Inspection on 13/08/07 for Carrick Lodge

This inspection was carried out on 13th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Carrick Lodge 31/03/09

Carrick Lodge 24/07/08

Carrick Lodge 19/10/06

Carrick Lodge 09/02/06

Carrick Lodge 15/06/05

Carrick Lodge 05/11/04

Carrick Lodge 20/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Carrick Lodge Belyars Lane St Ives Cornwall TR26 2BZ Lead Inspector Ian Wright Key Unannounced Inspection 08:00 13 and 17th August 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carrick Lodge Address Belyars Lane St Ives Cornwall TR26 2BZ 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) 01736 794353 01736 798621 carricklodge@btconnect.com Mr Ronald James Cottam Vacant Care Home 38 Category(ies) of Dementia (18), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (18), Old age, not falling within any other category (20) Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2006 Brief Description of the Service: Carrick Lodge provides care and accommodation for up to 38 older people- 18 of whom may be diagnosed with dementia and/ or mental disorder. The registered provider is Mr R Cottam. A manager has been appointed, her application has recently been submitted to the Commission for Social Care Inspection to be assessed for registration. Carrick Lodge is situated near the centre of St. Ives and is in an elevated setting with views of the bay. The house is a large three-floor property with a two-storey extension. There are two communal seating areas, a conservatory, the dining room, kitchen area, laundry and two offices. Two lifts and a stair lift are provided to assist access to the upper floors. A fenced garden is situated at the front of the home. At the time of the inspection fees range from £300-400 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the home’s management or the CSCI website. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Key Inspection took place in fourteen and three quarter hours over two days. All of the key standards were inspected. The methodology used for this inspection was: • To case track five people who use the service. This included interviewing the people who use the service about their experiences and inspecting their records. • Interviewing four staff about their experiences working in the home. • Informal discussion with staff and other people who use the service. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: This inspection has resulted in the issuing of eleven statutory requirements. Action regarding these is required by law within the timescales set. In brief improvement is required to: • Facilities, furnishings, decorations and maintenance of the home. Currently these are unsatisfactory. • The operation of the medication system. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 6 • • • • • Adult protection policies and procedures. Staff also need training in this area. Employment checks on staff for example regarding protection of vulnerable adults register checks and Criminal Records Bureau checks. Staff induction and training. Quality assurance systems. Health and safety precautions. The Commission will monitor suitable action is taken in these areas, and complete a further inspection to check compliance if this is deemed necessary. 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. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider has developed a statement of purpose / service user guide. The service user guide is available to people who use the service and their representatives. People who use the service are issued with a contract either via the social services department or the registered provider depending on who pays their fees. The provision of suitable information ensures people who use the service are aware of the services the registered provider offers. This information also helps ensure people who use the service are made aware of their rights and responsibilities. The registered provider’s assessment procedure is satisfactory and there is evidence that people who use the service are assessed before they are admitted to the home. Suitable assessment procedures ensure the registered provider only accommodates people for whom the provider can suitably meet their needs. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 9 EVIDENCE: Copies of the statement of purpose and service user guide were inspected and are satisfactory. A copy of the service user guide is placed in each bedroom and is given to each relative at the time of any initial enquiry. The registered provider said each person using the service receives either a contract issued by the registered provider (if their care is funded privately) or receives a contract issued by the Department of Adult Social Care (DASCsocial services) if they fund them. This provides information about the service offered and the person’s fees. A copy of this documentation is contained within each person’s file. The registered provider outlined a suitable approach to the assessment of potential residents. For example, one of the senior staff will visit the person before admission is arranged. Copies of pre admission assessments are contained on individual files. Residents who the inspector spoke to said they could not remember an assessment occurring- although some made the comment that their relatives made arrangements for them to come to the home. It is worth whoever completes the assessment records who was present at the assessment in the notes kept. It is recommended a copy of the social services or NHS assessment is obtained before admission is arranged. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have a satisfactory care plan for which there is evidence of regular review. Suitable care plans help to ensure people who use the service receive all the care they need, for example in a consistent manner. There is evidence that staff ensure health care needs are met. Improvement is required to the medication system. This will ensure people who use the service can be assured their medication is managed to a satisfactory standard. People who use the service said they felt staff worked with them in a manner, which respected their privacy and dignity, and this was also evident from the inspector’s observations. EVIDENCE: Care plans for some people who use the service were inspected. These appeared to be satisfactory, and contained suitable information to assist staff to provide care. All care plans need to have a photograph attached to them. This helps staff or agency staff, who for example are new to the service, to be Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 11 able to identify the individual. Care plans include a satisfactory risk assessment e.g. regarding manual handling. Although people who use the service, who the inspector spoke to, did not appear to be aware of their care plans, all people who use the service said the care they received was appropriate and carried out in a manner according to their wishes and needs. There was satisfactory evidence care plans are reviewed. Health care support appears to be satisfactory. People who use the service said they could see a doctor or other medical practitioner when this is necessary. Although there is satisfactory evidence that any medical interventions are recorded in day to day records, it is advised these are recorded on a separate sheet to make tracking easier e.g. to assess when someone last saw the dentist / GP /optician etc. The medication system was inspected. Medication is stored in locked cupboards and administered via a monitored dosage system. The operation of the system needs improvement. For example: • Some dosages of medication were signed for but did not appear to be administered. • Some medication was in stock, but no longer appeared to be administered. If this is required on an irregular basis, it must be recorded on the medication sheet. If it is no longer required it should be returned to the pharmacist. • Some medication, which is being administered, was not recorded or signed for on the medication sheet. • There was overstock of some medication. This should not be reordered until stock is used up. • Ear / eye drops should only be refrigerated when necessary. The date when each bottle is opened should be recorded on the packaging so it is disposed of within the recommended period. The registered provider needs to ensure the medication is monitored to a higher standard, and ensure there is more vigilance to avoid error. All staff involved in the management and administration of medication must receive training for example from a pharmacist. It is strongly recommended that a risk assessment is completed regarding the administration of any PRN (as required medication) particularly related to mental health. This should, for example, include under what circumstances the medication is administered. When this medication is administered, the reasons for it’s administration should be recorded; for example within the daily notes and / or on the back of the medication sheet. It should also be clearly recorded how many tablets are administered when the prescription allows some discretion regarding its administration. Such measures could protect staff and the registered provider from allegations of abuse. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 12 People who use the service spoke positively regarding the attitude of staff, and said staff respected their privacy and dignity. People who use the service said staff always knock on their doors, and post is always received unopened. People said staff encourage them to make choice for example when they can get up and go to bed. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible to meet the needs of people who use the service. Activities are offered and an activities co-ordinator is in post. This ensures people who use the service can have a daily routine that suits their needs and have various opportunities for social activity. People who use the service have opportunity to receive visitors. People who use the service are encouraged to make choices regarding how they live their lives, and can maintain control over their financial affairs. Arrangements for meals are good and ensure that people who use the service have a varied and wholesome diet. EVIDENCE: The first day of the inspection started at 08:00 so the inspector could observe the morning routine. This was relaxed, but organised. It was clear people who use the service could get up when they wanted to, and staff support was professional, relaxed and unhurried. The inspector was able to speak to many of the people who use the service and all said they could get up and go to bed when they wanted to. A good range of activities is available. An activities co-ordinator is in post and works four days a week, between ten and three, with people who use the service. Recently the home had a garden party which residents enjoyed. There are cream tea afternoons, a clothes sale, sing alongs, keep fit and music Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 14 sessions. Other activities include baking sessions, quizzes and massages. The activities organiser will also take individuals for short walks outside the home. At least once a month an organist will visit. The minister from the local chapel visits once a month. There is also a residents’ shop, which is operated by some of the people who use the service. This excellent facility is operated by a small group of people living in the home (predominantly by one lady), and enables people living in the home to purchase toiletries, sweets and other items. The shop is run independently of the care home, and any profits are given to the residents’ amenities fund. People using the service were positive about what activities are on offer. Some people, who use the service, said they were happy to