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Inspection on 26/07/05 for Carrington House

Also see our care home review for Carrington House for more information

This inspection was carried out on 26th July 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provides a good standard of accommodation where service users are supported to personalise their rooms and bring items of furniture where space allows. The staff are knowledgeable with regards to the service users needs and preferences. The home has a relaxed atmosphere where service users are positive about the efforts made by the staff to meet their needs.

What has improved since the last inspection?

The home has had major improvements to the communal areas, bathrooms and most of the service user bedrooms. The hallways have been redecorated and carpeted whilst the bathrooms have been refitted with new specialist assisted baths and new anti slip floor coverings. They have created a part time post of activities organiser. The service users who the inspector spoke with were very complementary with regards to this new service.

What the care home could do better:

The statement of purpose and service user guide needs to accurately reflect the current services on offer at the home. The manager needs to ensure that the pre-admission information is thorough and ensures that all parties are clear as to regards to the expectations of the placement. It would be helpful if the organisation adopted a discharge review where respite and interim service users could comment on their own individual experience.Care plans need to reflect personal preferences, expectations and aspirations of the service users. The review process must explore and reflect on significant events that happen, such as falls. The registered manager needs to contact the regulator should a future service user require nursing care but cannot be placed in a suitable environment. They also need to ensure that staff have further opportunities to refresh their vulnerable adults training.

