Inspection on 11/07/07 for Carlton Lodge Nursing and Residential Centre

This inspection was carried out on 11th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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... 11/12/08

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

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Carlton Lodge Nursing and Residential Centre 21 Victoria Parade Broadstairs Kent CT10 1QL Lead Inspector Sandra Crosby Key Unannounced Inspection 11th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton Lodge Nursing and Residential Centre Address 21 Victoria Parade Broadstairs Kent CT10 1QL 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) 01843 862577 01843 603793 lane@bupa.com ANS Homes Limited Deborah Jayne Lane Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (5) of places Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Of the 41 beds in the home 37 are registered for the admission of nursing patients and 32 for residential clients. To admit 1 service user to the home whose date of birth is 18/10/23. Date of last inspection New Registration Brief Description of the Service: Carlton Lodge is a detached 4 storey premises, which was built in 1899 and is over 100 years old. 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 large interconnecting lounges on the ground floor and a dining 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. According to its Aims and Objectives, Carlton Lodge aims to ‘provide the best possible care to Service User’s … and the highest possible standards of comfort’. Information received from the Registered Provider in June 2006 states that the fees range from £425.00 to £700.00 per week. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection visit was unannounced and carried out on Wednesday 11 July 2007 between 09.30 and 16.00 by two Inspectors. The Inspectors spoke with the Registered Manager who has been at the home since the beginning of September 2006, the recently appointed Head of Care, one of the nurses, several of the staff on duty and several service users. In depth discussion took place with a visiting relative. Various records were viewed and an accompanied tour of some areas of the premises was undertaken. The AQAA documentation that homes are required to complete, was only recently sent to the home, so information that will normally be used to inform the inspection process has not been used in this inspection report. Due to the short notice given to plan the visit, no Service User Surveys or Relative Surveys have been sent out. A random inspection visit was undertaken at the home on the 21 November 2006. The visit was made partly to discuss an Adult Protection referral as a number of the requirements previously made linked with the issues of concern raised. The Manager at the feedback provided stated that she agreed with the judgements made and would actively work towards addressing the issues of concern. This key inspection visit was undertaken in part due to concerns that have been raised. At the end of the visit feedback was provided to the Registered Manager, and following consultation with the Inspectors Line Manager Immediate Requirement documentation was issued, followed by the sending out of an Immediate Requirement Letter, and an Adult Protection referral was made. It is acknowledged that the home has been experiencing a difficult period of change, as BUPA officially purchased the company in December 2006, however the home has been registered for many years and the majority of the staff group transferred and remained in post. A number of the requirements given in this report have previously been required in inspection reports for example in relation to Standards 7,8,9 and 27. What the service does well: Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 6 A number of compliment acknowledgement letters were seen on file providing positive feedback about the home for example ‘thank you for kindness, so well looked after, thanks for all your care and first class treatment’. Mainly thorough recruitment procedures were seen to be in place at the home. A programme of activities is provided, by a dedicated activities co-ordinator. What has improved since the last inspection? What they could do better: Update the Statement of Purpose and Service User Guide. Ensure that comprehensive pre-assessment documentation is completed in order for an informed judgement to be made as to whether the home can meet the service users needs. Implement and maintain comprehensive service user plans, containing all relevant information together with regular reviews recording any changes. Promote and make proper provision for health and welfare of service users. Improve wound care documentation, nursing staff to undertaken further training in relation to wound care management and appropriate action to be taken to involve other professionals as necessary. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 7 Staff to adhere to the policy and procedures for the administration and recording of medications. Promote respect and dignity for persons at the home. Ensure that a varied and nutritious diet is provided with suitable arrangements being made for those persons requiring special diets. Provide suitable adaptations and equipment to meet the needs of service users. Provide appropriate sluicing facilities that are operational. Implement good infection control procedures to ensure that service users and staff are safeguarded. Ensure that at all times suitably qualified competent and experience persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Ensure that persons working at the home receive training appropriate to the work they are to perform. The Company to provide appropriate support to the Registered Manager to enable her to actively promote the standard of care provided at the home. 