Inspection on 16/11/05 for Carter House

This inspection was carried out on 16th November 2005.

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

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

Other inspections for this house

Carter House 31/05/07

Carter House 20/06/06

Carter House 29/06/05

Carter House 16/03/05

Carter House 26/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Carter House 1&2 Farnham Gardens West Barnes Lane London SW20 0UE Lead Inspector Emma Dove Unannounced Inspection 16th November 2005 10:10 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 Carter House DS0000042026.V268886.R01.S.doc Version 5.0 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. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Carter House Address 1&2 Farnham Gardens West Barnes Lane London SW20 0UE 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) 020 8947 5844 Central & Cecil Housing Trust Ms Hilma Dunn Care Home 45 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (23) of places Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Nursing Places To include no more than 15 service users requiring nursing care at any one time. Dementia Places To include no more than 22 service users with Dementia at any one time. Nursing Unit 2nd Floor - Qualified Staff A qualified 1st level nurse must be available on the nursing unit at all times. This person must not have any management responsibilities for the home other than within the nursing unit. Care Staff - All Floors 07:30 hrs to 14:45 hrs - a minimum of seven care assistants must be available at all times. 14:15 hrs to 21:30 hrs - a minimum of six care assistants must be available at all times. 21:00 hrs to 08:00 hrs - a minimum of five care assistants must be available at all times. Management One full time manager 40 hours per week. One full time deputy manager 40 hours per week. A member of the management team to be available seven days each week. Ancillary Staff Administrative staff 37.5 hours per week Domestic staff 136.5 hours per week Cook 49 hours per week Kitchen assistants 102 hours per week Laundry staff 70 hours per week Reviews The organisation must ensure that the above minimum staffing levels remain under review and that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. Distribution of staff The number and distribution of nurses, care staff and ancillary staff must be reviewed at regular intervals. If at any time the evidence indicates that there are insufficient staff of any category available to meet the assessed needs of service users, the CSCI will require additional staffing as appropriate. 4. 5. 6. 7. 8. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 5 Date of last inspection 29 & 30/06/05 Brief Description of the Service: Carter House is a purpose built care home, which has the capacity to provide nursing care for fifteen older people and residential care for thirty older people, twenty-three of whom may have dementia. Forty-five residents are currently residing at the home with one resident in hospital. The home is owned and managed by Central and Cecil, a charitable organisation who own and manage four other similar services in the Merton and Richmond area. Accommodation is provided over four floors with a lounge, dining room, kitchenette, bathrooms and single bedrooms available on all four floors. Residents have access to enclosed gardens to the rear and side of the home. A lift serves all floors of the home. The home is situated in a residential area of Raynes Park, close to local shops, public transport, churches of a number of denominations and leisure facilities. The home is staffed twenty-four hours a day by trained nursing staff and care assistants. Residents receive three meals each day with drinks and snacks available between meal times. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of eight hours, one day by three regulatory inspectors. The inspection consisted of examination of records, talking with residents, relatives and staff. The inspectors had the opportunity to speak with fourteen residents, five visitors, six members of staff and the deputy manager. The inspectors were let into the home by a member of staff and left in the entrance for over five minutes until they sought a member of staff to assist. This issue was discussed with the deputy manager who will be raising it with staff. What the service does well: What has improved since the last inspection? What they could do better: Consider revising the fees for residents to be the same for residents receiving the same services. Care plans must include more details to ensure that residents needs are recorded and can be met by staff. Care plans must be reviewed every month. Detailed risk assessments must be in place for all residents for safety reasons, particularly if there is a history of falls. Medication Administration Record Sheets must be signed at the time medication is administered. Risk assessments must be completed for residents who administer their own medication. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 7 Consideration should be given to reimbursing residents who purchase their own meals. The menu should be displayed for residents so they are aware of the meals to be provided. A clear record of food individual residents have eaten must be maintained. Staffing levels must be reviewed to ensure cover to enable staff to take their breaks and to ensure residents safety while staff are busy with one individual. The published staffing rota must be up to date and clearly indicate staff on duty in the home. Staff recruitment processes must be reviewed, to update the application form and give consideration to the person specification including that candidates should have some experience of care work prior to commencing employment at the home. Staff must receive training in working with people with dementia as a part of their induction and ongoing to keep up to date with changes in practice. The fire alarm must be tested weekly for safety reasons Evidence that the portable electrical appliances and the electrical supply have been tested must be available at the home. 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. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 8 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 Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 1 Prospective residents have access to appropriate information to make an informed choice regarding moving into the home. EVIDENCE: The Statement of Purpose and Service Users Guide to the home contain information to assist prospective residents in deciding to move into the home. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 & 9 Care plans are in place, however they do not contain sufficient detail for residents needs to be fully met and have not been kept up to date. Medication policies and procedures are in place to protect residents health, however some recording practices compromise residents health and safety. EVIDENCE: Care plans examined contained varying standards of information. One care plan contained good detailed information on the individuals interests, however the section regarding the individuals wishes for terminal care and death was not completed and evidence confirming the resident’s involvement in the plan was not included. One care plan included good information regarding staff assistance required when the individual is moving around the home, however records indicated the individual was not offered choice in clothing they wore. Generally, care plans must include more detail regarding individuals needs and how they should be met by staff. One care plan contained records of the individuals weight which has been monitored monthly for the last three months. Care plans examined had not been reviewed consistently which does not ensure residents needs are recorded and can be met. Daily recording was generally not very informative and included minimal information regarding social activities residents had participated in. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 11 Appropriate medication policies and procedures are in place and medication was appropriately stored at the home. Recording practices do not ensure residents health and safety is protected. Gaps were identified in Medication Administration Record Sheets and with one exception, the medication was not in the blister pack, indicating that the medication had been administered. One bottle of eye drops did not have the date it was opened recorded. One resident was self-medicating and a risk assessment had not been completed and, when an issue was identified with medication no evidence was recorded that the GP had been informed. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 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 the following standard(s): 15 Residents religious, cultural and health related dietary requirements are catered for at the home, however residents do not all get the opportunities to choose their meals or have a cooked breakfast. EVIDENCE: Residents receive three meals a day with drinks and snacks available in between meals. Records are not maintained of the food individual residents have eaten on a daily basis. Residents comments regarding the food they receive at the home was varied including ‘the lunch is reasonable’, ‘good variety at lunchtime’, ‘it’s not bad’, ‘I don’t know about the food, if I don’t like it staff get me something different’ and ‘the food is unappetising, stodgy and we don’t get a cooked breakfast’. One resident also said that they eat tea at 5pm and have nothing but drinks and a few biscuits or maybe some sandwiches until breakfast the next morning. This is a long time for residents to wait between meals. One person reported that one meal had included the main course and the pudding being served on the same plate. Staff reported that residents choose their meals the previous day, however evidence that this occurs for all residents was not available. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 16 & 18 Appropriate complaints and adult protection policies are in place at the home. EVIDENCE: An accessible complaints procedure is in place at the home with records maintained of complaints. One resident confirmed that they would speak to staff regarding issues and that they are addressed to their satisfaction. The CSCI has received three complaints regarding staffing and cleanliness at the home since the last inspection. These complaints were partially upheld and were appropriately managed by the home. The organisation has a policy for the protection of vulnerable adults with a copy of the local authorities adult protection policy available at the home. A training course for staff on the protection of vulnerable adults was cancelled and this must be rescheduled to ensure staff are fully briefed on their role and responsibilities regarding safety and protection issues for residents. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 25 Residents live in a safe and comfortable environment. EVIDENCE: The home was purpose built to meet the needs of current residents. No issues were raised regarding heating, lighting and ventilation. Emergency lighting is in place throughout the home which is checked at the appropriate intervals. Residents made positive comments regarding the home and their bedrooms and the cleanliness of the environment. One of the complaints received by the CSCI raised concerns regarding the cleanliness of the environment, alleging a drop in the usually high standards of cleanliness at the home. This issue was addressed at the time of the complaint and no further issues have been raised. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Residents needs are met by a small core group of staff with the support of bank and agency staff. Staff have limited access to training courses. Staff recruitment practices do not fully protect residents from harm. EVIDENCE: The published staffing rota was not up to date and did not clearly identify staff on duty at the time of the inspection. The abbreviations used on the staff rota must be clearly identified and be the same on the rota for each floor, night staff and management. The number of permanent staff employed at the home remains very low for the size of the home. The organisation has made progress in employing more permanent staff at the home, however the staffing rota identified fourteen vacant positions for both day and night staff with fourteen care staff employed at the home. These levels of permanent staff cannot provide consistency of care and good quality care to residents. A