occupy themselves. Many people received a daily newspaper. People said staff were always friendly, and a number of people appeared to have good support from relatives. People who use the service said they were able to receive visitors when they wished either in the lounge or in their bedrooms. There are pleasant views from some rooms of St Ives and the sea, which people said they enjoyed. People who use the service said they felt they could exercise choice over their lives for example how to spend their time, what they could wear etc. Management look after some money on behalf of people who use the service. Staff do not act as appointee for government financial benefits, for any of the people who use the service. Records are kept of fees paid to the registered provider. The registered provider can look after valuables on behalf of people who use the service. Records of cash looked after on behalf of people who use the service are satisfactory. People who use the service said they felt their personal belongings were safe, and said nothing that belonged to them had disappeared. The inspector shared a meal with some people who use the service. Food served was of good quality. People who use the service all said they were happy with the food provided. They said there was always enough food and meals were well cooked. A hot tea is available on some days and sandwiches are available on other evenings. It would be more beneficial if hot and cold options were available each evening. There were satisfactory levels of food supplies available in the home and these were of satisfactory quality. A concern was raised about the use of plastic beakers for drinks. The registered provider said, where appropriate, people would be offered either a glass or a china cup (these are already provided to some people). It was agreed the current beakers would be replaced with nicer replacements. The request for the provision of more fruit was discussed. The registered provider said he would ensure this, and ensure the less able people who use the service have equal access to it. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider has a suitable complaints procedure although the adult protection procedure requires some expansion. Policies in place should assist in ensuring people who use the service can be assured any concerns, complaints or allegations are taken seriously and dealt with effectively. Some improvements are required to pre employment checks to ensure staff are checked as suitable to work with vulnerable people. Staff also need to receive basic training regarding prevention of abuse and adult protection. This will help to ensure people who use the service, are protected against having staff working with them who are unsuitable to work in a care environment. EVIDENCE: The registered provider has a satisfactory complaints procedure. The registered provider has a complaints book. The registered provider has received two complaints since the last inspection in October 2006. These seem to have been dealt with satisfactorily by the registered provider. One of the complainants however subsequently approached the Commission regarding their concerns. Although these concerns were not treated as a formal complaint to the Commission, the person’s concerns were looked at as part of this inspection. The person’s concerns were regarding the care of someone who lived at Carrick Lodge. This was not substantiated. Secondly the complainant was concerned about the quality of food- this was not Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 16 substantiated. Thirdly regarding lack of recreational activities available to people who use the service. This was not substantiated. Lastly concerns were expressed about the quality of the environment. Requirements have been within the report regarding this matter. Another complaint was made to the Commission regarding food, recreational activities, the smell in the home, access to clean linen and staff turnover. Conclusions regarding food and recreational activities have been outlined above. The provider has however been asked to monitor consistency of quality regarding these matters as the Commission is concerned regarding two seemingly unrelated complaints being raised regarding these matters. The inspector was not concerned regarding access to linen as the linen store. This was well stocked and not locked when inspected at the start of the first day of the inspection. Staff turnover is no higher at this home than at other homes. There were no unpleasant odours on either day of the inspection. No other complaints have been received since the last key inspection in October 2006. Many people who use the service described staff as ‘kind’, and the people the inspector spoke to say they were not aware of any poor or abusive practice. Staff the inspector spoke to also said practices within the team were to a good standard. The registered provider’s adult protection policy needs to be expanded. For example it needs to outline a clear procedure to state what staff and management will do in the event of any allegation. The policy should pay reference to local authority procedures and the Department of Health’s ‘No Secrets’ guidance. The Department of Adult Social Care guidance can be found at: http:/www.cornwall.gov.uk/index.cfm?articleid=14581 The Department of Health guidance can be found at: http:/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPol icyAndGuidance/DH_4008486 Staff training records did not evidence that they had received training regarding how to recognise abuse or what they would do if they suspected abuse. Although some of the staff the inspector spoke to say they would report any concerns to management, staff should receive training in this area as outlined in the regulations. Such training is available from Cornwall County Council (Department of Adult Social Care). Information regarding this can be found at: http:/www.cornwall.gov.uk/index.cfm?articleid=37718 Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 17 Some improvement is required to procedures regarding Protection of Vulnerable Adults ‘First’ checks (POVA First) and Criminal Record Bureau records (CRB) checks. The inspector assessed the employment records for twelve staff. Although POVA /CRB records were satisfactory for most staff, two staff only had a CRB / POVA check completed by a previous employer. These checks are not transferable and need to be completed when a person applies to work at the home. There was also no evidence that a POVA First check had been completed for these two staff. The registered provider therefore cannot be assured there are not staff working in the home that are not suitable to be working in a care environment. This matter is discussed further in the staffing section of the report. No allegations of abuse have been made regarding people living in this home. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Carrick Lodge provides a suitable facility to provide care for elderly people. However parts of the building seem neglected, run down, and need refurbishment and redecoration. Bathroom and toilet facilities need improvement to offer suitable facilities to the frail and elderly. Current standards deflect from the general good standard of care, which is provided at the home. However the building is clean and relatively homely. With improvement Carrick Lodge will provide suitable facilities to meet their needs. EVIDENCE: The building was inspected. Various improvements are required so Carrick Lodge meets the environmental National Minimum Standards and associated Care Homes Regulations. For example: • Carpets: Some of the hall carpets are badly stained and do not look clean, welcoming or homely. • Toilet facilities: The downstairs toilet needs refurbishment and redecoration. There is a shower in this room, which is not now used as it Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 19 • • • • • • • • • • • has been deemed unsafe. This could be removed as long as there are satisfactory bathroom facilities elsewhere on the ground floor. Otherwise this room could be converted into a wet room, and a toilet could be situated elsewhere (as long as this is near to the communal lounges). There are still not enough bathrooms on the upper floors. One of the bathrooms on the second floor was locked and not used at the time of the inspection. The national minimum standard states there should be at least one assisted bath / shower to every eight people living in the home. A statutory requirement has been renotified regarding this matter. Another bathroom (opposite room 6) is also used for storage and this could create a risk for people living in the home when the bathroom is used. Items for storage need to be removed and stored elsewhere. The toilet opposite room 7 had no light bulb. Some toilets did not have toilet roll holders, and no soap was present by some wash hand basins. The laundry floor is damaged and needs replacement. A statutory requirement has been renotified regarding this matter. The food store carpeting should be removed and replaced with an impervious floor covering. The lounges and some areas of hallways and corridors need refurbishment and redecoration. For example wallpaper is peeling, and some paintwork is chipped. Some furnishings are now in need of replacement for example in the lounges and conservatory. The outside of the building needs some maintenance. For example some of the woodwork is rotten, and some of the woodwork needs to be repainted. Some areas outside need tidying, for example, some areas of the car park could do with a good sweep and tidy on the day of the inspection. The sign at the roadside of the home states Carrick Lodge is a ‘nursing home.’ This is inaccurate and misleading. These issues really detract from the generally good care provided and could put off many potential residents and their families. Where necessary previous statutory requirements have been renotified, and further statutory requirements have been issued. The registered provider said: • The carpets in some of the downstairs hallways will be replaced. • The shower in the downstairs toilet will be removed / replaced. (However the registered provider must ensure there are satisfactory bathing facilities downstairs and the requirement at the end of this report is fully addressed). • The laundry floor covering will be replaced. • There are plans to redecorate the lounge. • There are plans to replace some of the furniture in the lounges. • The sign at the gate of the home will be repainted. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 20 The other issues outlined above however do need to be addressed and an action plan (with timescales) is required from the registered provider. Bedrooms in the home are generally to a good standard. Decorations are to a good standard, and bedrooms are individual and clean. One bedroom accommodates four people. It is very unusual for a bedroom occupying more than two people to still be used in a care home. The registered provider said he would convert it into two en suite double bedrooms when finances allow. Such plans should be discussed with the Commission before they are actioned. The registered provider has tried to make the bedroom pleasant as possible, and current people who occupy the bedrooms spend most of their waking day in the downstairs lounges. However, the accommodation is not really satisfactory and should be reconfigured at the earliest opportunity. The home has two lifts and a chair lift to enable access to upper floors. The home has a pleasant garden which people living in the home use on a regular basis. The facility appears to be used by people safely with minimal staff support, although one person said the ramp from the lounge was too steep for them to use on their own. The home was clean on both days of this unannounced inspection. The Commission has received complaints and comments regarding unpleasant odours in the past. However these were not evident on the days of the inspection, and the registered provider said staff did their best to ensure appropriate action is taken to avoid these occurring. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate although significant improvement is required regarding staff training. This judgement has been made using available evidence including a visit to this service. Staffing levels are to a good standard and should ensure people who use the service receive appropriate levels of support when they need it. Recruitment procedures need improvement so people who use the service can be assured they are in safe hands and protected at all times. Staff training requires considerable improvement so staff have appropriate knowledge and skills to support people who use the service. EVIDENCE: On the first day of the inspection the following staffing was provided: • • • • • Three members of staff on duty from 08:00 to 14:00 One member of staff from 06:00 to 13:00 Three members of staff on duty from 14:00 to 20:00 One member of staff from 16:00 to 20:00 Two waking night staff from 20:00 to 08:00 In addition the registered provider and an administrator were working in the office. The cook, two cleaners, a handyperson, a laundry person and the activities co-ordinator were also working in the home. Similar staffing was provided on the second day of the inspection. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 22 People who use the service were positive regarding the support they received from staff. Comments were made that staff were approachable and worked well as a team. The registered provider has a suitable approach to enabling staff to have the opportunity to obtain a national vocational qualification (NVQ) in care. The registered provider said most staff either possess an NVQ 2 or 3 in care or are completing this qualification. However there was little evidence of completion (e.g. a copy of certificates) contained in staff personnel files. The home’s Annual Quality Assurance Assessment (AQAA) [An annual return which registered provider’s are required to return to CSCI], states 54 (6) have an NVQ with the remaining staff (7) working towards this qualification. A copy of completed NVQ certificates need to be kept on the individual personnel files. Recruitment checks completed when staff are employed are only adequate. The records of twelve staff (i.e. all the staff on duty on 2nd August 2007) were inspected. This included two staff that commenced employment since May 2007. Records show all staff have an application form, copies of two references, and some records regarding training received. However, there is no evidence that the majority of staff have, as required by the regulations; • Proof of identity (although this must be seen in order for the person to apply for a CRB). • A statement by the person as to his mental and physical health. All staff had a Criminal Records Bureau (CRB) check, although two staff only have a check from a previous employer. These checks are not transferable between employers. These two staff had no evidence that a Protection of Vulnerable Adults ‘First’ (POVA First) check had been completed. It is illegal not to check employees against the list of people who should not work with vulnerable people (POVA list) before the person commences employment. Training records were also inspected for the same sample of employees. By law all staff must have: • Regular fire training in accordance with the requirements of the fire authority. • There must always be at least one first aider on duty (at appointed person level). • All staff must have manual handling training. • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. • All new staff must have an induction and there should be a record of this. Records kept to evidence appropriate staff training are poor. There are significant gaps in training required by regulation. For example: • Fire Training. Five staff had attended a formal course, but no other records of fire training were seen. This needs to be acted on as a priority. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 23 • • • • First Aid. No staff in the sample had a first aid certificate including night staff. This needs to be acted on as a priority. Manual handling. Six staff had received some manual handling training, but only two staff had received this training in 2006, and training is required annually. This needs to be acted on as a priority. Infection control. No staff in the sample had received training in this area. Food hygiene. One member of staff in the sample had training in this area. The registered provider said both cooks had a food hygiene certificate. The provider said the manager had recently completed a manual handling ‘training the trainers’ certificate and would now be training the staff in this area. It is important manual handling training is comprehensive, a copy of the outline of training programme people will complete is available, and there is evidence the training programme has been completed by staff. Staff also need to receive training regarding the needs of people with dementia and mental health needs. Of the sample there is evidence that only one member of staff had a written record of an induction (in 2004). Several staff that commenced employment since 2006, who the inspector spoke to, said they had received an induction. They said this included shadowing more experienced staff. However it is essential staff induction is always recorded; for example a comprehensive checklist is in place. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate, although health and safety standards need significant improvement. This judgement has been made using available evidence including a visit to this service. Management arrangements currently do not meet regulatory requirements, as the current manager is not registered with the Commission for Social Care Inspection. Having an approved registered manager in charge of the home will ensure there is a legally accountable person managing the home on a day-today basis. The registered provider must improve the home’s approach to managing quality. This will assure people who use the service that there are suitable mechanisms in place for improving areas of the service where this is required. The management of monies of people who use the service is good, so if applicable, people can be assured staff look after their money appropriately. The management of health and safety needs significant improvement so people who use the service can be assured they live in a safe environment. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered provider is Mr R. Cottam. A manager has been in post for several months, although the registered provider only submitted an application to assess her fitness with the Commission on the first day of the inspection. Providing satisfactory information has been submitted the application should be determined within the next three months. Mr Cottam is based at the home, and is involved in the day-to-day management of the home, and it’s sister home, which is situated nearby. The registered provider has a quality assurance policy, which is satisfactory. For example, the policy outlines that there will be monthly audits of management systems, resident and staff meetings, and an annual audit. Although this is a good model there is little evidence the policy has been implemented. However there is evidence that staff have received an annual appraisal. Staff and residents spoke positively about care practices in the home. A copy of the homes Annual Quality Assurance Assessment has been submitted to the Commission, which outlines some plans the registered provider has for service improvement. However internal systems do need development for example to improve the environment, and to ensure employment and health and safety checks are completed appropriately. Policies and procedures, unless stated elsewhere in this report, appear to be satisfactory. Policies should also have details of the CSCI office now this is situated in Devon. Management of the monies of people who use the service is satisfactory as outlined under NMS 14. The registered provider has a health and safety policy. The fire prevention system was last serviced in September 2006 and is next due in September 2007. Records for the servicing of fire extinguishers were not seen. The home has a fire risk assessment, which was developed in January 2006. Staff regularly test the fire alarms and emergency lighting according to the logbook. Health and safety risk assessments were completed in June 2007. These are to a satisfactory standard, although there is not a risk assessment regarding the prevention of legionella (or what appears to be any precautionary measures regarding this matter) as required by regulation. The Health and Safety Executive publishes useful publications regarding what needs to occur regarding this matter; for example see: http:/www.hse.gov.uk/pubns/indg253.pdf Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 26 Advice can also be sought regarding this matter via the local environmental health department, which is the regulatory authority regarding this issue. The registered provider has said the water tank has been checked and is covered. The passenger lift appears to be satisfactorily maintained, for example this was last serviced in June 2007. The stair lift was last serviced in July 2007. The registered provider said gas appliances and the boiler were to be serviced later in the week of the inspection. A copy of the gas safety certificate needs to be forwarded to the Commission. The registered provider said the maintenance man serviced portable electrical appliances. However no records have been maintained regarding these tests, and this measure must be introduced. The electrical hardwire circuit needs to be tested. This test is required every five years, must be completed, and the certificate available for inspection. A certificate of compliance must be forwarded to the Commission for Social Care Inspection. Suitable records of servicing of bath hoists and mobile hoists are maintained. This equipment was last serviced in July 2007. There is no record the emergency call bell system is serviced and this needs to be completed in line with the manufacturers instructions. The owner said the boiler controls the temperature of hot water. No records are kept regarding bath temperatures. These need to be maintained, and the temperature checked before residents have a bath. Otherwise thermostatic temperature valves need to be fitted to baths. The Environmental Health Officer last visited the home to inspect food standards in March 2007. Standards were seen as generally satisfactory although some legal requirements were made. Training in various aspects of health and safety need to take place so the registered provider meets legislative requirements (e.g. moving and handling training, fire training). This is outlined in the previous section of the report. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 1 X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 01/09/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (For example the issues of concern raised in the report need to be addressed, and appropriate monitoring of the system, by the registered provider, need to take place). 01/12/07 Requirement 2. OP29 13, 18, 19 The registered person shall ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (For example all staff who are involved in the management and administration of medication must receive formal training for example from a pharmacist) Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 29 3. OP29 OP18 18. 