Inspection on 06/05/08 for Carlton Nursing Home

This inspection was carried out on 6th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Carlton Nursing Home 29/05/09

Carlton Nursing Home 01/08/07

Carlton Nursing Home 15/08/06

Carlton Nursing Home 24/01/06

Carlton Nursing Home 07/06/05

Carlton Nursing Home 02/03/05

Carlton Nursing Home 30/04/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Carlton Nursing Home Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ Lead Inspector Paul Newman Key Unannounced Inspection 6th May 2008 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 Nursing Home DS0000001326.V364697.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 Nursing Home DS0000001326.V364697.R01.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 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.V364697.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 Years and Over Date of last inspection 1st August 2007 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 £543 per week for Local Authority funded people and £580 per week for privately funded people. Fees do not include personal newspapers and magazines, hair dressing, private chiropody and some outings. This information was provided by the home on 6 May 2008. Further written information about the services and facilities at the home can be found in the statement of purpose and service user guide that are available at the home. These documents are reviewed annually. Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The accumulated evidence in this report has included: • • • • • • The previous key inspection. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. Relevant information from other organisations. What other people have told us about the service. Information obtained from residents, relatives, staff and other health care professionals. Two inspectors made an unannounced visit to the home that lasted six hours on 6 May 2008. The visit was originally planned for later in the year but was brought forward following concerns being expressed to the CSCI. We do this sometimes to make sure the home is operating as it should do. During the visit, a number of documents were looked at and some areas of the home used by the people living there were inspected. A proportion of time was spent speaking to the operations manager, one of the job share managers, nurses, other staff, people who live at the home and visitors. Time was also spent in communal areas and the dining room, watching what was going on with people and whether they seemed comfortable and cared for. As part of CSCI policy to carry out themed inspections, we carried out a ‘thematic probe’ into safeguarding policies, procedures and practices at the home. Feedback was provided at the end of the inspection to the manager on duty and the operations manager. What the service does well: Information about the home is readily available for people considering living there. People are properly assessed before they come to live at the home. This helps to make sure a good care plan can be drawn up that identifies peoples’ needs. The home works closely with other healthcare professionals, makes referrals at an early stage and takes the advice that is given. Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 6 The staff team are being properly trained and those we met are motivated and equipped for the job. They are committed to providing high standards of person centred care. The needs of residents are the focus of the staffs’ attention and people looked happy and well cared for. Staff make sure that residents are treated with dignity. The home conducts satisfaction surveys and relatives have taken a lot of time to complete these in a detailed and constructive way that gives indicators of where improvements need to be made. The home has responded to this and is holding regular meetings to give more opportunities for them to talk about what they are trying to do and relatives to air their views. There were positive comments about the staff in the surveys returned to the home – • ‘I have found the staff very friendly with good interaction with the residents’. • ‘Staff always seem friendly to the residents and respectful of their needs’. • ‘Staff always had plenty of time and patience to talk and discuss matters to do with my late Aunt. They were exceptionally kind and considerate’. What has improved since the last inspection? Most of the requirements and recommendations made in the last inspection report have been addressed or are in the process of being done. These included: • • • • • • • People having a copy of their contract on file. More detail in the pre-admission assessments. The development and organisation of care plans. The need for all staff, including nurses to receive adult protection training. Improvements in the range and regularity of activities. TV’s being checked regularly and action taken to ensure good reception. The appointment of two job share managers. In addition there have been improvements to staff training with the introduction of weekly learning forums covering a range of topics. There has been some further redecoration of the building and a new boiler fitted to make sure the home is warm and there is plenty of hot water. There is a clearer vision about documentation and person centred care. After a rocky patch of staff leaving, staff sickness, new appointments being made the manager reported that the position is much healthier and team of bank staff is being appointed. There is a more proactive approach to quality assurance. A fenced area has been made next to the conservatory so that people can relax and enjoy the surroundings, but further work needs to be done to level the ground so that is safe for people unsteady on their feet. Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 7 What they could do better: 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 Nursing Home DS0000001326.V364697.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 Nursing Home DS0000001326.V364697.