Inspection on 19/06/06 for Charlton Court

This inspection was carried out on 19th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 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 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 19th and 26th June 2006 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.V298074.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.V298074.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.V298074.R01.S.doc Version 5.2 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 17th January 2006 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; 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. With effect from April 2006 the weekly fees are from £420 to £550 per week. These charges do not include hairdressing or chiropody and a separate list of charges for these and other services is available from the provider. This information was supplied in the pre inspection questionnaire in May 2006. Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by the assessed quality rating of the home. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a visit to the home. All regulated services will have at least one key inspection before 1st July 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people living at the home. All core National Minimum Standards are assessed and this provides the evidence for the outcomes experienced by residents. At times it may be necessary to carry out additional visits, which might focus on specific areas like health care or nutrition and are known as random inspections. The last inspection was in January 2006. Visits were also made in February and March 2006. At that time seventeen requirements and seven recommendations of good practice were made. This along with other information meant the home was given a quality rating of poor. In March 2006 the CSCI met with the provider and the home’s management team to discuss the lack of progress made in meeting requirements made over the last two years. They acknowledged that there had been problems and said that plans would be put in place to deal with them. Reassurances were given that appropriate action would be taken to make sure that residents benefited from a well-managed service that met their needs. This visit was unannounced and carried out by two inspectors over one day. It started at 9.30am and finished at 6.00pm on the 19th June 2006. Feedback was given to the management team on the 26th June 2006. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents and to see what progress had been made meeting requirements from the last inspection. Information to support the findings in this report were obtained by looking at the pre inspection questionnaire (PIQ). Examples of information gained from this document include details of policies and procedures in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. Records in the home were looked at such as care plans, staff files, and complaints and accidents records. Residents, their relatives and visitors were spoken with as well as members of staff and the management team. CSCI comment cards and post-paid envelopes were sent to the home to be given to residents and their relatives three weeks before the visit was made. Survey cards were also sent to GP’s (General Practioner’s), social workers and district nurses who visit the home to find out their views of care provided. At the time of writing this report no resident and relative survey responses had Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 6 been received but seven GP and other healthcare professionals surveys (e.g. social workers and district nurses) have been returned. The evidence gathered at this inspection means that the quality rating for this home is now adequate. What the service does well: What has improved since the last inspection? As said before there were seventeen requirements and seven recommendations made at the last inspection. The provider has recognised and dealt with the problems identified about the management and running of the home. A new management team has been put in place and the operations manager will be making an application to become the registered manager. Over the last three months the home has worked with the adult protection team, social services and nurses from the primary care trust (PCT), to review all residents’ needs. This showed that they were being met, and that they and their relatives were satisfied with the care and services received. There has been a lot of training for staff at all levels, which has included specialist training on care planning for the nurses as well as other courses on dementia, abuse awareness and health and safety related topics such as moving and handling. The systems for dealing with resident’s medications have been reviewed and regular audits are carried out to identify and deal with any problems that may arise. Nursing staff have received training around dealing with medication. This has led to safer practices in the administration of medicines in the home. The activities organiser has put together a programme of regular in house activities along with some special in house events that have been well Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 7 received. These have included celebrations held for the Queens 80th birthday party and trips out to local shopping centres. A new chef has been in post for two months. During that time she has spoken to residents to find out what they like to eat and altered the menu plans. Residents said that the food had improved. What they could do better: The management team must continue to implement the positive changes that have started. They are to be commended for the hard work that has taken place. The manager must make sure that information from the pre admission assessment is used to properly identify whether or not the home can meet their needs. The home’s registration categories must be taken into consideration along with the knowledge, skills and competency