Inspection on 15/08/05 for Carlton Road Care Home

This inspection was carried out on 15th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Road Care Home 23/02/07

Carlton Road Care Home 12/07/06

Carlton Road Care Home 24/11/05

Carlton Road Care Home 11/03/05

Carlton Road Care Home 13/09/04

Carlton Road Care Home 19/02/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Carlton Road Care Home 181-183 Carlton Road, Worksop Nottinghamshire S81 7AD Lead Inspector Jayne Hilton Unannounced 15 August 2005 @10:00 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Carlton Road Care Home Address 181-183 Carlton Road, Worksop, Nottinghamshire, S81 7AD 01909 473 831 01909 475 162 Telephone number Fax number Email 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 Fred Parsons Andrew Graham Beech Care Home (CRH) 9 Category(ies) of Learning disability (LD) registration, with number of places Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11/3/05 Brief Description of the Service: 181/183 Carlton Road supports 9 adults with learning disabilities and who have an autistic spectrum disorder. The service is owned by NORSACA (Nottingham Regional Society for Adults and Children with Autism). Accommodation is in 2 adjoining houses. There is linked access between the houses but through access is encouraged to be for emergencies only. 181 Carlton Road accommodates five service users with around the clock support needs. 183 Carlton Road accommodates four service users who are identified as being more independent. As part of the home’s ethos, some service users at 181 Carlton Road have progressed and have chosen to move on to 183, the semiindependent house. All of the bedrooms are single. The home has recently registered from 8 to 9 service users, with a 4th bedroom, which has e-suite facilities, in the semi-independent house.The home is sited close to the college attended by some service users, and within walking distance of town centre amenities. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by Jayne Hilton on 15th August 2005 and lasted four hours. The methodology used included observation of staff practices. Speaking with three staff and the Head of Services (for Nottingham Regional Society for Adults and Children with Autism, (NORSACA)), Mr Keith Lancaster and three service users. A tour of the environment was facilitated. A sample of service users personal files was examined, as was a sample of staff personal files and associated records. The requirement and recommendations set at the previous inspection were assessed and were, found to be met. Standards not assessed at the previous inspection were looked at and several of these were key standards. Two standards are assessed as exceeded. The inspector wishes to thank the staff and service users for their help and cooperation with the inspection, particularly as the manager was not available. What the service does well: Staff, enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. With the recent development in communication aids at the home the service users with greater support needs now have increased opportunity to develop communication and social skills. The ethos of Carlton Road Care Home is to promote independence and to encourage service users to work towards their own identified and achievable goals. Service users have regular opportunities to access community facilities, including going down the pub, going swimming, accessing the library and shops, going to college. Leisure activities are included in the care planning process and interests are recorded. Service users are offered a healthy diet and enjoy their meals and mealtimes. Service users benefit from a well managed home. Record keeping on the whole was good and service users rights and interests are safeguarded by effective policies and procedures. Service users also benefit from a competent and accountable service. Prospective service users have the information they need to make an informed choice about where they live. Service users needs are assessed, which include their wishes and preferences to ensure that staff can support them, in a way, which meets their individual and specialist needs. Service users are supported by an effective care plan structure, which enables them to participate and make decisions about their daily lifestyle and promotes independence and responsible risk taking where they are able to do so. Confidentiality is Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 6 promoted within the home. Service users receive personal support in the way they prefer and require and generally service users healthcare needs appear to be met. Service users wishes for the end of life are documented. Complaints procedures are accessible to service users. Service users are protected from abuse, neglect and self -harm. The homes have been well maintained and do not look out of place in the community in which they are placed. The homes are maintained and decorated to provide a homely and safe environment and bedrooms were in reasonable decorative order and reflected the tastes of the occupier. The communal spaces are well equipped with TVs, music centres and computers for service users to use, and there is a sensory room, which will shortly be available for those needing such activities. No service user currently requires physical adaptations to the building. Necessary policies and procedures were in place to maintain standards. The home appeared clean and free from offensive odours. Service users are supported by a well supported and supervised team committed staff team. What has improved since the last inspection? What they could do better: Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 7 The manager is absent currently due to sickness. A requirement has been set for CSCI to be notified of this. Limitations and restrictions on freedom were not recorded and action is required to improve in this area. A requirement is set around risk management for service users who self medicate and a recommendation for the development of medication profiles. The Statement of purpose/service user guide needs to be reviewed and updated. Service users are not currently provided with a contract and this needs to be