CARE HOMES FOR OLDER PEOPLE
Carlton Nursing Home Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ Lead Inspector
Sue Dunn Key Unannounced Inspection 1st August 2007 10:20 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 Nursing Home DS0000001326.V347173.R02.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 Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Carlton Nursing Home Address Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ 0113 2509633 P/F 0113 2509633 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) Mr John Lamb Mrs Helen Lamb vacant post Care Home 29 Category(ies) of Dementia (29), Mental disorder, excluding registration, with number learning disability or dementia (29) of places Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 60 Years and Over Date of last inspection Brief Description of the Service: The Carlton Nursing Home is a converted Victorian building situated in a residential area on the borders of Leeds and Bradford. Personal care with nursing is provided for older people with dementia or mental disorder. Both men and women are catered for in this 29 bedded home which can provide single bedrooms as well as shared accommodation. The home is set in large grounds, which are not accessible to service users without close supervision. The area is purely residential and as such there are no convenient local shops or other amenities. The home is not accessible by public transport. The current fees are £535 per week. Fees do not include personal newspapers and magazines, hair dressing, private chiropody and some outings. This information was provided by the administration manager. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcomes for service users. The inspection report is divided into separate sections with judgements made for each outcome group. The judgements reflect how well the service delivers outcomes to the people using the service. The categories are “excellent”, “good”, “adequate” and “poor”. More detailed information about these changes is available on our website – www.csci.org.uk. A self-assessment questionnaire (AQAA) was sent to the home before the visit, but had not been returned at the time of writing. Information supplied since the last inspection was used as part of the inspection process. Questionnaire leaflets were sent to the home requesting people who live in the home and their relatives to comment on the service. One had been returned at the time of writing. Questionnaires were also sent for visiting health professionals but none had been returned. One inspector carried out the unannounced inspection visit arriving at 10:20 am and leaving at 18:10 pm. During the visit, the inspector spoke to staff, the proprietor, the operations manager and the administrative manager and two visitors. The care records of three people were examined carefully, staff records and other documentation was examined, there was a tour of the building, and some observation of care practices. People living in the home had a diagnosis of dementia or mental health illness, therefore had varying levels of communication. Some were asleep. Several were spoken with and observed. None of the people seen appeared to be in a state of ill being. The operations manager who assisted with the inspection was taking responsibility for management of the home and working there three days a week until such time as a new manager could be appointed. Managers and staff were helpful and cooperative during the visit. What the service does well:
Clothing and bedding was well laundered and people were neatly dressed in appropriate clothing. A visitor said that she was happy with the level of care and the way her relative was always dressed the way he liked to be. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 6 The home works with other health care professionals such as the tissue viability nurse to ensure people’s health care needs are met. The home encourages visitors and was seen to provide assistance with transport to ensure one person was visited regularly. It was good to see that family pets were also welcomed as visitors. Staff were observed to speak to people in a gentle and unhurried way and spend one to one time talking. The food was freshly made and nutritious. Staff were patient and unhurried whilst assisting and prompting people to eat. The cook has direct contact with people who live in the home and takes account of likes and dislikes. A relative said she would have no concerns if she had a complaint as she felt she would be listened to and some action would be taken to resolve a complaint. The operations manager has identified areas for improvement and was able to provide a copy of the new recruitment and selection pack and the new induction-training package for new staff which are soon to be introduced. Both were detailed and provided the basis for more thorough systems of recruitment and training. It was apparent that maintenance and repairs are dealt with speedily. Bedrooms were clean and comfortable, some containing personal items and belongings which made the rooms pleasant for the people occupying them. The home encourages people to bring personal possessions to help them settle but this often depends on the support given by families. All but three staff had done the distanced learning dementia training from a local college The home is committed to NVQ training. Nine staff had achieved NVQ2 in care (National Vocational Qualification), one NVQ 3 and three others were working towards NVQ 3. Staff were observed to approach the people in the home in a pleasant and respectful way and work at their pace. It was apparent that some staff were very fond of people in their care. What has improved since the last inspection?
