Inspection on 08/04/08 for Carlton Specialist Care Centre

This inspection was carried out on 8th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Specialist Care Centre 17/04/07

Carlton Specialist Care Centre 23/05/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Carlton Specialist Care Centre 18 Greenway Milnsbridge Huddersfield HD3 4RZ Lead Inspector Cathy Howarth Key Unannounced Inspection 8th April 2008 10:30 Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 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 Specialist Care Centre DS0000064511.V361288.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 Adults 18-65. 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 Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton Specialist Care Centre Address 18 Greenway Milnsbridge Huddersfield HD3 4RZ 01484 649899 01484 649899 carltonshare@btconnect.com 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) Carlton Nursing Homes Ltd vacant post Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 10 17th April 2007 2. Date of last inspection Brief Description of the Service: Carlton Specialist Care Service aims to provide support to individuals who may present severe challenges to a service. The home aims to provide an individualised service tailored to people’s needs. The building is a converted club which has a large open living space with numerous other rooms geared towards specific activities such as a TV room, gym, wet room with hot tub and Jacuzzi, arts and crafts room and a sensory room. People have their own bedroom with ensuite shower room or bathroom. There is a dining room with another seating area and a kitchen. The outside space is mainly used for car parking and the whole unit is surrounded by a metal fence for security. Prospective users and commissioners are given the Service User Guide and Statement of Purpose, which give them information about the home. Fees on 8.4.08 ranged from around £2,000 per week but are dependent on individual assessments and care packages. Commission for Social Care Inspection reports are available from the home on request and are published on the internet at www.csci.org.uk Carlton Specialist Care Centre DS0000064511.V361288.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 0 star. This means the people who use this service experience poor quality outcomes. This inspection was carried out using information supplied by the acting manager in the Annual Quality Assurance Assessment (AQAA); information from discussions with professionals and relatives; observations and discussions with people using the service and staff on this visit; and examination of records relating to care and management. The service aims to provide a highly specialised resource for people with significant needs. However it is failing to do this adequately at the present time. The provider must make significant improvements in important areas such as staff training and management in order for the service to improve. The Commission for Social Care Inspection will be asking the provider to achieve these improvements as a matter of priority. What the service does well: What has improved since the last inspection? There is now more freedom of access in important parts of the building such as the kitchen so that people can have access to food and drinks more easily. Some bedrooms have been redecorated to suit the preferences of people living at the home. There is now a functioning domestic washer for people who wish to do their own laundry to develop their skills. Complaints and their outcomes are now recorded so that these can be monitored by managers, to improve the service for people living there. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 6 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 Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The pre-admission assessment process is good. EVIDENCE: The home admits people following a detailed assessment process and only after careful planning for the transition. This was evidenced in the most recent admission where there was clear information about the particular needs of the person and a very detailed transition plan was implemented which involved staff from the home visiting the person in their previous placement, then slowly introducing them to the home and preparing their room in a way chosen by them before finally moving in. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Individuals are involved in some decisions about their lives, but do not yet play an active role in planning the care and support they receive. EVIDENCE: Case files for three individuals were examined as part of this inspection. It was found that care plans did identify the main needs of individuals, for example what support they may need in personal care, dietary needs or in developing self help skills. Where appropriate, there were clear plans in place for management of any difficult behaviour. It was noted that two plans seen needed to be updated in certain key areas, such as behaviour management and the use of ‘as required medication.’ There was little evidence of people being involved in developing or reviewing these plans. The manager explained that she is introducing person centred plans to the home and that some work has started on this. This was seen and Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 10 looks promising and will involve people more in the process. One person told us that he had been involved in developing his plan along with his key worker Finance arrangements were not clear on some plans. It was noted that agreements have been made with individuals, but these have not been written up in the plans and subsequently the staff involved have left the home, leaving it unclear exactly what the arrangements are supposed to be. For instance one person has an Internet broadband account but the arrangements for paying for this were not recorded. Another person had no plan regarding nail care but it is known that he does scratch people when he is angry. This had resulted in a situation where the person was restrained to cut his nails because he was being aggressive to staff and users. The manager wrote out a care plan to address this more proactively while the inspector was present. Risk assessments showed that staff are aware of potentially dangerous situations and in talking to staff they have a clear understanding of things such as how many people are required to support each individual when out of the home. Within the home staff were allocated at the beginning of each shift to work with individuals and were responsible for their safety and occupation throughout the day. It was clear that individuals are given some limited opportunities to choose their activities at the home, and staff were observed offering choices around food for example. It was observed throughout this inspection that people had more freedom in moving around the building for example in using the kitchen to make drinks and snacks. Even though some individuals’ needs mean they require extra support this does mean that mostly people had access to most areas of the building. It was noted that people’s individual files were being kept in a cabinet in the manager’s office which does not have a lock fitted. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People who use services are able to make choices about their life style, but could benefit from more support to develop their life skills. Social, educational, cultural and recreational activities are limited. EVIDENCE: During the course of this inspection visit and from looking at records of daily activities, it was clear that while staff are committed to enabling people to participate in activities, the reality for individuals living at the home is that these are fairly limited by a number of factors. Staff shortages on shifts have contributed to this to some degree, as some people living at the home need to have a high staff ratio in order to be able to go out in the community safely. Some individuals find going out very stressful and for them being able to do Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 12 this is a slow process. Within the home there are opportunities for activity and development of skills, such as craft activities, use of the sensory room, gym equipment as well as developing self care skills and domestic activities such as washing and cooking. In reality, very little of this was seen over the course of this visit. The people who need the most support were observed mainly watching TV or DVDs in the main living area. Two people spent much of the time in their rooms, with support from staff, playing computer games or other activities of their choosing. One person was supported to complete painting his bedroom. One person was taken out for a drive. People did talk about being involved in planning holidays and all who could discuss this, talked about where they had chosen to go. One person is going to Majorca another to Butlins. People are supported to visit or keep telephone contacts with their families and friends. One person goes out with family two or three times a week and another person has just been supported to restart home visits. It was of concern again, on this visit, that some people living there do not have opportunities to make friends and socialise with peers. One person told the inspector that he did not really socialise other than with staff, but would very much like to meet people especially girls. One relative commented that they felt if they did not visit their son they would have little outside contact. This was highlighted at the last inspection but there was little evidence that this has been addressed. One person has a job in a local café once a week and also goes to a college course. Another person explained that they had been on several college courses including a radio broadcasting one. Most learning and personal development is left to staff within the home. One parent commented that they were concerned about this, and had even considered obtaining the services of a personal tutor to help their relative’s development. The inspector advises the home to consult with people who live at the home and their relatives about their views on social and education opportunities. One area that has improved since the last visit has been that people are less restricted around the home. The kitchen was left unlocked for most of the time during this visit. The manager said that it was still necessary to lock it at certain times but that mostly it is now open so that people can go and make themselves drinks and snacks with staff support. One person living there confirmed that this is usually the case now. One parent expressed some concern about the food and whether people were getting a proper diet. However, records of food served shows that people are getting a varied diet overall. Special diet products were available for one Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 13 individual who needed them. People are offered choices in their meals and likes and dislikes were clearly known to staff on duty. At tea time three people ate together in the dining room but on separate tables supported by staff. This limited the opportunity for social interaction. For one person this may be because of their difficulties around food, but it was not clear why the other two people were separated. Staff eat with people, but generally bring their own food. This means that staff meals are served at different times as each staff member had to get their own meal after people had been served. This made it feel less like a communal social event. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People are adequately supported to maintain their health but should be more involved in planning their own care and support. EVIDENCE: People living at the home are supported in their personal care as outlined in their care plans. It is not clear from the plans to what extent people have been consulted about their preferences, but there were some references which indicated that staff had some knowledge for example of whether people prefer bath or shower and how much support they need with personal care. One concern was that staff were overheard using words such as “X will bath you when they come back.” This gave an impression of staff ‘doing to’ people rather than supporting and encouraging people to do things for themselves. In this particular instance, the care plan for this individual indicated that they were largely able to do this themselves with only minimal support. The use of language can promote good practice and this should be addressed by the Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 15 manager to encourage staff to think of supporting people rather than doing things for or to them. There was evidence that people’s health needs are managed well generally. Feedback from a GP suggested that they had confidence in the staff to promote people’s health needs and seek medical advice appropriately. At the time of this visit one person was suffering with toothache and had consulted a dentist they day before. Despite being in pain, the person had been told by the dentist they must wait possibly for some months for treatment, as it would need a referral to hospital. It is not acceptable for someone to be in pain for months. The inspector discussed with the manager that staff should plan to follow this up urgently to get an earlier appointment and this was agreed. The medication arrangements were examined as part of this visit. Supplies were found to be kept locked up securely and stocks balanced with the records held. Regular audits of medication are undertaken. There is the facility for controlled drugs to be stored within the home. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The welfare of people living at the home is not fully safeguarded by the current systems and arrangements. EVIDENCE: The home has a complaints procedure and there is advice for people using the service on making a complaint, which is written in simplified language. This could be improved by the addition of pictures to support the text. Two records of complaints were seen and these appeared to have been responded to appropriately by the acting manager and the outcomes recorded. One person who spoke with the inspector said that they felt that staff listen when they raise issues and felt confident that people would respond appropriately. The new acting manager has instigated meetings for people using the service. The first one was held in January this year and another was held in March. This indicates that people are beginning to be consulted about what activities they would like to do and on changes within the home. The home has had one incident, which required a referral to the local authority, to safeguard the welfare of people living at the home. This occurred in December 2007 and resulted in a staff member being referred to the POVA (Protection of Vulnerable Adults) list. The home did not comply with the local safeguarding procedures at this time as there was a delay in acting to protect Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 17 individuals when a staff member was behaving a in a way that may have threatened the well being of people living there. Also there was a delay in reporting the issue to the appropriate agencies when a related incident occurred. As an outcome of the Safeguarding Adult procedures the local authority made recommendation to the home to improve their practices. It was clear that further training was required to ensure that staff and managers were aware of their roles and responsibilities in relation to this. The acting manager has taken steps to emphasise the importance of this with staff at team meetings and in supervision and has reviewed some of the reporting forms such as incident forms. There is some further work to be done in updating staff training in safeguarding issues and in improving staff awareness around issues relating to potential abuse, such as mentioned above in recording decisions in relation to finance or any limits on freedom of individuals. Records of physical interventions were also seen. The home has a fairly high level of physical intervention with people who live there. Staff are trained to do this safely. Whilst most of those recorded were appropriate, there was one noted where a person had been restrained in order to cut their nails because they were upset and scratching staff. This was not appropriate and does not comply with the requirements of the Mental Capacity Act 2005 (MCA), which requires that care services and staff must reasonably believe that the restraint is absolutely necessary to prevent the person coming to harm; and that the restraint used is reasonable and in proportion to the potential harm. Financial records for people living at the home were seen. These were found to be accurately completed on the whole, apart from one where the wrong month had been documented. As mentioned previously, people’s finance arrangements were not detailed on file so that as staff change, the arrangements might fail. Also not all individuals sign for their own monies even though some may have capacity to do so. It was not documented on files that people lacked capacity. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 People who use the service experience poor quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The environment is poorly maintained and presents hazards to people living there. Individual accommodation is adequate. EVIDENCE: From the outside the home appears unkempt, with peeling paint on the weatherboarding and painted perimeter walls, straggly weeds and a front door that has a filed hole where a lock used to be. The metal fence, which protects part of the home, is still only partially painted despite this being promised by the provider since the home was first registered in 2005. The original plan to landscape some of the outer area has never been realised and so there is nowhere for people to enjoy the outdoors. The acting manager explained that she has a plan to address this and one person has displayed some enthusiasm for making a sensory garden and indeed was looking at a gardening book during this visit and making plans for it. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 19 Inside the home also lacks atmosphere and since its opening in 2005 has suffered from problems of how to use the space available. Furniture and equipment were seen left lying around making the home feel cluttered and uncared for. The TV room had the chairs arranged haphazardly, all the pictures had been removed and the TV was missing, as the old one had been broken. A new one was in the office, awaiting being fitted. On one corridor there was a great deal of dirt and grit. It was thought that the handyman had been removing rubbish the previous week and had left this mess. However no one had made the effort to vacuum the area. There were no curtains in the dining room. On this visit it was noted that some repairs were outstanding from previous visits, namely holes in the ceiling of the main area. There were also two items that needed immediate attention as they posed a hazard to people living there. An immediate requirement notice was served to replace glass in a fire door which had exposed shards and to