addressed. Further development in meal option provision would be beneficial to the service users. There is a good practice recommendation made regarding weight monitoring and the provision of training for staff in adult protection is strongly recommended. Work is also needed to ensure policies for adult protection are consolidated and up to date. Observations on the day of the inspection highlighted that some practices require review and discussion in relation to food safety practice and issues of cross infection, protective clothing etc. Training and recruitment issues were highlighted as needing some minor attention. Pillows in all rooms examined appeared to be ready for replacing. Two service users did not have headboards, one service user reported that his had broken and not been replaced. One service users bed head [with headboard] was sited next to a radiator that was not covered and action needs to be taken regarding this. 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 Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5 Prospective service users have the information they need to make an informed choice about where they live, this information needs to be reviewed and updated. Service users needs are assessed, which include their wishes and preferences to ensure that staff can support them, in a way, which meets their individual and specialist needs. Service users are not currently provided with a contract and this needs to be addressed. EVIDENCE: A statement of purpose is available and this was assessed in detail. The document was found to require some minor updating of information regarding the accommodation, room sizes and current staffing structure, but otherwise met the standard. The inspector advised that information regarding staffing structure, details of fees and room sizes be added as extra sheets that can be easily changed as necessary without the whole document needing to be re written. Two service users support plans were examined in detail and two others were selected for sampling purposes throughout the inspection. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 10 All prospective new service users are fully assessed prior to admission and additionally applications are submitted to an admissions panel for approval. A transition plan for each new service user is produced. Prospective service users have a full assessment of their needs and the approval of the application by the admissions panel prior to any transition to the home. Each transition is planned to meet an individuals unique needs. The home does not take emergency admissions. NORSACA have recently been in the process of assessing the needs of all their service users in order to ensure that individuals’ are housed in the most appropriate environment where their needs are best met. As a result of this process one service user has left Carlton Road and 2 service users have moved to 183 Carlton Road. Through discussion with the manager and other staff it is evident that the home can meet the assessed needs of individuals admitted to the home. The cultural needs (including dietary preferences) of a service user of AfricanCaribbean origin are recognised and met. There is regular access and consultation with specialist professionals such as a consultant psychiatrist. There was evidence of development in meeting the communication needs of service users, with speech and language input and the subsequent production of communication tools such as pictures and symbols. The terms and conditions/contract between the home and service user were not available for inspection and staff reported that these had been discussed recently as needing to be in place. The manager was unfortunately off sick and staff reported that some paperwork could not be accessed. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 Service users are supported by an effective care plan structure, which enables them to participate and make decisions about their daily lifestyle and promotes independence and responsible risk taking where they are able to do so. Limitations and restrictions on freedom were not recorded and action is required to improve in this area. Confidentiality is promoted within the home. EVIDENCE: Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 12 Service users spoken with (from the semi-independent house) said that they are involved in the review of their care plans through discussion with their key workers. Key workers review care plans monthly and the manager reviews these plans every 4 months. In addition to monthly reviews, staff can bring care plans to the staff meetings for peer advice and discussion in how best to meet service users’ needs. The care plans seen were detailed and comprehensive. There is also a ‘Star Profile’ on each service user file, which is a model that measures the levels of different skills / needs and where further input and development is required. For example, on one star profile additional social skills training was identified. The ‘Star Profile’ model very clearly identifies different types of needs and it has been recommended that care plans follow the same headings for easier cross-referencing and even more detailed and effective care plans. Individual’s risk assessments were also evident within the files. One service user had not had an annual review since February 04, however it was explained that the delay had been out of the staff teams hands and that the review was shortly due to take place. The Support plan reviews and review of risk assessments were noted to be due for review and some overdue based on the four monthly system of the manager. As the manager is off sick staff reported that the documentation is reviewed on the computer and that again they did not have access to this. The Head of Services (for Nottingham Regional Society for Adults and Children with Autism, (NORSACA)); Mr Keith Lancaster was present for a small part of the inspection and agreed that there needs to be a system whereby access can be obtained in the event of a managers absence. Service users are encouraged to participate in care planning and reviews. Evidence was also seen where more independent service users record their own daily diaries. Three