Inspection on 17/03/09 for Charlton House

This inspection was carried out on 17th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Charlton House 26/03/07

Charlton House 08/02/06

Charlton House 23/03/05

Charlton House 26/07/04

Charlton House 29/01/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Charlton House 21 Walliscote Road Weston Super Mare North Somerset BS23 1EB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paula Cordell     Date: 1 7 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Charlton House 21 Walliscote Road Weston Super Mare North Somerset BS23 1EB 01934625978 01934625978 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Lal Gunaratne care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: May accommodate 2 named persons aged 18 years and over with physical disabilities, requiring personal care only. Will revert to LD when named persons leave. May accommodate up to 15 persons aged 18 years and over requiring personal care only The Manager to gain a formal LDAF qualification by June 2006 Date of last inspection Brief description of the care home Charlton House provides care for up to fifteen people with learning disabilities. Though most of the people who live there are over fifty years of age the home also provides care for some younger adults, including two specific places for people with additional physical disabilities. There is an activity room in the garden in which a good range of activities are provided. The home is a short walk away from local shops and facilities, Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 15 0 15 1 Brief description of the care home and a reasonable walking distance from the town centre and seafront.The current scale of charges is 475 to 700 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the progress to the requirements from the visit in March 2007 and monitor the care to the individuals living at Charlton House. There has been one additional visit in October 07 as part of a safeguarding strategy and concerns raised by an ex-employer who was concerned about manual handling practices in the home. A number of requirements were made during this visit and the home has demonstrated compliance. There have been no other concerns raised since that visit. Information was reviewed prior to this visit which assisted in the pre-planning of the visit. This included surveys from people who use the service, staff and visiting professionals. In addition the home sent professional visit questionnaires to relatives Care Homes for Adults (18-65 years) Page 6 of 35 and their views are included. The home completed an annual quality assurance assessment which gave some statistical data and evidence on how the home was intending to improve the quality of the care in the home. This assisted in the planning of the visit along with correspondence and regulation 37 notifications. The visit was conducted over 6 hours. During the visit an opportunity was taken to review the records that are required for the running of a care home, a tour of the home, a review of health and safety practices. In addition to talking with people who use the service, the manager and staff. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 35 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have some information about the service however this could benefit from being expanded. Individuals would benefit from more information in respect of the cost of the service ensuring an open and transparent service is provided. Individuals can be confident that the home will conduct a thorough and comprehensive induction. Evidence: The home has a statement of purpose and a service user guide. The manager stated that this is being reviewed and a new accessible format is being developed. This will be available in a DVD format. The manager was directed to the National Minimum Standards and the Care Home Regulations. The manager stated that they did not have a copy. It is strongly advisable that the home obtain a copy. This will assist the home in ensuring they cover all areas as defined in schedule 1 of the Care Home Regulations. The home has two vacancies. Many of the individuals have lived in the home for many Care Homes for Adults (18-65 years) Page 10 of 35 Evidence: years. The manager was able to describe the assessment process which would include obtaining a copy of the assessment and care plan from the placing authority, meeting with the individual, their relatives and other professionals where relevant. The manager stated that the individual would be encouraged to visit and stay over night as part of the assessment process. Contracts were viewed for three of the individuals. The contract did not capture the true fees for the placement but gave a range. In addition the contract did not state what was included in the fees and any chargeable extras. Individuals contribute towards the running of the vehicle and one pound towards their day care. There were no agreements from individuals in respect of these payments. Care Homes for Adults (18-65 years) Page 11 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their assessed care needs are being met and there are systems in place to ensure their safety without restricting their freedom. Evidence: Three persons care documentation was viewed as a means to determine the outcomes for people living in Charlton House. Information was clear and included information pertinent to the individual. The home uses the activities of daily living covering all aspects of a persons wellbeing. The manager stated that she was in the process of reviewing the documentation and is planning to implement a new system that is more person centred and will be accessible to the individuals living in the home. Individuals confirmed that they could make decisions about their care and were involved in meetings about them. One person said it was alright living in the home they could listen to their music and do what they wanted when they wanted. Care files Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: included information about daily routines including personal care. From the care documentation and talking with staff it was evident that individuals are encouraged to be as independent as possible. From reading an individuals placing authorities care plan it was evident that they needed some support around being angry. Whilst this was acknowledged in the care plan if did not detail how staff were to support the individual or the triggers. The home was reviewing care plans ever six months or more frequent where care needs were changing. Annual reviews are conducted with the individual, their relative and the placing authority. Risk assessments are drawn up on any areas of particular risk for individuals. These clearly state what the risk is and what strategies should be adopted to reduce these. Risk management strategies evident ensure the safety of the individual without unduly restricting freedom. The manager stated that they are looking to expand the risk assessments to cover all areas of daily living and activities that individuals undertake. This would be good practice. People living in the home are involved both in the planning of their care and the running of the home. Individuals views are sought from an annual questionnaire and three monthly house meetings. House meeting topics included meal planning, holidays, activities and a means to inform people about changes in the home. Individuals spoken with said they could do what they wanted on an evening and on the weekends. From conversations with individuals it was evident there was an expectation that they would take part in the activities organised in the occupational therapy unit if they were not attending college or their external day care. Care Homes for Adults (18-65 years) Page 13 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are offered a wide range of activities both in the home and the community. It is evident that the home is meeting the diverse social needs of both the younger individuals and the older people that live in the home. Individuals are encouraged to maintain contact with friends and relatives. Individuals are offered a healthy and varied balanced diet. Evidence: From talking with the individuals it was evident that there was lots of activities available to them. Some of the younger individuals attend a day centre, college and work placements. On the days that individuals are at home they attend the occupation unit which is situated in the back garden. Individuals from Southside House also attend. A member of the care staff works in the occupational unit supporting individuals with arts and crafts, gardening, listening to music, exercises and games to name a few. Some of the activities take place in the community including shopping Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: trips, attendance at the local coffee morning at the church and a karaoke afternoon at a local pub. The people living at Charlton House have varying needs. From talking with staff, the manager and the individuals it was evident that activities were organised to suit the individuals. Some of the individuals have retired and enjoy listening to music whilst others enjoy going out and attending a coffee morning at the local church or going to clubs or the local sports centre. Charlton House has built good links with the local church. Individuals are supported to maintain contact with their friends and family. This is recorded in the individuals care plan. Individuals are also supported to attend local clubs where they can continue to meet up with friends. From talking with individuals it was evident that they could speak with friends and family on the telephone and staff would support them to visit when they wanted. Individuals confirmed that they were having a holiday and that they were going to Cornwall. The manager stated that two holidays are being organised this year with some people going to Cornwall and others going to Devon. Where individuals have expressed not to go then day trips are organised. There is a wide age range among the individuals accommodated. This is reflected in the widely different interests of the individuals as well as in their attitudes to life. Some of the older individuals have long-term institutionalized behaviours that can be challenging to people around them, and many of the younger people have strong expectations of leading a normal life. These differences can sometimes give rise to tension. Strategies are in place for dealing with antisocial behaviour and defusing situations. Individuals are supported to attend a local deaf club, a local social group for people with a learning disability and the Trefoil guides. From talking with individuals it was evident that they enjoyed attending and meeting up with friends. Records confirmed that they regularly attend these groups. There are two staff working in the evenings and the individuals are supported to attend these groups by taxi although additional staff would be employed for organised activities. The home employs a driver to assist with individuals getting to and from their planned activities and social events. On the day of the visit the driver was supporting individuals to go to a Hydro pool in Bristol. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: Individuals confirmed that the food was good and that the home catered for their likes and dislikes. The home has recently developed a pictorial menu book to aid individuals making a choice on what they would like to eat. The menu seen provided evidence that individuals are offered a varied and healthy diet. From talking with staff and the manager it was evident that the home was providing a number of options for the individuals. For example some of the individuals do not like spicy food so two different meals are cooked. Staff stated that individuals are asked regularly what they would like and this is then encompassed into the weekly menu. Staff described any special diets and how this is planned into the weekly menu. One person said that the staff makes puddings and cakes which they can eat and takes into account their diabetes. The kitchen was well stocked and organised. Staff said that one person assists with some of the cooking especially sandwiches and cakes but no other person has expressed an interest. However, it was noted in records that one other person had said they were interested in cooking more. They also attended a weekly cookery course. From talking with the manager it has been assessed that the kitchen was not suitable due to the individuals disability. This should be reviewed and measures taken to enable the person to access this area safely if this an area where they are interested. Individuals were offered refreshments throughout the day including snacks. Individuals said they could have a choice of what to drink including coffee, tea or squash. Care Homes for Adults (18-65 years) Page 16 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals health and personal care needs are being met. The lack of guidance for staff to follow in respect of medication practices could put individuals at risk. Individuals can be confident that the home will respond sensitively in the event of death and dying. Evidence: Care documentation included information relating to health and personal care. Each person has a health action plan which clearly describes the support needs of the individual. However, this could of been clearer for one individual which stated staff need to support. The care plan did not describe the role of staff, the independence of the individual or the equipment that was required. Clear records were in place demonstrating that the individuals have access to a doctor, dentist, optician and other professionals. The home has good links with the local Community Learning Disability Team in addition to Dementia Pathway Professionals. Staff said that they had some dementia training from one of the visiting professionals. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: Care plans included information where relevant on sleep, pain relief, skin care, mobility, weight and foot care. Other health care plans included diabetes, epilepsy to name a few. Records show that staff are quick to identify any possible changing needs and external health care input is prompt. Medication records were thorough and up to date. One person self medicates there was no risk assessment. Staff stated that there have been a few areas of concern with this. It is strongly recommended that this is kept under review involving the appropriate professionals. Medication that was kept in the fridge was not locked and could pose a risk to individuals. Appropriate storage must be sought ensuring the safety of the individuals. All other medication was stored appropriately. It was noted that medication belonging to a person who no longer lives in the home was still in the medication cupboard and another was out of date. This must be destroyed appropriately. Staff maintain a returns book of all medication that is destroyed by the local pharmacy. Training records indicated that staff have had medication training. The manager stated that a refresher course is being organised by the local pharmacist. From reading the complaint record there was evidence that a member of staff had made a medication error. There was no other record made in the persons day to day notes or a regulation 37 notification in respect of the error to the Commission for Social Care Inspection. An opportunity was taken to review the medication policy and guidance for staff. This needs to be expanded on the role of staff in respect of a medication error or omission and the disposal of medication. The manager was directed to the Royal Pharmaceutical guidelines which details what should be included in a medication policy for a care home. The home has experienced three deaths over the last twelve months. It was evident that this time has been difficult. The home has liaised with the primary health care team to ensure that the end of life care was in place for one of the individuals and additional staff have been employed to assist with the day to day care of the person. Whilst staff have not had bereavement and loss training it was evident that the team and the individuals living in the home supported each other. The manager was in the process of reviewing the policies and guidance for staff on supporting people with death and dying. The manager said they are exploring how this can be approached Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: with the individuals so that they can make choices and be involved in their end of life plans. In light that some of the individuals are getting older this is good practice and demonstrates that the home is being proactive. Care Homes for Adults (18-65 years) Page 19 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their concerns are being responded too. Staff feel confident that they can raise concerns on the behalf of the individuals. However, the record of complaints could better evidence that actions taken to address the concerns. Indiviuduals can be assured that they are protected and staff are knowledgeable about the procedure. Evidence: The home has a written complaints procedure. Individuals stated that they would tell the manager or staff if they were unhappy. From reading the complaints record it was evident that staff were raising concerns on behalf of the people living in the home. The complaints record contained concerns raised in the main by staff about areas of care that were not satisfactory. Whilst it is good practice that these are raised it would be advisable to review whether the complaint log is the appropriate place to record them. For example one of the records related to a medication error. From reading the record of complaint it was not clear what action was taken to address the concern or the outcome. It would beneficial if the complaint record clearly recorded the complaint, the action taking to address the concern and the outcome. This