The Statement of Purpose has been updated and the information brochure reprinted. The latter includes pictures of the home and a summary of facilities and services. There had been some improvement in the care plans in that everyone now had a care file which was consistent in layout
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 7 Daily blood sugar levels are now recorded on the medication record sheets. A new recruitment pack has been developed and is to be introduced which has sufficient detail to show that candidates have equality of opportunity. The home now keeps a record of nurses PIN numbers to ensure these are up to date. A new induction training pack (a copy of which was seen) is to be used for all future staff. This complied with the National Training Organisation (NTO) workforce specification for new staff. The hoist in the ground floor bathroom has been repositioned. Funding has been received to install two tracking hoists to make it easier for people to be transferred in and out of the bath. The proprietor had booked three dates for Health and Safety training updates for all staff. The ex manager had started the process of formal staff supervision with 4 supervisions and 2 appraisals a year. A relatives meeting has been booked for August and the intention to appoint a deputy will give people more contact with management. What they could do better:
There was a copy of the contract between the local authority and the home for those people whose fees were paid for. This did not give the person living in the home details of their own and the home’s responsibilities. Everyone should have a contract with the home which also includes the number and type of room to be occupied. Pre admission assessments should all be done before admission and be thorough enough to give people assurances before they enter the home that their needs can be met. The operations manager acknowledged that the care plans needed further work. Files for people who had been in the home for some time included useful care plans from previous placements which were still relevant and care plans and assessments carried out by the home. The most recent file had no photograph, no information and no risk assessment, which could result in care needs being overlooked. The care plans were not easy to find in the file. It is recommended that these be held in a separate section in the file for easy access. There was a relaxed atmosphere but little in the way of stimulation for less able people. One person commented on the lack of people to talk to. The
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 8 operations manager was aware of this and said he was in the process of recruiting an activity coordinator. The pre admission assessment format completed by an occupational therapy student for one person provided a really good format, which the home could follow to build a person, centred social and recreational care plan. More could be done to improve mealtimes. There should be enough chairs for staff to sit on whilst assisting people to eat. More suitable protective clothing could be used and napkins provided to maintain peoples’ dignity. Menu boards and more discussion about the food on the plate would have provided people with more information and stimulation. The system of serving should be reviewed so that people sitting together are served their food at the same time The old aluminium food covers needed replacing. The complaints log should be used to document any in house complaints and show how matters had been resolved. It was disappointing to note that the two nurses on duty were rather vague about what they would do if faced with an allegation of abuse and had to refer to the procedures. All nurses should have updated training on adult protection. Well-tended gardens surround the house but the people living in the home do not have the security of an enclosed area to enable them to sit outside without a member of staff to accompany them. Consideration should be given to providing a safe area for sitting outside. Bedroom doors did not have suitable locks which allowed staff access in the event of an emergency and allowed people the privacy, choice and security of being able to lock their bedroom doors. The TV reception was very poor for those people watching TV in their bedrooms. It was agreed this would be rectified. Bedroom doors must not be held open with wedges, as this does not allow doors to close freely in the event of a fire. The laundry area needed a thorough clean to reduce risks of cross infection. It is recommended that the Key Lines of Regulatory Activity document (KLORA) be used to direct any further Quality Assurance programmes. A publicly available report arising from the findings of Quality assurance audits should be completed. 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
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 9 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 10 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 Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 11 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): 1, 2, 3, 4 and 5 People who use 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. All people using the service should have a copy of the terms and conditions of their occupancy so that each can be clear about their rights and responsibilities. Pre admission assessments should be consistent in quality and content so that people can be assured before entering the home that their needs can be met. EVIDENCE: The Statement of Purpose was updated in May of this year but as the manager has since left it will require updating again when a new manager is appointed. The information gives prospective occupants and their relatives enough information to know what services the home provides. A newly printed brochure includes photographs of the home and a summary of facilities and services.
