Inspection on 12/09/07 for Carlton Lodge

This inspection was carried out on 12th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Lodge 18/08/09

Carlton Lodge 11/09/08

Carlton Lodge 26/09/06

Carlton Lodge 12/01/06

Carlton Lodge 18/05/05

Carlton Lodge 12/10/04

Carlton Lodge 03/09/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Carlton Lodge 28 Carlton Street Normanton West Yorks WF6 2EH Lead Inspector Tony Brindle Key Unannounced Inspection 12th September 2007 11:30 Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 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 Lodge DS0000006171.V340429.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 Adults 18-65. 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 Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton Lodge Address 28 Carlton Street Normanton West Yorks WF6 2EH 01924 223652 01924 227516 care@haptoncarehomes.co.uk 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) Hapton Care Homes Mr John L McIntosh Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: Carlton Lodge provides personal care for nine people with learning disabilities. The home is in Normanton, close to the town centre and all local facilities and shops. The home is close to a main bus route, rail station and the M62. Carlton Lodge has a small walled garden. People living at the home are all provided with single bedrooms, which they can personalise. The staff support people to go out on trips, go to day services and develop daily living skills. People benefit from a visiting reflexologist and manicurist. The current individual fees for September 2007 range from £816 to £1050 per week. Information about the home is available to people via the Statement of Purpose, Service User Guide and the last inspection report, which are available in the home’s reception and are given to people who enquire about living at the home, and to people who currently live at the home. These documents also give people information about the Commission for Social Care Inspection. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit started at 11:30 and ended at 17:00. There was discussion with people living at the home as well as some of the care staff. Prior to the visit, the manager gave information about the service (in a form called an Annual Quality Assurance Audit). A survey was also carried out to hear what people who live at the home, or have contact with the home, think about the care provided. From the 6 surveys that were sent to people living at the home, 4 people responded. Of 6 surveys sent to relatives 4 replied. From 8 surveys sent to healthcare/social care professionals 3 responded. The feedback received was positive. Since the last visit some social workers have looked at records of activities of some people living in the home and have discussed with the manager their concern that more activities should take place. This is considered more fully in the Lifestyle section of this report. Three peoples records were seen and included assessments, care plans, daily and medical records and the record of activities. Three staff records were also seen and included, application forms, references, police checks, training and supervision records. The inspector would like to take the opportunity to thank the people using the service and the staff team for their hospitality, patience and co-operation throughout the visit. What the service does well: The manager has good systems in place to ensure people are kept safe and that their views and opinions are listened to and acted upon. Staff receive training and undergo the correct employment checks before they start work with people to make sure people are cared for safely. Peoples needs are assessed to make sure that there are enough staff on duty to provide the support and care needed. People live in a comfortable home that is kept clean and tidy. People are given information about how to complain about the service they receive. If people are unable to complain themselves, there are good systems in place to give support, protection, and to respond if others raise concerns or questions about how someone is being cared for or supported. People take part in some activities based on their own individual interests, and some of these activities enable people to get out into the community. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 6 The meals provided at Carlton Lodge are liked and suit people’s individual tastes. The care and support people need is recorded in an individual plan of care which is used by the staff to help people make decisions about their daily life, and understand the risks that might be linked to those decisions. People who come to live at Carlton Lodge have their needs assessed before they move in, so that the staff know how to support and care for the person, and meet their individual needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s individual needs are assessed before they live at Carlton Lodge to make sure that staff can provide the support and care they want and need. EVIDENCE: All of the files seen on the day of the visit included an individual pre-admission assessment based on activities of daily living, included past medical history as well as current needs. The records show that the manager and staff try to ensure that they can meet peoples needs and have a good approach to making admissions right for people, and are clear when they feel the home might not be able to meet the needs of a person. People living at the home said that they were happy about the way they had been supported to move into Carlton Lodge and one spoke about being given the opportunity to spend time in the home before moving in. The records show that people living in the home receive a contract. The comments made by people living at the home were supported by information found in documents within people’s individual files. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Regular reviews of peoples care should occur to make sure individual needs and choices are met, whilst setting out the risks that might be linked to decisions made. EVIDENCE: One staff member spoke about how the care plans are put together after assessments to find out people’s capabilities and needs. Another spoke about how the care plans set out the care and support people need on a day to day basis, and added that the plans are individualised to reflect each person’s personal care and support needs, their abilities and personal goals. Several of the people living at the home have communication difficulties, and one staff member spoke about how they have to really get to know the person in order to fully understand what people are trying to communicate either through non verbal cues or verbal sounds the person uses. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 10 One person living at the home said that they speak to the manager and staff about how they want to be spoken to, how they want to be supported when dressing and bathing, and about the kind of leisure activities they would like to undertake. Due to the nature of some of the communication difficulties experienced by people living at Carlton Lodge, the subject of care planning and care delivery could not be fully discussed. However, two people did speak briefly about how they sometimes get involved in decisions about what they are going to do during the day, where they are to go, and who with. One staff member spoke about how the different activities that people take part in are individually assessed to see what the risks to that person may be. Another staff member spoke about how action is taken to reduce risks and even do away with them where possible. They added that this is done to make sure people are kept safe and avoid limiting people’s preferred activity or choice. One staff member said that the staff at the home do review the care and support people receive, and this was supported in three of the care plan files seen on the day. For the three people who were case tracked, evidence could not be found to show that the placing authority had undertaken a full review of their care and support. The comments made by people living at the home and by staff were supported by information found in documents within people’s individual files. Care plan files do contain information relating to people’s care and support needs, their abilities and basic goals to achieve, as well as risk assessments. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 16 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are supported to maintain family relationships, and develop new friendships, however, very limited opportunities are provided for people to take part in a range of activities based on their own individual interests and abilities. EVIDENCE: Some people living at the home said that they take part in educational activities outside the home. One person said that they were going to start a pottery making course at a local day center. Another person said that they had just come back from college, and that they were really excited about going as it was their first time. People living at the home said that they go out into the local community for walks, visits to cafes and shops, and day trips. Others spoke about going for minibus rides around the local area. One staff member said that some of the people living at the home do enjoy going out on the minibus, and said that some people “go along for the ride” when other people Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 12 from the home are taken to visit their relatives. Staff at the home said that people are able to have visitors at any reasonable time. People living at the home confirmed this. Feedback from people who replied to our survey showed that they are given the opportunity to develop and maintain important personal and family relationships, with some relatives saying that they visit the Carlton Lodge, and also encourage their relative to have home visits. People were seen to be given the opportunity to exercise their choice in relation to meals and mealtimes. A staff member spoke about supporting people to make healthier choices about food, and that this is discussed with the person and recorded in their care plan. One member of staff said that there is a varied menu on offer at Carlton Lodge, which is suited to people’s individually, assessed requirements. One member of staff said that meals are usually taken altogether, but the times can be flexible depending on a person’s preferences. People living at the home said that they enjoy the meals that are provided, and that sometimes they get the chance to make their own meals and deserts. Staff at the home said that people living at the home don’t really have the capabilities to handle own financial affairs, but if a new person moved into the home who did have the ability to do this, then they would be supported for as long as they wished to manage their own affairs. Another staff member said that people’s ability to deal with their own personal finances is individually assessed. The comments made by people living at the home, by staff and by people who responded to our survey, were supported by information found in documents within people’s individual files. The inspector spoke to the staff about a recent visit by social workers who also looked at into the subject of activities for people occurring inside and outside of Carlton Lodge. The social workers’ findings, which were supplied to the Commission, indicated that for some people, the opportunities to engage in meaningful activities were limited. The manager of Carlton Lodge said that in the past the staff had not fully recorded what people did, and so the picture was not very clear. He added that the recording of activities had recently improved. Following a detailed look at people’s individual records regarding the activities they do, a discussion took place with staff. The staff said that for some people the only activity they take part in, involves going for short walks around the local area, going for rides on the minibus, and the occasional day trip. In addition to this, some people take part in a weekly aromatherapy session. The records show that for others, spending a few hours at the local day centre once a week provides another opportunity to get and about. Recent discussions with the manager prior to the inspection indicated that the provision of day time places by external organisations is very limited, and the manager has great difficulty in securing placements. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 13 Observations on the day of the visit showed that over the course of a two hour period, one person was seen to sit on a sofa in a communal area and do very little. Very little staff interaction took place with this person, and the person looked unconnected from the world around them. Other observations made on the day found that some people do go out for short periods of time to the shops and surrounding area with staff support, and others go out to college. Some people were seen to take part in group activities in the home making craft based items, and some people did chat to members of staff. However, the two hour observation found that for some individuals, the vast majority of their time was spent sitting watching TV, or sitting in communal areas watching the world go by. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People generally get the support they need, but a reminder to the staff team about how to put into practice person centred care would ensure that people continue to receive high levels of individualised care and support that meets their personal and healthcare needs. EVIDENCE: One person living in the home said that the staff do listen to them, and help them in relation to their medication, healthcare appointments and any problems that they may want to talk through. One person was observed to be in need of personal support, and a staff member encouraged the person to go to the privacy of their bedroom in order to receive the support they needed. However, this was done in a loud voice, which had the effect of announcing the person’s needs and situation to everyone in the foyer area of the home. Another person living in the home picked up on this, and started to repeat what the staff member had said. This observation was the only negative staff interaction that was seen during the visit to the home . Other interactions by the staff were positive with staff Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 15 members talking to people, listening to people and acknowledging what was important to them. The records show that the manager has in place a policy and procedure relating to the receipt, recording, storage, handling, administration and disposal of medicines. Feedback from people who completed our survey indicated that they were satisfied with way they were supported in relation to medication. Two people living at the home said that the staff are very good at making sure that doctor’s appointments and district nurse visits are arranged, adding that the staff are very caring. Feedback from people who completed our survey indicated that they were satisfied with the ways in which their healthcare needs were supported. The comments made by people living at the home, by staff and by people who responded to our survey, were supported by information found in documents within people’s individual files and the home’s policies and procedures. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given information about how to complain about the service they receive, and are supported in this when needed. There are systems in place to safeguard people. EVIDENCE: Staff working at the home were able to talk through the complaints procedure, and were able to explain the stages and timescales for the process. Feedback from people who completed our survey indicated that they were fully aware of who to complain to over issues at the home. The deputy manager said that no formal complaints had been received. Another staff member spoke about the procedures that are in place for responding to the suspicion of, or allegation of abuse or neglect. This person was able to talk through the process, explaining how if allegations and incidents of abuse are reported, what appropriate action would be taken to make people safe. This person explained how information would be recorded, and that it would be passed onto the manager. The deputy manager confirmed that the appropriate authorities would be then informed. People living at the home said that they felt safe and comfortable and knew who to speak to if they were unsure about a situation or the way someone was behaving or treating them. One member of staff spoke about the training and supervision they have received to make sure that they are fully aware of the policies and procedures Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 17 relating to protecting and safeguarding the rights of people living at the home. This person was able to talk about how to recognise signs of abuse and how to respond appropriately. One person living in the home said that said that they would not have a problem going to a member of staff if they felt unsafe. The comments made by people living at the home, by staff and by people who responded to our survey, were supported by information found in the home’s policies and procedures. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable home that is kept clean and tidy. EVIDENCE: A look around the home found that its location and layout is suitable for its stated purpose, and that it is accessible and nicely maintained. The handyman explained that he had just completed the external decoration of the building. This was seen to have been finished to a good standard. It was noted that the home was free from offensive odours throughout and that there are systems in place to control the spread of infection. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten. Appropriate hand washing facilities are available; the records show that there is an appropriate infection control policy and procedure in place to maintain good hygiene. The quiet room linking the foyer to the dining area has now been fully decorated, and a doorway has been added to the foyer area which one staff member said has now improved Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 19 access to the bedroom corridor for people who use wheelchairs. A person who uses a wheelchair confirmed. Discussions with people living at the home showed that they are encouraged to see the home as their own. A look at people’s rooms confirmed that they can personalise their own space. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are cared for by well trained staff, who have been properly recruited and are sufficient in number to meet the assessed needs of people living there. EVIDENCE: The rota shows that the staffing numbers and skill mix of qualified and unqualified staff on duty are linked to the assessed needs of the people living in the home. One staff member spoke about the fact that there is always enough staff available to support the needs, and activities of the people using the service. The records show that two written references are obtained before appointing a member of staff, and any gaps in employment records are explored. Further to this, the deputy manager said that new staff are confirmed in post only following completion of a satisfactory police check, and satisfactory check of the Protection of Vulnerable Adults register. One member of staff said that they receive good levels of training in areas such as health and safety, fire safety, movement and handling, safeguarding, and food hygiene. Another staff member talked about receiving training on the Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 21 principles of care, safe working practices, the organization and safeguarding people, and added that they do also get specialized training to help them with their job in areas such as epilepsy. Feedback from people who completed our survey indicated that they believed that the staff were well trained. Observations made on the day showed that there is a diverse staff team that has a balance of skills, knowledge and experience to meet the needs of people who use services. The comments made by people living at the home, by staff and by people who responded to our survey, were supported by information found in documents within people’s individual files. The principles of person centred care were seen to be put into practice, but as mentioned earlier in the report, one staff member was seen on one occasion to fail to stick to these principles, and announced to another of people that someone needed personal care support. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and there are good systems in place to ensure people are kept safe and that their views and opinions are listened to, and acted upon. EVIDENCE: The manager of Carlton Lodge is registered with the Commission and has the appropriate qualifications and experience to manager the home. The records show that there are systems in place such as quality assurance and quality monitoring systems that measure various aspects of the delivery of the care and support provided by the staff team. The deputy manager said that she, and the manager are currently putting together the home’s annual survey, the results of which will be published soon. Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 23 Staff members spoke about how the manager and other members of the team are involved in various checks and quality monitoring which give them evidence that the home is working properly to promote the health and safety of people living and working there. They went onto to talk about how the fire alarm is tested, medication is audited, risk assessments are carried out, care planning takes place, and other health and safety audits are undertaken. One staff was able to talk about how accidents, injuries and incidents are recorded and reported to the manager and appropriate authorities when necessary. Feedback from people who completed our survey indicated that they feel safe living in the home, and that they believe it is well run. The comments made by people living at the home, by staff and by people who responded to our survey, were supported by information found in documents within people’s individual files and the home’s own policies, procedures and recording systems. Carlton Lodge DS0000006171.V340429.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 Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? no 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 YA12 YA13 YA14 Regulation Requirement Timescale for action 25/11/07 16:2(m)(n) The registered person must review the level and variety of daily activities provided by the home, or through external service providers, to ensure people living at Carlton Lodge can engage in meaningful social, leisure and educational activities that enhance their daily lives. 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 Refer to Standard YA6 YA7 Good Practice Recommendations The manager should ensure that a full care review for people living at the home occurs regularly, which would involve relevant people or organisations that support individuals living at Carlton Lodge, in order to determine what opportunities are available for people to take part in a range of social, leisure and educational activities. . Carlton Lodge DS0000006171.V340429.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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