Inspection on 19/02/09 for Charlton Court

This inspection was carried out on 19th February 2009.

CSCI found this care home to be providing an Adequate service.

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.

Other inspections for this house

Charlton Court 21/08/08

Charlton Court 22/05/07

Charlton Court 19/06/06

Charlton Court 17/01/06

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 09/07/2009.

CARE HOMES FOR OLDER PEOPLE Charlton Court 477-479 Bradford Road Pudsey Leeds West Yorkshire LS28 8ED Lead Inspector Paul Newman Key Unannounced Inspection 19th February 2009 08:30 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.V373949.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. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 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 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.V373949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following catgory of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Learning disability - Code LD; Physical disability - Code PD The maximum number of service users who can be accommodated is: 71 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 One specific service user under the age of 65, named on variation dated 20th December 2006, may reside at the home. 22nd May 2007 2. 3. 4. 5. 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 service users. It is located in a residential area of the Leeds suburbs and is very close to the boundary with Bradford. It provides accommodation on two floors, mainly in single rooms, some with en-suite facilities and has three communal sitting rooms and a dining room. There are wide corridors in the home and a passenger lift. There are facilities for laundering all communal linen and personal clothing and a central kitchen that provides all meals (there is, in addition, a kitchenette on the upper floor where drinks and snacks can be prepared). There is a large car park for staff and visitors. There are grounds to the rear and an outside area where residents can sit comfortably and safely. There are local facilities nearby - shops, pubs etc.- and it is well placed for access to public transport. Information about services provided by the home is available in the home’s combined Statement of Purpose and Service User Guide. Copies are kept in the reception area and can be taken by relatives or visitors. At the time of the inspection, 19 February 2009, the weekly fees were from £538 to £575 per week and are subject to review. These charges do not include hairdressing or chiropody and a separate list of charges for these and other services is available from the provider. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The accumulated evidence in this report has included: • • • The results of the last Key Inspection carried out in August 2008. The results of a Random inspection carried out in December 2008. The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. Relevant information from other organisations. What other people have told us about the service. Information obtained from people living at the home, relatives, staff and other health care professionals. • • • • • This was a Key Inspection and the third inspection visit made to the home since 21 August 2008 when the quality rating of the service was 0 Star and we considered that people using the service experienced poor quality outcomes. A further random inspection was made 9 December 2008 to check on progress made. Two inspectors made an unannounced visit to the home that lasted seven hours on 19 February 2009. Before the inspection visit, the manager was sent an Annual Quality Assurance Assessment (AQAA) to complete. This is a self-assessment that if completed properly, should give us a lot of information about how the home is operating and what is planned for the future. It tells us where we can find evidence that the home is meeting National Minimum Standards. The AQAA that was returned could have provided more detail but gave us enough information to help plan the visit and get an idea of the improvements the home was trying to make. During the visit, a number of documents were looked at and all communal areas of the home used by the people and some bedrooms were inspected. On the day of the last Random visit in December we learnt that the newly appointed manager had resigned but this position was resolved quickly by the appointment of a manager from another of the Company’s homes. On the day Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 6 of our visit, the manager was contacted and changed her plans for the day to assist in the inspection. Time was spent with the manager, staff, visitors and people living at the home. Surveys were prepared for staff, and all staff on duty had the opportunity to complete one. Time was also spent in communal areas and the dining room, watching what was going on and checking whether people appeared comfortable and cared for. Verbal feedback was given to the manager at the end of the visit and the Operations Director for the Company sent an email the same day, outlining how the home was going to deal with some of the issues we had raised. What the service does well: What has improved since the last inspection? What they could do better: Whilst recognising the significant improvements made, there are still things that need to be done to fully meet National Minimum Standards and comply with Care Home Regulations. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 7 The most significant of these are to do with the environment. We found major problems with the standards of cleanliness and hygiene and the condition of some equipment in the kitchen and no evidence of regular ongoing cleaning schedules. (See Environment section) We also found health and safety issues with regard to fire safety in the kitchen. We discussed the issues with the manager and later in the day the Operations Director emailed us to inform us that they were taking immediate action to address all of these issues. Because there had been no new admissions to the home, we case tracked two people who had been in hospital to see if they had been re assessed before they returned, so that the home could be sure it could continue to meet the people’s needs and have the equipment that might be needed to provide the care. This had not been done, but we acknowledge that the manager is introducing an assessment tool for people who return from hospital. We found that in one case although the person had the right equipment, the pressurerelieving cushion they used, had not been transferred from the lounge where they normally sat, to their bedroom where they were sitting throughout the morning. People should be re assessed prior to them being readmitted from hospital to make sure their needs can be met. Other issues are about people’s quality of life. In our discussion with people and relatives we found a strong anxiety and discontent from people who had been asked and agreed to move from the ground floor to the first floor to allow the redecoration of the ground floor. They were cynical about the reasons for this and the length of time it was taking and felt that the move had been made for financial reasons. They were concerned that they would not be able to return to their rooms and these were the rooms that they had chosen and are identified in their contract. We found that there was just the maintenance person undertaking this work and although we had been notified on 12 January that this was going to happen, only three bedrooms had been finished at the time of our visit. This is a situation that the company must address and speed up their work, communicate with people and relatives and give assurances that they will be able to return to their rooms. We once again found that people and relatives felt there were not always enough staff on duty and some of their lifestyle choices like when they want a bath, the times they want get up and go to bed are not always met. The staffing arrangements during our visit were sufficient to meet the basic needs of people but even so people said that they had to wait later than they would have liked to be assisted out of bed. The staff felt that things were better and more manageable with all the residents on the first floor. We looked at the duty rotas and noted that the staffing levels in the afternoon and evening were reduced and cannot understand why this is the case because most people need two staff to help them and these needs do not change at tea time or bedtime and people will still need their personal care. The communal areas will still need a staff presence to make sure people are safe. We are asking the company to review this and explain why this happens. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 8 There were no activities on the day of our visit and we noticed that a lot of people were sitting passively in lounge areas and their rooms. We were told that the new activity organiser comes in three times a week and this is less than was provided previously. Staff said that she has been focusing on one or two individuals and we discussed this with the manager who said she would address this. The full range of legal requirements and good practice recommendations are in the final section of this report. 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. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 9 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.V373949.R01.S.doc Version 5.2 Page 10 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): 2 and 3. Standard 6 does not apply to this home. People who use the service experience adequate quality outcomes in this area. People have contracts that outline the terms and conditions of residency but not all are currently living in the rooms identified in the contract and they are concerned about this. People’s needs have not been fully assessed before they are re admitted to the home from hospital and this could place them at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a letter to us in January 2009, we had been made aware that because occupancy levels were low, with their agreement, people in ground floor bedrooms were going to temporarily move to the first floor so that the ground Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 11 floor areas could be redecorated. When we spoke to people and relatives who were in this position, all told us that they felt things had gone on too long and were concerned that they were not going to be able to return to the rooms of their choice. Some said they believed the move was more to do with saving money and reduce the staffing and running costs. We checked the contracts held on file and these clearly showed the room number. It would appear that the Company need to reassure people and relatives that they will be able to return to their rooms and give them timescales. There have been no new admissions to the home since our last visit and in the random inspection report we advised that people who were going to return to the home following a period in hospital should be reassessed before they return to make sure the home can continue to meet the person’s needs and the right equipment is in place to care for the. We checked two care plans for people in this position. In the first case the person had been in hospital for approximately one week before they returned to the home. No staff had been able to get to the hospital to re assess the person before their return and there was no record of any telephone conversations to re assess and get an update on the person’s condition. In the second case the person had also been in hospital for approximately a week following a fall and fracture and returned to the home. Moving and handling assessments, waterlow, nutrition and bed rail assessments were not completed until three days after their return. This was discussed with the manager who was able to show us an assessment tool for people returning from hospital that she intends to introduce that was not available in the period where these two people returned to the home and neither was the manager in post at the time. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 12 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. People who use the service experience adequate quality outcomes in this area. The plans of care identify people’s heath, personal and social care needs but in practice, the care is not always delivered, as it should be. If people take medicine and the care home supports them with it in a safe way. People value and appreciate their relationships with the care staff who treat them with respect and dignity. We have made this judgement using available evidence including a visit to this service. EVIDENCE: There is a much improved situation since the inspection in August 2008 with regard to care planning. We case tracked two people. In the first of these the person was fed by peg tube and there was a good care plan for this that Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 13 described how to clean it and what signs of infection to look out for and the action to take if this occurred. All of the care plans for this individual were person centred and in good detail. Photographs done by the occupational therapist to show how the person should be positioned in the chair were in the plan. A Physiotherapist, Occupational Therapist and Community Psychiatric Nurse had also seen the person. In the care plan for nutrition, it stated that the person needed to be weighed monthly. This was recorded on two weight charts and taken individually it looked like the weight checks were not being done regularly. We suggested to the manager that only one chart is used so that staff are clear that weight checks are being made as they should be. In the other case, we focused on pressure relieving equipment. The care plan identified that a special mattress should be used. This was checked and was in place with the correct setting. It also identified that a special cushion should be used. The person was in their bedroom up to past lunchtime sitting in an easy chair but there was no cushion in place. This was pointed out to the manager and it was found that the cushion was in the main lounge where the person normally sat. People must have the right pressure relieving equipment at all times to reduce the risk of skin damage. The same person’s notes showed they had been seen by the Community Matron who made an entry saying they needed assistance with drinking as they were unable to hold the cup steady. The nutrition care plan had not been updated to reflect this. We spent time with the person who felt she did not need assistance and was observed managing quite capably. The care plan identified that the person needed a feeder beaker with the lid removed and a plate guard for their plate. We felt that the detail in the care plan required reviewing with the person and observation of them at mealtimes to make sure the information was correct and account for why the comments of the Community Matron had not been followed. In the tracking of these two people’s medication we found that there were omissions in the recording of the administration of drugs but this was predominantly when agency nurses were on. The manager and permanent nursing staff need to keep on top of this and check the Medication Administration Records after each shift so that errors are picked up quickly and the Nurse Agency alerted to the shortfalls of their staff. There was a recommendation at the Pharmacy inspection carried out on 14 October 2008 to review the medication policies and we found that the guidance in the drugs room was old. The manager has this as part of her action plan and is aware that there is up to date guidance on the CSCI website. We looked at the storage and records of controlled drugs kept at the home and checked the storage of drugs like eye drops that have a limited lifetime and may need to be stored in a fridge. There were no problems with these. People and relatives we spoke to all praised the staff and said they were very caring and committed. With their approval some issues raised specifically about the care of their father by relatives, were brought to the attention of the Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 14 manager. We found the staff to be good in the way they related with people, including visitors. They were careful about making sure that they respected people’s privacy and dignity, like making sure that doors were closed when personal care was being delivered, knocking on doors before going into rooms and making sure people looked well and cared for. The hairdresser was visiting during the visit and a number of people enjoyed their time with her. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 15 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. People who use the service experience adequate quality outcomes in this area. The care home does not fully support people to follow personal interests and activities. More can be done to stimulate them. Peoples’ choices and personal preferences for lifestyle can be restricted. The food provided at the home is generally good but can vary according to who has done the cooking. There is improved attention to nutrition and weight loss that makes sure peoples weight and dietary needs are monitored more closely. We have made this judgement using available evidence including a visit to this service. EVIDENCE: At the time of the random inspection made in December 2008 good progress had been made in identifying people’s social care needs and identifying these in the care plan. Pen pictures had been completed that help staff know people better. The activity organiser at that time informed us that she had resigned. