CARE HOMES FOR OLDER PEOPLE
Charlotte James Nursing Home Oakhurst Shobnall Road Burton On Trent Staffordshire DE14 2BB Lead Inspector
Mrs Sue Mullin Unannounced Inspection 20th February 2006 02:00 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 Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 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 James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Charlotte James Nursing Home Address Oakhurst Shobnall Road Burton On Trent Staffordshire DE14 2BB 01283 569417 01283 542950 charlotte.james@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Pamela Dawn Worthington Care Home 28 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) Category(ies) of Physical disability over 65 years of age (28) registration, with number of places Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 28 beds - PH (Physical Disability) - Minimum age 60 years on admission 3 beds - PD (Physical Disability) - Minimum age 55 years on admission Date of last inspection 25th September 2005 Brief Description of the Service: Charlotte James Care home is a 28-bedded establishment providing personal care and nursing care to service users suffering with a physical disability over the age of 60 years. The building dates around 1901 with a later extension added on. The home is located off the main road in a rural setting with a pleasant country feel. The home is situated just outside Burton On Trent, with local amenities nearby. Ground and first floor accommodation is provided, accessed via a passenger lift. There are single and double bedrooms available and some of these are en suite. There is a selection of communal areas and a Victorian conservatory overlook the pleasant gardens. There is adequate parking space. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection focused on 23 of the National Minimum Standards indicated throughout the report. Those not covered at this inspection were addressed at the previous inspection. On the day of the inspection the home had 23 residents receiving general nursing care (including one resident currently in hospital) and 2 receiving general residential care. The inspector undertook a sample tour of the building internally, and made a visual check of the environment from the exterior. Care plans inspected continue to be very comprehensive. Several residents and relatives were consulted and all made positive comments on the high standards of care delivered in the home. The environment creates a homely atmosphere. Communal areas are spacious and comfortable. Staffing levels provided at the home were found to be satisfactory. Staff training is given high priority and NVQ training is ongoing. The registered manager has been in post now for eight years and once again during this inspection, it was noted that the staff team was working very agreeably together. Effective and productive teamwork was evident throughout the inspection. Staff were sure of their roles and duties and carried them out with minimum direction. All routines and regimes were well understood by all staff working in the home. Residents were the primary focus of the 24-hour period and staff were seen to administer care with diplomacy, empathy and professionalism. What the service does well:
Charlotte James is a home specialising in the care of older people with physical disabilities and as such, the environment, staffing levels and training, along with care planning are all organised to meet the needs of highly dependant residents requiring nursing intervention. Written information provided to residents prior to admission was of a very good standard and a thorough pre admission assessment procedure was in place. The home offers its residents the opportunity to experience a good quality of life, with flexible daily routines and a wide range of social activities. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 6 The health and personal care needs of residents were being met appropriately and each resident had a written care plan, a sample of which were examined and found to be very satisfactory. All care plans were written legibly in black ink, dated and signed in line with NMC requirements. All risk assessments were in place beside long and short-term problems, which were reviewed monthly or more frequently if required. Competent trained staff met wound care needs. The staff maintain comprehensive care planning notes, up to date, reflecting the current condition of each resident. The staff in the home actively seeks out further training, to enhance their skills and continue to strive forward and improve standards throughout the home. The home offers placements for local student nurses and also undertakes qualified overseas adaptation courses. Care staff are receiving formal supervision every two months and this formed the basis of staff development and continues to improve the standards of care delivered in the home. Observations of staff conduct throughout the inspection confirmed to the inspector that staff continue to be knowledgeable, competent and caring. Residents told the inspector that they enjoyed the comfort of the home and that nothing was too much trouble for the care manager or members of her staff. What has improved since the last inspection? What they could do better:
The only requirement of this report is that the registered provider ensures that a suitable sluicing facility is installed in line with infection control regulations. Sluice facilities in the home are available in manual form only and commode pans and urinal cannot be disinfected as required for nursing homes under Standard 26.6. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 7 The home continues to meet all other national minimum standards. The home employs an activity organiser for 12 hours a week and it was recommended that her hours are increased to keep up with the ongoing demand from the residents. A sample tour of the premises was conducted without revealing any major areas of concern, for the health and safety of residents or of staff or visitors to the home. Maintenance is of a very good standard. However, the driveway leading up to the home is at times rather bumpy. Previous attempts by the home to fill in the holes only last temporarily as the rain eventually washes the fillings away. The care manager confirmed that quotes have been received for the driveway to be re surfaced and new lighting put in. This will checked on the next inspection. 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 James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 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 Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 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): 1,3,4 Information was available to perspective residents and representatives, ensuring that residents seeking respite or permanent care will have all the information that they need to make an informed choice about residing in the home. The home confirms that it is able to meet residents assessed needs prior to admission. EVIDENCE: During the course of the inspection, two relatives of a resident confirmed that they had been provided with verbal information, and a copy of the Statement of Purpose, and service users guides for the home. The staff confirmed that they were able to meet resident’s needs, and this was supported when talking with residents about their life in the home. The care manager and her staff had a good sound knowledge about the needs of their residents, their lifestyle, and the things each individual liked and disliked.
Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 10 Reference to the care plan of the most recently admitted resident demonstrated that as well as implementation of long and short term problems, the resident and his relatives were fully aware of how the home could meet identified needs and whether Charlotte James was a home suitable to provide care for those needs. It was established that a full assessment of physical, mental and social needs, prior to their admission was undertaken for all prospective residents. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 11 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): 7,8,10 Records examined, practices observed, and the comments of residents and staff, confirm that health and personal care needs are being well met. All residents receive full NHS entitlements. EVIDENCE: The inspector looked at a care plan of a recently admitted resident who was requiring Oxygen 24 hours a day. The documents included a complete overview of the health and personal care needs of this individual. There was also a comprehensive record of how these needs were being met on a daily basis. All long-term problems are reviewed monthly, with short-term problems being reviewed weekly or more frequently if required. All residents have a named nurse and support key workers linked to their care. The care manager explained that there were four unwell residents in the home, one that stays in bed over the 24 hour period, one gets up every three days for short periods and two sit out of bed daily. All care requirements are met. Residents stated that they could choose their daily routines and had the flexibility to take a rest or simply spend private time in their room during the course of the day.
Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 12 The staff reported a good working relationship with external health care professionals. At all times during the inspection staff were seen to be treating residents with respect and dignity, and this was confirmed by those residents who were spoken to in private, as well as those in the communal areas. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 13 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): 12,14 Residents and relatives informed the inspector that they were extremely satisfied with the way the home met their social needs, encouraged their family and friends to visit and encouraged them to take decisions affecting their lives. EVIDENCE: Residents and relatives praised the level of care given in the home and satisfaction with the freedom that residents have to live their lives according to their wishes. The comprehensive activity programme of events includes regular gentle exercise sessions, art and crafts and much more. There are outdoor events also held on a regular basis. The home employs an activity organiser for 12 hours a week and it was recommended that her hours are increased to keep up with the demand from the residents and fulfil her duties. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 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 Residents and their representatives felt confident that their complaints would be listened to, taken seriously and acted upon, and that all steps possible were being taken to prevent them from all aspects of abuse. EVIDENCE: The inspector spoke in detail to two relatives about their understanding of the complaints procedure, and they were able to describe a reasonable interpretation of the written policy, in so far as they knew who in the home to complain to if they were concerned about anything, and who to take the matter up with further if they were not satisfied with the result of complaining within the home. There have been no complaints made to the home or the Commission since the last inspection. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 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): 19,20,21,23,24,25,26 Residents are living in a safe and well-maintained environment. The home had adequate washing and toilet facilities, including comfortable and personalised bedrooms, all well maintained, clean, and free from odours. EVIDENCE: Part of the inspection included a sample tour of the premise and visiting resident’s bedroom accommodation and communal space. These were all found to be very clean, tidy and very much in keeping with the resident’s preferences and direction. A visual examination was conducted on the grounds and exterior condition of the building. All areas seen were in line with Health and Safety Executive’s regulations. The communal areas are maintained to a good standard, and most overlook garden areas with patios abundant with flowerbeds and shrubs. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 16 The bedrooms that were occupied were easily distinguishable as belonging to an individual, by the inclusion of items of personal choice such as photographs, ornaments and small pieces of furniture. Those residents the inspector spoke to assured her that the rooms were comfortable and met their needs. The home has adequate toilets and bathroom facilities throughout the home. The home was clean, fresh, neat and tidy throughout, All radiators and pipe works guarded against the incident of accidental burning. Hot water outlets randomly tested in resident’s rooms being regulated to provide a temperature in line with the Health and Safety Executive’s regulations. All furnishings provided by the home were of a good standard with good carpeting and comfortable seating in the communal areas. The only requirement of this report is that the registered provider ensures that a suitable sluicing facility is installed in line with infection control regulations. Sluice facilities in the home are available in manual form only and commode pans and urinal cannot be disinfected as required for nursing homes under Standard 26.6. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 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): 27,30 Residents could expect continuity of care provided by sufficient levels of welltrained and motivated staff. All mandatory training had been undertaken in line with national minimum standards. EVIDENCE: As this is a care home that provides nursing home the staffing levels and skill mix are maintained as South Staffs Health Authority agreed them in March 2002. There is always a qualified nurse on duty throughout a 24-hour period. Additionally there are 4 care staff on the early shift, on the late shift there are 3 care staff. On the night shift there are 2 care staff. All staff are waking staff. The care manager is fully supernumerary and has not only met all but one the national minimum standards inspected on this occasion but has maintained a commendable level of training and updates for her staff. The staffing levels and skill mix were found to be in line with minimum requirements on the day of the inspection and duty rotas are created in plenty of time to ensure the appropriate continuance of the skill mix and level of care staff. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 18 Catering, domestic and laundry hours are sufficient. There is an administrator who works 25 hours per week There is a part time handyman employed this amounts to 30 hours. There are adequate first aiders employed in the home as well as qualified trained nursing staff. Observations of staff on duty throughout the inspection confirmed that staff were competent and caring in their conduct. The Inspector was again particularly impressed with the positive rapport and friendliness towards both residents and visitors to the home. The care manager confirmed that manual handling and all other mandatory training was completed. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 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): 31,33,36,38 A very competent, caring and experienced nurse manager directs the care delivered in the home. The home is run entirely on the best interests of the residents. The home has appropriate policies and procedures in place and health and safety aspect were good. EVIDENCE: From observations made and discussions with residents/ relatives and staff, it was clear that the home was being run in the interests of the service users. Staff supervision is ongoing and care staff receive two monthly sessions, which are documented. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 20 A sample tour of the premises conducted without revealing any major areas of concern, for the health and safety of residents or of staff or visitors to the home. Maintenance is of a very good standard. However, the driveway leading up to the home is at times rather bumpy. Previous attempts by the home to fill in the holes only last temporarily as the rain-washes the fillings away. The care manager confirmed that quotes have been received for the driveway to be re surfaced and new lighting put in. This will checked on the next inspection. Other health and safety aspect that were confirmed fully compliant were: • • • • • Fire drills for all staff Weekly fire alarm testing Appropriate emergency lighting testing Hot water testing Hoists- mobile or fixed to baths have been serviced twice a year. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 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 4 4 X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 X 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 2 STAFFING Standard No Score 27 3 28 X 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X X 4 X 3 Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 22 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 OP26 Regulation 23 (2)(k) Requirement The registered provider ensures that a suitable disinfecting sluicing facility is installed in line with infection control regulations. Timescale for action 20/04/06 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 Refer to Standard OP12 Good Practice Recommendations The home employs an activity organiser for 12 hours a week and it was recommended that her hours are increased to keep up with the demand from the residents and fulfil her duties. Charlotte James Nursing Home DS0000049239.V283537.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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