Inspection on 17/01/06 for Charlton Court

This inspection was carried out on 17th January 2006.

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.

Other inspections for this house

Charlton Court 19/02/09

Charlton Court 21/08/08

Charlton Court 22/05/07

Charlton Court 19/06/06

Charlton Court 27/09/05

Charlton Court 10/05/05

Charlton Court 07/12/04

Charlton Court 13/05/04

Charlton Court 12/09/02

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

CARE HOMES FOR OLDER PEOPLE Charlton Court 477-479 Bradford Road Pudsey Leeds West Yorkshire LS28 8ED Lead Inspector Nadia Jejna Unannounced Inspection 09:30 17 and 20 January 2006 th 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 Charlton Court DS0000001330.V273209.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. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Charlton Court Address 477-479 Bradford Road Pudsey Leeds West Yorkshire LS28 8ED 01274 661242 01274 656799 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) Charlton Care Homes Limited Mrs Pamela Moule Care Home 71 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (71), Physical of places disability (2) Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for Learning disability under 65 is for the service user specified in the NCSC Notice dated 2 October 2003 The places for Physical Disability under 65 are for the named service users only 27th September 2005 Date of last inspection Brief Description of the Service: Charlton Court is a large, purpose built care home, which provides care, with nursing, for up to 71 people of either sex. It is located in a residential area of the Leeds suburbs and is very close to the boundary with Bradford. Accommodation is provided over two floors, mainly in single rooms, some with en-suite facilities. There are three communal sitting rooms and a dining room. The home has wide corridors and a passenger lift; there are facilities for laundering all communal linen and personal clothing. A central kitchen provides all meals (there is, in addition, a kitchenette on the upper floor where drinks and snacks can be prepared). The home has a large car park for staff and visitors. There are grounds to the rear and an outside area where service users can sit comfortably and safely. There are local facilities nearby - shops, pubs etc.- and it is well placed for access to public transport. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections; these may be announced or unannounced. The last inspection was in September 2005. This showed that the home had made some progress towards meeting requirements and recommendations made at previous inspections but there were still 8 requirements and 7 recommendations outstanding from inspections dating back to July 2003. The purpose of this inspection was to monitor the home’s progress since the last unannounced inspection. Time was spent looking at whether the requirements made had been addressed. The inspectors also looked at care plans and other records as well as speaking to the operations manager, staff, residents and visitors. Comment cards/questionnaires were left for residents and visitors so that they can share their views of the home with the CSCI. Ten resident survey cards and two from relatives/visitors had been received at the time of writing this report. This inspection was unannounced and was carried out by two inspectors. The visit started at 9:30am and ended at 6:00pm on the 17th January 2005. A second visit was made on 20th January 2005 lasting 2.5 hours to provide feedback to the operations manager. The people who live in the home prefer the term residents, and this is the term that will be used throughout this report. What the service does well: What has improved since the last inspection? What they could do better: Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 6 This was a disappointing inspection. No progress had been made towards meeting the requirements and recommendations outstanding from previous inspections. Serious concerns about the safety and well being of residents were identified, some of which placed residents at risk of abuse. These included serious shortfalls with the care planning and documentation, updating risk assessments, accessing advice and support from relevant health care professionals and dealing with medications. It was also found that resident’s monies given in for safekeeping had been kept and used inappropriately and no proper records kept. The operations manager was asked to take immediate action to deal with the medication and financial issues on the first day of the inspection. It was reassuring that action had been taken to deal with them when the second visit was made. A letter outlining the serious concerns and immediate action that must be taken was sent to the registered provider. Further requirements and recommendations have been made which can be found at the end of this report. The registered provider must take urgent action in order to make sure that residents in the home receive a good standard of care and that the home is run in the best interests of the residents. Continued failure to meet the Care Homes Regulations 2002 may result in enforcement action being taken, advice is being sought with regard to this. Regular monitoring visits will be made to check the progress being made. 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. Charlton Court DS0000001330.V273209.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 Charlton Court DS0000001330.V273209.