Inspection on 18/08/09 for Carlton Lodge

This inspection was carried out on 18th August 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Lodge 11/09/08

Carlton Lodge 12/09/07

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 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Carlton Lodge 28 Carlton Street Normanton West Yorks WF6 2EH Lead Inspector David White Key Unannounced Inspection 18th August 2009 08:45 Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Carlton Lodge DS0000006171.V377201.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 10 Category(ies) of Learning disability (9) registration, with number of places Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2008 Brief Description of the Service: Carlton Lodge provides personal care for nine younger 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. Information about the home is available to people via the statement of purpose, service user guide and the last inspection report, which are available from the home 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. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star adequate service. This means that people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations-but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We went to the home without telling them that we were going to visit. This report follows the visit that took place on the 18th August 2009. The visit lasted from 8.45 am until 4.15 pm. The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the manager on an Annual Quality Assurance Assessment questionnaire (AQAA). Surveys returned from people who live at the home, staff who work there and health professionals who visit the home. A telephone conversation with a health professional that has involvement with the home. During the visit time was spent talking to people who live at the home, care staff and the registered manager. Staff were observed caring for people in communal rooms, records relating to care, staff, and maintenance were looked at, as were some parts of the building. The registered manager was available throughout the site visit and the findings were discussed with him, the deputy manager and a senior member of staff at the end of the inspection. The current individual fees at the time of the inspection visit on August 18th 2009 range from £550 per week. The previous inspection visit took place on 11th September 2008. What the service does well: Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 6 The registered manager follows pre-admission procedures to make sure he gets enough information about people before they are admitted into the home. This usually involves people visiting the home beforehand and spending time with other people who live there. This helps in making sure that only suitable people are admitted into the home. People who live at the home say that they are treated well by staff who listen to their concerns and act on them. This helps people to feel safe in their environment. People said they like living at the home. One person particularly liked the views from their bedroom. Staffing turnover is low so people receive support from people who have known them for a long time. This helps with the consistency of care being provided. What has improved since the last inspection? Action has been taken to make sure that all bedroom windows have coverings to help maintain people’s privacy and dignity. The appointment of an activities person has helped in improving the range of opportunities for people to pursue their social interests. One person said, ‘I can get out more now and I enjoy going to the pub’, another person said, ‘I enjoy my holidays and days out’. A cook has been employed to work at the home. This has helped to reduce the burden of work on care staff so enabling them to spend more time with people living in the home although staffing levels need to be kept monitored. A Health Action booklet has been introduced and is in the process of being completed for each person. This has encouraged person centred care by seeking people’s views about their wishes if becoming unwell. Certain parts of the home have been re-decorated and this has created a more pleasant and comfortable environment for people although further work is needed to improve other parts of the environment and this has been planned for. A previous problem with a person’s bedroom door has now been rectified so that the door is able to fully close. This has created more privacy for the person in there and makes it a safer place to be in the event of fire. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 8 order line – 0870 240 7535. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 9 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.V377201.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not move into the home without an assessment of need being completed to make sure their needs can be met. EVIDENCE: Before people are admitted to the home their needs are usually assessed by the registered manager and his deputy. Information about the person’s care needs is also obtained from other sources such as the placing authority to support the home in their decision about whether they can meet the person’s needs. The manager said that the home’s procedure for any person moving into the home would be for them to come and have a look around and spend some time with people already living there. One person had been admitted in an emergency just prior to the site visit. The manager had taken some verbal information about the person and had obtained detailed information from the placing authority about the person’s needs before they arrived. The manager said that this information would form Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 11 the basis for the person’s care plan. He also said that a review would be arranged within three or four weeks to discuss how the placement was going. Everyone who returned their survey said that they got enough information about the home before they were admitted. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by the staff team who care for them. However, further work needs to be undertaken to develop a more person centred approach to care in order to develop peoples’ independence and choices. EVIDENCE: Each person has a care plan that details people’s individual needs and how these are to be met. The plans focus on different aspects of daily living and include people’s preferences on such things as their food likes and dislikes and their preferred times for getting up and going to bed. For those people with communication difficulties some information was in picture format to support people to make their own choices. The quality of information in the care plans Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 13 varied. Whilst in some cases it was evident that people had been involved in developing their care plan, this was not evident in some of the care plans. The registered manager did explain that efforts are made to involve people in planning their care but in some cases due to the complexity of the individual’s needs this could be difficult. The manager said that annual care plan review meetings are held in which the person if they choose, their relatives and others involved in their care are invited to attend a meeting to discuss how things are going. Four out of five people living in the home who returned surveys said they are able to make their own decisions at all times and choose how they wish to spend their day. One person said, ‘I can do whatever I want’. Care planning information contained individual risk assessments to support people but some lacked detail and did not specify triggers when referrals needed to be made to outside agencies where concerns arose. The risk assessment information and discussions with some staff about people’s daily living skills tended to mainly focus on safety and people’s limitations. Whilst this has to be considered at all times staff attitudes also need to be developed in positive risk-taking with more focus on developing people’s individual strengths, abilities and independence within a risk assessment framework. In the care records looked at there was little evidence to show that risk assessment information is reviewed and updated regularly. This means that staff may be unaware about any changes to people’s care including areas of risk. Staff did say risk assessment information is discussed but if there were no changes they did not make a record of this. Staff said that they have handover periods between shifts and there is a communication book to keep staff informed about any changes. All the surveys returned by staff working at the home said that the communication systems worked well. Each person at the home has a key worker team who help to organise and plan their care. Daily records are maintained and kept up to date to reflect the support being given. However these were being stored near to the entrance of the home and could be accessed by people visiting the home. The records contained personal information about people’s needs and discussion was had with senior staff about the need to store these records in a more secure way in order to maintain confidentiality. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 14 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): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The expectations of people living at the home are being met with regard to their social needs and daily living activities although more work is needed in supporting them to develop their independent living skills. EVIDENCE: Whilst some people who live at the home attend college courses such as cooking and pottery, others prefer to spend their time at the home. Due to the complex needs of people living at the home people’s abilities varied. However, no one did their own cooking and only one person attended to their own laundry. A survey returned by a person living in the home said, ‘I would like to do more cooking for myself’. One staff member said that people using the service would not be able to go into the kitchen because it was too unsafe for Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 15 them. However this had not been risk assessed and alternative options had not been explored as to how this may be achieved. An activity co-ordinator is employed to work 20 hours a week at the home and as well as providing in-house activities, supports people to go out. People living in the home and staff both said that this has helped to provide people with more opportunity to go out and to do things they enjoy. One person said, ‘I get out more now and I enjoy going to the pub on my own’, another person said, ‘I enjoy my holidays and days out’. Most people need staff support when going out and said that they receive this. One person has a motorised scooter to help with their mobility. As a result of listening to people the home now has pets. Three people enjoyed a holiday in Spain earlier in the year. Two other people had holidays in Filey and Skegness. People are encouraged to maintain relationships with their friends and relatives. Some people visit their family at home and are supported by staff to do this. The registered manager said that the home is looking to re-start family support meetings. The home employs a cook who works 20 hours a week. The cook was not working at the time of the site visit so a designated member of staff undertakes these duties in the cook’s absence. People’s care records include information about their food likes and dislikes. Surveys returned by people at the home all said that they enjoy the food that is on offer. However, whilst one person said at the time of the visit ‘the food is good’ another said, ‘there is little choice at mealtimes’. The manager said that efforts are made to seek the views of people about what kinds of food they would like on the menu. At the time of the site visit people could be seen eating lasagne as the main meal. An alternative warm meal was not provided. People could be seen to be making themselves drinks between mealtimes and staff provided drinks to those people who were unable to do this. Staff said that some people enjoy baking. The care records of one person had identified the person as being at risk of choking. A risk assessment is in place to guide staff on actions to be taken to minimise any risk from this. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the way in which some aspects of people’s health care is monitored. People’s rights to privacy and dignity are not always protected by some of the care practices within the home. EVIDENCE: All the surveys returned by people living in the home said they are treated well. At the time of the visit staff could be seen providing support to people in a patient way. Since the previous inspection visit all bedroom windows have been fitted with coverings and this has improved people’s privacy in their private accommodation. However, some practices do not promote people’s privacy and dignity and this needs addressing. A reflexologist was visiting the home at the Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 17 time of the site visit to carry out a reflexology session with one of the people living at the home. This was being done in the dining room and whilst no other people were in the dining room the door leading into it could be opened. A member of staff who was accompanying the inspector during a look around the environment was not aware that the dining room was occupied and entered the room. Throughout the visit staff could be seen entering people’s private accommodation and bathroom and toilet areas without knocking on the door first. In a discussion with a health professional who visits the home a comment was made that ‘staff can say things about others in front of people’ although this was not witnessed at the time of the visit. People who live at the home have access to GP (General Practitioner) and other healthcare services. They also have involvement with local community health teams. Care records showed that staff support people to attend appointments and outcomes from appointments are recorded. The home has recently introduced a Health Action Plan booklet. This is good information that seeks people’s views about their wishes if becoming unwell. Care plans contained information about how peoples’ behaviour was to be managed if the behaviour presented problems to the service and included specific deescalation techniques to be used to calm down situations. In most cases referrals had been made to healthcare services when a person’s health was causing concern. However, the care records of one person did not show this. The person’s previous care plan review identified that the person’s weight could fluctuate and that staff would monitor this. During a six month period the person lost a stone and a half. Whilst staff had been weighing the person there was no care plan in place about what actions staff were to take to meet the person’s needs. Neither was there any information about at what stage a referral was needed to healthcare services. The person has since gained weight however arrangements need to be put in place so that in future the person’s health needs are properly monitored and acted on. Staff did say that there had been some problems with the weighing scales and they thought this may have led to inaccurate readings of peoples’ weights. The weighing scales have since been replaced. A survey returned by a health professional said that the home had sometimes sought advice on health care matters, indicating that on occasions this may not have happened. None of the people living at the home administer their own medication so staff look after this on their behalf. The Medication Administration Records were up to date and accurate and included good information about the medication in use, reasons why it was being prescribed and potential side-effects from the medication. Medication is mainly supplied in blister packs that are prepared by the chemist. One person’s medication was checked against the medication records and found to be correct. The registered manager said that all staff responsible for medication have completed training. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s concerns are listened to and acted on. Systems are in place to make sure that appropriate action would be taken in response to abuse. Where physical interventions may be used, information about this in the care records needs to be made clearer to show how this has been agreed and is to be used. EVIDENCE: The home has a complaints procedure that is available to people using the service and others. Surveys returned by people living at the home said that they know how to complain and that staff listened to them and acted on what they said. A survey returned by a health professional commented that the home had sometimes responded appropriately to concerns. The registered manager said that the home has not had any complaints during the last twelve months and the complaints records supported this. The commission did receive a complaint about the heating in the home and staffing levels. These matters were passed on to the provider to investigate. The provider responded appropriately to the complaint and the issues raised in the complaint were satisfactorily dealt with. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 19 The home has policies and procedures about safeguarding people from abuse. Staff also receive training about this and those spoken to knew about their responsibilities in reporting abuse. During the last twelve months there had been no incidents that needed safeguarding procedures to be followed. Some care plans stated that in some instances in order to manage an individual’s behaviour to reduce risks to themselves and others then physical interventions may be used as a last resort. However, the care plans were not specific in detailing the type of physical intervention to be used and who was to use this. There was also no evidence that the use of physical intervention had been agreed with the person, relatives or professionals involved in the person’s care. The registered manager did say that physical intervention is rarely used and that most situations are managed through the use of de-escalation techniques. Staff have received training in the use of physical interventions and de-escalation techniques. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment mostly meets the needs of the people living at the home although some improvements would make the home a more comfortable and safer place to live. EVIDENCE: The home has two floors with bedroom accommodation on both floors. There are no lifts in the home so people with mobility problems would need to have a bedroom on the ground floor. There is ramped access to and from the home to support people with mobility problems. Each person has their own bedroom that they have helped to personalise through their choice of décor. There are sufficient bathing and shower facilities and a walk-in shower facility on the ground floor to assist people with mobility problems. People spoken to said Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 21 that they like their accommodation. One person said, ‘I have nice views from my bedroom’. Work is currently being undertaken to develop an additional bedroom and the registered provider has applied to the commission to have this approved so that the home can accommodate an extra person. The work is impacting on the amount of communal space that is available to people on the ground floor. In order to try to reduce the impact from this a large screen television has been installed on the first floor and there is seating to enable people to watch this although this arrangement is not ideal as people walk through the area where the television is located. As part of the ongoing work a communal lounge is being developed on the first floor to replace the communal space that will be lost by the creation of an additional bedroom on the ground floor. Some parts of the home have been re-decorated and this has made these areas brighter and more pleasant for people. However other parts of the home, particularly the lounge area looked bare and this did not create a homely feel to the environment. During a look around the environment it was observed that there was a lack of sufficient storage facilities. Storage areas looked cluttered and this could potentially pose fire safety risks and needs addressing. Surveys returned by people living at the home all said that the home is kept fresh and clean. At the time of the visit there were no odours. The home has separate laundry and kitchen facilities. A washing machine had recently broken down and had been replaced. The home does not have a domestic washing machine to accommodate those people who may wish to attend to their own laundry to develop their independence. On the day of the site visit infection control procedures were being followed. Information provided by the manager in the AQAA (Annual Quality Assurance Assessment) stated that all the staff had completed infection control and food hygiene training. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support from an experienced staff team who receive the training they need to support them in meeting people’s needs. The recruitment process recently followed does not protect people from unsuitable workers. EVIDENCE: The manager described the staff team as ‘flexible’ and ‘dedicated to providing good care and support’ to people. Staffing turnover is low and most of the staff have worked at the home for a number of years and said that they had a good understanding of each person’s needs and knew them well. However a health professional commented that staff had ‘limited knowledge of people’s needs’. The duty rotas showed that in a morning and afternoon there are usually five members of care staff excluding the registered manager and his deputy. Two waking members of staff work the night shift. Since the previous inspection visit the home has also employed a cook to work 20 hours a week and an Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 23 activity co-ordinator also for 20 hours a week. Staff who returned surveys all said that the staffing levels are sufficient. People living at the home also felt this although one did say that on occasions they had been kept waiting for call bell requests to be answered. People also said that ‘we can get out more now’. On the day of the site visit the cook and activity person were not working so a member of staff was delegated to do the cooking duties. Staff could also be seen doing laundry. Staff did say that the workload could become difficult if doing these duties as well as care work. On speaking to staff it was also evident that when the activity person was not working alternative arrangements had not been put in place for staff to carry out activities with people. One person has recently been admitted to the home and the assessment information showed that this person will need 2:1 support from staff when going out. The registered manager explained that additional staff are in the process of being recruited so that there will be sufficient staffing levels to meet everyone’s needs. Written information was received from the management of the home shortly after the inspection visit stating that the cook and activity person’s hours are to be extended to cover 7 days a week in order to make sure people’s needs are met at all times. The staff files of two recently recruited staff were looked at. One file contained all the necessary information including satisfactory police checks. However, in the other file only 1 written reference had been obtained and the member of staff had started working at the home before the Criminal Record Bureau (CRB) and POVA (Protection of Vulnerable Adult) checks had been completed. This practice puts people at risk from unsuitable workers. Four out of five staff who returned surveys said that they received a good induction when starting work at the home so that they understood what was expected of them in providing good care in a competent way. The majority of staff have either completed or are doing National Vocational Qualifications (NVQ) in care at level 2. One staff member said, ‘the training is good’ and another said, ‘the service is good at providing training’. Staff receive training on safe working practices as well as training about such things as the principles of person centred care and managing the behaviour of people who may challenge the service. The training records lacked information and there were some gaps so it was difficult to see when people had received training and when updates were needed and it was recommended that a training matrix be used so that training could be better monitored. Shortly following the site visit a training matrix was sent to the commission by the registered provider. This showed that all the staff had received up to date training and provided dates as to when training updates had been booked for. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is well experienced to run the service. Systems are in place to seek people’s views about improving the care and services on offer. Improvements are needed to help maintain the health, welfare and safety of people who use the service. EVIDENCE: The registered manager has the relevant qualifications and experience to run the home. At the time of the site visit the registered manager disclosed that he is to leave his current post although he will continue to work for the company Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 25 in a different capacity. His post had already been advertised and the current deputy manager has been appointed to replace the manager when he leaves. The deputy manager has NVQ at level 4 and will be undertaking additional management courses to develop her management and leadership skills. Staff and people at the home said that they like the registered manager and that they can go and see him at any time about anything. One staff member said, ‘management are helpful’ another said, ‘the service is good at keeping staff and people who live at the home updated about any changes’. The home has systems in place to monitor the performance of the service. Annual surveys were sent out to relatives and professionals with involvement in the home. These were seen and provided mostly positive feedback. There were some comments that information systems could be better. The manager gave written feedback to people who had completed the survey and said that he tries to see relatives informally to keep them updated. Meetings are held with people at the home and staff and these are recorded. Staff said they also have supervision to support them in meeting people’s needs. The home continues to hold the Investors in People Award for their commitment towards improving the quality of care and services provided. The self-assessment form (AQAA) completed by the deputy manager prior to the inspection visit indicated that all the required health and safety maintenance checks were up to date. It did state that the previous hoist check had been done in 2006 but the registered manager explained that hoisting equipment is no longer used. This will need to be reviewed if people are assessed as needing a hoist to assist with their mobility. A sample of records were looked at relating to checks of electrical appliances and water tests and found to be satisfactory. Since the previous inspection visit action has been taken so that a person’s bedroom door is now able to close fully in the event of a fire. Improvements need to be made in some aspects of health and safety to maintain people’s safety. Fire alarm tests are currently being carried out monthly and need to be checked weekly so that any problems can be identified at an earlier stage and acted on. Proper recruitment procedures need to be followed in all cases. Care planning information needs to be more specific about the use of physical interventions and risk assessment information needs to be kept updated so that staff are aware of changes to people’s needs to help minimise any risks to the individual or others. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 3 X 3 X 3 X X 1 X Version 5.2 Page 27 Carlton Lodge DS0000006171.V377201.R01.S.doc Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA18 Regulation 12 Requirement Arrangements must be put in place to make sure that care and support is provided in a way that maintains people’s privacy and dignity at all times. Where potential concerns exist about a person’s weight, this must be properly monitored so that timely referrals can be made to healthcare professionals where this is needed. This will enable people to get the right kind of support to maintain their health and have their health needs met. (Previous timescale of 11/11/08 not met). 3. YA23 13 Where individual care plans 18/10/09 identify that physical interventions may be needed to help minimise risk to the person themselves or to others, the care plan must be clear in: • Detailing the type of physical intervention to be used and the reasons for Version 5.2 Page 28 Timescale for action 18/10/09 2. YA19 12 18/10/09 Carlton Lodge DS0000006171.V377201.R01.S.doc • it. Showing how the decision about the potential use of physical interventions has been agreed by the person and/or their representatives. 4. YA34 19 This will help in making sure that the use of physical intervention has been agreed, is appropriate to the individual and that safe practices are being followed. Proper recruitment procedures must be followed so that satisfactory police checks and two written references are obtained before new staff start working at the home. This will help in making sure only suitable people are employed to work at the home. 18/09/09 5. YA38 23 Arrangements must be put in place for fire alarms to be tested on a weekly basis and a record made of these tests. This will help in making sure that any problems with the fire alarm system is identified at an early stage and acted on. 18/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 Good Practice Recommendations Care planning information should be reviewed more regularly in order to make sure that staff are up to date with any changes to people’s needs. Action should be taken to develop staff skills and DS0000006171.V377201.R01.S.doc Version 5.2 Page 29 YA9 Carlton Lodge 3. 4. 5. 6. YA10 YA12 YA17 YA19 7. 8. YA19 YA19 knowledge about positive risk-taking to help support people who live at the home with their choices and independence. Daily records should be stored more securely and in accordance with the Data Protection Act. People should be more actively encouraged to develop their personal and independent living skills. Arrangements should be put in place so that more choice is available at mealtimes. The planned maintenance programme for the redecoration of the home should be implemented in order to make the home more homely, brighter and comfortable for the people living there, especially in the lounge area where people sit. Action should be taken to create more storage space to help minimise any potential fire safety risks from the current storage arrangements. Arrangements should be put in place to have equipment in place to accommodate people who wish to attend to their own washing to help encourage their independence and daily living skills. Carlton Lodge DS0000006171.V377201.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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