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 16 A replacement has been found but with reduced hours over three days a week. In conversations with people and other staff it was clear that her focus was on one or two individuals and there were few activities. This was discussed with the manager who said that the organiser had only been employed for a very short period and she would make sure that there was a bigger focus on involving groups of people so there was more going on. With all the people living on the first floor, the communal area there is limited and although some people were using the smoking lounge and the main lounge on the ground floor, this had apparently not been available for a period of time because of a problem with the heating. This was a similar situation with the dining room although it was being used during our visit and the heating problem had been fixed. People who chose to spend time in the main lounge were, in the main, unsupervised because of the pressures on staff with people in bed, and those needing personal care etc. Efforts had been made to make a ‘cosy’ area where people could watch the TV but not everyone chose to sit in the area and looked quite isolated in the large lounge. Visitors were seen coming in and out during the day. Those spoken with said that they felt welcomed in the home and found the staff generally friendly and helpful. Although the comments made about staff were generally very positive and that they do their best, comments were generally clarified with the rider that there are not always enough to give sufficient time and attention for, as one person said, the ‘niceties of life’. Our observation was that there was not a lot going on, staff were busy attending to personal care, refreshments and meals, and although people generally looked well cared for and staff made sure their privacy was maintained, there were a lot of ‘passive’ people and little in the way of stimulation; although where staff had the time, they were good at engaging people and brightening their day. There were comments made by both people and their relatives that whilst people eventually get the care they need, their choices are restricted by staffing levels and they feel that things like getting up, going to bed times and when they want a bath are led by staffing levels rather than personal choice. These issues are addressed by requirements and recommendations in the staffing section. Comments about the food by staff, relatives and people living in the home suggest that the new cook has made a big difference to the quality of the food and the main meal of the day looked good, there was a choice available and people generally enjoyed the meal. However this is clearly not always the case and if the cook is not on duty the food is variable, the menus are not always followed and the manager was aware of this problem and must tackle it. Meal times are a testing time for staff in the current circumstances with some people choosing the dining room on the ground floor, some eating in the upstairs lounge and some in their bedrooms on the first floor. Staff were doing their best to make sure people got the meal of their choice and where Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 17 necessary the assistance they needed. We noted in the upstairs lounge that one person was being assisted by a carer and finished her main course, but the carer noticed that another person was not eating and went to assist. The first person started shouting that she wanted her desert and the carer had to ask her to wait. This was discussed with the manager who might consider two sittings for lunch so that staff can focus and assist on the many people who need assistance and through this approach avoid people having to wait. Generally, we felt that there is much improved attention to people’s weight, nutrition and making sure that referrals are made to healthcare professionals in a timely way. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 18 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. People who use the service experience adequate quality outcomes in this area. If people have concerns about their care, they and their relatives know how to complain but some people’s concerns raised have not been dealt with promptly. The care home has taken steps to safeguard people from abuse and neglect. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The people and relatives we spoke to said that they knew how to complain and one relative said they had done so and felt the new manager was approachable. We checked the records to make sure that the complaints were recorded and the manager has started a complaints record. The AQAA had stated that the number of complaints before the manager started was not fully known so we do not have a clear picture of the level of complaints and issues involved. We felt that the records that have been started should be more detailed in particular the outcome of any investigation and response or agreement with the complainant. Once again some people said that they felt it is not worth complaining, for example about not getting a bath when they Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 19 expected, because things have not improved so they just accepted things – ‘that’s the way it is’. The new manager has already begun evening surgeries to make herself available to relatives who cannot visit during the day and she will need time to address the day to day operation of the home. At the previous two inspections we had concerns about safeguarding but steps have been taken to train and inform staff about whistle blowing and protecting people from abuse. Steps have also been taken to address some poor care practices that were neglectful. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 20 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. People who use the service experience poor quality outcomes in this area. People live in a home that has the space and facilities for them to lead the life they choose, but things need to be done to enable them to do this and kitchen hygiene and cleanliness must be improved. We have made this judgement using available evidence including a visit to this service. EVIDENCE: On 12 January 2009 we had been informed in writing that, with their agreement, people living on the ground floor were moving to vacant rooms on the first floor, so that whilst occupancy levels were low, the ground floor would be redecorated. We had expected that our visit would find the work completed or near completion. We found this was far from the case. The home’s maintenance person who was completing his third room was undertaking work, Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 21 at that point on his own. When asked when the work would be completed he said that he was working on the first nine bedrooms in a section of the ground floor and expected he would be finished in about six weeks time. This accounted for about only half of the bedrooms. He was not sure if he was to decorate the corridors and lounge areas. Although people and relatives told us that they were asked if they would move bedrooms to the first floor, they were cynical about the reasons – ‘money saving’, ‘they are short of staff, that’s what its all about’. One relative said that their Father’s room had only been redecorated six months previously. They described being on the first floor as ‘being in a prison cell’. One person was clearly close to tears as they talked to us. All the people we spoke to want to get back to their rooms as quickly as possible but had no idea when this would be. We think this is unfair and people should not be left in that position, especially when they have a contract that identifies their room. ‘We’ve been conned’ one said. Another said they are ‘about to explode’. These comments were contrary to a statement made in a monthly report made by the Operations Director of a visit made on 10 February 2009 that said, ‘It was noted that there was no disruption to residents’ routines whilst the refurbishment is ongoing as residents had happily re-located to the first floor’. The report also indicated that it was anticipated that the maintenance person will need assistance with the lounge areas and the Company will arrange this at this point in the redecoration programme. This does not suggest the redecoration will be completed with great urgency. Generally the home has a lot of potential to give people a comfortable lifestyle. We know that one of the lifts has been unreliable and was out of order having been deemed as unsafe by an engineer. There have been ongoing problems with one of the laundry machines. We discussed with the manager one area where unpleasant odour was noted. When we went into the kitchen we were very concerned with what we found and asked the manager to join us so that we could point out the issues. We found that one of the steamers was not working but when we opened it there was a horrible smell and it was dirty. The one that was working was also smelly and needed a clean. Hot trolleys that are used for taking food to the first floor were dirty in the corners. A lot of the crockery was chipped and not fit for use. We had noticed that the administrator had gone out before lunch to buy new bowls for the lunch desert. The dishwasher was not working. Generally, the kitchen needed cleaning, including the cooker hood extractor which was very greasy. We noticed de-stainer under the sink and this had to be locked away as it should always be if not being used. There was an uncovered jug of cooking oil on a window sill that had a fly in it. When we asked to see cleaning schedules we found one for the week that we were visiting but no others could be found. The door to the kitchen was being wedged open and this posed a fire risk. This was not a good situation and was even more disturbing as the report made by the Operations Director a visit made on 10 February 2009 stated that ‘the kitchen although busy, was clean’. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 22 Later the same day of the inspection visit the Operations Director contacted us saying that arrangements had already been put in place to deep clean the kitchen and replace the crockery. It also said that two other maintenance people employed by the company would be brought to the home to be involved in the redecoration programme. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 23 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. People who use the service experience adequate quality outcomes in this area. Peoples’ quality of life is affected by staffing levels but people appreciate being cared for by care staff they consider to be committed, friendly and caring. We have made this judgment using available evidence including a visit to this service. EVIDENCE: In a letter dated 12 January 2009 the new manager informed us that they were closing the downstairs bedrooms of the home. The letter stated that: ‘There are several reasons for this. With the reduced service user numbers as they are, it makes sense to have them all in one area so we are not splitting a smaller staff team (we are keeping safe staffing levels, but splitting them over two floors is leading to some discord as it is seen to be lighter work on the lower floor. We are not doing this to reduce staff numbers, they will remain the same’. The letter went on to say that it made sense to look at a programme of refurbishing bedrooms and corridors. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 24 On the day of our visit we found two nurses on duty with six carers during the early shift. The administrator, cook, a kitchen assistant, three housekeeping staff and the maintenance person supported them. There were thirty-nine people living in the home. At the time the AQAA was completed there were forty-one people and of these thirty-five needed two or more staff to help with their care many of whom are also doubly incontinent. This level of dependency was our observation as we watched staff getting people up and getting them prepared for the day. Whilst things were busy, the staff were dealing with people sensitively and caringly. Comments made to us that are noted in earlier sections of this report indicate that people feel they do not always get the care they need and want. We tried to assess through the surveys if staff felt that there were always enough staff on duty but these ranged from always, to never enough staff on duty, with the majority saying usually or sometimes. Those spoken with said that the situation was improved with all the people living on one floor. Overall, it would appear that having all the residents on one floor has eased stresses on staff, but it is our understanding that people have been given the choice to return to their rooms on the ground floor and when this is honoured the company must review staffing levels again to make sure that peoples needs are met. During our inspection visit we noted that people in the downstairs lounge spent a lot of time without a staff presence and also noted that staffing levels during the afternoon reduce to four carers. This will further place staff under pressure, reduce opportunities for people to get care when they want or need it like going to bed at a time of their choice and will potentially increase the risk of accidents or incidents if people are not supervised in lounge areas. Many people are very dependent and need high levels of support through out the whole of the day and it is not apparent why things are less busy during the afternoon and evening. This must be reviewed. In our last report, we recommended that the company use its sickness monitoring and disciplinary procedures to deal with staff who were regularly sick at short notice or simply not letting the home know they were not coming in for duty. The manager said that this process has started and other staff were aware and given time some of the problems that this absenteeism creates should be resolved. Nurses confirmed that where needed, agency staff are used to maintain staffing levels. We also recommended that steps be taken to make all staff fully aware of the responsibilities of nurses and senior care staff who take charge in the absence of the manager. This is being done. Steps have also been taken to investigate and address allegations that some night staff may be sleeping on duty. We did not check staff files as, with the exception of the manager, we were told that there has been no new staff appointed. The manager is currently starting the process for registration with CSCI and in fact, was on her way to Newcastle in connection with her Criminal Records Bureau check on the day we Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 25 visited to but changed her plans to assist in the inspection. At our previous two visits we found that recruitment policies, procedures and record keeping met requirements. Through the training records and conversations with staff we were happy that the requirements we made for some training had been done. With the numbers of staff currently enrolled for National Vocational Qualifications and those already completed, the home meets targets outlined in National Minimum Standards. The manager is currently working on the next years training programme and said this will include safe working practice up dates, and Protection of Vulnerable Adults. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 26 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, 32, 33, 35, 37 and 38. People who use the service experience adequate quality outcomes in this area. People’s confidence in the way the home is managed needs to be developed although people, relatives and staff appear to respect the new manager who they see as having an open approach. The home has clear financial and accounting procedures for looking after people’s personal money. People’s health and safety is compromised by some poor practices in the kitchen. We have made this judgment using available evidence including a visit to this service. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 27 EVIDENCE: Over the last year the Company has faced many challenges, particularly in securing the services of a competent manager. A new manager took up post on 5 January 2009 so has had little time leading up to our visit to tackle some of the problems. Nevertheless, an action plan was on her office wall that clearly outlined the areas that she was prioritising and wanting to improve. This included regular auditing of care provision and we found evidence that this had started. The manager has begun evening surgeries to make herself available to relatives. The people, staff and relatives we spoke to recognised the difficulties she faced but liked her open approach. To assist the manager, we previously recommended that the senior structure of the home was reviewed and the manager told us that they are now being proactive in appointing a deputy manager who will take the lead for clinical oversight of nurses and