Inspection on 20/06/06 for Carter House

This inspection was carried out on 20th June 2006.

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 16/11/05

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 20th June 2006 3:00 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.V295055.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. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 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 with Nursing 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.V295055.R01.S.doc Version 5.2 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.V295055.R01.S.doc Version 5.2 Page 5 Date of last inspection 16/11/05 Brief Description of the Service: Carter House is a purpose built care home, which can provide nursing care for fifteen older people and residential care for thirty older people, twenty-three of whom may have dementia. Thirty nine residents are currently living at the home with one resident in hospital. The home is owned and managed by Central and Cecil Housing Trust (CCHT), 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. Information regarding the CSCI is available in the Statement of Purpose and Service Users Guide to the home and is displayed in the entrance of the home. The weekly fees are from £418.00, further details are provided by the home. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over four and a quarter hours on the 20th June and eight hours on the 29th June 2006 by one regulation inspector. The inspection included the examination of records, inspection of communal areas of the home, four residents bedrooms, talking to residents, relatives, staff and the registered manager. The inspector spoke with twelve residents, seven relatives and four members of staff. Questionnaires were left for residents, relatives and staff and sent to health and social care professionals. Eighteen questionnaires have been received and comments from these are included in the relevant section of this report. What the service does well: What has improved since the last inspection? What they could do better: Care plans should clearly record residents needs. Risk assessments must be in place for residents who smoke. Medication administration records to be signed at the time it is given. More permanent staff should be employed at the home and a review of staffing levels on each unit to ensure residents needs are met. Staff must complete training in the protection of vulnerable adults. Staff files must contain a recent photo and references from previous employers. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 7 Questionnaires indicated a number of areas the home could improve its services which included more permanent staff being employed, extra funding for ‘the little extras’, name badges for staff, more exercise classes for residents who are less mobile, more meetings for relatives and staff, a better response when equipment such as dishwashers break down and notices for visitors to prompt them to wash their hands. 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.V295055.R01.S.doc Version 5.2 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.V295055.R01.S.doc Version 5.2 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, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents have access to information to help them in making an informed choice about moving into the home. EVIDENCE: The Statement of Purpose and Service Users Guide contain satisfactory information for prospective residents and their relatives and representatives to make an informed choice about moving into the home. Questionnaires noted that residents had a contract and received information about the home prior to moving in. A residents comment about the home was ‘I’m very happy here, they look after me well’. Relatives noted that they visited the home and chose it for their relative and that they know their relative is safe. The manager and relatives said that they are setting up a system for new residents to be linked with current relatives to offer information and support regarding moving into the home. Assessments are completed before admission to the home which are developed into care plans. Carter House DS0000042026.V295055.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Residents needs are recorded in care plans, which could be more detailed, risk assessments are required. Medication policies and procedures protect residents health, with some gaps in the recording. EVIDENCE: Care plans are in place and have been reviewed although some care plans required updating to reflect changes in residents needs or abilities. Care plans include a ‘problem identification sheet’, this is a negative name for the form and leads staff to focus on areas of need, not areas the resident is able to complete without staff support. Generally the care plans on the ground floor require updating. On the first floor care needs to be taken to ensure care plans contain factual information and not staffs opinion. On the nursing unit care plans have improved and include more detail. One care plan noted ‘staff to assist the individual to bed’, when the assessment indicated that the resident is not able to lay down. Staff reported that they do not assist the resident to bed. This care plan requires updating to reflect the Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 11 residents needs. One care plan did not include a profile of the residents history, this does not help staff with information about residents. One care plan contained a detailed profile which gives a full history including employment, leisure and family information. One care plan noted that the resident has expressed a need to attend church and this has been followed through with the individual attending services at the home. One file noted that the resident smoked, staff confirmed that they support the resident to ensure they are safe. No risk assessment is in place and one must be completed to ensure that the resident and other residents health and safety is maintained at all times. One care plan for night care was not completed. One care plan identified that the resident is confused, to maintain their dignity and to keep doors locked for safety reasons. Two questionnaires noted that residents always get the care and support and medical support they require. Relatives questionnaires indicated that they are welcome at the home, kept informed and up to date with their relatives care requirements, with one exception. One relative noted that they do not receive feedback from GP, dentist and opticians appointments. Comments included ‘the care is first class’ and ‘they maintain dignity and privacy’. Residents are all registered with a GP who visits the home weekly and as required. Records are maintained of residents weight on admission to the home and on a monthly basis with concerns and actions noted. Appropriate medication policies and procedures are in place, with medication correctly labelled and stored. Medication Administration Record Sheets were up to date and signed with one gap noted on one residents record. One medication for one resident is required every two months, it is not clear where the date when this medication is required is recorded. The manager confirmed that this will be recorded in the diary and added to the next MAR sheet to ensure it is administered as required. One bottle of eye drops did not include the date of opening. Staff reported that these eye drops had come with the resident on admission to the home and would be disposed of immediately as a new bottle was available. The manager reported that all staff who administer medication have completed training and are aware of the policies and procedures. Information about residents wishes around terminal care and death were noted in the assessments on files. One questionnaire noted that staff had ‘dealt with a death with great tenderness, to enable the ending both the resident and relative wished for’. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents have access to a variety of regular activities and outings. Residents receive a varied diet with choices available. EVIDENCE: Residents, relatives and staff reported good level of activities, entertainments and outings arranged at the home. Relatives meetings have been used to discuss and plan suitable activities, parties and outings for residents. A selection of cards, videos, books and games is available for residents and staff on each unit. Scrapbooks have been developed as a record of events, parties and outings which have taken place at the home, which are available on each unit. A film show is still provided every month which is accessible to all residents. Residents were in the garden, talking with staff, watching tennis, reading the paper and spending time with their visitors during inspection visits with preparations in place for the garden party the following week. A varied diet is provided which caters for residents religious, cultural and health dietary needs. Comments about the food included ‘very good, just like home made’, ‘limited choice of soft diet’, ‘the food is good’ and ‘food is always Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 13 well served’. Lunch was seen to be well managed on one unit with residents offered a choice and encouraged to sit at the dining table or on comfortable chairs with a table brought to them. The use of ‘bibs’ should be reviewed and residents offered the choice of serviettes. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. Complaints procedures are available to residents and their representatives and complaints are well managed. EVIDENCE: The complaints procedure is included in the Statement of Purpose and Service Users Guide to the home and is displayed in the notice board in the entrance of the home. Records are maintained of complaints and actions taken. The CSCI has not received any complaints since the last inspection in November 2006. Questionnaires noted that residents were aware who to speak to and how to complain and relatives were aware of how to complain but had either not needed to complain or had raised a concern which had been ‘acted on appropriately’. Policies are in place for the protection of vulnerable adults. The manager reported that staff are due to complete training in the protection of vulnerable adults at the end of June and early July 2006. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home provides a safe, well-maintained environment for residents. EVIDENCE: The home was purpose built and meets the needs of current residents. It is separated into four units, with single bedrooms with ensuite toilet and wash hand basin, bathrooms and shower, a lounge/dining room and a small kitchen to make drinks, breakfast and light snacks on each. Two small enclosed gardens are available to the side and rear of the home which are well kept. Relatives have recently been involved in developing the garden with the addition of a water feature and tomato plants. Residents made positive comments about their rooms, the home and the garden and the lounge on ground floor is very homely with photographs of residents displayed and a number of plants. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 16 All areas of the home were clean. Questionnaires noted that the home is always clean, that the general cleaning is good and the laundry service is excellent. The laundry is away from the kitchen and dining rooms and staff are aware of infection control guidelines and follow them. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 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 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this home. Residents needs are met by permanent, bank and agency staff. Staff have access to appropriate training. Recruitment records do not contain all information required by law. EVIDENCE: The staff rota identified one member of staff on duty on the ground and third floor, two members of staff on the first floor, four members of staff on the second floor with the manager, administrator, domestic and kitchen staff also available at the home. These staffing levels were observed to be sufficient, however a number of comments from relatives and visitors raised concerns or ‘serious concerns’ about the low numbers of staff available. Questionnaires noted that staff are always available and listen to residents and are friendly, courteous, supportive and approachable. Staff files contain two written references, confirmation that a Criminal Records Bureau check has been completed, a copy of the induction process for new staff, supervision records and copies of training courses attended. One staff file contained a photograph of the individual, other staff files looked at were for staff who had commenced employment the previous week and day. The manager confirmed that these new staff were due to have their photograph taken for their records. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 18 Staff have completed training in food hygiene, medication, manual handling, First Aid, health and safety and indication. Staff questionnaires confirmed that they had appropriate checks when they were first employed, that they receive good training opportunities, unless they are part time, that the home is a nice place to work and that the pay scales should be reviewed. The staff team do not reflect the ethnicity and gender of residents. This was not raised as an issue, however, the manager is aware of the differences and works with staff to build an understanding of residents needs. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 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 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): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. The home is managed to meet the needs of residents. Residents financial interests are protected. EVIDENCE: The manager demonstrated a good knowledge and understanding of residents needs, working with relatives and staff management. The employment of senior staff has improved staff supervision and enabled appraisals to take place. Regular relatives meetings are now taking place, these could be developed further to involve residents to ensure their views are sought about the services provided. Questionnaires were sent out in April 2006 seeking comments from residents, relatives and visitors about the services provided. The outcome of these have not been published yet. A copy should be sent to the CSCI. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 20 Residents financial interests are protected by policies, procedures and practices in place. A random check or residents money showed that the balances were correct, up to date and signed by staff. Policies, procedures and recording protect residents and staffs health and safety. The fire alarm system, electrical supply, portable electrical appliances, gas safety and hoists have been checked at the required intervals. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 22 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. The registered person must ensure that risk assessments are completed for residents who smoke. The registered person must ensure that medication is signed for at the time of administration. (previous timescale of 31/12/05 not met) The registered person must ensure that staff complete training in the protection of vulnerable adults. (previous timescale of 31/12/05 not met) The registered person must ensure that staffing levels are kept under review. Timescale for action 14/09/06 2. OP8 12 (1) a 24/08/06 3. OP9 13(2) 24/08/06 4. OP18 18 (1) c 24/08/06 5. OP27 18 (1) a 14/09/06 Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 23 6. OP29 12 (1) The registered person must ensure that the staff files contain a recent photograph and for references to be sought from previous employers. The registered person must ensure that staff receive training in dementia. (previous timescale of 31/12/05 not met) 14/09/06 7. OP30 18 (1) c 14/09/06 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. Refer to Standard OP7 OP10 Good Practice Recommendations Consideration should be given to changing the name of the ‘problem identification sheet’. The use of ‘bibs’ should be reviewed with residents offered the choice of using a serviette. Carter House DS0000042026.V295055.R01.S.doc Version 5.2 Page 24 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.V295055.R01.S.doc Version 5.2 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. 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