This inspection was carried out on 10th June 2009.
CQC 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Carshalton Nursing Home 28 Salisbury Road Carshalton Surrey SM5 3HD zero star poor service 16/12/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alison Ford Date: 1 0 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Carshalton Nursing Home 28 Salisbury Road Carshalton Surrey SM5 3HD 02086692592 02086699558 sweethomes@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sweet Homes Ltd care home 33 Number of places (if applicable): Under 65 Over 65 10 33 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 33) Dementia - Code DE(E) (of the following age range: 65 years and older) (maximum number of places: 10) Date of last inspection Brief description of the care home Carshalton Nursing Home is registered to provide care for up to thirty-three older people who may have dementia. 1 6 1 2 2 0 0 8 Care Homes for Older People Page 2 of 11 Brief description of the care home As an existing care home the facilities would not meet the requirements of a newly registered home. A large proportion of the accommodation is provided in what were previously designed to be shared rooms, without en-suite facilities and others are smaller than would now be acceptable. There is only one lounge/dining area and this is in the form of a conservatory, which despite fans, is sometimes uncomfortably hot. There is a shaft lift to ensure accessibility throughout the home and the conservatory overlooks the rear garden. There is limited off-street parking however, the home is in a quiet road and close to public transport links. At the time of this inspection we were told that fees range from £525- £850 per week. Any extra charges payable for services such as hairdressing would be discussed prior to admission. A copy of the homes Statement of Purpose, Service User Guide and the latest inspection report can be obtained from the homes Registered Providers or the latter can also be obtained from the Commission For Social Care Inspection from their website. www.csci.org.uk Care Homes for Older People Page 3 of 11 What we found:
This inspection was undertaken to check the homes progress in addressing the requirements made at the last key inspection, which was undertaken on 30th April 2009. The Commission is concerned about the continued lack of compliance with requirements that are issued therefore, this visit was undertaken in conjunction with a member of the enforcement team. At this inspection we found that there were errors in the safe handling and administration of medication. Records were not all accurate and there were some concerns raised that residents may not be receiving all of their medication as it has been prescribed by their Doctor. The home uses a blister pack system and records the receipt and administration of medication on individual Medication Administration Records. We found some omissions in recording and there were also some discrepancies in the amount of medication still remaining in the packs. One resident is prescribed Digoxin 6.25mcg daily. We noted that on 5th June 2009 the medication had been signed for but was still in the pack and had not been administered. One resident is prescribed Citalopram 20mgs daily. According to the record sheet there should have been twelve tablets left however, there were only eleven. One resident is prescribed Loperamide 2mg capsules. Eighty four capsules had been received on 31st may 2009 and, according to the records, four had been given between that time and the th June. However we found one hundred and one capsules remaining rather that the eighty there should have been. On one residents records we noted that there had been twenty six Co Codamol tablets on 31st may 2009. Two tablets were recorded as have been given since that time however the nurse was unable to find the remaining tablets. We also found that topical cream was left in a residents room and was unlabelled. We were told that it was being used however there was no evidence that it had been prescribed for her. We found that care planning did not always reflect the assessed needs of the residents. Some people had been assessed as having a high risk of developing pressure sores and yet appropriate interventions such as pressure relieving equipment had not been put in place to minimise the risk. One resident had a waterlow score recorded as being 17 which is a high risk. This had not been reviewed for several months. Their record detailed several physical and mental health conditions which would indicate that they were at risk of pressure sores however, the home had failed to identify and address any of these risks. The care plan stated that pressure relieving equipment was in place however when we looked there was no pressure relieving mattress on the bed and we were told that it had been sent for repair. Care Homes for Older People Page 4 of 11 Wound care practices were not properly documented and this had resulted in inconsistencies in treatment. One resident had had her pressure sore dressed with one product by the nurse and a few days later another nurse had used a different product. None of this was documented. There was little evidence that residents are able to contribute to the care planning process and influence the way that they are supported. Activities which meet the needs of people with dementia are limited. In the care plan that we looked at there was no evidence to show that residents are consulted about their interests so that activities which suit them can be organised. The home does now keep a log of activities which are arranged but we have no way of knowing if these are of any interest to the residents in the home. There was still insufficient evidence available to confirm that there is a robust recruitment procedure in place. Therefore we cannot be sure that residents are protected from those who have been judged as being unsuitable to be working with vulnerable adults. We have asked the provider to ensure that this information is in the home and available for us to see whenever we inspect. The providers were in the middle of putting new curtains up in the lounge. We did raise some concerns about the lack of privacy that these would provide and he agreed to address this. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking
Care Homes for Older People Page 5 of 11 following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 30 18 Staff must receive regular training appropriate to the work that they perform. So that they are kept updated and are able to meet the needs of the people that they are caring for. 30/08/2009 2 31 26 There must be records 30/06/2009 available to show that The Registered Provider visits the home. As evidence to show that they are happy with the standard of care being provided by the home. 3 38 37 The Care Quality Commission 30/06/2009 must be informed of any incident affecting the health and safety or wellbeing of anyone in the home. In order to monitor the situation in the home and plan any future inspection activity. Care Homes for Older People Page 7 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Service users care plans must be kept under review and where appropriate revised in order to detail the arrangements in place to meet changing needs. To ensure that any changes are identified and adddressed. 10/07/2009 2 7 15 Written care plans must 10/07/2009 detail the arrangements in place to meet the health and welfare needs of the service user. So that everyone is aware of the way that they need to be supported. 3 7 15 A written care plan must be prepared for each service user after consultation with the service user or their representative unless it is not practicable to do so. So that they have the opportunity to influence the way that care is provided. 10/07/2009 Care Homes for Older People Page 8 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 4 9 13 Medication received in to the 10/07/2009 home must be properly recorded, handled administered and disposed of. To protect residents and ensure that they receive their medicatiobn as it has been prescribed. 5 12 1 There must be proper 10/07/2009 intervention and treatment in relation to any wounds on service users. To ensure that residents are receiving the most appropriate care. 6 12 1 The home must be conducted in a way which makes proper provision for the care and treatment of service users To ensure their safety and well being. 10/07/2009 7 22 2 All equipment in the home must be kept in good working order. In order to protect the health and safety of both residents and staff. 10/07/2009 8 29 17 There must be evidence, available for inspection, to show that no one is employed without all of the necessary checks being carried out. 10/07/2009 Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action In order to maintain the protection of residents in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 There should be regular audits of medication procedures in the home so that any errors can be identified promptly and rectified. Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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!