service users were present at the time of the inspection and there was evidence through documentation and observations during the inspection that staff provide service users with the information, assistance and communication support they need to make decisions about their own lives. Signs, symbols and pictures are being used to enable service users with communication needs, to help choose meals and menus and what activities they would like to participate in. Advocacy services are available to service users if they wish to use them. The staff were using a monitor alarm for one service user which in effect is a limitation /restrictions that had been implemented but this was not documented in the individual support plan even though it appeared to be justified to be in the persons best interests. The staff members present at the inspection were advised that all limitations on facilities, choices or human rights to prevent self harm or self neglect or abuse or harm to others should be fully documented in the individuals care plan and agreed by the relevant representative and professionals involved in the service users care. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 13 Service users spoken with confirmed they are consulted and informed about proposed events in the home. There are regular residents meetings where issues about the running of the home are discussed. An information board using pictures and photographs has recently been introduced to 181 Carlton Road. This tells service users what meals are available, which staff are on shift and what activities are on offer for that day. NORSACA are currently looking at meaningful ways in which service users are to be involved in the recruitment process. Service users’ views are not only obtained as part of NORSACA’s quality assurance review but there is also opportunity for service users to be on the working party that visits different services to obtain the views of its residents, staff and relatives. The policy for confidentiality and data protection were seen and staff spoken with were clear about when confidential information needs to be shared and how this needs to be communicated to the service user. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 14, 16, 17 Staff, enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. With the recent development in communication aids at the home the service users with greater support needs now have increased opportunity to develop communication and social skills. The ethos of Carlton Road Care Home is to promote independence and to encourage service users to work towards their own identified and achievable goals. Service users have regular opportunities to access community facilities, including going down the pub, going swimming, accessing the library and shops, going to college. Leisure activities are included in the care planning process and interests are recorded. Service users are offered a healthy diet and enjoy their meals and mealtimes. Further development in this area would be beneficial to the service users. EVIDENCE: Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 15 It was clearly evident throughout the inspection that staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. The ethos of Carlton Road Care Home is to promote independence and to encourage service users to work towards their own identified and achievable goals. A service user has recently moved from 181 to 183 as part of his progression to further independence and another has moved out of the care home to live independently with support in the community. One service user spoken with was on his ILS (Independent Living Skills) day, which means that he was cleaning the bathroom, vacuuming, polishing and cooking. Service users take it in turns to assist staff with the weekly food shop. Service users are supported to follow leisure pursuits and college courses of their choice and work placements are also pursued. With the recent development in communication aids at the home the service users with greater support needs now have increased opportunity to develop communication and social skills. Care plans include what support individual’s require in order to access the community and its facilities. Some service users need a member of staff to accompany them into town whereas other service users (all in the semiindependent) have progressed and been risk assessed as being able to go out into town independently. By talking with service users and staff it was apparent that service users have regular opportunities to access community facilities, including going down the pub, going swimming, accessing the library and shops, going to college. Providing this support is regarded as a fundamental part of staff duties. Service users are offered a wide range of activities. All service users have the opportunity to have holidays and these are taken in small groups throughout the year. Local trips are taken and people have the opportunity for meals out and pub visits. Leisure activities are included in the care planning process and interests are recorded. Service users spoken with said that members of staff always knock on the door and wait for an answer before entering their room. In 181 Carlton Road all service users have a key to their bedroom and to the front door of the home. All service users in this house who were spoken with are rightfully proud of the fact that they now have more independence and can come and go as they please. From observation during the inspection it was evident that staff naturally interact with service users. In 181 Carlton Road staff were observed engaging with service users who have significant communication difficulties. Service users spoken with said that they could choose when they want to be alone or in company and when not to join an activity. Service users have responsibilities for household tasks and these are recorded and agreed in individual care plans. In 181 Carlton Road, cooking is shared Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 16 and each service user has a day when they clean their own rooms and when they vacuum and polish the house. Menus were examined and appeared to be varied and nutritious. These are planned over