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): 3 and 4. Residents needs are identified but there is a risk that they will not be met because the staff team does not have the appropriate skills and knowledge to meet them. EVIDENCE: Pre admission assessments are carried before residents are admitted to the home. These were seen in the care plans looked at. But it was seen that they were often done the day before the resident was admitted and information was brief. The operations manager was advised to make sure that this document is used to properly identify resident’s needs, make sure that they can be met in the home, that any specialist equipment needed is in place on the day of admission and that staff have the appropriate skills. Confirmation of this should be given to the resident and/or their representatives. The pre inspection questionnaire (PIQ) and care plans seen showed that there are still residents in the home whose assessed and identified needs do not fall within the homes registration categories. Seven residents have dementia, one of these presents with challenging behaviour and three residents have mental health needs. Staff said that they were waiting for these peoples needs to be Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 9 reassessed. Information forwarded with the PIQ said that very little training had been provided to staff around dementia, none on mental health or dealing with challenging behaviours. Staff are therefore ill equipped to meet the needs of these residents. Previous requirements have been made for the home to reassess the needs of residents whose needs cannot be appropriately met and take appropriate action to make sure that they are met. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. Poor practices around dealing with medications place residents at risk of errors being made and of prescribed treatments not being given as directed by their doctors. The care plans do not give a clear picture of individual residents needs and how to meet them. This places residents at risk of not having their health, personal and social care needs met. EVIDENCE: Five care plans were looked at. It was disappointing that the progress made toward improving the care plans and moving towards person centred care has not been continued. The care plans had not been audited since August 2005 and shortfalls identified had not been rectified or any attempts made to follow up on the audits. The care plans seen showed that: a) Information around meeting hygiene needs was basic and did not give detail about individual’s preferences for washing, dressing or bathing. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 11 b) There was no information about preferred daily routines and preferences. For example what time they would like to get up, go to bed, how they like to spend their time. c) Continence assessments were carried out but not reviewed as individual’s needs changed. The continence and/or night care plans said to make sure that appropriate pads were worn but did not state what type and size of pad should be used. d) Falls risk assessments were in place, but identified actions were not always carried out. For example to review the risk monthly. One resident had fallen six times in December but the risk assessment had not been revised and there was nothing to show if advice had been requested from the GP or the falls prevention team. e) Waterlow pressure area risk assessments were seen. But for one resident who had become ill and bedfast, it had not been revised to show the increased risk even though daily records showed that appropriate action was being taken to protect their pressure areas. f) Nutritional risk assessments were seen but they did not always reflect the resident’s needs. For example a visitor said that their relative had a very poor appetite, had lost weight, preferred to eat little and often and had a preference for puddings, drinks of tea and biscuits. This was not reflected in the assessment or the care plan. g) The care plans for a resident with dementia did not show how this condition affected them or how to help them. The care plan for the resident with behavioural problems said that staff should look out for ‘triggers’ to these behaviours and avoid them but there was no detail as to what the ‘triggers’ were. h) Care plans were evaluated monthly but most entries were the same statement about no changes and continue, they did not always reflect changes or improvements. It was clear that the plans are not person centred; rather they were to a nursing/medical model. There was no continuity between the assessments and care plans and daily records. Serious shortfalls were identified around the homes systems for dealing with medications. There were no systems in place for dealing with stock control and there were large stocks of drugs, many of which had been received over three months ago but not used. Medication was found for one resident that had been dispensed in August but not given, the medication administration record (MAR) showed that a different dose had been given. The nurse said that dose had been altered and the pharmacy had sent two lots of the same tablets, but this did not explain why the MAR had not been altered when the first prescription of the new dose had been received, none of the tablets had been given or why they were still in stock rather than safely disposed of. There were other examples of medicines prescribed for residents that had not been given as prescribed resulting in large amounts held in stock. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 12 There was verbal evidence from staff that tablets have been found in rooms and when returned to nurses they were asked to put these in the bin. This further raises concerns that residents are not receiving prescribed medication. There are serious concerns about practices followed in the home. It was clear that the nurses responsible for dealing with medicines were not following the homes policies and procedures or abiding by the Nursing and Midwifery Council (NMC) professional codes of conduct and practice. The operations manager was advised to take immediate action. A letter of serious concern was sent to the provider detailing the identified problems and actions that must be taken. Residents and visitors said that most of the staff were kind, caring and respected their privacy and dignity. But some residents said that sometimes they felt rushed by staff and had to ask them to slow down. Another resident said that there was a ‘wait a minute’ culture, when wanting to go to the toilet and that staff had favourites. They said that they had not had a bath for three weeks before Christmas because on their nominated bath day, staff had been too busy. Some relatives, staff and one resident talked about communication problems and not always being sure that some staff (where English was their second language) understood what was being said. There was an incident seen in the main lounge where a resident was asking to go to the toilet, this was addressed by two visitors, not by the member of staff sat a few yards away from the resident. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 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): 15 Not all residents were satisfied with the meals provided. It is anticipated that this will be resolved when the new cook is in post. EVIDENCE: The home did not have a regular cook but were hoping that one would be in post by the 6th February 2006. In the meantime agency cooks are being used. The residents had mixed views about the food and commented that: • • • • • • It was fine, Often poor, One would not comment, as ‘it goes down OK’, Sometimes meals were not hot, Often no bread for toast at breakfast time, Often no choices offered. Menus were in place but every day the alternative at lunchtime was fish and on Fridays there were two fish courses. The residents needing a pureed diet were not offered a choice; their dietary preferences, likes and dislikes should be taken into account, this could be the reason why daily records state ‘small diet taken’. The pureed meals were served appropriately but had large amounts of gravy, some people may not want it. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 14 One of the residents said that they had been in the dining room that morning at 7.10 but had not got a cup of tea until 8.15. There are drink making facilities on both floors and staff should provide residents with drinks of their choice on request. It is acknowledged that there will be some problems until a permanent cook is in post. But efforts must be made to make sure that residents receive hot, nutritious appealing meals and that they are offered choices. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 15 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 Practices in the home are placing residents at risk of abuse. EVIDENCE: Major concerns were identified during the inspection, which showed that residents are at risk of abuse in that: • • Their care needs are inappropriately identified and not being met. Residents have had money taken into safekeeping by the home. But there were no records kept of monies received, spent on their behalf or returned to them. In one case it was clear that the money received had been spent inappropriately to buy food items for the general use in the home. The operations manager was told to contact the adult protection unit to inform them of the possibility of financial abuse and to make sure that appropriate action was taken to deal with the situation. It was reassuring that this had been done and investigations were under way on the second visit to the home to provide feedback. Conversations with some residents, visitors and staff indicated that they did not feel able to voice concerns to the people in charge. From the PIQ the number of complaints received and resolved over the last twelve months did not add up. The operations manager said that all complaints/concerns received were logged as a complaint but many of them were rectified immediately and not responded to in writing. Records showed Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 16 that during 2005 there had been a total of twenty-one complaints, seven of these since the inspection in September 2005. A complaint received by letter in December 2005 was looked at. The response to the complainant did not answer all the concerns raised and it was clear that not all aspects of the complaint had been investigated. This had also occurred with a complaint that the CSCI had passed on for the provider to investigate. The person dealing with complaints should receive training to help them deal with them more effectively. The operations manager said that they were going on a course in the near future that should address this. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 17 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): None of these standards were looked at. EVIDENCE: A requirement was made at inspections in May and September 2005 for : The registered person to make sure that there were enough accessible bathrooms for the numbers of service users in the home. The provider action plan indicated that this will be met by 31st March 2006 and therefore it was not assessed. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 18 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. There is a risk that the needs of residents will not be met because there are not enough staff on duty that have received appropriate training or that can communicate effectively with them. EVIDENCE: The PIQ had not been fully completed and did not provide information about resident’s dependency levels. The operations manager said that staffing levels were appropriate to the needs and numbers of the residents. From the care plans and residents seen it was clear that there were a large number of highly dependant residents living in the home. Staff said that currently there were enough on the rotas but there was no time to spend with residents it was just meeting personal care needs and residents spent a lot of time on their own. Resident and visitors survey cards said that there were not always enough staff on duty. Comments from residents included that they often had to wait for attention