Inspection on 11/12/08 for Carlton Lodge Nursing and Residential Centre

This inspection was carried out on 11th December 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Carlton Lodge Nursing and... 18/12/07

Carlton Lodge Nursing and... 11/07/07

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

Thorndene

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Carlton Lodge Nursing and Residential Centre 21 Victoria Parade Broadstairs Kent CT10 1QL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Sumner     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Carlton Lodge Nursing and Residential Centre 21 Victoria Parade Broadstairs Kent CT10 1QL 01843862577 01843603793 roscar@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (ANS) Ltd Name of registered manager (if applicable) Mrs RoxanaRosca Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 41 The registered person may provide the following category of service : Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP),(Physical disability (PD) Date of last inspection Brief description of the care home Carlton Lodge is a detached 4 storey premises, which was built in 1899 and is over 100 years old. The home is registered to provide nursing care and support for up to 41 older people over 65 years and 5 individuals with physical disabilities. From previous information received there are 18 single bedrooms and 6 doubles. Ten bedrooms have en-suite facilities of toilet and washbasin, two of which also have en-suite baths. The day space consists of two interconnecting lounges on the ground floor, a dining room Care Homes for Older People Page 4 of 27 care home 41 Over 65 41 0 0 41 Brief description of the care home and a large activity room in the basement. A shaft lift provides access to all levels. Each bedroom has a television point and a call alarm. Some bedrooms also have telephones. The Home is located near the town centre, on the seafront, overlooking a bandstand and the Victoria Gardens. It is within close proximity to the local shops and all public amenities. There is a small garden to the rear and small car park. Fees charged range from £425 to £700, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report is based on information received about Carlton Lodge Nursing and Residential Centre. We (the commission for social care inspection - CSCI) carried out an unannounced visit to the home. The people living in the home, staff and homeowners did not know that we were calling. Information was gathered before the visit by sending surveys out to people, including the people living in the home, reading notifications sent in by the home and discussions with visiting professionals. The visit included talking with people living in the home, members of the staff team and the manager. General observations were made during the day of how people are supported. We walked round and looked at the building and various records were inspected. Care Homes for Older People Page 6 of 27 No requirements or recommendations were made at this time. The manager knows what improvements need to be made and what her priorities are and has a plan of how she is going to manage this. What the care home does well: What has improved since the last inspection? What they could do better: The staff need to develop their confidence to make decisions based on changed in individual need when the manager is not available. The manager has been assisting staff to develop their skills and competency to be able to do this and will continue. Care Homes for Older People Page 8 of 27 Mental capacity act training would be beneficial. The manager has organised this. The National Vocational Qualification (NVQ) programme of training has been set up and needs to be implemented as soon as possible. At present there are no assessors in the area. The manager is requesting that BUPA provide assessors as soon as possible. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 until a full needs assessment has been made and the home has made sure it can meet their needs. Evidence: A new pre-assessment form has been used since June 2008. The manager said that she or one of the nurses complete this. The new pre-assessment process is designed so that the person moving into the home and the family can be more involved. Two assessments were looked at and contained clear information to show that their needs could be met in this home. The assessments are updated as individual needs change. The information in the assessment is used as a basis for the plan of care and support that is written. Intermediate or rehabilitative care is not provided at Carlton Lodge. Care Homes for Older People Page 11 of 27 Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare support is responsive to the varied and individual needs and preferences of the people living in the home. Individuals dignity and privacy are respected. Evidence: Each person has a care and support plan. Two plans were looked at in detail. The care plans start with information gathered as part of the assessment called, map of life. This gives a brief history of the lifestyle of the person before residential care and includes which people are important to them. Carers report any changes they have observed or spoken to the person about, and the nursing staff write in the care plans. We saw that skin care and nutrition are monitored by risk assessments, charts and written guidelines for what staff need to do for the person. We talked to the kitchen staff who showed us how they also monitor peoples’ nutrition and keep the manager informed of any changes. There is a mobility risk assessment and guidelines of what equipment to use. The ones seen were clearly written and had been reviewed so they Care Homes for Older People Page 13 of 27 Evidence: are up to date. There are assessment and treatment plans for people who need nursing care including wound care. There are also various forms of documentation for all aspects of the person’s life including equipment used for their safety. There are forms for monitoring visits from other health professionals including the GP. The care and support plans are routinely reviewed and there is an evidence sheet to record any comments and who was involved in the review.The home has a range of pressure relieving equipment for use if necessary. Medication administration and storage was discussed with the staff nurse on duty. BUPA has a policy for administration of medication. We looked at some of the medication storage and the medication administration records. These had been completed clearly and there were no gaps. If people wish to administer their own medication there is a risk assessment process and the person signs a disclaimer form. We saw that the systems for recording and checking controlled drugs were thorough. We saw that the nurses are careful giving medication to each person waiting until they have taken it before going away and chatting to the person while they are waiting. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 living in the home are able to enjoy varied activities. Mealtimes are relaxed and people have the support with their nutrition that they need. Evidence: The home has recently employed one of the staff as an activities coordinator. The staff said that this had made a huge difference to wellbeing of the people living in the home. There is a room downstairs that has been made into an activities room. It is spacious, has tables and chairs and has good light. Activities are also carried out in the lounge. And visiting entertainment is held in the lounge, like singing groups. There are a range of activities provided based on the interests of the people living in the home. As it was December, at the time of the visit, people were making Christmas decorations and cards. One person went out Christmas shopping with one of the carers during the afternoon. The lady’s tea, cheese and biscuit parties are popular. One of the people said she does not like joining in with the activities usually but the activities coordinator encouraged her to watch the recent entertainers and she knew she could leave at any point but actually enjoyed it. One person likes to spend most of his time in the activities room doing collage. Care Homes for Older People Page 15 of 27 Evidence: People said they like the choice they have of doing something themselves or joining in with the activities in the home. There is a hairdressing room and the hairdresser was in the home attending to those that wanted their hair done. The atmosphere in the home is welcoming to visitors. We saw that the staff are polite and friendly to the people living in the home and to their visitors. We had lunch with the people living in the home, which was well presented and good. The menu for the day is on each table. The chef explained that he finds out what people’s preferences are and who needs a special diet. He organises meals with alternatives and provides a similar meal to the one on the menu for people who have diabetes. Records are kept in the kitchen of what people have eaten. We saw that all records for food hygiene and health and safety are kept in the kitchen. The kitchen staff link in with the monitoring of individual nutritional needs to make sure that people are well fed and hydrated. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 home has an open culture that allows people to express their views and concerns in a safe and understanding environment. People in the home are protected by the homes policies and procedures. Evidence: The complaints procedure is on view in the home and a copy is provided to new people moving in and their relatives. The manager keeps a complaints log, which we looked at and discussed. Only two complaints were in the log and had been dealt with swiftly. The manager said that she makes herself available to the people in the home and any issues are dealt with at the time so there are not many complaints. People said they know if they have a concern they can talk to the manager or staff and said they had no complaints. Staff have had training in safeguarding and protection of vulnerable adults. The company has a procedure for staff to follow if they suspect abuse or in the event of an incident where a vulnerable person might be at risk. There have been 2 safeguarding alerts which have been investigated since the last inspection. One was regarding the moving and handling procedure a member of staff did not follow correctly. This is now closed and the member of staff no longer works in the home. And one was critisising the homes wound care and infection control. The Care Homes for Older People Page 17 of 27 Evidence: manager has carried out a thorough audit of infection control procedures. A further multi-agency meeting is planned for this to be finalised. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 home is clean and comfortable and suitable for the needs of the people living there. Evidence: The company have a maintenance department who make sure all the health and safety checks are carried out. They have a refurbishment plan with a cycle of redecoration and replacement of furniture. We looked round the home and it was clean and warm. Rooms are attractive and homely and there are different areas for quiet and activities. Bedrooms are personalised. Specialist equipment is provided to assist with people’s mobility, safety and pressure care. People have the choice of a bath or shower. There is a wet room shower. There are 3 full hoists and 2 standing aids. The home has a specialist bath and 6 baths with bath chairs. All equipment is serviced regularly to comply with legislation.There were recent problems with the shaft lift that have now been resolved after lengthy repairs and refurbishment. The manager explained that as the lift was out of action for some time and it was very inconvenient for the people living in the home she has purchased a stair walker. This is a gadget that will enable someone to go up stairs in their wheelchair should the need arise. Care Homes for Older People Page 19 of 27 Evidence: Staff have had infection control training and there are good procedures in the home. The manager stated in the AQAA that they use a specialist micro fibre cleaning system that combined with effective cleaning regimes keeps the home clean and odour free. The sluice and laundry facilities are appropriate for the needs of the home. The manager monitors and reviews the infection control policies in the home and supervises staff to make sure these are being carried out effectively. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 living in the home have confidence in the staff who care for and support them. Evidence: There is a stable staff group in the home. We looked at the duty rota and discussed how the home is staffed with the manager. The home is staffed each day by 2 nurses and 5 carers; this reduces to one nurse in the afternoon. There is a maintenance man, a housekeeper and 3 cleaners. In the kitchen there is a head chef, a 2nd chef and 3 kitchen assistants. All the shift timings are worked around what is happening in the home for example if there is a party the chefs work later and the kitchen assistants work various times to include the cleaning and washing up. 2 of the kitchen assistants are training to become chefs. An activities co-ordinator works each weekday and alternate week ends. The activities coordinator also works in the evening when events are planned. The home recently held a Christmas bazaar during the weekend in the late afternoon and evening. The deputy has left recently and the manager said as a result she is more involved with the direct care. The staff spoke about their roles in the home and about how they support the people living in the home. They felt there are enough staff in the home to meet individual needs without being rushed. We saw that the atmosphere in the home is calm and people look well cared for. The manager said she does not use agency Care Homes for Older People Page 21 of 27 Evidence: staff because it takes too long to show them what to do and counteracts any time they may be able to give. She will cover within the team including herself. The people living in the home made positive comments about the staff. One person said everyone who works here is very kind and caring and listens to service users. The company has a thorough recruitment process to make sure the people applying for the job are who they say they are and will work in the right manner. The manager explained that a member of the company human resources department checks the staff files to make sure all the checks and records are in place. The manager asks for identification like a passport and 2 references from people who know the person including their previous employer. She requests a Criminal records bureau (CRB) check and protection of vulnerable adults list (POVA) check to make sure they have not done anything in the past that will indicate that they are unsuitable or cannot be trusted. The manager prefers to wait until the CRB has returned before employing staff but had lost staff this way due to delays with processing so she uses her discretion. Staff work for a trial period of time while everyone gets to know each other and the member of staff decides whether this is the right job for them. Each new member of staff has some initial training using the Skills for Care Induction training. The training matrix was looked at and discussed with the manager. We saw that there is good range of training that is organised regularly. We talked to staff about the training they had received. Almost all staff have been updated with moving and handling. The remaining staff are booked for next week by an instructor from another home. The deputy was previously the moving and handling trainer for this home. Mental capacity act training is booked for Feb 09. NVQ training is planned and staff are ready to start. BUPA are training some new assessors as some of the staff who were assessors have left the company. When there is an assessor in the area they will start. The manager has one-to-one meetings with the staff and also supervises their work to make sure they understand and follow the procedures in the home. Staff meetings are held monthly to discuss planned events and any changes that are being introduced. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 home is well managed and in the best interest of the people who live there. The health and safety of the people is promoted and protected. Evidence: The manager has worked in the home since February 2008. She is Romanian and worked in her home country managing a large care home. She has experience supporting people with dementia, mental health needs and older people with nursing. The manager is currently working towards her registered manager award. The staff were very complimentary about the manager. And in one of the surveys received from the people living in the home they said the current manager is the best the home has had. The manager said she gets involved with direct nursing care if a person develops complex needs. She has recently supported one individual who died a few days previously. Generally there is only one person at a time who requires her additional Care Homes for Older People Page 23 of 27 Evidence: support. The company have a quality monitoring system. Surveys are given to the people living in the home. Surveys are also sent out to families, staff, GPs, nurses and other visiting professionals.The company have produced forms for the manager to complete each month and the audit outcome is communicated to the company quality and compliance department. We looked at the audit paper and discussed the areas of improvement the manager has identified. The manager recently carried out the Health Care Essential Steps audit for infection control following critisism about their procedures. CSCI expect providers to continuously monitor their service and always look for ways to improve. The manager has a development plan for the home with the plans for how she intends to make the improvements. All the staff have attended essential training for health and safety law. Where training needs to be repeated and updated this is booked. The accident records were looked at and discussed with the manager. The staff are good at recording events and incidents. The manager works alongside the nurses to guide them and assess their competency in different areas. She is working on developing the staff knowledge and confidence. This is so that when they are in charge of the home in her absence they are confident to respond to changes in individual need and make necessary decisions without waiting for her return. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!