of the staff team to provide the level and type of care needed. Residents and their relatives must be involved with the assessment and care planning process so that accurate information about an individual’s needs and preferences around personal, health and social care is recorded and acted upon. This must also include taking into account resident’s cultural and religious needs. Advice and support from other healthcare professional and specialists must be sought if residents are identified as at risk of falling or losing weight and appropriate records kept. The provision of staff training must continue in order to make sure that all staff in the home are qualified and competent to meet the needs of residents. This must include making sure that all nurses are aware of their professional responsibilities and that they provide other healthcare professionals with relevant information when they visit. The manager must make sure that residents have access to drinks at all times and that those who need help to eat or are at risk of losing weight receive frequent nourishing meals or snacks and help to eat as and when needed. Action plans showing how negative responses to satisfaction surveys should be put in place. For example in May 2006 a quarter of those who responded said they did not know about the complaints procedure. The staffing levels must be reviewed taking into account the numbers and needs of residents. Other factors that must be considered when doing this are the size and layout of the building, the physical, psychological, emotional and social needs of the residents. Steps must be taken to make sure that there are enough staff on duty at key times, particularly meal times. Please contact the provider for advice of actions taken in response to this Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Charlton Court DS0000001330.V298074.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.V298074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care needs are identified but the information is not always used when making the decision about providing their care. Therefore residents are admitted to the home whose care needs cannot be properly met. EVIDENCE: The homes combined Statement of Purpose and Service User Guide were updated in May 2006 to show the changes in the management structure. Copies were in the main reception area. Copies of past inspection reports were not seen. From the care plans seen it was clear that pre admisison assessments had been carried out for most residents. One care plan for a resident admitted in December 2005 did not contain a pre admission assessment. The information in the assessments seen was clear and detailed enough for the home to make a decision as to whether or not they could meet that persons needs. For one resident the initial enquiry was made by a social worker and it was not clear if Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 11 the resident or their relatives had been to look round the home. But for another resident it was clear from the information provided by the hospital and the home’s pre admission assessment that the resident had mental health problems and it would be challenging for staff to meet their needs. The manager said that this had proved to be the case and an urgent meeting had been held with another planned in the near future. Over the last three months most residents in the home have had their care needs reassessed by either the Primary Care Trust nurses or social services. These showed that their needs were being met and that they were satisfied with the care and services provided. The administrator said that most residents were placed and funded by social services, contracts were in place for these as well as for those who paid privatley. Charlton Court DS0000001330.V298074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place, which identify most of residents’ care needs. But the lack of continuity between these and other records kept means there is still a risk that they will not be properly met. EVIDENCE: The manager said that all nurses had now received training in writing care plans and that this was being put into practice. Nurses on duty confirmed this. The care plans for people admitted to the home since the training had been given were more detailed and individual to their assessed needs. But there were still gaps within the plans where clear and detailed information was not seen. For example the plan for a resident at risk of developing sore patches of skin did not say how to prevent this and what to do if it did happen. The plan also showed that the resident had very fragile skin and bruised easily but there was no information telling staff what to do to protect the resident. Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 13 Care plans for diabetic residents did not say where results of blood glucose checks should be recorded. Nurses were aware of Hazard Alert letters that had been issued about blood glucose monitoring machines and had taken appropriate action. They also said that each resident had their own machine. This is good practice. Falls risk assessments are carried out but appropriate care plans were not in place for one of the residents identified as at risk. There was nothing to show that they had been referred to the falls prevention team for advice and support on preventing falls. But on reviewing the accident records it was seen that another resident who had fallen five times in March 2006 had been referred to the falls prevention team. The manager said that referrals were requested via the GP’s who often carried out some tests before making the referral. Nutritional risk assessments are carried out for all residents but the care plans seen did not always reflect the outcomes of the assessments. One showed that a resident who was losing weight was assessed as medium risk and consider referral to the dietician but their care plan said they were eating and drinking well. The care plans seen for