Score 16 3 17 X 18 3 2 X X X X X 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 25 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. 2. Standard OP3 OP7 Regulation 14 15 Requirement That a thorough pre admission assessment be undertaken on all prospective service users. That care plans are kept under regular review and reflect actual current practice. (Timescale 15.08.06 not met) That daily records about service users are expanded; ensuring mental health needs are reflected. (Timescale 15.08.06 not met) That risk assessments are implemented for all service users, with particular attention to falls. That hot water is delivered around the recommended 43°C. (Timescale 20.07.06 not met) That all parts of the care home and equipment in use are kept clean and in a good state of repair. That a more structured quality assurance and quality monitoring system be implemented and results be made available. That all staff participate in regular fire drills. DS0000014187.V299340.R01.S.doc Timescale for action 15/12/06 31/12/06 3. OP7 Schedule 3 (k) 15/12/06 4. OP7 13(4) (b&c) 13(4)(c) 23(2)(d) 15/12/06 5. 6. OP25 OP26 15/12/06 30/12/06 7. OP33 24 30/12/06 8. OP38 23(4)(e) 30/12/06 Carlton House Rest Home Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP9 OP25 OP28 Good Practice Recommendations That handwritten prescriptions on MAR charts be checked and double signed by two staff who have undertaken medication training. That any hand written amendments on MAR charts are signed. That hot and cold taps are clearly identified. That the home continues to work towards having 50 of care staff NVQ level 2 qualified. Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East Sussex Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Carlton House Rest Home DS0000014187.V299340.R01.S.doc Version 5.2 Page 28 - 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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