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): Standard 1 and 3. Standard 6 does not apply to this home. People who use the service experience good quality outcomes in this area. People have written information about the home to help them decide if the home is suitable for them to live in. People are properly assessed before admission so all concerned can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We wrote to the Company in February 2008 asking for some additional information about the home and how it was addressing issues raised in the last inspection report and arising from concerns raised in a complaint that the Company had investigated. Part of the information they sent was an updated statement of purpose. We had looked at this before the visit. The only change that needs to be made is Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 10 the fact that the job share mangers’ are described as registered, but they are not. This was raised during the inspection visit and formed part of a useful discussion about the management arrangements for the home, lack of referrals to the home and how the Company was dealing with this. Three care files were checked in detail. One of these was for the last person to have been admitted to the home. We checked to see if the home had completed pre-admission assessments so that they were in a position to decide if the home could meet the persons care needs. These assessments had been done and the information used to formulate a plan of care. The home does not provide intermediate care, so Standard 6 was not inspected. Carlton Nursing Home DS0000001326.V364697.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): 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. Peoples get the care they need and the care plans are being reorganised to provide clear instruction for staff to follow so they are fully aware of peoples’ needs. People are treated with respect and in a dignified way. People are not protected by safe medication procedures and practices. EVIDENCE: The information that the home had sent us in March 2008 outlined changes they were making to the care plan documentation. The home is using the experience of one of the job share managers who is a nurse qualified in mental health. Where the files had some of the new documentation introduced the information was more organised, clearer and more easily followed. We found that information in files where the new documentation had not been introduced was much harder to find and to understand what the person’s current care Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 12 needs were. It was good that when we spoke to staff, they had a good knowledge of the people they look after and this gave confidence. Some examples of what we found were discussed with the manager. There was good evidence in the care plans that the home refers people to other specialist healthcare professionals where staff have concerns. The manager on duty has been working on a training package for staff and showed us an example of a ‘model file’ that she will be using in the training. We felt that these changes are going to be beneficial and that there was a commitment to get the care plans consistently organised with consistent documentation. Because we could see evidence of regular auditing of the care plans, discussion in staff meetings, examples of new documentation, the ‘model file’, and training plans, there are no requirements made but we will check that things have been put in place the way that was described to us at the next inspection visit. We will also monitor things through the monthly reports that are done by the operations manager. In the information sent to us during March 2008, we could see that there had been some training about drugs administration and storage from the pharmacy and in-house auditing and checking. We did not expect to find any problems. We checked the medication storage and drugs administration charts for the people whose care plans we had checked. We also checked any controlled drugs and the way these are stored and recorded. The drugs administration charts showed some omissions in the recording. It was not clear from the records if the person had refused the drug or this was an error on the part of the nurse that might have resulted in the person not getting their prescribed medication. Staff had not used any codes to identify and record the reason for the omission and they must do this. There was an issue for the home to take up with the pharmacy – the drugs administration charts provided by the pharmacy were photocopies and codes that identify reasons why a person did not get a prescribed drug were missing on the bottom of the sheets. Nevertheless, experienced nursing staff who are used to administering drugs should be aware of this and use the codes in any case. We found that the home was storing and administering a Schedule 3 controlled drug, Temazepam. This must be stored in a Controlled Drugs (CD) cabinet. Although there is no requirement to record the administration of the drug in a controlled drugs register, it is good practice to do so. One person was prescribed Temazepam tablets. These were not stored in the CD cabinet. The home was not controlling and checking these properly and stocks did not equate with the administration charts. On the most recent chart, no balance of any drugs brought forward was noted. This was poor. The CD cabinet did have a bottle of Temazepam in liquid form. This had been supplied to the home on 18 October 2007 to a person who died earlier this year and was ¾ full. The drug should have been disposed of at the time the person’s death. This was also poor especially as it is a CD. It shows that the in-house auditing was not thorough enough. The operations manager was particularly Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 13 concerned/angry as a lot of time, effort and training had been invested in making sure people knew what they were doing. He reassured us that the matter would be investigated and put right within 48 hours. The home’s auditing systems also need to be reviewed and/or the skills and knowledge of the person doing the audit, to make sure that all medication storage, handling, administration and disposal follows guidelines. It is only through this that the home can clearly demonstrate that medication is handled safely. One of the most positive features during our visit was the way the staff