residents who were at risk of losing or had lost weight did not provide staff with guidance on providing a nourishing diet with foods that were high in protein, carbohydrate and fats. Not all of them said what the individual’s food likes and dislikes were. A dietician had seen some residents and the advice given was being followed. Bed rails were in use for a number of residents but the resident or their relatives did not always sign the consent forms. There are some residents in the home who have dementia but this was not their main reason for being in a care home. The care plans made reference to this but did not give clear information on how residents were affected by the dementia and the best ways that staff could communicate with and look after needs. The plans did not contain any psychological assessments. Some of the plans had been evaluated on a monthly basis. They did not all show that the resident or their relatives had been involved with producing them. However some plans did show that the care assistants were being actively involved in finding out what the resident’s personal hygiene and nutritional preferences were. This is good practice and should continue. After the inspection in January 2006 a number of problems with the systems for looking after residents medications were identified. An immediate requirement was made that these must be dealt with. A random inspection in February showed that this had been done and it was pleasing to find that this has continued. The manager or her deputy carry out a monthly audit of all medication systems and any problems found are dealt with immediately. The ground floor drug storage areas were seen and it was clear that stocks kept now are enough for the next month and unused drugs are disposed of Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 14 correctly. The stock levels of some of the controlled drugs were checked and corresponded with the record book. The medication record charts seen had been filled in correctly. It was seen that staff used safe procedures when giving out medications at lunchtime. Nurses said that they had received training around dealing with medication from the supplying pharmacist. Survey cards were sent to GPs and other health and social care professionals who visit the home. Some had been returned when this report was written. Comments were varied. The GPs had some concerns about the skills, competence and knowledge of some of the nurses. They said that they were often called in to see a resident who was not well but the nurse would not have any further information to back this up and often basic observations such as temperature, blood pressure or urine tests had not been done. This made it difficult for them to assess what treatment was needed. They also had concerns about residents losing weight but did say that the home had asked for referrals to the dietician for a number of residents over the last few months. Resident’s said that they were settled and comfortable living in the home. They said that staff were kind and caring and respected their privacy. Some resident’s preferred their bedroom doors closed while others liked them open so that they could ‘see what’s going on’. Throughout the day staff were seen knocking on doors before entering and where they were providing personal care to residents in their rooms, they made sure the door was closed. Similarly residents’ privacy was protected when bathing and toileting was taking place in communal facilities. A number of residents need lifting with a hoist, and when this was carried out in communal areas, staff were sensitive and made sure that the resident was lifted in the most dignified way possible. Charlton Court DS0000001330.V298074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s social care needs are being met but this is not clear from the records kept. Residents were satisfied with the meals provided. But residents at risk of losing weight or who need to help to eat are at risk of these needs not being met because there are not enough staff available at mealtimes to provide the support needed. EVIDENCE: Residents social, cultural and religious needs are identified as part of the pre admisison assessment but the care plans seen did not always show what action was to be taken to meet them. For example the care plan for a resident with an eastern european background did not mention how their religious needs would be met. But it did provide staff with some information on the best ways of communicating with them. The end of life care plan for another resident showed that they were Roman Catholic and that the family said last rites would be needed but there was no other mention of how the residents religious needs would be met. The manager said that the home does have equal opportunities policies for staff but when seen they do not address meeting residents diverse Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 16 social, cultural and religious needs. During general discussions it was clear that staff understanding about different religions was limited. The manager said that she would make sure information and training was made available to staff. The home has a full time activities organiser who is very committed and enthusiastice about their role. There were a number of posters in the entrance hall that publicised forthcoming events. There are regular in house activities such as bingo and quizzes, as well as special events like the celebrations held for the Queens 80th birthday and the various trips held and planned to shopping centres and seaside resorts. Residents said that they had enjoyed the ‘birthday’ celebration and were looking forward to the trips. Bigger events designed to encourage and involve relatives and the local community are being planned, for example a summer fair. Visitors were seen coming into the home at different times and said that they were made to feel welcome. One resident said that staff were helping them to ring their relatives