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 Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 and 6 were inspected at this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User Guide do not provide service users and prospective service users with all the information they need to make a decision about moving into the home. The needs of service users are not always fully assessed prior to admission and Service Users may not feel confident that their needs will be met. It is not the general policy of the home to admit service users on a short-term basis, and this standard was judged as not applicable at this inspection visit. EVIDENCE: The Statement of Purpose and Service User Guide provided by the Company was seen. This documentation has been updated since BUPA purchased the Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 10 home, but has not been updated since the Registered Manager has been in post. The Registered Managers Post was said to be vacant and the staffing information was not up to date, therefore the documents does not provide service users and their relatives with the information they need. The Registered Manager agreed to review the documentation. Pre-admission assessments are in place, but were seen to be brief and only gave basic information of the reason for admission for example admitted from hospital following a stroke and did not identify the care needs, with no activities of daily living completed. The documentation seen did not give enough information for the home to ensure that the service users needs could be met. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were inspected at this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning system meets the requirements of the national minimum standards and regulations. However, it was found that some information in relation to health matters was not recorded and that this could be detrimental to the well being of service users. The care of service users may be compromised because regular reviewing of the service user plans was not being maintained. Whilst the systems for medication administration are good if adhered to, with clear and comprehensive arrangements being in place to ensure service users medication needs are met, poor medication practice could compromise the safety of service users. Service users cannot be confident that their personal care is offered in a way that will protect their privacy and dignity. Service users and their relatives/representatives cannot feel confident that they will always be treated with respect. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 12 EVIDENCE: At the random inspection carried out at the home on the 21 November 2006 following an Adult Protection Alert, it was evidenced that five service users plans were examined and showed that although all components as required by legislation are in place in the service user plan documentation provided by the Company, examples of shortfalls were – care plan documentation not being completed in a timely fashion – moving and handling assessment not completed – reviews in one plan did not record the changes that had taken place – no weights recorded for one service user and poor fluid chart recording. An improvement was noted in the written records for wound care management in the ones seen At this inspection visit, similar concerns were discussed. Four service user plans were seen and found to contain insufficient information in relation to meeting the needs of the service users. Risks assessments seen were not reviewed monthly and were not accurate. The regular reviews of the care plans had not been maintained as required by regulation. Changes in relation to instructions given for example following a SALT and language therapist assessment by the dietician due to altered swallowing, showed that the care plan was not updated to include instructions, and no guidance was provided for staff. Meeting health care needs was judged as standard not met at the random inspection visit dated 21 November 2006 and it was again found that documentation in relation to meeting health care needs was poor. It was seen that fluid charts were poorly completed in June and July and gave no fluid balance for ensuring hydration. The catheter care documentation was insufficiently maintained. The wound care management documentation was again poorly completed and it was difficult to audit these. One example was that the wound care notes and care plan did not follow the plan identified i.e. different dressing on wound. It was also found that areas of broken skin integrity had not been recorded in the notes, and the three staff members spoken with could not provide any information about these areas. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 13 The Registered Manager reported that the Company is to implement in the near future a new care planning system, and that staff will soon be receiving training in the use of this system. There were issues of concern in relation to the practices used at the home for the recording, storage and handling administration and disposal of medications at the random inspection visit dated 21 November 2006. The medication records were seen and poor recording of administration was identified by the many gaps seen. It was indicated that staff are often called away whilst undertaking administration of medications, and it was discussed with the Registered Manager that staff deployment and numbers need to be reviewed to ensure the administration is safe. It was also found that staff are not signing and dating course complete or verbal orders. The controlled drugs register was poorly completed, and medication for a deceased service user had not been returned as appropriate. Medication returns are not documented till the end of the month, when one nurse tries to record it all for disposal. This practice may lead to errors and misuse. It was identified in the sharps bin that nurses are re-sheathing needles. No pain assessment charts were seen as part of the medication documentation. An incident was witnessed that compromised the dignity and respect of service users and relatives. This issue was discussed with the Registered Manager who agreed to take appropriate action to address this issue. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were inspected at this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyles experienced by service users in the home might not always meet their expectations. Service users are able to maintain contact with family and friends together with access to the local community as they wish. Service users benefit from being given meals in the home that are mainly good, offering both choice and variety, and catering for special diets. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 15 EVIDENCE: A barbeque was planned on the day the visit took place to celebrate 60yearrs of BUPA. Unfortunately, although it was planned for this to be held outside, this was cancelled due to the weather. This was held inside and the staff were seen dressed up in a James Bond 007 theme and relatives joined in. Service users were seated in the two lounges and a James Bond film was shown. It was noted that on this occasion the lounge was very crowded and the television was not suitably place for easy viewing. When BUPA purchased the home many of the staff remained, and the full time Activities Co-ordinator continues to provide a range of activities. A programme of activities is available in the reception area. Visitors were seen around the home during the time of the inspection visit, and service users had previously talked about family and friends that visited them at the home. In relation to the meals at the home, the day of the visit provided evidence that service users were not always provided with appropriate choices for example one service user at approximately 10.15am, was seen to be given a bowl of porridge only, no cup of tea or coffee was offered. The service user when she had finished told a staff member that she was still hungry and the staff member said ‘you will be having a barbeque later’. A further incident was witnessed by the Inspectors, and indicated that a nutritious and balanced diet was not being provided. These issues were discussed with the Registered Manager who agreed to take appropriate action. Discussion with relatives indicated that cake is served without plates being provided, and that meals are served without trays in rooms. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were inspected at this visit Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be confident that their complaints and concerns will be properly addressed by the home. EVIDENCE: Policy and procedure in relation to complaints and protection lacked clarity. The complaints file evidenced that the Registered Manager follows the procedures set in the BUPA handbook. Compliments about the home contained within the folder stated ‘thank you for kindness, so well looked after, thanks for all your care and first class treatment’. Due to the raising of an adult protection alert following the inspection visit, further information has been put forward by another relative that would indicate that not all complaints made to the home have been documented and appropriately dealt with. The home has the necessary documentation in relation to service users being protected from abuse. No judgement could be made in relation to staff training as the Registered Manager was unable to provide an up to date training matrix for the home. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,22,23,24,25 and 26 were inspected at this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of care of some service users is compromised because they do not have access to the specialist equipment they require. The routine maintenance, decoration and renewal of fabric of the premises could be improved in order to benefit the service users at the home. Whilst the home was mainly clean and pleasant at the time of the inspection visit the health and safety of service users was compromised because of poor practice with regard to cross infection control. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 18 EVIDENCE: An accompanied tour of some areas of the home was made. Currently there is scaffolding to the outside of the building in order for repair work to be carried out to the roof. It was evidenced that not all appropriate adaptations had been provided for a service user. A pressure relieving mattress seen was incorrectly positioned on a bed thereby it was not working effectively, and it was questioned as to whether this was an appropriate mattress to use to meet the needs of the service user. The bed had bed rails in place, but there were no bumpers in place, and again indicated that service user needs were not being met. From information received a service user was being manually moved in bed without the recommended aids such as sliding sheets being used. It was seen that the sluice areas are currently non-operational and this situation was discussed with the Registered Manager. It was indicated that staff are using plastic bags for commode waste. A further issue discussed was in relation to cardboard clinical waste boxes seen stacked in one of the sluices. It was discussed that as the top was not on the box currently in use that there was a possible infection risk. Due to the number of boxes seen stored this could also indicate a fire risk. The procedures in place in relation to MRSA were poor. For example, there was no gel outside of a room. It was also noted that there were some swing bins in use and these bins need to be changed for foot operated ones. Red bags were seen left in service users rooms without appropriate facility. There was poor practice evidenced as a member of the domestic staff was seen leaving her cleaning equipment on a service users table which contained fruit and open sweets. Further poor practice observed was catheters left out ready for attaching thereby compromising the dignity of service users. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were inspected at this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers and skill range of the staff currently indicate that service users needs are not always met. Service users are protected by the home’s thorough recruitment procedures. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 20 EVIDENCE: It was previously reported at the random inspection visit dated 21 November 2006 that the staff rota for the home was seen, and indicated that there were sufficient staff on duty to meet the needs of service users at all times. It was discussed that a review of the afternoon staffing levels be undertaken, together with reviewing the weekend staffing levels, as it is indicated that at these times the home may be insufficiently staffed. It was agreed that action would be taken to address this issue. It was also noted at that visit that a number of staff were working twelve-hour shifts, and this issue was discussed. It was again found that staffing numbers and deployment of staff needs to be reviewed, as a number of the issues of concern raised throughout the inspection may indicate that staffing levels and staff competencies might not be sufficient to meet the needs of service users. One example was that a call bell was activated and when no staff member attended, the Inspector had to leave the bedroom to seek assistance. Due to poor practices observed and the complexity