related and cared for people. Staff seemed organised and efficient in making sure people got the attention and care they needed. Staff were personable and professional and relationships appeared good with some friendly banter from time to time. There were examples of good practice in making sure that peoples’ dignity was maintained. Clothing was clean and all of the residents looked well cared. Staff were careful to make sure doors were closed at times when personal care was delivered and were seen knocking on doors before entering rooms. They were attentive to people and some overheard conversations showed staff to have a nice manner that people appreciated. We looked at the results of the homes own satisfaction survey that was carried out very recently. The home copied some of these for us and the people who had completed them had clearly spent some time thinking about their comments that were quite detailed. There were positive comments about the staff – • ‘I have found the staff very friendly with good interaction with the residents’. • ‘Staff always seem friendly to the residents and respectful of their needs’. • ‘Staff always had plenty of time and patience to talk and discuss matters to do with my late Aunt. They were exceptionally kind and considerate’. There were some comments made about communication that staff should take account of. In response to a question about staff attitudes, their relationships with regard to respect, friendliness, empathy and giving time, one said: • ‘Generally very good. There are a lot of very young staff and also a lot of foreign staff and the residents cannot always understand their accents. Mum responds more to someone speaking to her slowly and gently’. Carlton Nursing Home DS0000001326.V364697.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): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. Peoples’ social expectations and personal preferences are generally met and are improving. They are able to exercise choice in their lifestyles so they can be as independent as they can be. People living at the home are provided with a varied and nutritious diet so they can eat healthily, but improvements can be made in staff practices when the meals are served. EVIDENCE: The last inspection report noted that it was the home’s intention to appoint an activity organiser. This has been done with the person coming in for 3 afternoons a week. Part of this person’s role is to provide ideas and ‘role modelling’ to the care staff to increase their awareness of peoples’ emotional and social needs. During the morning of the visit, care staff had been doing some card making with some people. Staff were cheerful and encouraging conversations and it was good to see that there was someone in the communal Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 15 areas at all times to keep an eye on things. In the conversations with staff they felt that more was being done and some additional games and resources had been bought. The home intends to use local library resources and get out on loan, ‘memory boxes’ that can be used to help people reminisce. Some trips out have been organised like ‘tea dances’ and a trip to the theatre. The manager on duty recognised that while improvements have been made further work can be done and this was consistently echoed in some of the written comments made in the home’s satisfaction survey. There are plans to improve the care plan documentation for individuals so that they have a personalised activity check list and weekly planner and this should make sure that peoples’ preferred activities are known and can be met. The surveys we saw gave a clear picture of relatives being able to visit freely and being made to feel welcome in the home. Some visitors were seen during the day and one said how much she enjoyed her time there. We were told that priests visit two people on a regular basis. The home is situated in a private and rural estate so people don’t have ready access to shops and other local services, but they will be well aware of this when they choose the home to live in. Its setting is a haven for wildlife and more use could be made of the grounds. An attempt has been made to enclose an area next to the conservatory, but work will need to be done to level the ground to make sure it is safe for people to walk about. There has been some good work through training with the community dietician using the ‘food for life’ resource pack and documentation for assessing and meeting nutritional needs. The training included the chef, nurses and care staff. The experienced chef cooks fresh food and people enjoy his daily home baking. The main meal of the day looked good and was wholesome, but our observations showed that improvements need to be made to make sure food is hot and that people are offered a genuine choice of meal. Examples of what we saw were fed back to the operations manager and manager on duty. One person was only offered fish pie and when asked about this the chef said that the person may choke if given the alternative steak pie. Another was asked ‘do you want fish pie’? but was not told of the alternative. There was another example of a member of staff making the choice. More work can be done in the way food might be pureed, the way people are offered choices and work to develop information for things like menus in a pictorial form so that people with dementia or communication problems can identify things easier. The kitchen is situated a distance from the dining room. No hot trolley is available so we felt that the emphasis was on getting food to the table quickly rather that people being given time to choose what they might like to eat. There was some good practice seen, for example a member of staff sitting next to one person eating her own meal so that it encouraged the person to eat more. The assistance given in the lounge area where people needed to be helped was good and dignified, but there was little conversation and what was a stimulating place to be earlier had become more inactive during the meal. Carlton Nursing Home DS0000001326.V364697.