so that they could keep in touch. It was clear that residents exercise choice about where they spend their time. Some residents said that they preferred to spend time in their rooms watching TV and reading while others spent time in the lounge areas. They said that they could choose when to get up, go to bed and whether or not to join in with the planned activities. Residents were sat in the downstairs lounge without any drinks and there were no jugs of water or juice. Staff did not offer drinks during the hour that the inspector was there. The manager said that this was not the norm and would rectify the situation. Residents in the lounge upstairs had drinks and there were jugs of juice available. Most residents have meals in the dining room but they can choose to eat in one of the lounges or their own room if they wish. The meals seen were attractively served and looked appetising. Most residents who needed help to eat were given one to one attention by care assistants but some staff were seen sitting between two residents and helping them to eat their meal at the same time. This is not good practice. Some residents needed prompting to eat their meals and it was seen that they did not eat much. One care assistant said that they would offer them a yoghurt or ice cream but this was not seen at lunchtime. There are a number of residents who are frail and under weight and appropriate action must be taken to make sure that their dietary intake is adequate. Some of the staff said that residents were not always asked why they had not eaten a meal or if they wanted something else. There were some residents on the first floor who ate in their bedrooms who did not finish their meals. It was difficult to work out if this was by choice or if there was a need for more staff to be available to encourage and assist people. Those identified as definitely needing assistance in the lounge area and in their bedrooms were helped in a caring and sensitive way. Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 17 Since the last inspection a new chef has been appointed. In a conversation with her, she said that at the outset of her appointment she had much work to do in ensuring that the kitchen staff team followed good food hygiene standards and maintained an efficient and effective kitchen. She felt that over the two-month period since her appointment her objectives in this respect had been achieved. There have been different methods of surveying the residents to establish what they think of the menus and find out new suggestions. The chef said that as part of this exercise she had been around the residents chatting with them. This was confirmed by some of the residents who said that they appreciated this personal approach. The chef said that she is made aware of the personal preferences and any special dietary needs of new residents coming to the home and that she would always sees them to check. One resident said that there had been a definite improvement since the new chef had started. She confirmed the system of choosing the meals from the menu and said that if neither of the choices were to her liking, an alternative would be given. Staff said that for residents who did not have the mental capacity to make a choice, they would complete the choice menu sheet for them, basing their decision on awareness of the residents’ likes and dislikes. A visitor spoken with who had sat with his father in a lounge during the midday meal, said that he visited at different times of the day and felt that the food generally looked good and although his father had a pureed diet, this too was presented as best it could with each portion of food being separate on the plate. Charlton Court DS0000001330.V298074.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe living in the home. There are appropriate procedures in place for responding to and dealing with complaints. EVIDENCE: The PIQ and complaints records showed that there have been eighteen complaints over the last twelve months. Two were fully true and five partly true. The complaints were mostly about standards of care provided. One complaint is awaiting the outcome of an investigation. The forms that are used to record complaints should be revised in order to provide more detail. They gave information about how the complaint was received, what the complaint was about and what action was taken. But the details of investigations made were not clear, it was difficult to see if the complaint was founded or not. The home’s own satisfaction survey sent to relatives during May 2006 showed that approximately a quarter of relatives said that they were not aware of the home’s complaints procedure, but there was no action plan to increase awareness. Complaints procedures were seen on notice boards around the building and the procedure is also included in the Service User Guide but a more proactive approach to informing people about it should be taken according to the results of the survey. Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 19 Adult protection procedures are in place and most staff in the home have received training. Staff said they would not hesitate to report abuse to the person in charge. Residents said they felt safe. After the inspection in January 2006 referrals were made to the local adult protection unit on the advice of the CSCI. It was good to see that the homes management team worked in partnership with them and CSCI to resolve the identified problems. A previous investigation with regard to some residents’ personal money that involved an adult protection coordinator from the social service department and referral to the police has been completed and dealt with appropriately to the satisfaction of all concerned. Charlton Court DS0000001330.V298074.