a 6 weekly cycle. One service user in 183 had made himself some cheese and tomato sandwiches and another explained he had purchased some ham and pickle sandwiches from the supermarket. The main meal on the menu only provided one option and it is recommended that informed choice for service users should be extended to offer service users at least one further option. Options should include a vegetarian choice. Regulation 17 [Schedule 4] requires that food provided for service users is recorded in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. It is therefore recommended that all food intake of service users is documented. A practical method of this was suggested by the inspector, of using a page a day diary to document all service users dietary intake, for that day and which can easily be monitored by staff. The diary could also be utilised for food probing records and fridge and freezer temperatures. A good supply of food items were seen in the fridge and store cupboards. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19,20,21 Service users receive personal support in the way they prefer and require and generally service users healthcare needs appear to be met, there is a good practice recommendation made regarding weight monitoring. There is some improvement in the organisation of medicine management within the home, however a requirement is set around risk management for service users who self medicate and a recommendation for the development of medication profiles. Service users wishes for the end of life are documented. EVIDENCE: All service users have a designated key worker. Service users who were spoken with know who their key worker is and what they are for. The service users spoken with are happy with the support they are given and feel they have control in their lives. Care plans indicate likes and dislikes and the different forms of support that are required for each individual. For example, where ‘hands on’ support is not applicable, prompting is. Care plans record when other specialist support has been obtained. Healthcare needs of service users appeared to be well met. One service user has diabetes, which is controlled by medication. Routine, blood monitoring checks are carried out by the nurse at the medical centre. Another service user suffers from epilepsy. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 18 Healthcare needs of service users are well monitored and documentation is kept of routine chiropody dental and ophthalmic checks. Weight records do not have a comment/action section. It is recommended that this be included. A staff member reported that staff communication is good and that any concerns would be handed over and GP input obtained should there be any concerns. There was no evidence provided of handover communication, as service users weights had remained stable recently. The medication systems were not fully assessed at this inspection, however the recommendation made at the previous inspection was assessed and was found, to be, implemented. One service user is self- medicating and therefore the standard was assessed in relation to this. The service user has a lockable facility and the service user confirmed that staff did monitor him to ensure that he was safe with his practice. Staff also confirmed this practice, however there was no written risk assessment or evaluation of this task within the service users personal file. The policy examined in the home was appropriate but staff had not been following this. A requirement is set in relation to this. There was little information regarding medication in the service users files, and it is recommended that a medication profile section is developed and include details of medication reviews and changes of medication. Consent forms for medication should also be part of this section. Written policies and procedures include those on dealing with death and bereavement. Records are kept of individual/family wishes in the event of a service user’s death. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Complaints procedures are accessible to service users. Service users are protected from abuse, neglect and self- harm but the provision of training for staff in adult protection is strongly recommended. Work is also needed to ensure policies for adult protection are consolidated and up to date. EVIDENCE: There is a complaints procedure and this is displayed in both 181 and 183 Carlton Road. The procedure needs to be updated by referring to the Commission for Social Care Inspection as opposed to the National Care Standards Commission. Service users spoken with are familiar to the procedure and know what to do in order to make a complaint. There has been one complaint recorded since the previous inspection and appears to have been resolved. A formal system has been introduced for documenting and filing complaints. The complaints procedure has appropriate time scales for response and action. Relevant policies and procedures are in place for adult protection, however information is kept in various policies. The main information regarding reporting procedures is contained within the policy for sexuality and sexual abuse and not in the adult protection policy section. It is recommended that the Protection of Vulnerable adult’s policies are reviewed and consolidated to ensure that staff have clear information about all aspects of this subject. The NCVAP [Nottinghamshire Committee For Vulnerable Adults Procedural guidance manual] is held in the home. Some of the information regarding adult protection reporting and investigating is not up to date and therefore needs amending to the current status that all adult protection issues need to be referred to Social Services [and the Adult Protection Team and CSCI] and that Social Services will decide who will investigate and allocate a co-ordinator and Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 20 investigating officer etc. This information is particularly needed where the manager is absent and other staff may need to report an incident. Staff reported that they have not undertaken training in adult protection. Staff were aware of the policy for whistle blowing. Policies for dealing with challenging behaviour are included within the policies for adult protection. A sample of service users personal cash held records were examined and found to be satisfactory. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28,29 The homes have been well maintained and do not look out of place in the community in which they are placed. The homes are maintained and decorated to provide a homely and safe environment and bedrooms were in reasonable decorative order and reflected the tastes of the occupier. The communal spaces are well equipped with TVs, music centres and computers for service users to use, and there is a sensory room, which will be shortly available for those needing such activities. No service user currently requires physical adaptations to the building. Necessary policies and procedures were in place to maintain standards. The home appeared clean, however observations on the day of the inspection highlighted that some practices require review and discussion. EVIDENCE: Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 22 Carlton Road Care Home is made up of 2 adjoining houses, 181 and 183 Carlton Road. Given that each house provides a different level of support and are treated as separate houses, this helps to ensure that the environments at both 181 and 183 are relaxing and homely, with adequate communal space. The kitchens in each house are spacious and equipped to enable service users to be supported in using facilities and developing cooking and daily living skills. There is good access from the home to local amenities. There has been some work done outside the front of the house to improve access, in accordance with the Disability Discrimination Act. A new relaxation room is currently awaiting fire officer approval. The premises appeared safe, comfortable, and bright The bedrooms were all very personalised to reflect individual service users’ tastes. Bedroom seen had pictures and posters displayed on walls and further shelving where requested. The rooms have sufficient furniture and fittings sufficient and suitable to meet the needs of the service users. Bedding was also personalised and one service user informed the inspector that he had recently purchased new bed covers. Pillows in all rooms examined appeared to be ready for replacing. Two service users did not have headboards, one service user reported that his had broken and not been replaced. One service users bed head [with headboard] was sited next to a radiator that was not covered and action needs to be taken regarding this. All bedrooms are lockable and service users were observed in both 181 and 183 Carlton Road using keys to lock and unlock their bedrooms. There are lockable facilities available in all bedrooms. There is also the choice to have a mini-fridge. Except for one bedroom with en-suite, there are shared facilities for the other service users. There is the choice of a shower or a bath in both houses. The facilities are adequate in meeting the needs of the service users and offering sufficient personal privacy. There are no specific aids and adaptations in the home as all current service users are fully mobile and have no assessed needs in relation to these. The laundry facilities were not inspected at this visit. The home appeared clean, however observations on the day of the inspection highlighted that some practices require review and discussion. It is important to maintain a balance for promoting the philosophy of the home and yet meet regulatory requirements and protecting service users health safety and well being. The issues raised were regarding staff and service users not wearing protective clothing for cleaning and food preparation and the risk of cross infection. It is recommended that the registered person seek advice from the environmental health officer regarding the issue and how to successfully and safely balance this. The freezer in 183 had excessive ice build up requires defrosting. Liquid soaps and paper towels were provided in the home. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 34, 35 Service users are supported by a well supported and supervised team committed staff team, Recruitment practices, were, noted to be improved, however training and recruitment issues were highlighted as needing some minor attention. EVIDENCE: Three staff personal files were examined and staff were spoken with regarding their roles and responsibilities. Job descriptions and terms and conditions are all in place. Staff also confirmed knowledge of the General Social Care Councils Code of Conduct. New staff, undertake induction and LDAF training and has received a structured induction programme that meets with skills for work requirements. NORSACA has its own thorough recruitment policy and procedures. NORSACA are currently looking at ways that service users can meaningfully be involved in the recruitment of new staff. Staffing and personnel issues are dealt with centrally and subsequently staff files have been held at a central office. The Head of Services Mr Keith Lancaster explained how this arrangement is currently being reviewed as Care Home Regulations state that relevant staff files should be kept on site and has been highlighted in recent other NORSACA homes inspections. On commencement of the inspection the staff member contacted the appropriate person to arrange for staff files to be brought over Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 24 to Carlton Road Care Home, for inspection. A requirement made at the last inspection regarding a reference for a member of staff was, found to be, met. Mr Keith Lancaster acknowledged, that the system for internal transfers of staff, needs to be reviewed and accommodated in relation to two references being held on file for these particular staff members. Staff confirmed they had training in first aid, speech and language course, food hygiene, manual handling, BILD and fire safety training was taking place on the afternoon of the day of the inspection. As the manager was not available the standards regarding training could not be fully assessed. Staff spoken with reported that training provision was generally good, although it did take time on occasions to access training courses. Mr Keith