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 12 A contract named as ‘Terms of Residence’ was seen for a person who was self funding. There was a copy of the contract between the local authority and the home for those people whose fees were paid for. This did not give the person living in the home details of their own and the home’s responsibilities. Everyone should have a contract with the home which also includes the number and type of room to be occupied. The administrator said she would inform the CSCI when this was done. The pre admission assessments were examined for two of the most recently admitted people. Both had pre admission referrals from hospitals. One was very thorough including an occupational therapy student’s assessment describing past and present interests and a clear care plan for catheter care. A relative said she had visited the home before making a decision. The more recent assessment had a hospital treatment plan which was dated the day after admission. The admission assessment by the home was very limited, unsigned, did not state where the assessment took place and gave no information about arrangements for a pre visit. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 13 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): 7, 8, 9 and 10 People who use 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. Lack of consistency in the care plans could lead to the care needs of some people being overlooked. The homes medication systems are safe. EVIDENCE: A person who returned a survey form was very happy with the level of care and said her relative was always dressed the way he liked to be dressed. Staff usually kept her informed about any health concerns. The operation manager felt that the care plans had improved and everyone now has a care file. He acknowledged that there was need for further improvement particularly as the most recent care plan had not been completed. It was difficult to find the care plans in the files as they were stored behind the daily records The care plans should be in a place where anyone coming into
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 14 the home to work a shift can find them easily and know how people wish to be cared for. Three care files were examined. One gave a brief description of past life history, an ‘activities of daily living’ form stated what the person could do and areas where assistance was required. This provided a basis for the care plan. A weight chart showing loss of weight could be referenced to the Health professionals’ form which showed two referrals had been made to the GP and the tissue viability nurse as a result of the weight loss. There was no care plan however to show what action the home was taking to try to monitor diet and increase nutritional input. Care plans were in place for catheter care, personal hygiene, falls, emotional well being, diet and orientation but those included in the file which had been done by hospital staff whilst the person was in hospital were far more detailed and gave good guidance for staff to help them give person centred care. The home should try to achieve the same level of detail. There was evidence to show that care plans were being reviewed. The care file for a relatively recently admitted person did not have a photograph and none of the care documentation had been completed. There was no risk assessment or care plan to reduce any risks associated with smoking. The pre admission assessment gave no social history and the information it contained was very limited therefore didn’t demonstrate how the person’s care needs were to be met. A care plan for a third person included a photograph, had a fully completed admission assessment and well documented pressure care plan which showed that the tissue viability nurse had visited as part of this care process. It was said that the care staff keep a note of any events during the day which are then passed on the nurse who writes the information in the care files. It is recommended that the care staff who have more hands on contact in providing care take a more active part in this process to ensure information is not overlooked. There were satisfactory systems in place for the receipt storage and administration of medication. The daily blood sugar levels of two people on insulin are now recorded on the MAR (medication record forms) sheets. Senior care staff have been trained to monitor blood sugars. The GP’s review the medication of people two to three weeks after admission or by request. A care worker described how arrangements are made for soft music to play and someone to sit with people as they are dying. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15 People who use 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 home needs to provide more person centred social and recreational stimulation for people on a daily basis. It is acknowledged that there is an intention to appoint someone to carry out this task. Food was well cooked and wholesome but more thought could be given to the arrangements at mealtimes in order to inform and empower people. EVIDENCE: A visitor said that ‘someone’ comes to the home every few weeks to do games and quizzes with the people who live in the home. The operations manager said that he was in the process of recruiting an activity coordinator for 30 hours a week who could organise recreational activities. There was a relaxed atmosphere but little in the way of stimulation for less able people. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 16 One visitor spoken with visits every day, takes his wife out in the car and home and brings the family dog. The staff arrange to collect another relative to ensure the person living in the home receives regular visits. One person in the home said ‘there is nobody here for me to talk to as none can hold a conversation’. Staff were observed to speak to people in a gentle and unhurried way and spend one to one time talking. Some of the assessments seen gave a good background picture of intellectual and socials interests but this had not been utilised to direct activities. The pre admission assessment format completed by an OT student for one person provided a really good format which the home could follow to build a social and recreational care plan which is more person centred. Menus which were on display in the kitchen were on a 4 week rotation. The main meal which offered two choices was sampled. This was freshly made and hot when it reached the table. Those people who required assistance had plate guards to stop their food being pushed off the plate and others were assisted and prompted by staff. The lack of spare chairs in the dining room led to staff having to kneel on the floor whilst assisting people, an uncomfortable experience for staff and those being helped. The staff were patient whilst assisting people to eat but could have given more explanation about what was on the plates. A daily menu board would have provided information and stimulation. People were given plastic aprons to protect clothing whilst eating. Napkins and a more dignified type of protection for clothing could have been used. The aluminium food covers were old and battered and looked very institutional The cook has direct contact with people who live in the home and takes account of likes and dislikes. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 17 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): 16, 17 and 18 People who use 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. Any complaints by people living in the home or their families should be recorded in a log, which shows how any complaints have been dealt with. All staff, particularly those in charge of a shift, should be given training so that people living in the home and staff are protected by the home’s adult protection procedures. EVIDENCE: The nurse in charge of the shift stated that there had been no complaints recorded in the log, as they did not have any complaints. The log should be used to document any in house complaints and show how matters had been resolved. A relative said she would have no concerns if she had a complaint as she felt she would be listened to and some action would be taken to resolve a complaint. All people living in the home are registered to vote. The nurse said ’nobody has any interest in current affairs’ and none had been to the polling station in the previous year. Nine staff in the home had done training in adult protection in the past year. Understanding abuse has been included in the new induction-training package
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 18 so all staff will receive training within the first few weeks of working in the home. It was disappointing to note that the nurses on duty were rather vague about what they would do if faced with an allegation of abuse. One went to find the procedure, which was found to give a step-by-step guide to follow. It is recommended that a notification to the police should be included in the first steps to take. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 19 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): 19, 20, 21, 22, 23, 24, 25 and 26 People who use 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 home provides a comfortable environment with ongoing maintenance work to keep the home in good repair. More work could be done to make the home more suitable for people with dementia so that they can retain a degree of independence. EVIDENCE: A maintenance book is used to record all repairs and show when work has been completed. This indicated that repairs are dealt with speedily once reported. The proprietor was dealing with a blocked drain, which was affecting the basement laundry area on the day of the visit and had a professional company out to unblock the drain by the end of the day.