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care is provided to residents in a clean, well-maintained environment. EVIDENCE: The home was clean and tidy and there were no odours. The laundry was tidy and well organised and residents clothing looked well laundered. The manager said that there is an ongoing programme of redecoration. An audit of all bedrooms has been done and this has identified bedrooms, which will be decorated as a priority. The manager said that work on providing an assisted shower has almost finished. A new nurse call system has been fitted. But the home was let down by the fact that during one observation session on the first floor one resident made an Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 21 emergency alarm call. Because the response was so poor, indeed nobody responded over a three minute period, the nurses who were at the nursing station talking with each other were asked to see to the resident. Emergency calls must be responded to without delay. Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a risk that resident’s needs might not be met because there are not enough staff on duty. EVIDENCE: Evidence was collected by checking past duty rotas, making direct observations of staff carrying out their work and speaking with residents and staff. The home is operating well below full occupancy. On the day of the inspection there were fifty-two people resident in the home. The standard rota showed early shifts with three qualified staff and eight carers, late shift three qualified staff and six carers and on nights two qualified staff and four carers. The duty rotas for the week beginning 22 May 2006, showed times when the number of carers was below this. Residents had higher dependency levels on the first floor and it was here that more focused observations were made of staff at their work. Staff were busy dealing with residents’ personal care (dressing and bathing etc.), serving meals and helping residents with their meals. There was little time to spend with individuals giving them personal quality time and emotional support. Staff said that they felt frustrated and guilty some times knowing that they could not give residents emotional and psychological support. They said that at times when they worked below rostered numbers of staff, they were conscious that people had to wait to be attended to – to be washed, dressed and helped to go the toilet. This was recognised by one resident who said that they sometimes had to wait longer than they wanted to Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 23 be assisted to get up because of the staffing situation. She said with some understanding and acceptance of the situation that ‘you just have to wait your turn, they can’t deal with everyone at the same time’. A GP survey card said that ‘there never seems to be many staff in the home’.The manager must take account of these views and make sure that there are enough staff on duty to meet not just the personal care needs of residents, but also their psychological, emotional and social care needs, also to assist those residents who need help to eat as mentioned in the section on Daily Life and Social Activity. The PIQ shows that while there has been some significant training input there are only 4 of the staff team who have achieved NVQ (National Vocational Qualifications) level 2. Three care staff also have nursing qualifications in their country of origin. The manager said that she is looking for people to enrol for NVQ’s. This was confirmed by staff who are looking forward to doing it. Three staff files were checked. All had appropriate documentation that provides evidence that good and thorough recruitment procedures are followed and that appropriate checks have been made for criminal records and lists of people prevented to work in a care setting. The files were well organised, indexed and information was easily found. The Januaury 2006 inspection report showed that there were shortfalls in the staff training programme. There has been a tight programme of training for all staff that has covered safe working practice issues. In addition more specific and specialist training has been provided such as care planning and dementia. A copy of the training programme was provided and will give the CSCI an opportunity to measure and monitor progress at future inspections. The home will also need to address the new common induction training programmes that must be followed from September 2006. Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The changes to the management systems mean that the home is now being run and managed in the best interests of the residents. EVIDENCE: The home is operating without a registered manager. The CSCI has been made aware that the operations manager for the company is to make application. This must be done without further delay. In addition information that has previously been requested in connection with the previous registered manager must be provided so that the CSCI is clear about actions that were taken. The acting manager of the home is an experienced nurse with management experience and has made significant inroads to re-establishing proper management practices and management systems at the home. The deputy manager has also been important in assisting in this process. Staff said that Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 25 working at the home is much better now with the altered management team. The manager and the deputy are approachable and supportive and make sure they know what is happenning in the home. Support staff do not feel they are being taken away from their own roles and can do what they are supposed to do. Staff said they were working together as a team and communication systems had improved. They said that this had resulted in making things better for the residents. There was evidence that the home is now beginning to carry out quality audits in a range of areas. This included care planning and medication. Survey questionnaires have also been sent out to relatives and visiting professionals and the results have been formulated into a report with actions that need to be taken identified. Thought should be given to