and that the call bells were not answered promptly. Staffing levels must be reviewed in order to make sure that resident’s needs are met. From the PIQ it was clear that over 60 of staff in the home speak English as a second language. Residents, relatives, visitors and staff said that there were communication problems. There were concerns that residents struggled at times to make themselves understood and that the staff did not fully understand what was being said or what they were being asked. This has implications with the training provided to these staff and being sure that they fully understand what has been taught. Requirements have been made from Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 19 previous inspections that staff must be able to communicate effectively with residents. The operations manager said that the General Social Care Council Codes of Conduct are issued to staff in their own language. It was suggested that the policies, procedures and key information be translated. New starters were spoken to and the induction training received appeared to be appropriate. They worked the first few days as supernumery and were allocated a mentor. Ongoing training was more difficult to establish and whilst there is a training programme there was no clear evidence that staff are up to date with safe working practice training. Those staff who had been for their appraisal on the day of inspection confirmed that training had been discussed. The manager needs to complete this analysis and design a programme accordingly making sure that staff attend updates. Information on training given over the last twelve months was sent with the PIQ. This showed that a large number of topics had been covered but that very few staff had actually attended them. The operations manager said that further training sessions were planned and external training providers would provide these. These included sessions on dementia and care planning. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 20 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, 32, 33, 35 and 38. Management arrangements in the home are unclear and this has resulted in low staff morale and the home not being run in the best interests of the residents. EVIDENCE: At the last inspection the home was in the process of revising the management arrangements. The registered provider informed the CSCI that a new manager was being recruited and that the present registered manager would report to them as the clinical manager. In the meantime the operations manager would be working closely with the manager. While speaking to staff it became clear that there was still confusion over the management arrangements. They were not sure who was running the home and who they should report to. They said that they did not feel able to approach the manager/clinical manager as they said that she could be sharp, rude and shout at them in public places. Staff were wary of speaking to the Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 21 inspectors because they would be questioned about what they had said to the inspectors the day afterwards and were fearful of recriminations. They said that morale was low and that there were tensions within the home. Posters displayed in the staff room showed that there was a ‘dictatorial’ approach to dealing with issues. Minutes of team meetings seen for Birch and Ash units suggest that there is conflict amongst the staff. They made reference to: a) ‘Tolerating each other, showing each other respect’, (different nationalities), b) ‘Staff must not argue in corridors or in residents rooms’. c) ‘Confidentiality must be maintained at all times’. d) Staff to ‘communicate with residents before, during and after administering care’, e) ‘care staff must respond to any residents request regardless of which floor they are on’. This reinforces the views expressed by one resident about having to wait for the toilet and the ‘wait a minute culture’. f) Staff found using inappropriate moving and handling techniques will be given a warning and disciplinary action taken if it continues. Another relative said that ‘you are alright if you are resident who can ask for things, if not, you are left alone’. The same relative said that they had raised an issue with a nurse who had been rude to them and had ‘blanked’ them since. This does not indicate that the home is run in the best interests of residents. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 22 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 1 X X 2 Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 23 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 OP3 Regulation 14 Requirement Timescale for action 31/03/06 2 OP4 14 3 OP7 14 The registered person must make sure that when prospective residents needs have been assessed, that the home confirms in writing if they can be met and that the home will be suitable for them. 31/03/06 The manager must make sure that the home can meet the assessed needs of all residents. Where it has been identified that this is not being done, the manager must make sure that these placements are reviewed. (Previous timescales for meeting this standard of 31.3.04, 30.11.04, 31.3.05, 30.9.05 and 31.1.06 were not met.) A plan of care must be in place 31/03/06 for each resident, which shows clearly how all assessed health, personal and social care needs will be met. These must detail the actions taken and provide an accurate picture of the service user. Staff must be trained in writing care plans and appropriate systems put in place to ensure this. (Previous timescales, which have not been DS0000001330.V273209.R01.S.doc Version 5.0 Charlton Court Page 24 4 OP8 12 and 14 5 OP9 13 6 OP10 12 7 OP15 16 met, are 31.10.03, 31.3.04, 30.11.04, 31.3.05 and 30.9.05.) The registered person must make sure that steps are taken to promote and make proper provision for the health and welfare of residents, taking into account