change in the agency staff used at the home during the summer caused a number of issues for residents, relatives and staff. This period of instability appears to have settled with new regular agency staff and bank staff in place to offer consistency. Residents comments regarding staff included ‘staff are alright’, ‘some staff are rude, show no respect and are not trained’, ‘the carers are very good and understanding’, ‘some staff are better than others’, ‘staff treat me with respect because I’ve got my marbles’, ‘staff are nice’. A note displayed in the office to all staff indicated that all training except the mandatory health and safety, first aid, food hygiene and manual handling had been cancelled. Staff files indicated that six members of staff have completed Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 16 training in manual handling, five members of staff have completed training in food hygiene, three members of staff have completed health and safety training and one member of staff has completed training in dementia. Six members of staff are in the process of completing NVQ training to Level 2. All staff should complete training in working with people with dementia and consideration should be given to this being added to the mandatory training. Three new members of staff are completing the TOPPS induction. Evidence was not available confirming that nurses have completed any relevant training recently. Staff files did not contain all of the required information, six files did not contain a clear enhanced Criminal Records Bureau (CRB) check, eight staff files did not have any proof of identity and ten staff files did not include copies of two written references. No indication was available at the home regarding the Protection of Vulnerable Adults initial check having been completed when staff are already at the home without a clear CRB check. Changes in legislation indicate that staff files may be held centrally within an organisation with evidence available at the home confirming checks completed and the dates information was received. Application forms for prospective candidates were observed to be partially completed, interview notes must clearly indicate what supplementary information is gained regarding applicants at interview. Adverts for vacant positions within the organisation indicated varying rates of pay at different homes for staff doing the same job. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 & 38 Residents financial interests are safeguarded by policies and practices at the home. Residents and staffs health and safety is protected by policies and procedures in place at the home, however some recording practices do not fully protect health and safety. EVIDENCE: Appropriate policies are in place regarding handling residents finances. Random examination of seven residents individual finances identified that they were up to date and the balances correct. The fire alarm has been serviced at the required intervals. The fire alarm has not been tested weekly by staff. The portable electrical appliances were tested in August 2004 and these should be tested every year. Gas safety checks were completed in April 2005 and the lift has been serviced as required. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 18 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X 3 X STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 19 YES 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 OP7 Regulation 15(1&2) Requirement The registered person must ensure that the care plans include more details to ensure all the individuals needs are recorded and can be met by staff. (previous timescale of 30/08/05 not met) The registered person must ensure that care plans are kept under review. The registered person must ensure that risk assessments are completed, especially when there is a history of falls. The registered person must ensure that medication is signed for at the time of administration. The registered person must ensure that risk assessments are completed for residents who self medicate. The registered person must ensure that records are maintained of food eaten by residents. The registered person must ensure that staff complete training in the protection of DS0000042026.V268886.R01.S.doc Timescale for action 31/12/05 2 3 OP7 OP8 15 (2) b 12 (1) a 31/12/05 31/12/05 4 5 OP9 OP9 13(2) 13(2) 31/12/05 31/12/05 6 OP15 17 (2) Sch 4 (13) 18 (1) c 31/12/05 7 OP18 31/12/05 Carter House Version 5.0 Page 20 8 OP12 16(2)n 9 OP27 18 (1) a 10 OP27 17 (2) Sch 4 (7) 11 OP29 12 (1) 12 13 14 15 OP30 OP30 OP38 OP38 18 (1) c 18 (1) c 23 (4) c 13 (4) vulnerable adults. The registered person must ensure that an activities programme is developed in consultation with residents. (previous timescale of 30/08/05 not met) The registered person must ensure that staffing levels are reviewed to ensure cover to enable staff to take their breaks and to ensure residents safety while staff are busy with one individual. The registered person must ensure that the published staffing rota is up to date and clearly indicates staff on duty at the home. The registered person must ensure that the staff recruitment process is reviewed to update the application form and give consideration to adding to the person specification that previous experience is required. The registered person must ensure that staff receive training in dementia. The registered person must ensure that nurses receive appropriate training. The registered person must ensure that the fire alarm is tested weekly. The registered person must ensure that the portable electrical appliances are tested every year and evidence that the electrical supply has been checked is available at the home. 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 21 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 OP9 OP15 OP15 Good Practice Recommendations It is recommended that all eye preparations be labelled with the date when opened. The registered person should give consideration to reimbursing residents who purchase their own meals. The registered person should ensure that the menu is displayed for residents. Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Carter House DS0000042026.V268886.R01.S.doc Version 5.0 Page 23 - 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!