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): 16 and 18. People who use the service experience adequate quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. The people who live at the home and their relatives know how to complain and feel confident that they will be listened to and that action will be taken when necessary. There are adult protection procedures that staff are aware of and understand but the written procedures must be clearer. People can be assured that they can feel safe at the home because staff know what to do. EVIDENCE: We know that the home carries out satisfaction surveys that invite comments, suggestions and criticism. We saw a letter to people from the managers that acknowledged that they had appreciated the comments and outlined some of the actions that they were taking. This includes meetings with relatives every two months and a dairy of these was attached. People were also invited to speak to the managers at any time. The operations manager visits the home at least once a month and writes a report of his visit. Part of the visit has to include speaking with people living at the home to check how they are feeling. The one complaint made since the last inspection was made anonymously but was not a resident or relative and this was fully investigated by the company who reported the outcome to the CSCI and was further discussed during the Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 17 inspection visit. We felt that the home is making the right efforts to make sure people can express their views. Periodically, the CSCI carries out themed inspections to look in a detailed way about whether a home is fully meeting a particular standard. This inspection included a detailed and themed check of Standard 18 that is about safeguarding people. Other related standards to do with staffing and management were also checked in detail. We looked at written information we already had about the home, staff recruitment files, staff training records, any previous safeguarding referrals, the homes quality assurance systems and written policies and procedures. We also checked things out with staff – that they had been trained and their understanding of policies and procedures. In all respects the standards were met with the exception of the written policy and procedure on safeguarding and abuse. This had some good information for staff so that they had a clearer understanding of the indicators of abuse. Although when asked the manager was able to give a clear description of the steps she would take in response to suspected abuse, the written procedure had less clarity about what steps to take and when to do things. This must be reviewed and was discussed at the feedback session where further advice about a ‘clear ‘flow chart’ that included telephone numbers of the agencies that need to be contacted. Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 18 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 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. There is a good deal of work and investment needed to bring the environment up to acceptable standards so that people are safe from infection, can live with some privacy and can enjoy the benefits of the homes location. EVIDENCE: Comments made by relatives in the homes satisfaction survey were mixed. One said the environment looked ‘run down’, another said ‘comfortable and homely, spotlessly clean. We walked around the building looking at communal areas, bedrooms, the cellar/laundry area and kitchen. It is a converted Victorian house and the isolated position means people living in the home need transport to access to Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 19 local amenities. There are positives about the homes location, in that the gardens are interesting and a tranquil and relaxing place to be. Since the last inspection an area next to the conservatory has been fenced off to make it secure. The ground is not level though, so it makes it a risky place to be for people unsteady on their feet. There are some difficulties with the roof which clearly is not fully weather proof and some bedrooms have signs of damp in the ceilings and upper walls where rain has seeped in. Some windows do not open, some need attention to the sashes and some could have better restrictors for safety and security. We noticed in one bedroom that the wall light lampshade had scorched, probably because the bulb used was too strong and were worried about this generally, so we asked that these be checked as a matter of urgency. As found at the last inspection, it is still the case that not all bedrooms are fitted with suitable locks that allow staff access in the event of an emergency but allow people the privacy, choice and security of being able to lock their bedroom doors. In fact some doors had clearly had some form of lock removed and this had left a hole in the door so anyone could see into the bedroom and this does not protect peoples’ privacy and dignity. Infection control may be compromised as linoleum flooring in one bathroom/toilet had a hole in it. The laundry floor and walls were not suitable and impervious so that they could be thoroughly cleaned so they could be source of germs and infection. Some of the surveys that we saw made reference to items laundry going missing and clothes being washed at the wrong temperature and shrinking. This is something that should be addressed with staff. We were told that there are occasional problems with vermin entering the cellar area. The home employs a maintenance person. There is a system for staff to record things that need attention and we saw the record. It looked as though some of the work needed to be prioritised. For example one entry said that windows in two bedrooms and the lounge did not close properly and it was too cold. That entry was made twelve days before the inspection visit. Similarly a new toilet seat for a downstairs toilet was needed but had not been replaced during the eight-day period before the inspection. The comments made in the outcome box tended to be ‘fixed’ or ‘sorted’ but did not give any detail of what action had been taken like whether something had been repaired or replaced. The home has not received any referrals for some time and part of the reason for this could be the high ratio of shared rooms, so the Company is doing some rethinking about the homes future and this will include a major refurbishment. In the requirements section of this report we address issues of health and safety and privacy. It is for the Company to do a detailed room-by-room list of what needs to be done and prioritise the work. In this respect we will require Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 20 an improvement plan so that we can be satisfied that the Company is serious about improving things and we can monitor progress. Carlton Nursing Home DS0000001326.V364697.R01.