This inspection was carried out on 24th January 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
CARE HOMES FOR OLDER PEOPLE
Carlton Nursing Home Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ Lead Inspector
Michael Smithson Announced Inspection 24th January 2006 10:00 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.V270737.R01.S.doc Version 5.0 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.V270737.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Carlton Nursing Home Address Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ 0113 2509633 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 Miss Jennifer Teresa Clegg 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.V270737.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 60 Years and Over Date of last inspection 7th June 2005 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. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and took place over the morning and afternoon of the 24/01/06. The inspection started at 9.30am and concluded at 3.15pm. This was the second and final inspection for this year. Copies of inspection reports for this and previous inspections are available on the CSCI website. The focus of the visit was to look at issues outstanding from the last inspection and check progress made since the new acting manager took over the responsibility for the day to day running of the home. . What the service does well: What has improved since the last inspection?
The requirements highlighted at the last inspection were addressed. However a number of the wardrobes still need to be secured.
Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 6 All the private fee paying service users are now issued with the homes terms and conditions of residency. The manger is aware of the work needed to bring the home back up to standard and is making good progress. She has implemented a new key worker system and is involving the staff in the decision making process. What they could do better:
The statement of purpose and service user guide needs to be reviewed and the change of manager included. A review must be undertaken of the use of bed safety rails, the acting manager should consult with a tissue viability specialist regarding the correct use of bed safety rails with special pressure relieving mattresses. Regular safety checks must be undertaken of the safety rails and a record kept of maintenance checks. An activity programme should be produced with includes activities suitable to the service user needs and abilities. The use of an activity organiser should be considered. Adult protection training must be provided for the staff team. The senior staff that takes charge of the home in the absence of the manager must be prioritised. A system for recording and monitoring complaints must be implemented. A check must be undertaken to ensure that all the wardrobes are secured. All the required recruitment checks must be completed for all staff. These include CRB checks, nurse registration pin numbers and expiry dates. The planned training audit must be completed and any shortfalls identified. The training required following discussions with staff were adult protection and dementia training. A training plan for next year must be identified. Progress must continue to be made regarding achieving 50 NVQ level 2 qualified care staff. A system of staff supervision must be implemented. The acting manager has produced a format to be used, which was acceptable.
Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 7 The requirement to undertake the Regulation 26 monthly visits must be completed and reports made available to CSCI. This is particularly important while the home is without a registered manager. A system must be put in place to give the manager access to personal allowance held on behalf of service users. Accurate records of expenditure and balance held must be kept 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. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 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 Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Information regarding the home is available to service users and relatives, however the information is due for review. EVIDENCE: The statement of purpose and service user guide are due to be reviewed. The acting manager will undertake the review and up date the registered manager details. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8. The general care and health care needs of service users are met and are well recorded, however the use of bed safety rails must be reviewed. EVIDENCE: The records for 2 service users were checked during the inspection. The information was well recorded and was generally kept up to date. However the nutritional assessment and care plan for 1 service user required up dating. The records contained detailed assessments and care plans. A system of clinical audit is in place to make sure the identified needs are regularly up dated. A new key worker system is in place which links into the care planning system. The key workers are organised into groups and are supported by a qualified nurse and a senior care worker. A number of the service users are provided with bed safety rails. It was noted that 2 accidents involving the safety rails occurred before Christmas. The use of the safety rails must be reviewed. A number of the beds fitted with safety rails are also fitted with pressure sore prevention mattresses. They raise the levels of the mattresses and may make the fitting of safety rails unsafe. The
Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 11 review of the use of the safety rails should include input from a tissue viability nurse to determine that the proper equipment is being used. The safety rail must be checked on a regular basis to make sure they are properly fitted and maintained. This is not taking place. The manufacturers instructions must be obtained and regular safety checks undertaken and recorded. The accident records for service users were checked. The records were reasonably well recorded, however one accident did not contain adequate details. The accidents must also be audited by a competent member of staff to determine whether they are well recorded and identify any patterns and areas of high risk. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Activities are undertaken by the staff team in and amongst the daily duties. However the range of activities offered at the home should be improved. EVIDENCE: During discussions with staff it was noted that activities tend to be undertaken in and amongst the staff daily duties. The activities tend to be sing a longs, dancing and bingo. The staff felt that it did often prove difficult to organise activities that suited the needs of the service users. It was recommended that a programme of activities be produced which contains activities appropriate to the needs of the service users. The home should consider using an activity organiser to co-ordinate the activities. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The levels of training for staff regarding adult protection must be improved. A system of monitoring and recording complaints must be put in place. EVIDENCE: There has been 1 complaint made about the home since the last inspection the complaint was being investigated by the previous manager, however it was not fully resolved. The new acting manager of written to the complainant to complete the investigation and resolve the complaint. The acting manager is looking at a better system of recording complaints to prevent complaints being left unresolved. At the last inspection a requirement was made that adult protection information is provided for the staff team. This has still not been undertaken. During discussions with the staff it was evident they had little knowledge of the adult protection issues. The staff that takes charge of the home in the absence of the manager must be prioritised. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The building meets the needs of the service users. EVIDENCE: A full building check was not undertaken during this inspection. However a check was undertaken of the requirements made regarding the environment at the last inspection. The majority of the work required has been completed, however it was noted that not all the wardrobes had been secured to the wall. Some of the dinning room windows were scratched and unsightly and must be replaced. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. The staff recruitment records and checks must be improved. The training needs of staff must be identified and prioritised. EVIDENCE: The current staffing was adequate to cover the numbers of service users living at the home. However the acting manager is looking to recruit 2 full time qualified nurses to provide additional cover. Many of the qualified staff are employed part time and do not have the flexibility to cover additional shifts. The acting manager is looking at completing a training audit for all the staff. This will identify any training needs. From discussions with the staff it was noted that adult protection and dementia training were needed. The acting manager has recommenced the NVQ training for the care staff. The home does not currently achieve the required levels of NVQ level 2 qualified staff. However she is confident this will be achieved as soon as possible. Four staff was interviewed during the inspection. Staff with differing roles and experience was chosen. The staff felt the home had gone through a difficult time, however they now felt they had come through it and that staff morale had improved. They felt they were given more guidance and responsibility for organising the daily routines. The new key worker system allows staff greater input into the needs of individual service users. The staff have better support
Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 16 and contact with the management of the home and were involved in the decision making process. The required recruitment checks for new and existing staff is an area, which has been neglected over the past 12 months. Sixteen of the staff has CRB checks outstanding. A number of those have been sent to the Criminal Records Bureau and are awaiting return. A number are of forms given to staff for completion has not been returned. The manager agreed to set a 7-day deadline for return of the completed forms. One of the qualified nursing staff does not have confirmation of a nurse registration pin number. A number of the qualified staff do does have their pin registration expiry dates recorded. The manager was aware of the short falls and is taking steps to obtain the information. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36, 37 and 38. The provider must provide better evidence of the support provided for the acting manager and the staff team. EVIDENCE: The previous registered manager has resigned from the home. The last 12 months have been a very difficult period for the staff. Many of the tasks previously completed to a good standard were being neglected. The post of registered manager for the home is being advertised. The current acting manager is fully aware of the work required to bring the information up to date. She has been very open with the inspector and brought many of the shortfalls noted to our attention prior to the inspection taking place. The acting manager has made very good progress in bringing records up to date and reorganising the daily duties and staff responsibilities. She is keeping
Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 18 staff up to date with any changes and is involving them in the decision making process. A number of staff meetings have been held and she is looking to re-introduce the individual staff supervision sessions. She is also looking to write all relatives to invite them to a meeting to up date them with the current changes. This would be good practice. The providers are not undertaking the required Regulation 26 monthly visits. This is particularly important to support the current acting manager until a registered manager is in place. It was discussed that the organisation employ an operations manager to manage all the homes in the group and undertake the Regulation 26 visits on behalf of the providers. This is seen as a positive step. The acting manager is looking at the current policies and procedures to make sure the information has been up dated. Any up dates required will be completed. The staff will then be required to read and sign the policies and procedures. The organisation of service user finances has now been centralised at the company’s main office. The information is no longer kept on the premises. There is currently no access to any personal allowance held on behalf of service users. This is being addressed with the use of a petty cash float system. The records must include details of monies spent on behalf of service users and the balance available. At the last inspection it was required that terms and conditions of residency are available for private fee paying service users. This has now been completed; copies of the terms and conditions are kept for inspection. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 19 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X 2 1 2 2 Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 20 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. 2. 3. 4. 5. Standard OP1 OP8 OP12 OP16 OP18 Regulation Reg 4 Reg 5 Reg 4 Reg 16 Reg 22 Reg 13 Requirement The statement of purpose and service user guide must be reviewed and up dated. The use of bed safety rails must be reviewed. A programme of activities geared towards the specific needs of the service users must be produced. A system for proper recording and monitoring of complaints must be introduced. Adult protection training must be provided for all staff. This requirement is outstanding from the last inspection. All the wardrobes in bedrooms must be checked to make sure they are firmly secured. All items stored on top of wardrobes must be removed. This requirement is outstanding from the last inspection. All the required recruitment checks for both care staff and the qualified nurses must be completed. The staff training audit must be
DS0000001326.V270737.R01.S.doc Timescale for action 01/05/06 01/03/06 01/05/06 01/05/06 01/03/06 6. OP19 Reg 4 01/03/06 7. OP29 Reg 19 01/03/06 8. OP30 Reg 18 01/05/06
Page 21 Carlton Nursing Home Version 5.0 9. OP30 Reg 18 completed and any training required undertaken. 50 of the care staff must achieve NVQ level 2 by the end of 2005. This requirement is outstanding from the last inspection. The required monthly visits must be undertaken and copies of the report made following the visit sent to CSCI. A new registered manager must be recruited. The manager must be provided with access to personal allowance held on behalf of service users. Records of any expenditure and balance held must be recorded and the information available for inspection. A staff supervision system must be implemented. The policies and procedures must be reviewed and up dated where required. Staff must be made aware of the information contained in the policies and procedures. The accident records must be fully completed. The accidents must me reviewed to ensure correct completion and identify areas of risk. The bed safety rails used must be checked on a regular basis and a record of the safety checks recorded. The safety rails must be maintained to the manufacturers safety instructions. 31/12/06 10. OP31 Reg 26 31/03/06 11. 12. OP31 OP35 Reg 8 Reg 17 01/05/06 01/03/06 13. 14. OP36 OP37 Reg 21 Reg 10 01/06/06 01/06/06 15. OP37 Reg 17 01/03/06 16. OP38 Reg 17 Reg 4 01/03/06 Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 22 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 OP19 OP33 Good Practice Recommendations The windows in the dinning room are scratched and unsightly. The providers should consider replacing them. The proposed relative meeting should be organised. Carlton Nursing Home DS0000001326.V270737.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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