19 4. OP18 13(6) The registered person shall not 01/09/07 employ a person to work at the care home unless the person is fit to do so. Satisfactory checks must be completed on the person to ascertain this. (For example a Protection of Vulnerable Adults ‘First’ check and a Criminal Records Bureau check etc. as outlined in Schedule 2 of the Care Homes Regulations 2001). The registered person shall make 01/12/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (For example the registered provider must: • Have a suitable adult protection policy and procedure. A copy of the policy should be forwarded to the Commission within the timescale. • Make arrangements for staff to have training regarding the prevention of abuse) Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 30 5. OP19 16, 23 (2) (b)(d) (l)(o) The registered person shall 01/03/08 having regard to the number and needs of the service users ensure that— (1) The premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; (2) All parts of the care home are kept clean and reasonably decorated; (3) Suitable provision is made for storage for the purposes of the care home; (4) External grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained; (For example the registered provider needs to provide the Commission with a maintenance and refurbishment plan outlining how concerns outlined within the report will be addressed and within what timescales.) The registered provider must provide the Commission with an action plan no later than 01/10/07 regarding how it is intended to meet the requirement within the timescale. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 31 6. OP21 23(2)(j) The registered provider must ensure there are provided at appropriate places in the premises sufficient numbers of lavatories, and of washbasins, baths and showers fitted with a hot and cold water supply. (For example all the bath and shower rooms at the care home must be functional and safe for use by service users-otherwise the registered provider must provide an alternative written plan to the Commission outlining how he intends to meet this regulation and within what timescale.) [Previous timescale of 30 April 2007 not met 2nd Notification]. 01/12/07 7. OP26 13(4)(c) 16(2)(j) 01/12/07 The registered person shall having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. (For example the flooring in the laundry room needs to be replaced with a suitable flooring covering). [Previous timescale of 30 January 2007 not met 2nd Notification]. Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 32 8 OP29 OP28 18. 19 The registered person shall ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This must include suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (For example: (a) This must include training required by regulation such as infection control, food hygiene, Fire training, manual handling training and first aid. [Regarding fire training: previous timescale of 30 December 2006 not met 2nd Notification]. (b) Training regarding people with dementia and mental health needs. ) Suitable records of training e.g. NVQ and other training certificates need to be maintained and available for inspection. The registered provider must provide the Commission with an action plan no later than 01/10/07 regarding how it is intended to meet the requirement within the timescale. The registered person shall ensure that the persons employed by the registered person to work at the care home receive suitable structured induction training. Suitable records must be maintained regarding this. 01/03/08 9. OP29 18. 19 01/09/07 Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 33 10. OP33 24(1) The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home (For example the registered provider must develop a policy regarding what measures to maintain and improve the quality of service will take place, and this must be implemented within the timescale set). 01/12/07 Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 34 11. OP38 12, 13(4) 23(2)(c) Carrick Lodge The registered person shall 01/12/07 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Any unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Any equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order (For example: • Ensure a risk assessment is completed regarding the prevention of legionella, and any necessary preventative measures are taken to prevent legionnaires disease. • Ensure portable electrical appliances are tested according to HSE guidelines and a record of tests is maintained. • Ensure the electrical hardwire circuit is tested at least every five years, and a safety certificate is obtained. This must be forwarded to the Commission within the timescale set. • Ensure a gas safety certificate is obtained. This must be forwarded to the Commission within the timescale set. • Evidence the emergency call bell system is serviced. This must be forwarded to the Commission within the timescale set. • Maintain a record of the DS0000008919.V342843.R01.S.doc Version Page 35 temperature of hot water 5.2 (for baths and shower facilities) 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 OP3 OP8 OP9 Good Practice Recommendations The registered provider should obtain a copy of the social services / NHS assessment as part of the assessment process for people moving into the home. Set up a record of medical appointments for each service user. Regarding PRN medication: • Complete a risk assessment for any medication related to mental health e.g. when it should be administered. • Ensure clear records are maintained regarding how many tablets are administered and why • Maintain an ongoing stock count. A hot and cold option of evening tea is offered each day 3. OP15 Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP (Covering Cornwall, Devon and The Isles of Scilly) 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 Carrick Lodge DS0000008919.V342843.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!