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 adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. People living in the home are cared for by committed staff who are properly recruited, trained and qualified for the job but on occasions there is a shortage of numbers of staff on duty. EVIDENCE: The staff we met during the visit came across as committed to the people they care for, enjoy the training and personal development and like getting the job done properly so that people are happy. They had good relationships with each other, relatives and people living at the home. In the conversations with them and in the CSCI surveys that were completed and returned by staff there were two major themes/issues. One was management of the home (see management section) and the other staffing levels. Of the eight surveys completed on the day of the inspection visit, six suggested that there are only ‘sometimes’ enough staff on duty with the other two saying there usually is. We were aware that there has been some staff turnover and recruitment, together with holidays and some sickness. These were a typical comments made in a survey: Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 22 • • ‘I think we should have more staff so more can be done around the home. Everything always seems to be rushed to get finished when more time should be spent on the residents’. ‘We can be really short of staff and then we get the staff then half the time they never come back………when someone is off sick we may find it hard to cover it, then it leaves us short and we can’t give full needs like doing activities with residents’. Nursing staff said that during an early shift one nurse on duty was not adequate and although one of the managers might be on duty, the assistance given varied. The operations manager said that numbers of staff on duty had changed because of the reduced occupancy. This was explained but although this is recognised, the strong evidence from staff indicates that at the least, there sometimes when there is a shortage and there must not be. It is situations where staff are rushed and stressed that mistakes can happen and things get missed. The manager reported that the home was now in a position of building up a number of bank staff they could call on and this should improve the situation. As part of the safeguarding themed inspection we did a detailed check of files of three most recently appointed staff. This were well organised and information/documentation was easy to find. Staff are not appointed until required checking and vetting is completed. This makes sure that people protected from staff who may not be suitable to work in the care industry. the the the are We also looked at staff training records, with a particular focus on safeguarding but it was also evident that safe working practice training is being updated again confirmed by staff spoken with and in the surveys returned. The manager on duty enjoys and is qualified in training adults. She has introduced a weekly learning forum for staff that covers a range of health issues, value based sessions and communication and practice issues. This is good and will only go to reinforce and improve the day-to-day work that staff do. A number of staff spoken with confirmed that they had either achieved a National Vocational Qualification (NVQ) or were working on one or were enrolling. Carlton Nursing Home DS0000001326.V364697.R01.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, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to this service. Inconsistent management of the home has affected staff moral. The opinions and interests of the people are important to the way the home is run and a clearer person centred approach to resident care is being developed so that this is the focus of staff practice. Some failures to carry out thorough auditing and checking of facilities, equipment and services does not always make sure the home is a safe place to live and work. Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 24 EVIDENCE: We were notified in August last year that the Company had appointed two job share managers following the resignation of the previous manager. They are a Registered Mental Health Nurse and a Registered General Nurse. They have yet to make application to be formally registered with the CSCI and must do this without further delay. They have had a difficult time since there has been some staff turnover and they wanted to make some changes that are beneficial to the home. In our conversations with staff and in reading the staff surveys it was very clear that there are inconsistencies between the styles and approach of the two individuals that have been affecting staff moral and the atmosphere in the home. This was discussed at the verbal feedback session with the operations manager and there was an awareness of the problems. Following the inspection we were made aware that the Company was carrying out an investigation. The outcome of this is not known at the time of writing this report. Previous sections of this report have mentioned that the home carries out satisfaction surveys and is introducing regular relatives meetings. Part of the focus of the new care plan documentation and training is on person centred care. These are good improvements and are part of quality assurance and quality improvement. From the written information provided before the inspection and discussions during the day there appeared to be a vision that needs to develop in practice. Other parts of quality assurance are the regular auditing and checks of documentation, systems, equipment and facilities. Previous sections of this report have highlighted failure to pick up serious failings with