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 Poor. 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.
CARE HOMES FOR OLDER PEOPLE
Charlotte Grange Residential Care Home Flaxton Street Hartlepool TS26 9JY Lead Inspector
John Trainor Unannounced Inspection 10:30 16 November 2005
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Charlotte Grange Residential Care Home DS0000021740.V255650.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. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Charlotte Grange Residential Care Home Address Flaxton Street Hartlepool TS26 9JY 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) 01429 860301 01429 222472 charlottegrange@c..c.co.uk Community Integrated Care Ms Julie Cowen Care Home 46 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (24), Physical disability (10) of places Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 10 people with a physical disability who are 55 years of age and over. The home may accommodate one named individual under 55 years of age on a short-term basis, until this accommodation is no longer required. 24th May 2005 Date of last inspection Brief Description of the Service: Charlotte Grange is in a quiet residential area in Hartlepool and is owned by Community Integrated Care (CIC) and is registered to provide care and accommodation for up to 46 people with the categories of dementia (12), Old age not falling within any other category (24) and Physical disability (10). Internally the home is divided into units with a central forum area at the entrance. Each unit has a lounge and additional seating areas as well as a dining area. Residents can choose to eat their meals in the dining area or in their own rooms. Kitchenettes are provided in each unit where snacks can be made. The home has a central kitchen which serves all the units. Residents are able to personalise their own rooms and relatives and friends are welcome to visit at any reasonable time Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over five hours during which there was tour of the home to see what the conditions were like for people to live in. People who live in the home were spoken to for their views, as were relatives and the senior staff member on duty, Wayne Conroy. Records were examined including health and safety documentation and care files. What the service does well: What has improved since the last inspection? What they could do better:
In some parts of the home the carpets and decoration still needed to be renewed to make things nice for people particularly in the dementia care area where several places smelled bad. There was faeces on cot rail bumpers which had not been cleaned and suggested staff needed to give more attention to these details to maintain good infection control and hygiene standards. One person who was a wheelchair user in the physical disability unit could not comfortably make use of the sink in the bedroom as there was insufficient access underneath for his legs and footplates. This should be reviewed and appropriate adaptation made. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 6 Care plans needed more attention to detail and risk assessments needed to be documented so that bed rails were used safely. In one case the bed rails were found to be fitted incorrectly and therefore posed a risk to the individual, staff must be trained to check bed rails when providing care to people to ensure they are safe. In one care plan though the person was described has having a good appetite and had consistent recording of a good diet, weight recording showed a loss of two stone in less than two months without additional nutritional screening or care plan in place. Staff must know to report such triggers as significant weight loss for further attention. More attention to detail to health and safety was needed in some circumstances to ensure things were safe for people. A razor was found to have been left in the bathroom on the dementia care unit posing a potential risk in an area where people’s mental capacity places them at greater risk. There was no risk assessment for the kitchenette area in the dementia care unit where an unattended electric kettle left people at risk from scalding. Fire safety training did not seem to take place at regular enough intervals for staff with current recommendations at six monthly for day staff and three monthly for night staff not being met. The homes electrical hard wiring certificate could not be found on the day of inspection so the safety of the installation could not be demonstrated. The Commission for Social Care Inspection has required this evidence be made available to ensure it is safe for people. 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. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 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 the following standard(s): 6 The home does not provide intermediate care. EVIDENCE: Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 9 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 People’s health and social care needs were at risk of not being met consistently and safely due to poor care planning and a lack of some risk assessment and risk management plans. EVIDENCE: People had moving and handling plans and practices of staff when observed were good. Some descriptions of personal care delivery were nice and accounted for protecting the dignity of the person. There was evidence of monthly review of care plans but not always evidence of revision when necessary. Care plans on dementia care were poor with no reference to current good practice Though care plans were documented on each of the files inspected none of them were of good quality. Assessments though being updated were poorly
Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 10 recorded with insufficient detail to record people’s needs or preferences. One person had a recorded weight loss of two stone in under two months without this triggering a care plan review or revision. Bed rails were being used with no risk assessment or risk management plan. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 11 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 and 15 People would benefit from more input to support them enjoying purposeful activity. EVIDENCE: The home does not have an activities co-ordinator and activities provision is limited in the home. Care plans inspected did not account for people’s occupation or social needs. Though the food was unanimously reported of good quality the menus follow a two week cycle and the home is in the process of reviewing this to increase variety. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 12 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 and 18 The home’s policies and procedures protect people from abuse. EVIDENCE: The home had a copy of the multi agency strategy on abuse and training was organised which some staff had completed. All staff should receive adult abuse training. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 13 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 and 26 Though it appears the environment has been improving there was still room to make it safer, cleaner and more pleasant for people. EVIDENCE: There was an action plan in place to refurbish areas of the home which had been identified from previous reports. Some fire door closures had been fitted on the kitchen office and hairdressing room in line with fire officer recommendations. Some rooms and corridors were found to smell unpleasantly which is not nice for the people living there. Smears of faeces were seen on cot bumpers and toilet raisers which staff had either failed to notice or failed to clean. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 14 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 and 30. People had sufficient staff support to help them with their needs. EVIDENCE: Staff were deployed in sufficient numbers to meet the needs of the people in the home. The company is committed to staff training with almost all staff trained to NVQ 2 or above. The company has an induction pack and programme. There was little evidence of good practice in dementia care though some staff had received training recently. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 15 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): 36, 37 and 38 Improvements were needed to ensure people’s rights and safety were not compromised. EVIDENCE: Hoists were maintained safely as were bath lifts some of which were new in the last year introduced as part of the refurbishment programme. The health and safety visit to the kitchen identified some staff had not received food hygiene training and there were still some gaps in the training matrix though there was some training being given. Fire tests, alarms and equipment were being maintained regularly though staff were not receiving training frequently enough in fire safety. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 16 Portable appliance tests had been completed though the electrical hard wiring certificate could not be found to evidence the safety of the installation. In one unit care plans were stored in an unlocked cupboard in the lounge which does not keep people’s information safe and confidential. Improvements to risk assessment and risk management strategies in the home were necessary to maintain the safety of the more vulnerable people residents Though the company have produced an action plan outlining a cascading model of supervision in the home there was little evidence of this in practice and so the requirement was brought forward with a timescale of a year to enable the home to evidence supervision has taken place in line with the national minimum standards. Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 17 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 1 1 1 Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14, 15 Requirement Timescale for action 31/03/06 2 OP19 13(4) 3 OP19 16(2(k)) , 23 The registered person shall ensure that the assessment of the service users needs and plan of care is kept under review and revised at every time necessary. (Previous requirment not met by 24th August 2005.) 30/11/05 Risks and hazards to people must be assessed and managed in the home within a recognised risk management strategy in particular razors must not be left in bathrooms on the dementia care unit and a risk assessment must be completed of the kitchenette area in the dementia care unit with risk management strategies put in place. The registered person shall 31/03/06 ensure that the home is kept reasonably decorated and suitable adaptations are made for service users. (Previous requirement not met by 24th August 2005). Priority attention should be given to replacing carepets and décor in areas which are malodourous and unpleasant for people. Adaptations must be fit for
DS0000021740.V255650.R01.S.doc Version 5.0 Charlotte Grange Residential Care Home Page 19 4 OP26 16(2(j)) 5 OP36 18(2) 6 OP37 17 7 OP38 12 (1(a)), 13 (6) 8 OP38 13 (4(a&c) purpose in the physical disability unit so that people’s independence is maximised. Spills of faeces on surfaces, equipment or furniture must be cleaned by staff immediately in line with the homes infection control policy this must be standard practice for care staff. The Registered provider shall ensure that persons working at the care home are appropriately supervised and care staff receive 6 times per year in line with the national minimum standard. In the Sandwell unit care plans were stored in an unlocked cupboard in a communal lounge. This practice must stop as people’s information should be protected and maintained securely. The electrical hard wiring certificate was not available for inspection and therefore the safety of the installation could not be verified. In order to ensure the safety of service users it is required that evidence of the safety of the hard wiring, (hard wiring certificate) be supplied to the Darlington office of the Commission for Social Care Inspection before 30th November 2005. Bed rails were found to be fitted incorrectly in one case and thus caused a potential risk to safety. There was no evidence of risk assessment or risk management plans in care files inspected for bed rails. It is required all people requiring the use of bed rails have a risk assessment and risk management plan completed and recorded to ensure practice is safe before 25th November 2005. Staff should be instructed
DS0000021740.V255650.R01.S.doc 16/11/05 16/11/06 30/11/06 30/11/05 25/11/05 Charlotte Grange Residential Care Home Version 5.0 Page 20 9 OP38 23 as to how to check bed rails are fitted safely. Staff must receive fire safety training more frequently in line with current guidance from the fire officer of 6 monthly for day staff and 3 monthly for night staff. 31/03/05 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 4 Refer to Standard OP7 OP12 OP15 OP16 Good Practice Recommendations Care plans should be clear, task specific and instruct staff in the detail of how people choose to have their care delivered. People living in the home would benefit from having a dedicated activities co-ordinator to help promote social activities. The home should review the frequency at which menus are changed within the home. Though there was an updated copy of the complaints procedure on the office wall people still did not have up to date contact details for the Commission for Social Care Inspection. Each person resident should be given a copy of the updated complaints procedure. Though some staff had received adult abuse training it is recommended a strategy is developed to ensure all staff working in the home receive this training. 5 OP18 Charlotte Grange Residential Care Home DS0000021740.V255650.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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