must include timescales so that the home can audit how the home is responding to concerns. The Commission for Social Care Inspection conducted a random visit in October 2007 in response to a concern raised by an ex-employee who was concerned about manual handling practices in the home in relation to accessing the minibus and that they were Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: left to supervise individuals whilst staff had staff training. They were concerned that they had not been employed in the role of carer. This was fully investigated and the home was required to have clear guidance in relation to manual handling tasks for individuals. The home has demonstrated compliance. In respect of the member of staff supervising the individuals reassurances were given that the staff were available as the training was taking place in the home and they were available if an individual required support. Staff were aware of safeguarding and confirmed that they had attended training with the local Council. The home has a policy on safeguarding and a whistle blowing policy. Staff said they would have no hesitation in contacting the appropriate persons in respect of an allegation of abuse being reported with the first port of call being the manager. The home has financial procedures, these were not viewed on this occasion. Finances were checked for three individuals. Good systems were in place to protect the finances of individuals. Documentation was in place describing the support each person required. Individuals sign a record for their personal allowances that they have control over. However, it was not clear from this record the amount each person was being given. This should be made clearer so that the individuals can account for their own finances. Care Homes for Adults (18-65 years) Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Charlton House provides a safe and comfortable place for the individuals living in the home. Evidence: Charlton House is in a residential area close to amenities including shops, a church, local college and the seafront of Weston Super Mare. The home is in keeping with the local neighbourhood. The home is well decorated and maintained and comfortably furnished, creating a pleasant and welcoming environment. All areas of the home were clean and free from odour. There are two communal lounges and a dining room. In addition the individuals have access to an Occupational Therapy Unit situated in the garden. Individuals were observed accessing both the communal lounges and the occupational therapy unit. It was noted that the bedrooms on the first floor were all locked. Staff said that individuals could access their bedrooms but they were locked as there was a risk that one person could wander in to the bedrooms of others. The locking of the bedroom doors was not documented either in a risk assessment or the statement of purpose. Individuals confirmed they could access their bedrooms when they wanted. However, Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: this should be clearly documented and kept under review. It was noted that some of the bedrooms were lockable. Staff stated that all the individuals can lock their doors from the inside and these can be opened in the event of an emergency. However, some have requested a lockable devise and a key from the outside so they can lock them when they are not in their bedrooms. Bedrooms had been personalised by the occupant. One person said they liked their bedroom and they could sit and listen to music or watch the television. Bedrooms are situated on both the ground and first floor. Access to the first floor is by a stair lift. There are two shared bedrooms. Individuals have shared together for many years and from talking with staff and the individuals it was evident that they were happy to continue to share. Where a vacancy occurs in a shared room the manager is aware that it may no longer be suitable or an option for the future. A visiting professional also highlighted this as an area for improvement and that double rooms should no longer be an option for the future. There are adequate toilet and bathing facilities situated in the home. It was noted on two occasions that there was no toilet roll in the bathrooms on the first floor. Staff stated that one of the individuals takes the toilet rolls and that they complete regular checks to ensure that there are adequate toilet rolls, soap and hand towels. It was suggested that in this instance that a toilet tissue dispenser be purchased. The home supports two individuals with a physical disability. Appropriate equipment is in situ to assist staff with lifting and aid the individual with personal care. These were being routinely checked by an external contractor. Care plans did not alway tell staff what equipment was to be used as mentioned previously. However, from talking with staff it was evident that they had attended training in manual handling and had a good awareness of the equipment to be used. Grab rails were situated in bathrooms, corridors and toilets. The bathroom door has been widened to enable individuals in a wheelchair to access this area more safely. In addition the radiator has been raised to prevent scalds should someone fall and the hot water pipes have been covered. This was in response to a random visit conducted in October 2007. The home during the random visit was required to risk all radiators in the home by October 2007. The manager stated that the provider has agreed that all radiators will be covered where there is a risk. This has been completed in the sister home Southside House and will now continue in Charlton House. A contractor has been Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: employed to commence the work pending a satisfactory criminal record bureau disclosure. Some work has commenced as already mentioned with the bathroom radiator being moved and a radiator in the hallway being covered. This work must continue where there has been an identified risk and in light