medication. Similarly there is a failure or lack of urgency to address some matters to do with the building, like things that might increase the risk of infection. We noticed that the form that records hot water temperature checks stated that although the temperature should be 43 degrees centigrade, 3 degrees above or below is acceptable. It is not acceptable unless there has been an agreement with a service user that has been risk assessed. We noticed that there was some door wedging that compromises fire safety. If fire doors are to be kept open for practical reasons then there are ways to do this without compromising fire safety. We also looked at other records of the checks of systems like fire safety (system checks, drills and training) and accidents. These were thorough. We checked the health and safety policies and procedures manual that is available to staff to give them guidance and these appeared to meet requirements. As part of the themed inspection we found that money left with the home for safekeeping is stored securely. Accurate records of all transactions are kept to prevent the risk of financial irregularities. Residents can have access to their money at any time. The records for two people were checked and a cash Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 25 reconciliation made. This shows that people are being protected from financial abuse. Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4 Timescale for action The statement of purpose and 30/06/08 service user guide must accurately reflect the status of the managers. The registered person must 30/05/08 reintroduce and retrain staff in safe systems and records for the storage, administration and disposal of medicines. This will fully evidence that people are getting the medication that they are prescribed and that mistakes are not being made. The registered provider must 30/06/08 formulate a written action plan that outlines what improvements are going to be made to the building, how these will be prioritised and the timescales involved. This will demonstrate to the CSCI, relatives and people living at the home that they are serious about improving things and can be used to monitor progress. Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 28 Requirement 2. OP9 13(2) 3. OP19 16 and 23 4. OP24 23 Suitable locks that can be 30/09/08 accessed by staff in the event of an emergency must be fitted to the doors of every bedroom. This will afford people privacy they might like. the 5. OP26 16 Outstanding from inspection report of 01/08/07. Timescale 0f 30/12/07 not met. Attention must be given to the 30/09/08 basement and laundry areas to make sure that walls and floors are impervious and able to be cleaned thoroughly. This will reduce the risks of cross infection. Advice should be sought from the local environmental health service. The registered person must 30/06/08 make sure there are sufficient numbers of qualified and care staff on duty at all times. This will make sure that the needs of people living at the home are met in a safe and organised way. The people appointed as job 30/06/08 share managers must make application to the CSCI for formal registration. This process will demonstrate that they are fit people to do the job. The registered person must 30/06/08 investigate conflicts in the day to day management of the home and get these resolved. This will make it a better and more consistent place to work. The registered person must 30/06/08 make sure that fire doors are not DS0000001326.V364697.R01.S.doc Version 5.2 Page 29 6. OP27 18 7. OP31 9 8. OP31 9 9. OP38 23(4) Carlton Nursing Home wedged open but fitted with hold open devices which allow them to close in the event of a fire. This will make sure the home is safer in the event of a fire. Outstanding from inspection report of 01/08/07. Timescale 0f 30/08/07 not met. The registered person must 30/05/08 make sure that hot water temperatures are maintained at 43 degrees centigrade unless agreed and risk assessed. This will make sure people are comfortable and safe from the risk of scalding. 10. OP38 23(2) 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. Refer to Standard OP7 Good Practice Recommendations The training package to introduce the new care plan documentation and person centred approach should be implemented as soon as possible. This will improve staffs’ knowledge, approach and treatment to the people they care for. The registered person should build on the work done to introduce a more and varied range of activities and the introduction of social aspects of care plan documentation. This will capitalise on the motivation of staff keen to give their best efforts to further meet the needs of people living at the home. Mealtimes should be improved as following:• Thought should be given to the further introduction of pureed/soft meals for people at risk of choking so they have a real choice to make at mealtimes. • Staff should pay more attention to the way they DS0000001326.V364697.R01.S.doc Version 5.2 Page 30 2. OP12 3. OP15 Carlton Nursing Home • • describe the meal choices so that there is a genuine choice offered and staff are not making the decision based on what they might feel best. The provision of a hot serving trolley should be strongly considered so that the emphasis is on a social, unrushed and relaxed mealtime with food at the right temperature. Thought should be given to the way the meal of the day is described in menu form for example in a pictorial form. 4. OP18 The policies and procedures for safeguarding people from abuse must be reviewed and given more clarity about the steps to take and the people to notify. This will make it clearer for staff to act in the correct way and not compromise investigations that might be undertaken by other agencies. Maintenance jobs should be prioritised and the record show in more detail what actions have been taken to remedy things. This will make sure that urgent and important things are dealt with in a timely fashion and people know what actions have been taken. 5. OP19 Carlton Nursing Home DS0000001326.V364697.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V364697.R01.S.doc Version 5.2 Page 32 - 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!