of residents needs it was judged that staffing levels were insufficient. Three staff files were seen and showed that on the whole a thorough recruitment system was being used by the home. The Registered Manager needs to ensure that contracts of employment are provided to new staff and returned within an appropriate timescale, as one staff file seen did not contain evidence of a contract of employment even though the staff member was employed at the end of last year. Previously information obtained indicates was that there are insufficient numbers of care staff qualified in NVQ to meet the requirements of legislation. No up to date information was collected at this inspection. The Company has provided folders to be used for induction training. It was previously seen that the training package indicates compliance with the requirements of Skills for Care, and on completion provides a foundation for NVQ Level 2. However no completed induction training folders were seen, and the Registered Manager was unable to show written evidence that a member of staff member who started work at the home at the end of last year had completed an induction programme, although she confirmed that the member of staff had received induction training. The Registered Manager was unable to provide a staff training matrix and a copy of this will be requested as part of the improvement plan the home will be required to provide following this inspection visit. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,37 and 38 were inspected at this inspection visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not currently benefit from a well run home and the health, safety and welfare of service users and staff was not evidenced as being promoted. Service Users are safeguarded, by the accounting and financial procedures of the home and systems are in place in relation to the safe storage of records. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 22 EVIDENCE: The new Registered Manager started work at the home at the beginning of September 2006, and at that time it was stated that she was starting the Registered Managers Awards course. She assisted positively with that inspection and indicated that issues of concern discussed would be addressed. It was evidenced during the inspection visit that the Registered Manager was not always aware of what was happening in the home. She had to repeatedly ask staff where documents were and presumed certain things were happening, but it became evident that were not. Quality monitoring systems operated by the Company were not inspected at this inspection visit, and no judgement has been made under this Standard. An incident of poor practice in relation to moving and handling was observed at the random inspection in November 2006 and the Registered Manager agreed to take appropriate action to address the situation. It was again observed at this inspection visit that the dignity of service users is compromised with poor practice in transferring. Further examples of poor moving and handling practices were discussed with the Registered manager. In relation to Service Users Personal Allowance monies, it has been previously seen that a thorough accounting system is in place at the home, and the person managing the system confirmed at that time that currently there has been no changes to this system, and that other finances systems within the home are currently being changed to conform to the systems used by the Company. The Registered Manager confirmed that appropriate work has been carried out in relation to the electrical wiring systems at the home but that the certificate had not as yet been received. Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 1 2 2 3 1 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X 3 1 Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N/A 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 OP1 Regulation 6 Requirement Timescale for action 30/09/07 2. OP3 14(1) The Registered Person shall (a) keep under review and where appropriate revise the statement of purpose and service users guide and (b) (b) notify the Commission and service users of any such revision within 28 days The Registered Person shall not 31/07/07 provide accommodation to a service user at the care home unless so far as it shall have been practicable to do so (a) needs of the service user have been assessed by a suitably qualified or suitably trained person To ensure that the home is able to meet service users needs, the assessments undertaken need to provide sufficient information especially in relation to nursing care needs The Registered Person shall (b) 31/07/07 keep the service users plan under review DS0000069044.V345783.R01.S.doc Version 5.2 3. OP7 15(2) Carlton Lodge Nursing and Residential Centre Page 25 4. 5. OP7 OP8 17(1)(a) Sch 3 (n) 12(1)(a) 6. OP9 13(2) 7. OP10 12(4)(a) 8. OP15 16(2)(i) 9. OP16 22 A record of incidence of pressure sores and of treatment provided to the service user The Registered Person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework The Registered Person shall make suitable arrangements to ensure that the care home is conducted (a) in a manner which respects the privacy and dignity of service users The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times The registered person ensures that there is a simple, clear and accessible complaints procedure that includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively 12/07/07 12/07/07 31/07/07 31/07/07 12/07/07 31/07/07 10. OP22 23(2)(n) All complaint to be appropriately recorded together with information in relation to the action taken and the outcome Suitable adaptations are made 31/07/07 and such support equipment and DS0000069044.V345783.R01.S.doc Version 5.2 Page 26 Carlton Lodge Nursing and Residential Centre 11. OP26 13(2)(b) 12. OP27 18(1) 13. OP28 18(1) 14. OP30 18(1) 15. OP31 9(1) 16. OP38 12(1) 13(4)(a) 18(1) facilities including passenger lifts as may be required are provided for service users who are old infirm or physically disabled The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff DS0000069044.V345783.R01.S.doc 12/07/07 31/07/07 31/12/07 31/07/07 31/12/07 31/07/07 Carlton Lodge Nursing and Residential Centre Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Carlton Lodge Nursing and Residential Centre DS0000069044.V345783.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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