replace a lock which had been removed from a cupboard that was designated to be locked shut by the fire safety officer and also housed cleaning equipment. The provider addressed these issues within the timescales given. Since the last inspection there have been some improvements in the environment. The sensory room has been moved to the old arts and craft room and has been redecorated by one of the people living at the home. It was very cold in the room however and this may deter people from using it. Another improvement has been that the laundry has now got a working washer for people to use. The paint on the walls in this room was peeling from the walls due to the humidity. This was also found to be the case in the main bathroom. The gym has had the weights removed so that people are not using unsafe equipment. Unfortunately the Jacuzzi suite was out of use on this visit because the steps to get in have been broken. The acting manager said new ones are to be made but this has meant that it has not been used for some months. Again the delay in addressing repairs, directly affects the quality of service that can be offered to people living at the home. The acting manager said that at present the home shares a handyman with the other services in the vicinity. She said they have however appointed a dedicated handyman for the home and are awaiting completed checks before he can start work. Individual bedrooms were seen to be much more homely, and all have ensuite facilities. Several have been redecorated and indeed one person was in the process of helping redecorating his room during this visit. Unfortunately, the room this person was living in temporarily had no curtains at the window. This is unacceptable as it meant he had no privacy when getting changed. This was Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 20 rectified after it was highlighted to the manager. Other people’s rooms reflected their personal interests and preferences. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 21 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use the service experience poor quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Staff recruitment management and training systems are poor improve in order for the service to improve the quality of care offered to people who use it. EVIDENCE: In recruiting staff, Criminal Records Bureau checks are made and references sought for individuals so that unsuitable individuals are not employed who might put people at risk. . However one recent incident highlighted the need to be vigilant, as a staff member was taken on who had been dismissed from another care service. This service was listed on the person’s application form but not given as a reference. The reference offered was for a food retailer instead. Any instances where people have worked in care services must be followed up to verify the reason given for leaving that work. The problem only came to light, as someone who uses the service from time to time knew the individual, and their relative contacted the manager when they realised that the person was working there. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 22 There were no details of the manager’s recruitment available as these are kept at the company’s head office. these records should be available for inspection along with details of other staff. The service has had a large turnover in staff since the last inspection. Information supplied by the manager indicated that about half the staff team have left and been replaced by new staff. Some of this is positive in that unsuitable staff have left, but in addition a number of the staff working at the home were only there temporarily until a new unit in Bradford opens. This could be unsettling for people living there. The service offers a good induction training programme to staff but unfortunately some staff were noted to have to wait several months for this to be given. Regulations say this should be offered within 6 weeks. One person started work in December 07, but was not due to have induction training until 15 April 08. There is no record of any other interim induction training for this person. One other person who had been working approximately five weeks spoke with the inspector and explained that he felt he had been well supported by staff to work in the home. Again no structured induction had been offered and no mentor assigned. No supervision sessions had been undertaken with this member of staff so he said it was hard for him to know if he was doing well or not in his new job. Staff who have been working at the home for some time have not had update training and some are still awaiting training in First Aid, which was a requirement from the last inspection. Some staff have not had update training in safeguarding vulnerable adults, fire safety and in control and restraint. Only a few staff have had training in food handling but all are required to do this so should be trained. This could mean that people may be at risk because staff lack up to date knowledge and skills. Progress in helping staff achieve NVQ level 2 qualifications has been slow. Information provided by the acting manager indicates that only 30 of staff have achieved this. The National Minimum Standards recommend 50 of staff should have this qualification. The manager said that a new training manager has been appointed to help ensure that all staff are offered training and that refreshers are delivered in a timely way. This is positive. Staff who responded to the surveys and spoke with the inspector identified staffing issues as being the area that caused them the most concern. They said, in recent times staff have worked below minimum numbers or have had to work extra shifts because of covering for sickness in order to safely care for the people living at the home. The rota showed that senior staff in particular, were working quite a number of ‘double shifts’ to provide adequate cover. This puts a lot of stress on staff particularly given the demanding nature of the Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 23 work at times. This could put people living at the home at risk if staff are tired and their patience has been severely tested. The manager explained that new staff have been recruited and are awaiting clearance, and the issues of sickness are being addressed through appropriate channels. At present staff are meeting together only every few months and not all staff attend. Likewise staff supervisions are not as frequent as recommended in the National Minimum Standards. This makes it more difficult for the large number of new staff to be brought into the team effectively and for staff to be focused on the areas that need to be improved. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 24 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience poor quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The manager is making improvements but needs better support from the provider. EVIDENCE: Carlton Specialist Care Service has had no registered manager since October 2006. Since then three acting managers have been in post. This instability in management has made it difficult for improvements to be made and sustained. The current acting manager has been in post since December 2007, and says she is committed to remaining at the home and making the necessary improvements. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 25 At present the home does not have a clear development plan and monitoring of quality is limited. Monthly visits by the provider are not taking place as required. In the last nine months only three reports of visits as required by regulation 26 of the Care Homes Regulations 2001 were available. The reports from these visits were very limited. The same points were noted in several reports, for example the need to paint the outside fence, but no action has been taken. This must improve. The new manager has started holding more regular meetings with people using the service to listen to their views. This is positive. Health and safety in the home again lacks robust management. There are regular checks and reports are sent through to the provider about works that need action, but the response is poor. Essential repairs and maintenance are not addressed promptly as noted previously in the ‘Environment’ section of this report, resulting in some dangerous hazards being left and people put at risk of harm. The home has not had recent tests of electrical equipment and no records of gas servicing were found. Fire safety checks are carried out weekly but there is a lack of training and drill practice for staff. This puts people at risk should a fire break out, as staff have not had up to date training or practices. Some staff have had no training since their induction when the home opened. The record of drills could not be found on this visit, and staff who were on duty confirmed that they had no recollection of any fire drills taking place. Carlton Specialist Care Centre DS0000064511.V361288.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 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 1 X 1 X X 1 X Carlton Specialist Care Centre DS0000064511.V361288.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 YA39 Regulation 24(1) Requirement The service should develop a quality assurance system and a development plan for the service. (From May 2006 original timescale was 30/7/06 and April 2007 timescale was 30/06/07) Staff must receive training in emergency first aid. (From April 2007 original timescale was 30/6/07) The environment must be maintained, safe and clutterfree. (From December 2006 timescale was 31/12/06 and April 2007 timescale of 30/6/07) Individual case files must be kept in a lockable cupboard. Incidents of physical intervention should be fully recorded and include the duration of that intervention. The manager and the provider should monitor incidents of physical restraint as a matter of course, to ensure DS0000064511.V361288.R01.S.doc Timescale for action 30/06/08 2 YA32 13(4) 30/06/08 3 YA24 13 (4) 30/06/08 4 5 YA10 YA23 17 (1) (b) 13 (8) 30/04/08 31/05/08 Carlton Specialist Care Centre Version 5.2 Page 28 6 YA23 YA34 19 Schedule 2 (3,4 and 6) 23(2) 7 YA24 8 9 YA35 YA39 18 (10 (c) 26 (3–5) 10 YA42 23 (4) (d) 11 YA42 13(4) that any that take place are necessary and appropriate. When appointing new staff previous employment histories must be checked and verification of the reason for leaving posts working with vulnerable adults or children must be verified. The broken glass in the fire door and the lock on the freezer room cupboard must be replaced in order to keep people safe. (Immediate requirements made and addressed within given timescale.) Staff must have a timely, structured induction and this must be recorded. Visits to comply with Reg 26 must take place visits every month with reports available and sent to the Commission for Social Care Inspection. Fire drills should be done often enough to ensure that staff participate a minimum of twice a year. Electrical and Gas equipment must be tested to ensure it is safe to use. 08/04/08 11/04/08 30/04/08 30/04/08 30/04/08 30/04/08 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 Refer to Standard YA6 YA7 YA15 Good Practice Recommendations Care planning should involve the individuals themselves and plans should be kept up to date. Where agreements are made with individuals for example in relation to finance or other decisions, they should be recorded and kept on the file for future reference. People living at Carlton Specialist Care should receive DS0000064511.V361288.R01.S.doc Version 5.2 Page 29 Carlton Specialist Care Centre 4 5 6 7 YA17 YA18 YA23 YA23 8 9 10 11 YA24 YA35 YA36 YA37 more support to socialise and make friends outside of the home. Mealtimes should be organised so that they promote all aspects of enjoyment and social skills. Staff should receive training in encouraging support for people using the service, rather than ‘doing to’ people. The manager and the provider should monitor incidents of physical restraint as a matter of course, to ensure that any that take place are necessary and appropriate. Staff and managers should receive guidance and training in the implication of the Mental Capacity Act 2005 to ensure that they comply with it when considering using physical restraint with individuals. The person who wants to enhance the garden should be supported to do this. 50 of staff should have NVQ 2 qualification or equivalent. Staff should receive supervision at least six times per year. The home should have a registered manager. Carlton Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 Page 30 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 Specialist Care Centre DS0000064511.V361288.R01.S.doc Version 5.2 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. 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