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 20 The isolated position of the house means people living in the home need transport to access to local amenities. The home does not have its own transport. A member of staff was seen to use his own car to ensure the relative of one person could continue to visit. Well-tended gardens surround the house but the people living in the home did not have the security of an enclosed area to enable them to sit outside without a member of staff to accompany them. Five bedrooms were for shared occupancy, the others singles. Two vacancies in the home were in shared rooms. The shared rooms had screening between beds to afford some degree of privacy. Hoists, pressure relieving equipment, hospital style beds and bed rails, and plate guards were seen during the visit. The proprietor said that funding had been agreed for two overhead tracking hoists for the bathrooms to make transfer in and out of the baths more comfortable. Bedrooms were clean and comfortable, some containing personal items and belongings which made the rooms pleasant for the people occupying them. The home encourages people to bring personal possessions to help them settle but this often depends on the support given by families. It was disappointing to find that bedroom doors were not fitted with suitable locks which allowed staff access in the event of an emergency and allowed people the privacy, choice and security of being able to lock their bedroom doors. This was discussed with the operations manager and proprietor and made a requirement before the year-end. Some people were in their bedrooms watching TV but the TV pictures were very poor as all were dependant on an internal aerial. The operations manager said he would take immediate steps to rectify this to improve the quality of TV reception for people living in the home. One person liked to have her bedroom door propped open. A wedge was said to be used for this, which would not provide protection from smoke in the event of a fire. The proprietor said he would provide hold open devices linked to the fire alarm systems for those doors. Clothing and bedding looked carefully laundered but the basement laundry needed a thorough clean. A build up of dust and debris on and around the machines could become a source of cross infection. The operations manager said he would arrange for this to be done within the next couple of days and the proprietor acknowledged that the area would benefit from redecoration. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30 People who use 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. Staff are trained to give them the knowledge and skills to look after the people in their care. The induction training is detailed and will improve the training given to new staff. EVIDENCE: There were 27 people living in the home on the day of the inspection being cared for by two Registered Mental trained nurses and 4 care staff. They were supported by a cook, general kitchen assistant and cleaner /laundry worker. A maintenance worker was employed for three days a week. The two nurses had shared responsibility for the shift. Examination of the documentation in the files of the two most recently appointed staff showed that one was interviewed by three people and the other interviewed by one. An interview assessment form was used to record the findings of the interviewer but this was not in sufficient detail to demonstrate that candidates were given equality of opportunity during the interview process. Criminal Record Bureau and Protection of Vulnerable Adult checks had been carried out and two references had been obtained before people were employed. An up to date list of registration PIN numbers for nurses was held.