their wishes, feelings and decisions. This must include making sure that appropriate assessments are carried out, kept under review and advice sought from relevant healthcare professionals. This must include falls and nutrition. Records must be kept. The registered person must make sure that there are arrangements in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. A full audit of all medications must be carried out and the advice of the supplying pharmacist must be sought. An investigation must be carried out to ascertain responsibility for the errors identified and appropriate action taken. Advice should be sought from the NMC. Appropriate training must be provided to all nurses involved with medications, including reminders about their personal and professional responsibilities. The registered person must make sure that the home is conducted in a manner that respects the dignity or residents. Staff must provide care to residents at a pace suitable to their needs and which meets their expectations for personal and hygiene needs. The registered person must DS0000001330.V273209.R01.S.doc 31/03/06 20/01/06 31/03/06 31/03/06 Page 25 Charlton Court Version 5.0 8 9 OP16 OP18 22 13 10 OP18 16 11 OP21 23 12 OP27 18 13 OP29 19 14 OP30 18, 19 make sure that residents are provided with adequate quantities of suitable, wholesome and nutritious food, which is varied and properly prepared and available at such times as may reasonably be required by residents. The registered person must make sure all complaints received are fully investigated. The registered person must make sure that suitable arrangements are in place to protect residents from abuse. The registered person must make sure that a place is provided where residents can deposit money and valuables for safekeeping, and make arrangements for full records to be maintained. Steps must be taken to investigate the discrepancies with residents monies and valuables found in the controlled drugs cupboard. The registered person must make sure that there are sufficient numbers of accessible bathrooms for the numbers of service users in the home. (Previous timescale, which was not met, was 30.11.04. This standard was not assessed on this occasion.) The registered person must ensure that there are enough staff on duty to meet the needs of residents. The registered person must make sure that gaps in employment have been explored and records kept. (This standard was not assessed on this occasion and the timescale has been extended to 31/03/06) The registered person must make sure that the training DS0000001330.V273209.R01.S.doc 31/03/06 31/03/06 20/01/06 31/03/06 31/03/06 31/03/06 31/03/06 Page 26 Charlton Court Version 5.0 programme is kept up to date and that it is implemented with all staff. Training must be made available to staff which equips and enables them to carry out their duties. This must include mandatory training on safe working practices. The registered person must ensure that all staff can communicate effectively with service users. (The timescale for meeting this standard has not been altered.) 15 OP32 12 The registered person must make sure that good personal and professional relationships are maintained between the registered persons, staff and residents and that staff are encouraged and assisted to do so. The registered person must make sure that when visits are conducted under this regulation they speak with residents and staff to form an opinion of the standards of care being provided. Arrangements must be in place to enable staff to inform the registered person and/or the CSCI about the conduct of the home as it may affect the health and welfare of residents. The registered provider must ensure that monthly visits to the home take place and that reports are kept, copies of which must be sent to the CSCI. (This standard was not assessed on this inspection. The previous timescales of 31.1.05, 30.7.05 and 31/12/05 have not been met.) All records as outlined in DS0000001330.V273209.R01.S.doc 31/03/06 16 OP33OP32 21 and 26 31/03/06 17 OP33 26 31/03/05 18 OP37 17 31/12/05 Page 27 Charlton Court Version 5.0 schedules 3 and 4 of the Regulations must be available. These must include details of the hours worked by all grades of staff in the home. Records must be kept securely as required by the Data Protection Act. (Previous timescales, which have not been met are 31.3.04, 31.12.04 and 30.7.05). 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. Refer to Standard OP2 Good Practice Recommendations The registered person should ensure that all service users and or their representatives are given copies of the homes contracts/terms and conditions of residence. Copies of which should be available for inspection. The revised policies and procedures around the administration of medicines should be implemented with all staff as soon as they are available. The registered person should make sure that the information in the social care assessments is incorporated into the care plans, implemented and followed up as part of the care plan review process. A system for tracking and auditing complaints should be put in place. Consideration should be given to providing training in dealing with complaints to the person responsible for doing so. When the infection control nurse has reviewed the infection control policy it should be implemented with all staff. The registered person should ensure that at least 50 of staff achieve NVQ level 2 by 31st December 2006. 2 3 OP9 OP12 4 OP16 5 6 OP26 OP28 Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 28 7 OP31 The registered provider should make sure that the management structure of the home is made clear. There should be clear lines of communication and accountability and all staff must be aware of aware of them. Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Charlton Court DS0000001330.V273209.R01.S.doc Version 5.0 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!