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Inspection on 28/02/07 for Charlotte House Mental Nursing Home

Also see our care home review for Charlotte House Mental Nursing Home for more information

This inspection was carried out on 28th February 2007.

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

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

What the care home does well

One of the residents commented: "...I`m happy here..." another saying "...everything is nice...". They said that this was due to the nice atmosphere and support from the staff team. Relatives were also complimentary, saying they always feel welcomed and that they have an overall confidence in the management and care at the home.

What has improved since the last inspection?

At the previous inspection there had been one area where the home had to improve. The home has taken action on this to ensure that appropriate contact information is provided about the CSCI for the use of residents and their representatives. This represents a positive response to the findings of the previous inspection.

What the care home could do better:

Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include improvements to the environment and medication recording by staff.

CARE HOMES FOR OLDER PEOPLE Charlotte House Mental Nursing Home Snowy Fielder Waye Isleworth Middlesex TW7 6AE Lead Inspector Louise Phillips Unannounced Inspection 28th February 2007 9:40am 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 House Mental Nursing Home DS0000010943.V325030.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. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charlotte House Mental Nursing Home Address Snowy Fielder Waye Isleworth Middlesex TW7 6AE 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 8758 0080 020 8758 0054 manager.burroughs@careuk.com Care UK Community Partnerships Limited Tony Anin-Boateng Care Home 60 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (0) Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to include a maximum of 10 DE over the age of 50 and up to 60 MD & MD(E) 2nd February 2006 Date of last inspection Brief Description of the Service: Charlotte House provides nursing care to sixty elderly mentally ill people over the age of sixty. It is also registered to provide care to ten people over the age of fifty. It is a two storey building divided into four units, with fifty-two single rooms and four double rooms. The home is located next to West Middlesex University Hospital and close to the amenities of Hounslow High Street. There is a large secure garden to the rear of the building that can be accessed from the ground floor. At the time of inspection the fees for the service were from £669 to £850 per week. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day. Time was spent talking to ten staff, four residents, one relative and the manager. Questionnaires were sent to a number of relatives and residents, with a total of 24 received back from residents and 21 from relatives. These are referred to in the report. A tour of the premises was carried out and care records were inspected along with other relevant paperwork. Information has also been gained from the inspection record for the home. What the service does well: What has improved since the last inspection? What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 6 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 House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 7 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 and 6 Quality in this outcome area is good. Residents are assessed prior to moving to the home and individual preferences catered for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 6 is not applicable to this service. Feedback from residents and their relatives are positive about their choosing the home, with a majority saying they felt they had enough information to make a decision about moving to the home. Relatives were pleased that they had the opportunity to look around the service, with one commenting that they “…went to see the home a few weeks before (relative) moved in – I was very happy…”. Another stated: “…I made a couple of visits to the home and found it to be the right place for my wife…”, with a further relative saying: “…we were told everything about the home and when we went to look around we thought how nice everything was…”. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 8 The file for two residents recently admitted to the home was examined. Findings indicate that the home has a good process for assessing and admitting new residents, with appropriate referral information being sought from the social worker, psychiatrist or other care professionals as necessary. The home uses it own assessment format that provides good information about the residents social and medical history, daily routine, likes and dislikes, work history, etc. which is then used to develop an individualised care plan. The assessment is carried out by the manager or deputy who also conduct an abbreviated mental test to assess the mental state of the potential resident, asking such questions as who the present monarch is, and their age. Records indicate that after six weeks of living at the home a review is held with the resident, their family, the manager and social worker to establish whether they are happy living at the home, and that the home can meet their needs. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. The residents’ needs are well met through attention to individual needs, preferences and care planning. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said that they feel they get good care and support, one commenting that there is: “…overall very good care…” and that staff usually give the care they want. Relatives feedback that they are satisfied with the overall care provided and that they are kept informed about important issues, with one saying: “…they are very good with the medical support if my husband is not well…”. A majority of the residents require help with personal care such as washing, dressing, bathing and using the toilet and this is documented in their care plan. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 10 During the inspection six care plans were looked at. Each were individualised for all needs regarding hygiene, aggression, personal care and when the resident is eating. For one resident who can only speak a little English there is a care plan for communicating which has been devised with the involvement of their family, who identified familiar English words for staff to use, and also informed them of relevant Punjabi words to encourage communication with their relative. Any areas of risk identified are referred to throughout the care plan, particularly in the ‘maintaining a safe environment’ section. An example of this is where a resident though fully mobile can be unsteady when walking. Good risk management plans have been documented such as ensuring they are wearing well-fitting footwear and removing any obstructions. The care plans and risk assessments are reviewed at least monthly. All the care plans at the home are computerised, along with the daily progress records. Staff said that the computerised system took a while to get used to, but that they feel it works well. One relative commented that: “…there is a care plan for each member in the home but unless this is observed each time a new shift of staff come on duty there is not much point in it, Perhaps a large notice in each room would be helpful stating the patients needs, dislikes and ability so this can be seen at a glance…”. The service should consider having a summary of the care plan in each resident’s bedroom. The care files for each resident contain a list of reviews and appointments they have had with various health care professionals, such as seeing their general practitioner, influenza vaccine and chiropody appointments. The medication system on one unit was examined. The service uses the monitored dosage system for administering medication, along with bottles for liquid medicines, which were appropriately labelled to when they were opened. There is a list of staff signatories and initials to identify who has administered the medicines, along with a photo of the resident attached to each medication administration record (MAR) chart. There are also good records of all medicines received and disposed of by the home. For one resident who had recently finished a course of antibiotics, there was no indication on the MAR chart when these had ended other than the chart no longer being signed. Similarly, for another resident who had recently started some newly prescribed medication, there was no date as to when this had started apart from the MAR chart starting to be signed by staff administering this. Staff should ensure that the MAR chart clearly indicates when a course of medication starts or finishes, along with the reason for this. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. Residents have the opportunity to be involved in activities provided by the home. The food provided is of a high standard for the residents to enjoy, with preferences and cultural needs catered for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: “…we are encouraged to join in activities…”, “…very happy…”, “…I enjoy activities, especially musical…”. These were comments from residents who said they enjoy living at Charlotte House. The service employs two activity co-ordinators who work 7:30am – 4:30pm, providing activities throughout the day such as sing-a-long and exercise, with the support of the care staff. Notice boards throughout the home display a list of up-and-coming activities, such as outings to the river and Syon Park. One activity co-ordinator spoke about how they can access the use of ‘Dial-a-ride’ for trips, and how they try to cater for individual activities if requested. There is also a sensory room on Kew unit, which is for the resident to use to relax in, through the use of Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 12 reflective and sensory lights. There is a lounge on each unit with a television for residents to watch. The television on Viscount unit had a constant green picture and is in need of replacing. Following the inspection the manager stated that a new television had been supplied for the unit. The care plan for one resident said how they enjoy listening to Indian music, which they were observed doing in their room on the day. However, another resident was seen in their bedroom with pop music playing loudly from the radio. The resident was unable to communicate with the inspector and it is unclear if the music was of their preference. Relatives and visitors to Charlotte House said that they are always welcomed by the staff and can usually always visit their friend/ relative in private. One relative was spoken to during the inspection, where they stated that: “…(relative) very happy…I can visit whenever I want…usually three times a week…staff contact me if they haven’t seen me…I value that…”. Residents and relatives commented positively about the meals provided, with comments such as: “…very nicely presented, well-cooked and appetising. A good variety…” “…the meals are excellent having had the chance on a couple of times to have a meal with my wife…”. During the inspection residents were observed being assisted with lunch where necessary and being gently prompted to eat independently. One resident was seen enjoying their lunch in the lounge, one in their bedroom, whilst other residents had this in the dining area. The lunch menu being a main choice of chicken or stuffed peppers, with an alternative of omelette, all day breakfast, baked potato or salad also an option. These choices are provided in a picture menu for residents to choose what they would like. The home chef talked about planning the menu along with the staff to ensure that all resident’s needs are catered for. The chef also demonstrated a good awareness of their responsibilities in relation to the standards and regulations for care homes. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made as residents and their representatives feel confident to raise areas of concern they have. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has the Care UK complaints policy and procedure for addressing complaints. All the residents and their representatives said that they knew who to speak to if there was something they were not happy about and that they know how to make a complaint. Although a majority of relatives were not aware of the complaints procedure. One relative said that: “…on the rare occasions that I have had any concerns about my husband, I have had an immediate response and explanation…”, with another saying that there is “…always someone that you can talk to about different things…”. The manager discussed the actions they had taken in relation to a recent complaint. This was appropriately investigated and relevant professionals notified of the outcome of this. The staff training records indicate that most staff have done POVA (Protection of Vulnerable Adults) training, with some staff still to do this. The manager demonstrated that their training in this is planned for this year. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The staff and residents make the environment welcoming. The home needs to make some improvements to ensure it is more comfortable for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment at Charlotte House is welcoming, bright, spacious and comfortable, with attention paid to making the bathrooms more homely and attractive through the use of stencils. One resident commented that: “…its nice here, comfortable…”. A relative stated that: “…a lot of times the overall temperature is too warm…”. The manager stated that the home is going through a period of refurbishment, with the carpets having already been changed on the first floor, in the reception area and office, with the rest of the home to follow. There is a new shower on Syon unit. They also plan to change all the net curtains by July Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 15 2007 and plans to upgrade all the beds to cater for needs of the ageing client group and their increased nursing needs. At the time of inspection there were a number of areas noted as needing attention, and these are the subject of requirement 1: • Viscount unit – four ceiling panels missing, paint peeled off from wall in hallway. The lock on the toilet door near the lounge – broken, not in place. • First floor, to the right – the wall next to the toilet opposite the lounge plaster coming away from wall. • First floor left lounge area – radiator to the left in the lounge is broken with bits hanging from the wall, wallpaper peeling above the radiator opposite the door. Following the inspection the manager stated that the above areas were being addressed. Residents are positive about hygiene at the home, saying that the environment is usually always fresh and clean, with comments being: “…standard of cleanliness is very good. Always appears fresh and clean…”, “…it is always fresh, clean and well looked after…”. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made because the service has good recruitment practices and provides training so that residents receive the right level of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated that there is a full complement of staff working at the service, with the occasional use of bank staff to cover sickness or holidays. He stated that he encourages staff to become multi-skilled, eg. with care staff being inducted to do work in the kitchen, in the event that they can cover any absence of staff in an emergency. Relatives and visitors said that they generally feel there are sufficient staff numbers working at the home. They also comment that: “…the staff at Charlotte are kind, helpful and caring…” and “…I think the staff are very good and really look after my wife to make sure she is happy…” The home holds recruitment information on each member of staff. The staff files contain relevant information such as proof of identification, correspondence relating to offer of job, POVA First check, statement of terms and conditions of employment, two references and record of the interview of staff. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 17 A record is maintained of all training done by staff, which includes training in continence awareness, health and safety and dementia. Training is provided in-house by senior staff and also through links with the local hospital. The manager stated that there is a minimum of 50 staff trained to NVQ level 2 in Care. One staff member spoke about having done POVA training last year, and that she feels there is good training and support offered by the home. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is excellent. The service is managed well and in the best interests of the residents. Relevant health and safety checks are carried out to maintain the safety of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One relative commented that the manager is always available to talk to, and that the “…manager always listens and acts on what I say…”. Another relative said that they “… find the home extremely well managed and the level of care provided excellent…”. Relatives also felt that they are kept well informed about issues concerning their relative and significant issues in the home. There is a relatives meeting Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 19 every three months. The manager stated that he invites guest speakers, eg. the POVA co-ordinator to talk to relatives about relevant issues. Observations and discussions with relatives and residents during the inspection were positive, indicating that the manager is respected and well-liked by the those living at and those visiting the home. The manager has worked at the home since October 2005. He is a registered nurse with 34 years experience of care work. The manager stated that Care UK are supportive of changes he has implemented, and that he receives good support from his line manager and other managers in the organisation. There are records to demonstrate that health and safety checks are carried out on the fire system and equipment, fridge and freezer temperatures, lift servicing, gas safety and Portable Appliance Testing, etc. One-to-one staff supervision is provided by the manager, deputy, unit managers and some senior staff. This occurs every other month, along with staff meetings also every other month. Quality assurance at the service is conducted via an outside agency who carry out a survey with residents families once a year and compile a report of their findings. The home holds a sum of money for each resident to pay for eg. hairdresser. These monies are kept in pouches in the home safe. Three balances were checked and found to balance that on the ledger, with good records kept of all transactions. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 20 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO 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 OP19 Regulation 13, 15 Requirement The Registered Persons must ensure that the areas detailed on page 17 of this report are addressed within the timescale. Timescale for action 31/05/07 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 OP9 Good Practice Recommendations The Registered Persons should consider having a summary of the care plan in each resident’s bedroom. The Registered Persons should ensure that the MAR chart clearly indicates when a course of medication starts or finishes, along with the reason for this. Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Charlotte House Mental Nursing Home DS0000010943.V325030.R01.S.doc Version 5.2 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. 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