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 22 The documentation for an overseas worker showed that a thorough check had been done to ensure the person was able to work in this country. A new ISO 9,002 recruitment and selection system is to be introduced for any new staff. It was agreed that the induction for new staff was not detailed enough. A new induction training pack (a copy of which was seen) is to be used for all future staff. This complied with the National Training Organisation (NTO) workforce specification for new staff. One of the proprietors is the fire trainer for the home. A list of dates for this training was seen in the office. The other proprietor and a senior care worker were the trained moving and handling trainers for the home. One of the trainers was observing the moving and handling techniques of staff on the day of the visit. All but three staff had done the distanced learning dementia training from a local college. A tutor from the college visits monthly and works with staff on a 1:1 basis. A nurse felt that there was an improvement in the practices of some staff and gave an example of breakfast time, which was said to be a slower and more relaxed meal. Appraisal and supervision training for more senior staff was booked for two dates in August. Nine staff had NVQ2 (National Vocational Qualification), one NVQ 3 and three were working towards NVQ 3. Staff were observed to approach the people in the home in a pleasant and respectful way and work at their pace. It was apparent that some staff were very fond of people in their care. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35, 36, 37 and 38 People who use 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. Systems were in place for the safe and satisfactory management of the home during the recruitment of a new manager. People in the home are protected by the homes policies and procedures. EVIDENCE: On arrival at the home it was found that the manager had left the home two weeks earlier. The operations manager gave assurances that a letter informing the CSCI of this event had been sent. A faxed copy of the letter was later received. The operations manager who assisted with the inspection was taking responsibility for management of the home and working there three days a
Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 24 week until such time as a new manager could be appointed. An advert for the post had attracted some interest. A deputy manager role is to be introduced when the new manager is appointed. The operations manager felt the previous manager had worked to move the home forward and improve systems but that there was further work to be done which is described earlier in the report. The maintenance person was not working on the day of the visit but his safety check records were readily available and up to date. Routine health and safety checks records were seen for water temperatures, fire alarm points, and bedrails and staff fire instruction. The proprietor had booked three dates for Health and Safety training updates for all staff. The head office manager was able to show the systems for managing the finances of people living in the home. She currently holds money for three people. Each person had a separated balance sheet with receipts of any purchases made. The receipts tallied with spending shown on the balance sheets. The ex manager had started the process of formal staff supervision with 4 supervisions and 2 appraisals a year. A supervision overview sheet was seen with dates booked for supervision. Training had been booked for allocated supervisors and the process was to start at the end of August. A nurse spoken with said he had received one appraisal and an informal supervision, which was not documented. The operations manager said that he conducted a recent customer satisfaction survey. Nine out of twenty five forms were returned. Relatives said they were pleased with the input of care by staff but that they wanted more opportunity for contact with the manager and more activities with people taken out. A relatives meeting has been booked for August and the intention to appoint a deputy will give people more contact with management. It is recommended that the Key Lines of Regulatory Activity document (KLORA) be used to direct any further Quality Assurance programmes. A publicly available report arising from the findings of Quality assurance audits should be completed. Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 x 3 x 2 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 3 2 Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 26 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 OP4 Regulation 14 Requirement The registered person must ensure a full assessment of needs is carried out before any person is admitted to establish their needs can be met All care plans must kept up to date and be easily accessible with evidence to show that risk assessments have been carried out to reduce risk and support independence. There must be a photograph of each person. All staff, including nurses must receive adult protection training (Previous timescale of 01/05/06 has not been fully met) The home must make suitable arrangements to enable people to engage in social and community activities Suitable locks which can be accessed by staff in the event of an emergency must be fitted to the doors of every bedroom. The laundry must be kept clean and free from debris to reduce the risk of cross infection Bedroom doors must not be
DS0000001326.V347173.R02.S.doc Timescale for action 01/10/07 2. OP7 Regs 14 and 15 01/10/07 3. OP18 Reg 13(6) 01/12/07 4 OP12 Reg 16 30/09/07 5 OP24 Reg 23 31/12/07 6 7. OP26 OP38 Reg 16 Reg 23 31/08/07 31/08/07
Page 27 Carlton Nursing Home Version 5.2 wedged open but fitted with hold open devices which allow them to close in the event of a fire 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 OP2 OP15 Good Practice Recommendations Everyone living in the should have a contract with the home stating the terms and conditions of their occupancy, the type and number of room to be occupied Mealtimes could be improved as following:by providing a menu board so that people know what is to be served each day. Staff could pay more attention to describing what is on each person’s plate The provision of napkins and a more discrete form of protective clothing. There should be enough chairs to allow staff to sit down whilst they are assisting people with their meals. The unsightly aluminium plate covers should be replaced. The system of serving should be reviewed so that people sitting together are served their food at the same time Consideration should be given to providing a safe area for sitting outside. TV’s should be checked regularly and action taken to ensure good reception It is recommended that the Key Lines of Regulatory Activity document (KLORA) be used to direct any further Quality Assurance programmes. A publicly available report arising from the findings of Quality assurance audits should be completed. The home should appoint and register a manager as soon as possible and keep the CSCI informed about any changes in the management arrangements 3 4 5 OP19 OP24 OP33 6 OP31 Carlton Nursing Home DS0000001326.V347173.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Nursing Home DS0000001326.V347173.R02.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. 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!