nursing practices in the home. It is not an easy time since the Local Authority has suspended admissions to the home when the home had a poor rating back in August 2008. This has undoubtedly placed financial constraints and pressures and there are indicators that this is the case through the lack of repair/replacement of equipment, the lack of urgency and consideration for the disruption in people’s lives in moving them to the first floor for a redecoration programme that is progressing veruy slowly. Staffing levels may be adequate to meet the basic needs of people but appear insufficient to improve the quality of life issues that people talked to us about. Our conversations with people and relatives showed a large degree of scepticism but this was more to do with the company and finance than with the manager herself. People’s confidence needs to be improved. Overall though, the home has made some significant progress in areas of care planning, care delivery, provision of equipment and nutritional oversight that caused us great concern in August 2008, because we felt that people could be at risk. We checked the finance records and the cash held for two people and found that the systems and records had an audit trail backed up by receipts and the cash balanced with the written record. The issues raised in the environment section of this report in relation to the kitchen compromise the health and safety of people and the issues of cleanliness and poor equipment are requirements in the environment section. Requirements are made with regard to the kitchen door being wedged open and hazardous substances being left out specifically as health and safety matters. Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 28 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 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 X X 1 Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 29 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 OP8 Regulation 12 and 13 Timescale for action Staff must make sure that 30/04/09 people have the pressure relieving equipment they need at all times. Then they will get the care they need and be less likely to develop pressure sores. The home must consult with 30/04/09 people and provide a range of activities for them to participate in if they wish. People’s social needs expectations will then be and they will feel happier. The food provided must consistent in its quality and staffing issues related to addressed. and met be 30/04/09 any this Requirement 2 OP12 16 3 OP15 16 4 OP19 23 People will then be more satisfied and eat more healthily. The Company must complete the 30/04/09 redecoration of the ground floor more speedily so that people and their relatives who are unhappy and feel their lives have been disrupted for too long can be DS0000001330.V373949.R01.S.doc Version 5.2 Page 30 Charlton Court 5 OP26 16 reassured that they will return to the rooms of their choice as quickly as possible. The Company must indicate to CSCI and people and relatives the expected timescale involved. The company must make written 30/04/09 confirmation that steps have been taken to deep clean the kitchen, including the cooker extractor fan and equipment and replaced chipped and cracked crockery. We can then be confident the kitchen is clean and hygienic. The home must produce and 30/04/09 keep up to robust cleaning schedules in the kitchen to make sure that conditions are clean and hygienic. Hygiene standards will not then be compromised. The company must review 30/04/09 staffing levels, in particular during the afternoon and evening and provide CSCI with a rationale of why levels are reduced at these times and assure us that people’s needs and lifestyle preferences will be met at all times. People come first and it is for the home to ensure there are sufficient staff on duty to meet the needs of the residents in a timely, caring way. The company must be proactive 30/04/09 in seeking the views of people, relatives, staff and professional visitors. The views expressed to CSCI are not consistent with those noted in Regulation 26, monthly reports. Peoples’ concerns must be Version 5.2 Page 31 6 OP26 16 7 OP27 18 8 OP33 24 Charlton Court DS0000001330.V373949.R01.S.doc 9 OP38 13 and 23 addressed so that they feel confident in the home’s management. The practice of wedging the 30/04/09 kitchen door open must be stopped and hazardous substances in the kitchen locked away when not in use. This will make the home a safer place to live and work. 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 company should take steps to reassure people and relatives that they will be able to return to the room of their choice that is outlined in their contract and the timescales involved in this. The manager should implement the re admission assessment document for people returning from hospital so that any changing needs and the need for any specialist equipment is identified before people arrive back at the home. All concerned can then be satisfied the home can continue to care for the person. Where a healthcare professional has made notes in a care plan that may affect the way care is delivered this should be assessed and considered and the care plan amended if needed. The medication policy should be updated to reflect the activities that staff are currently doing and to make sure that staff are working in accordance with the latest national guidance. 2. OP3 3 OP7 4. OP9 Charlton Court DS0000001330.V373949.R01.S.doc Version 5.2 Page 32 Care Quality Commission North Eastern Region Citygate, Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.ccqc.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.V373949.R01.S.doc Version 5.2 Page 33 - 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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