that some of the individuals are getting older. A large part of the rear of the garden is taken up with a large summer house which houses the occupational therapy unit. There is a patio area for individuals to enjoy the garden space and an area of garden which is being cultivated as part of the structured activities offered to some of the individuals who are interested. Two of the ground floor bedrooms have patio doors leading to this area. On a previous visit it was noted that staff were using this as a short cut to the occupational therapy unit. Staff confirmed that this is not acceptable and said that the manager has recently reinforced this with them. The kitchen area was clean and well organised. Policies and procedures are in place to guide staff on safe handling of food. Staff have attended training in food hygiene. The care staff complete all food preparation as part of their duties. The home has been visited by an Environmental Health Officer in June 2008. The home demonstrated that they had complied with the requirements and recommendations made during that visit. The home maintains a record of food probe temperature. However, the advice given to staff was conflicting and it is recommended that the manager seeks clarification from Environmental Health on the correct food probe temperature. Good records were maintained demonstrating that good food handling principles were being adopted including fridge/freezer temperatures and cleaning schedules. The laundry is situated off the kitchen and from talking with staff it was evident that staff had a good awareness of the prevention of cross infection with clothing not being carried through the kitchen but through the rear entrance. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff support the individuals living at Charlton House. Staff competence and knowledge could be enhanced if this was broadened to capture the needs of the individuals living in the home. Individuals could be put at risk if a thorough recruitment process is not completed. Evidence: The home is staffed 24 hours a day. Three carers work in the morning with two carers in the evening. Nights are covered by one waking and one sleep in carer. In addition the home employs an administrator and a domestic member of staff. The manager works in the home Monday to Friday along with an assistant manager. Additional staff on employed for social activities in the evenings for example the theatre or trips to pub. Some of the individuals go out independently and others attend activities in the evenings but are taken by taxi. Recruitment information was checked for four members of staff. All staff had completed an application and had completed a satisfactory criminal record bureau check prior to taking up employment with the home. Less apparent were two references and one being from their last employer. One staff had no references and three only had one. The manager said that she always obtains two references and was Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: concerned that these had not been filed appropriately. It was noted that recruitment information including criminal record disclosures were kept on an open shelve in the managers office. The manager said that this is always locked when she is not on the premises. However, there were times during the visit when the office was left unattended and unlocked. Records relating to staff recruitment must be held securely. The home has recently purchased a new induction system. A person had been working in the home for approximately five months and whilst it was evident that the staff had ticked off areas that had completed there was no date or staff signature. This must be rectified. The induction encompassed the guidance from the Skills for Care. However, there is an expectation that staff that support individuals with a learning disability complete the Learning Disability Award Qualification. The home employs 23 staff. The manager stated that 20 staff have completed a National Vocational Qualification (NVQ) at level 2 with some proceeding to complete level 3. The home has exceeded the governments target to ensure that 50 of the workforce have an NVQ in care. Staff training in the main focused on health and safety statutory training. Although staff have recently had some dementia training and supporting individuals with challenging behaviour. Less apparent was training specific to the needs of the individuals for example diabetes, care of the older person, bereavement and loss. Staff said that they had some training on dementia but could benefit from more to further build on their knowledge. The manager said that they were organising further refresher training on infection control and medication training. It was noted that some staff attended their safeguarding training in 2004 and could benefit from a refresher. Supervision was discussed and records seen. The manager said that she meets informally with all staff to discuss issues but this is often not recorded. One member of staff said that the manager is always available to listen to concerns however not all is taken on board. There was a lack of action recorded in the complaint book which further highlighted this. However, the manager said that some of the concerns raised are minor disputes between staff and there is an expectation that they will resolve these themselves. Supervision records were viewed. It was evident that many of the staff have had only one record of supervision session with the manager in the last twelve months. This was discussed during the visit and the manager was not aware of the National Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: Minimum Standards and did not have a copy in the home. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals benefit from a well managed service where their safety is paramount. Individuals views are sought to improve the service provided. Evidence: Mrs Veronica Bishop is the registered manager and has completed the Registered Managers Award. Mrs Bishop has many years experience of supporting people including individuals with a learning disability and older persons. Mr Lal Gunatne is the owner, staff and the manager stated that he visits regularly. It was evident from the conversations that he spends time with both the staff, the manager and the people living in the home. Staff spoken with during this visit had mixed views on the approachability of the manager. One person said that they have been really supportive during a difficult time in their personal life and another said that she does not always listen and her way is the best. One member of staff said that the house cleaning appears to take priority over spending time with the individuals. However this did not fit with what the Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: manager was saying who said if individuals want to go out or spend time with staff this is supported. Two visiting professionals stated that the manager is always available and acts upon the advice that is offered. One professional said both the staff and the management are proactive in dealing with any issues and their priority is the care of the people living at Charlton House. This was very much what was echoed by the manager. The home has a quality assurance policy and guidelines in place. The manager stated that the home regularly sends questionnaires to the individuals living in the home and thier relatives to actively seek their views. The manager said that this happens annually. In additon the home conducts audits on the environment and medication. Informally the home measures the quality of the provision of care through care reviews, staff and house meetings and as already mentioned the homes complaint record. Good systems are in place relating to health and safety including envrionmental audits, routine checks on electrical appliances, gas and manual handling equipment. The home maintains a record of checks on the fire equipment, staff fire training and the participation in fire drills at appropriate intervals and in accordance with the fire officers advice. Staff training was in place in relation to health and safety including manual handling, food hygiene, health and safety, infection control and first aid. A member of staff said the manager is good at ensuring they attend a rolling programme of training. Accident records were being maintained of incidents that occur in the home. Appropriate action was recorded including any remedial action to address the issue. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 For the home to expand on the statement of purpose ensuring it includes information as per schedule 1. This will ensure that individuals are informed about the service that is to be provided. 20/05/2009 2 5 5 Contracts must clearly state what the fees are for the individual, and any chargeable extras. This will ensure that an open and transparent service is being provided. 15/04/2009 3 19 37 To keep the Commission for 08/04/2009 Social Care Inspection informed of any incident that effects the well being of the individuals living in the home. Care Homes for Adults (18-65 years) Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Ensuring that communication is open and appropriate action is taken. 4 20 13 Medication must be stored in 17/04/2009 accordance with the Royal Pharmaceutical Guidelines. A secure medication fridge must be purchased. 5 20 13 Where individuals self medicate this must be clearly risk assessed. Ensuring the individual has the appropriate skills and protecting them from harm. 6 20 13 Review the policy on 05/05/2009 medication to ensure that gives staff clear guidance on what to do in event of medication error or omission and the disposal of medication. Ensuring a consistent approach is followed. 7 22 22 For the home to maintain a record of complaints including the actions taken to address the concern and the outcome. This will better evidence the effectiveness of how the home is responding to concerns. 08/04/2009 08/04/2009 Care Homes for Adults (18-65 years) Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 24 24 To continue with the programme of ensuring that radiators are covered in line with the homes risk assessment. To ensure the safety of the people living in the home. 28/04/2009 9 34 17 Ensure staff recruitment information is held in a secure lockable cabinet. This will ensure staff information remains confidential. 08/04/2009 10 34 17 Ensure that two references are obtained prior to a member of staff taking up employment in the home. This will ensure that the individuals living in the home are protected. 08/04/2009 11 36 18 Ensure staff are adequately supervised. This will ensure staff are supported and given appropriate guidance. 05/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 5 The home should document the decision process for the chargeable extras seeking consent from the individuals or Page 33 of 35 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations what there is a lack of capacity their relatives and the placing authority. 2 22 Review how and what the home is recording in the complaints book detailing the complaint, the action taken to address the concern and the outcome. To review the record of signatures for finances so that individuals know what they are signing for. This should be an individual record rather than all signatures held in a central book. For individuals that are presently sharing to be given an opportunity to have a single bedroom. Where a vacancy occurs in a double room this should be reviewed. Ensure that toilet paper is available in all bathrooms and toilets explore other options if necessary for example a toilet paper dispenser. To review training to ensure it encompasses the needs of the people including care of the older person, bereavement and loss, diabetes to name a few. For all staff to have at least six supervisions per year. 3 23 4 25 5 27 6 35 7 36 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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