CARE HOMES FOR OLDER PEOPLE Carrington House Carrington Way Wincanton Somerset BA9 9BE Lead Inspector John Hurley Unannounced 26th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Carrington House Address Carrington Way Wincanton Somerset BA9 9BE 01963 32150 01963 33590 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Somerset Care Limited Miss Karen Smith Personal Care Home Only 44 Category(ies) of Old Age (44) registration, with number of places Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2nd March 2005 Brief Description of the Service: Carrington House provides residential care to 44 adults within the Old Persons category of registration. The home is part of Somerset Care Limited. The home was built in the 1960s on a hillside in the centre of Wincanton, close to shops a medical centre and other amenities. All areas of the home are accessible by passenger lift. Access to and from the home is difficult for frail service users due to the gradient and length of the path. There is level access at the back of the building from a small car park to the middle floor of the home. There are bedrooms and communal rooms on all three floors.There are small patio areas by the front door and at the back of the building that service users can access. The home’s kitchen provides for all catering needs of service users. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over eight hours, on two separate days. The inspector viewed all areas of the home and met with thirteen service users. The inspector did not have an opportunity to meet with relatives during the inspection. The inspector spoke with several staff on duty and briefly met with the area manager responsible for the home on the second visit. A number of records were examined including four service users care plans, risk assessments, health and safety records and staff recruitment files. What the service does well: What has improved since the last inspection? What they could do better: The statement of purpose and service user guide needs to accurately reflect the current services on offer at the home. The manager needs to ensure that the pre-admission information is thorough and ensures that all parties are clear as to regards to the expectations of the placement. It would be helpful if the organisation adopted a discharge review where respite and interim service users could comment on their own individual experience. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 6 Care plans need to reflect personal preferences, expectations and aspirations of the service users. The review process must explore and reflect on significant events that happen, such as falls. The registered manager needs to contact the regulator should a future service user require nursing care but cannot be placed in a suitable environment. They also need to ensure that staff have further opportunities to refresh their vulnerable adults training. 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. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5,6 The information provided to prospective service users needs to be accurate and up to date. When accepting interim or respite care this should only be offered when the homes management has good up to date information, which includes the prospective service users views, needs and wishes. The care plan for respite and interim placements need to set out likely time scales for any intervention and indicators that will be used to evaluate the effectiveness of the plan. EVIDENCE: The inspector sampled the statement of purpose and service user guide. These two key documents do not accurately reflect the types of service on offer in the care home. This is with specific reference to respite and intermediate care. The registered manager acknowledged this. The rooms that have been allocated as interim care beds are also used for respite care. Further more the beds that had originally been allocated as interim care beds are no longer available due to cost, these being larger and offering en-suite and kitchenette facilities. Those that are now allocated do not Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 9 easily offer the opportunity to promote independence and rehabilitation of the service user. A sample of the service users files was examined. The file concerning the last service user to take up residency contained good details relating to the individuals presenting issues. This care assessment had been completed by social services and was complemented by a discharge assessment and summary from the local hospital. This is not always the case. The service users documentation, which had been placed in one of the allocated interim care beds, did not clearly indicate their respite status. The discharge summary from hospital did not recognise any social or emotional needs. The community assessment completed by the care manager pre dated the hospital admission by some months and so was not robust enough to build a person centred care plan. Therefore, there was insufficient evidence that the care manager had been involved in the respite admission A service user told the inspector that they had been in residence since the beginning of the year. The said they had originally came into the home for a short break (respite care) and had taken the opportunity to take up residency on a permanent basis when things got too much at home. They confirmed that they had been given written information on the home and that they had agreed to the actions taken. They further told the inspector that their family had also came to see the home and talk with staff before they moved in. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 The care plans and associated periodic reviews need to accurately reflect the social, emotional, health and personal care needs of the service user. When assessments of needs indicate high levels of dependency, such as close observation at key times of the day, these observations must be made in such a way that respects the dignity of the user. EVIDENCE: The care plans that were sampled appeared to reflect some of the key areas of the original assessment, but not all. One service users pre admission assessment states that they can be aggressive and abusive. The care plan and associated risk assessments do not reference this information. The staff informed the inspector that this behaviour has not been apparent in the home and they do not consider this to be an issue, however this judgement is neither recorded nor made in a risk assessment framework. Social needs are not always formally acknowledged in the care planning documentation. For most of the service users the documentary evidence available appears to suggest that a range of health care professionals meets individuals health care Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 11 needs. Several service users confirmed that a General Practitioner, District Nurse and Chiropodist regularly visit the home. At the time of the inspection one service user was assessed as requiring nursing care. This individual has been assessed as requiring observation when eating due to poor swallowing reflexes, but no extra staff hours had been made available to meet this individuals increased dependency. Observations of this service user were achieved by leaving the service users door open, the manager watching from their office across the corridor. This practice does not meet the assessed needs and undermines the individual’s dignity. Another individual’s discharge summary from hospital states that the service user was on an air mattress at the hospital and that their tissue viability was poor. The care plan observed did not recognise this. The registered manager stated that they had made their own assessment and considered that this is no longer the case. It would be helpful if the service users file documented this assessment. The service users file of the individual who was receiving respite care as discussed in the preceding section lacked sufficient evidence to clearly demonstrate that a strategy was in place for the individuals return to their home. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 The daily rhythm of life at the home appears to meet most of the service users expectations and requirements. The service users appreciate the staff’s hard work. They are also complementary about the environment, food and activities. The service users report good levels of choice and autonomy. EVIDENCE: All of the service users spoken with agreed that the daily routines of the home suited their own individual expectations. There was a general consensus amongst the service users that the new activities that are being arranged are being well received. These include group trips to local attractions as well as individual trips to the town to shop or to go for a pub lunch. There appears to be a good balance between external activities on group and individual levels and internal activities such as exercise and bingo. The inspector spoke with the activities organiser who was able to demonstrate that they, with the help of the other staff, are developing a portfolio of activities that the service users enjoy. Several service users confirmed that people important to them could visit at any reasonable time. They also spoke about being able to tell the staff when they did not like something and that they (the staff) respect their right to speak out. One service user cited an incident relating to their laundry being confused with another individual, another service user spoke about the time they did not like the menu and how they were able to have alternatives. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 13 The lunch was briefly observed. It was served in a large communal dining area. The tables had tablecloths and the room was set out as you would expect considering over twenty people were eating at the same time. The meal was served in an unhurried manner. Meat was served on individual plates with vegetables provided separately so that those who were able could help themselves. Staff assisted those individuals who could not easily make these choices. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The service users and staff generally understand the complaints procedure There is a need to ensure that all staff understands the organisations corporate procedures with regards to vulnerable adults procedures and protocols. EVIDENCE: The service users informed the inspector that they feel able to raise issues with the staff and management. The home adopts a corporate style complaints procedure that is available to service users and people important to them. There has been one issue raised by a member of the public that the regulator is aware of. The records viewed indicate that this matter was explored at the time it was raised and a written response given. The registered manager informed the inspector that no other complaints have been made. The inspector spoke with staff about vulnerable adults procedures and how to respond to suspected abuse. Whilst the staff insisted that they would do something about suspected abuse they were unclear as to the corporate policy which has been adopted. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23 The home provides a good standard of accommodation, which has a degree of domestic character. Bathing facilities are clean and modern. EVIDENCE: The programme of refurbishment is now nearly completed and the home is presented as most attractive and comfortable throughout. Bathrooms and WCs had been upgraded and adapted to a high specification. The communal areas are generally pleasant with many of the fixtures and fittings of a domestic nature. All rooms were lit with domestic style lighting supplemented by emergency lighting in the case of fire. Service user’s bedrooms are furnished and decorated to a good standard and reflect individual taste in décor and furnishings. Staff confirmed that service users were able to bring items of personal furnishings to their room. The service users who commented expressed satisfaction with the facilities provided. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 16 The risks associated with the environment are noted in the individuals care records. Laundry facilities are on site, service users confirmed that their laundry is washed and returned promptly. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 Given the diversity of the services on offer, respite, interim and residential care the home needs to ensure that the staffing levels reflect the assessed needs of the service user. The home also needs to be able to demonstrate that it can increase and decrease its staffing hours in line with these assessed needs. The employment procedure needs to ensure that up to date guidance is followed. EVIDENCE: The inspector was informed that the organisation currently determines carestaffing levels using guidance published by the Department of Health. The homes staff structure is generally divided into three separate areas management, care staff and ancillary workers. As a general rule senior management (deputy and manager) do not undertake a hands on care role however, there is some expectation that other staff having a supervisory role (shift leaders) will carry out hands on care when required. Care staff carry out a hands on care role, ancillary staff (cooks, cleaners, administrators etc) support all of the above. The staff rotas indicate that the home operates a rolling two-week rota. The inspector decided to examine the management and care staff arrangements for Thursday and Saturday for illustration purposes. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 18 On Thursday of week one both manager and deputy were on duty between 8am and 5 pm. One shift leader was on duty between 7.45am to 2.pm supported by three care staff with another staff member providing a short shift between 7am to 10am. From 2 pm until 4.30pm the shift leader is supported by two care staff, from 4.30 until 9.30 another care staff member adds to the overall numbers. One member of care staff supports the night shift supervisor from 9pm until the next day. On Saturday of week one neither the deputy nor manager are on duty. One shift leader is on duty between 7.45am to 2.pm supported by three care staff with another staff member providing a short shift between 7am to 10am. Again another shift leader takes over from 2pm until 9.15pm, supported by two staff, the rota observed suggests that one other post for that shift is vacant. Two members of staff again provide the night shift. Through general discussions with the area manger the inspector established that a dependency analysis related to the needs of the current service users group had not been made for some time. The inspector asked the staff if requested could service users have baths in the afternoon instead of the morning. Staff informed the inspector that it would be problematic due to staff numbers. Service users commented that they felt the staff work very hard and wished there were more of them. The rotas indicate that at least one member of care staff works 12 days then has two days off before beginning another 12 days. The records of the last staff member to be appointed was sampled but did not demonstrate that all of the statutory checks had been carried out prior to this person taking up their role. The individual did not have a cleared Protection of Vulnerable Adults ( POVA 1st ) check. In mitigation the registered manager showed the inspector corporate guidance, which suggested that prospective employees could start without a POVA 1st check as long as it was applied for, this guidance is out of date. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,32,38 The home is being managed well but improvements are necessary. Attention is needed with regards to risk assessments and analysis of a situation following significant events such as falls. EVIDENCE: As illustrated in the preceding section relating to staff there is a clearly defined management structure in place. The registered manager has extensive experience of working with older people and continues to train in this field. The service users are able to identify the registered manager and inform the inspector that they can speak with them if they have concerns. Similarly staff are supportive of the manager and again appear confident with the management arrangements. The Health and Safety of service users and staff is generally addressed through risk assessment process. Whilst there is a good activities programme the activities, which are attended away from the home, are not risk assessed. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 20 The inspector noted that service user falls are recorded but not always analysed and so the risk assessment is not robust, as it is not updated in line with presenting situations. The home’s registration does not include nursing care. As acknowledged in the preceding sections of this report nursing care has been provided for a significant time at the home. The area manager for the home informed the inspector that this is not uncommon as the lack of specialist beds inhibits service users moving on to services more appropriate. Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 x 3 x x x STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x x 2 Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation schedule 1 Requirement Timescale for action 31/08/05 2. 38 3. 10 4. 27 5. 18 6. 1 The registered person must amend the statement of purpose and service user guide to ensure it accurately reflects the services on offer 13 4(a)(c Risk assessments must be conducted for all safe working practices. Significant findings of the risk assessments must be recorded 12 (5) The registered manager must (a)(b)(4) ensure care practices treat the (a) service users with dignity and respect at all times. 18(1)(a) The registered person must provide the Commission with a breakdown of their staffing arrangements which demonstrates that the staffing levels in the home meet the assessed needs of the service users at all times. 19(1)(b)(c The registered manager must ) ensure that no prospective staff member takes up a post without having undergone the necessary checks Schedule The registered manager must 1 not provide nursing care to any service user without consultation with the regulator. D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc 14/08/05 26/07/05 1/09/05 26/07/05 26/07/05 Carrington House Version 1.40 Page 23 7. 8. 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 7 38 18 Good Practice Recommendations That the registered manager should consider giving respite and interim service users exit questionnaires or reviews That the registered manager should consider clearly making on the service users files the status of their placement, respite or interim care. The registered manager should consider ensuring that training opportunities are made available to all staff with regards to the vulneralable adults policy Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carrington House D53 - D02 S16102 Carrington House V240627 260705 Stage 4.doc Version 1.40 Page 25 - 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!