Lancaster informed the inspector that there is a professional development plan for every employee from LDAF induction, NVQ2 and NVQ3 linking to skills for work. A training programme for the next twelve months should be made available at the next inspection. All staff must receive mandatory training for infection control, health and safety, first aid, fire safety, food hygiene and manual handling and additional training is recommended for Challenging behaviour, managing diabetes, epilepsy, food and nutrition, adult protection and working with people with autistic spectrum disorders. Evidence should also be provided of induction to skills for work standards and LDAF [Learning disability accreditation framework] and other accredited training such as NVQ’s [National Vocational Qualifications] Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,40,41 43 Service users benefit from a well managed home, however the manager is absent currently due to sickness. A requirement has been set for notification of this. Record keeping on the whole was good, apart from those already covered in the report. Service users rights and interests are safeguarded by effective policies and procedures. Service users also benefit from a competent and accountable service. EVIDENCE: Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 26 As stated, the acting manager was off work currently, being off since June 2005. The CSCI had not been informed of this absence and arrangements for the management of the home, as required by regulation and therefore a requirement is set in relation to this. The registered manager has worked his way up within the Company, NORSACA and was team leader at Carlton Road prior to becoming manager. The manager has NVQ Level 3 in care and it is reported is currently undertaking, NVQ Level 4/ registered managers award. There is a policy manual, which contains the necessary guidance documents for staff, apart from some consolidation of adult protection policies. It is recommended that staff sign the front of the policy file to state they have read and understood them. A sample of records was examined, included the accident book, fire test records etc all were satisfactory. Water outlet temperatures were also seen and found to be satisfactory.[some records that were not satisfactory are covered in other standards for example support/care plan, risk assessment reviews and medication records] Appropriate insurance documentation is in place and Mr Lancaster confirmed the home was financially viable. Regulation 26 visit reports were seen in the home. A business and financial plan has been provided for inspection. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 4 3 x 3 x 4 3 Standard No 31 32 33 34 35 36 Score 3 x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Carlton Road Care Home Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 2 x x 3 3 x 3 C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 28 No Are there any outstanding requirements from the last inspection? 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 YA7 Regulation 15 Requirement Any limitations imposed on service users must be fully documented within the individuals care plan The policy for self administration of medication must be followed regarding risk assessment and monitoring documentation Formal notification must be forwarded to CSCI regarding the managers absence and detailing the arrangements to cover for the absence Timescale for action 15th September 2005 15th September 2005 15th September 2005 2. YA 20 12, 13, Medicines Act 38 3. YA 37 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. 3. 4. Refer to Standard YA1 YA5 YA6 YA 17 Good Practice Recommendations The Statement of Purpose must be updated to contain the correct information. Ensure service users are issued with a contract from the home and keep a copy in the individual care plan. Ensure arrangements are in place for staff to access templates for care/support plan reviews, risk assessment reviews etc All food intake of service users should be documented. A C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 29 Carlton Road Care Home 5. 6. 7. 8. YA17 YA19 YA20 YA23 9. 10. 11. 12. 13. 14. 15. 16. YA26 YA26 YA26 YA30 YA30 YA35 YA35 YA35 practical method of this was suggested by the inspector, of using a page a day diary to document all service users dietary intake, for that day and which can easily be monitored by staff. The diary could also be utilised for food probing records and fridge and freezer temperatures. Provide a second and preferably a vegetarian option on the menu Add a section on the weight record for action taken regarding weight gain/loss Include medication profiles within care plans which provide information of medication review dates and changes of medication and consent documentation. Review and consolidate the policies for Protection of Vulnerable Adults to ensure information for staff is up to date.[Staff should sign to say that they have read and understood all policies and procedures] Provide new pillows as necessary. Keyworkers should address the missing headboards with service users as to whether they need replacing/repair etc Risk assess the surface temperature of the radiator identified and take appropriate action to minimise any risk to the service user Seek advice from the Environmental Health Officer in relation to balancing the philosophy of home life and food safety legislation, cross infection issues etc. Ensure fridges are routinely defrosted Provide a system to obtain two references where staff transfer employment from one NORSACA home to another. Provide a trianing programme for the staff team, which is available for inspection Training should be provided in managing diabetes, managing epilepsy, food and nutrition, adult protection and working with people with autistic spectrum disorders. Carlton Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 30 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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 Road Care Home C53 C03 S8815 Carlton Road V242308 150805 stage 4.doc Version 1.40 Page 31 - 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. 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