the questions that were used so that the questions that are used give more information and in particular should address National Minimum Standards and services that are received. Monthly reports on the conduct of the home have been regularly provided to the CSCI since the last inspection report. These have been useful in understanding the priorities and improvements the home is making. Whilst attempts have been made to establish a staff supervision system one to one sessions with staff have not been sustained with the regularity they should be. The staff spoken with and the managers all recognise the importance of supervision as a management tool and this must be re-established. The PIQ shows that regular checks have been made of the facilities and equipment to make sure that staff and residents are safe. In addition the records of testing fire safety equipment were seen and these also showed that checks were regular and up to date. Safe working practice training has now been provided. Information in the PIQ states that appropriate policies and procedures are in place. Three of these were reveiwed in Jan 2006 - medication, moving and handling and management of residents money, mainly as a result of problems identified at the January 2006 inspection. The administrator takes residents’ personal money into safekeeping if required. Appropriate records are kept. The home does not act as agent or appointee for any residents. Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 26 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 2 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X 2 2 X X x 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 1 X 3 Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 27 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 OP4 Regulation 14 Requirement 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, 31/1/06, 31/3/06 and 31/05/06 were not met.) The work started on making sure that a detailed plan of care is in place for each resident, must continue. These must detail the actions taken and provide an accurate picture of the service user. 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 DS0000001330.V298074.R01.S.doc Timescale for action 31/08/06 2. OP7 14 31/10/06 3. OP8 12 and 14 31/10/06 Charlton Court Version 5.2 Page 28 are kept under review and advice sought from relevant healthcare professionals. This must include falls and nutrition. Records must be kept. 4. OP15 16 The manager must make sure that residents at risk of losing weight or in need of help to eat receive adequate quantities of suitable, wholesome and nutritious food, which is varied and properly prepared and available at times as reasonably required by residents. The registered person must make sure that there are sufficient numbers of accessible bathrooms for the numbers of service users in the home. (Previous timescales not met are 30/11/04 and 31/3/06. The timescale of 31/08/06 has not been altered.) Systems must be in place, which make sure that residents are checked quickly when the emergency call system is activated. 30/08/06 5. OP21 23 31/08/06 6. OP22 13 26/06/06 7. OP27 18 The registered person must 31/08/06 ensure that there are enough staff on duty to meet the needs of residents. The size and layout of the building must be taken into consideration along with the physical, psychological and social needs of the residents. (The timescale of 31/05/06 was not met.) The registered person must make sure that at least 50 of staff achieve NVQ level 2. The manager must continue to DS0000001330.V298074.R01.S.doc 8. OP28 18 31/03/07 9. OP30 18 30/10/06 Page 29 Charlton Court Version 5.2 develop and sustain a training programme that will equip staff with the skills and knowledge to meet the needs of residents. This must include making sure that all staff, particularly the registered nurses are qualified and competent to carry out the jobs they have been employed to do. 10. OP31 9 The manager must make application to become registered with the CSCI. The manager must make sure that staff receive at least six one to one supervision sessions over a twelve month period. The registered provider must provide an improvement plan, with timescales, to the CSCI setting out the methods by which they intend to improve the services provided by the care home. 31/08/06 11. OP36 18 31/10/06 12. *RQN 24 30/08/06 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. 2. Refer to Standard OP1 OP8 Good Practice Recommendations Copies of past inspection reports should be made available. The manager should make sure that when bed rails are used either the resident or their relatives are involved with the decision and records are kept. The registered person should make sure that the DS0000001330.V298074.R01.S.doc Version 5.2 Page 30 3. OP12 Charlton Court information in the social care assessments is incorporated into the care plans, implemented and followed up as part of the care plan review process. The manager should make sure that appropriate policies, procedures and information are available to staff about equality, diversity, religious and cultural needs of residents. 4. OP16 Consideration should be given to providing training in dealing with complaints to the person responsible for doing so. The complaints records should provide more information and detail about how an investigation was carried out and clearly show if the complaint was founded or not. The manager should make sure that all residents, relatives and visitors are aware of the homes complaints procedure. 5. OP33 The manager should continue to develop systems and methods of monitoring the quality of services provided. The questions used in the satisfaction surveys should be reviewed in order to make them more informative. Charlton Court DS0000001330.V298074.R01.S.doc Version 5.2 Page 31 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.V298074.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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