Inspection on 08/02/06 for Charlton House

This inspection was carried out on 8th February 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Charlton House 17/03/09

Charlton House 26/03/07

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 08/07/2008.

CARE HOME ADULTS 18-65 Charlton House 21 Walliscote Road Weston Super Mare North Somerset BS23 1EB Lead Inspector Catherine Hill Unannounced Inspection 8th February 2006 09:30 Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 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 House DS0000008082.V272959.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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 House DS0000008082.V272959.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Charlton House Address 21 Walliscote Road Weston Super Mare North Somerset BS23 1EB 01934 625978 01934 625978 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) Mr Lal Gunaratne Mrs Veronica Bishop Care Home 15 Category(ies) of Learning disability (15), Learning disability over registration, with number 65 years of age (15), Physical disability (1) of places Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 15 persons aged 18 years and over requiring personal care only May accommodate 1 named person aged 18 years and over with physical disabilities, requiring personal care only. Will revert to LD when named person leaves The Manager to gain a formal LDAF qualification by June 2006 Date of last inspection 24th August 2005 Brief Description of the Service: Charlton House provides care and support 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 and support for younger adults, including one specific place for someone with physical disabilities. There is an activity room in the garden in which a good range of in-house activities are provided. The home is located a short walk away from local shops and facilities, and a reasonable walking distance from the town centre. Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, carried out during the course of the late morning and early afternoon. It focused on talking with people about their perceptions of the home, and on looking at residents care records, particularly those relating to health care. The inspector spoke privately with six of the residents and with two of the staff on duty. The picture built up from these conversations was of a relaxed and friendly place where people feel valued as individuals. Residents were generally very happy living at the home, and some people were able to give clear examples of the things they particularly like. Although one person had had a recent difficulty with a staff member, the overall impression was of warm relationships and mutual respect. There is a widening gap between the behaviours and expectations of some of the older residents and some of the younger ones, and this can lead to clashes. The home is trying to manage these as far as practicable, but this is likely to remain a significant issue. The records sampled were by and large clear, informative, and up-to-date. They gave a detailed picture of each persons needs and preferences, and of how these are being met. What the service does well: What has improved since the last inspection? What they could do better: Four requirements were made regarding the premises: locks are required on the toilet doors, and bedroom doors need to be fitted with safety locks only; Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 6 the smell of urine in the upstairs toilet must be eradicated, and the Occupational Therapist who has given advice on environmental adaptations needs to be consulted about additional outdoor grab rails. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 Residents needs are generally well documented and well met, although a recommendation was made to further improve this. Residents are consulted and their views are taken into account. EVIDENCE: The care plans sampled contained a good level of information about each persons needs and preferences. The care plans seen had been reviewed at least every six months, in line with the National Minimum Standards. Where these have been frequently updated, it can be confusing as to which entry is the current plan of action. Mrs Bishop has recently acquired a computer which she intends to use for work, so she will soon be able to print out updated versions of current care plans and archive the old ones. Although care plans had been updated to reflect all sorts of comparatively minor changes, it can be difficult to ensure that each plan is completely up-todate at any given moment. The inspector noted changes in the behaviour of one person that had not been incorporated in their written care plan. It is recommended that the care plan of this particular resident is updated to Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 10 include his recent habit of swearing. The homes staff have already been liaising with healthcare practitioners to investigate possible causes of this, and there is an unwritten strategy being used by staff to respond to this behaviour. This needs to be formalized. Significant information is noted in red at the top of care plans and at the front of residents files. Each file has a front sheet with all the essential information on it and a recent photo of a person. Health care plans were discussed at the unannounced inspection of the sister home before Christmas, and Mrs Bishop has now also started to look at health care planning for the residents of Charlton House. She has contacted residents GPs about routine health screening and has discussed smears and breast checks with all the female residents of the right age. Residents care records have been slightly redesigned to incorporate a record sheet for each person with the dates of all inoculations, routine tests, et cetera. Residents meetings were held in July last year and January of this year. The inspector noted an entry in the minutes of the latest meeting which indicated that night staff could be switching off the television in the lounge at bedtime, and requiring residents to continue watching television in their own rooms. Mrs Bishop said that this would be in contradiction to the instructions staff have to behave as if this is the residents own home, and that there is no set bedtime, but that she would look into the matter. It was a requirement of an earlier inspection that a policy is drawn up on residents access to their records. This was not discussed at todays inspection but will be carried forward to the next. Mrs Bishop has drawn up a risk assessment that includes guidance for responding to the person who makes unsubstantiated allegations. She has made various attempts to contact the social worker for this resident, and in the meantime has liaised with the manager of the day-care service attended by this person in drawing up this document. Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11-16 Residents get exceptional opportunities to experience varied and fulfilling lifestyles. Although residents are generally very happy, the wide range of ages and abilities creates some clashes. EVIDENCE: Records included lots of references to residents activities, social events, and visitors. Each person has their own timetable of regular activities, but many residents also share activities. For example, several people attend the same day centres, and quite a few of the residents regularly go to the local church for a coffee morning. The activities coordinator puts on a range of activity sessions in the occupational therapy hut in the garden. Each year, the residents and staff put on a pantomime at the church over the road. Regular outings are arranged, either to places of local interest or to community events. The home hopes to get its own people carrier within the next few Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 12 months, and to employ a handyman-driver. Cookery sessions had recently been started at the time of the last inspection so that residents could cook their own tea. Residents now only use the kitchen for planned tasks with staff supervision due to the risk of injury or cross infection with some of the less able people. The home is looking at providing hot drink-making facilities in the bedrooms of some of the more able people who would benefit from this. As some of the residents age, they are no longer enjoying holidays with a high level of activity, and some people do not want to spend a long time away from their own home. Two of the staff usually take small groups of the residents to Butlins each year, but it has been decided this year to provide a broader range of holidays for groups of two or three residents, and to lay on a schedule of regular days out for some of the older people. There is a wide age range among the residents accommodated. This is reflected in the widely different interests of the residents as well as in their attitudes to life. Some of the older residents have long-term institutionalized behaviours that can be challenging to people around them, and many of the younger residents have strong expectations of leading a normal life. These differences can sometimes lead to clashes. Mrs Bishop was already aware of this, and strategies are in place for dealing with antisocial behaviour and defusing situations. She is also considering introducing practices such as having two sittings at mealtimes. Ways of dividing the communal facilities for use by different age groups were also discussed. Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 There are effective systems in place to protect residents. EVIDENCE: Those residents who were able to tell the inspector their views felt very comfortable at the home, and generally enjoy good relationships with the staff. One person had recently had a disagreement with a member of staff but felt able to openly discuss this with the manager. Conversations with staff revealed a general belief that this is the residents home and that they should be treated with respect. Some people gave examples of how particular incidents had been handled, and these showed that staff try to work with the person rather than dealing with difficult behaviour in a confrontative manner. Neither the home nor the CSCI has received any complaints. The home logs any grumbles in its complaints book, along with a note of the action taken in response. Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 The environment is generally well suited to residents needs, but proper locks are needed and one toilet needs to be refloored. EVIDENCE: The home is well decorated and maintained, and comfortably furnished, creating a very pleasant and welcoming environment. There are two lounges and a dining room. The downstairs bathroom has been adapted to suit the needs of a new resident. There are two double bedrooms, one used by a married couple and the other by two people who both prefer not to sleep on their own. About half of the bedrooms meet the old spatial standard of 10 square metres, but the remainder are smaller than this. It was noted at the last inspection that some bedrooms have safety locks but others have locks that could prevent staff being able to reach the person in an emergency. The manager is gradually having these locks changed over to safety locks. At todays inspection, it was noted that some doors are fitted with bolts on the outside. One of the residents has the habit of going into Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 16 other peoples bedrooms, stripping their beds and throwing their belongings out of windows, so the bolts are in place to for those people who do not have room keys. There is a potential for these bolts to be misused or to be used inadvertently when someone is in the room, which could be disastrous if there were a fire. The inspector advised that these bolts must be removed as a matter of urgency. Ways were discussed of providing residents with room keys and supporting them to use these. The bolt on the door of the toilet under the stairs is broken as was the lock on the toilet opposite Room 7 on the first floor. Safety locks must be fitted to these rooms as soon as possible to preserve residents privacy and dignity. There was a strong smell of urine in the toilet opposite Room 7. Although the room looked clean, it may be that urine has got into the floorboards beneath the lino. The inspector suggested that the boards are treated and that floorto-wall lino is fitted. An Occupational Therapist checked the environment within the last six months and made a number of recommendations to improve access for the newest resident. These included grab rails and level access to the garden via French windows. The home carried all of these out, and is continuing to liaise with other agencies to ensure this person has the best equipment for enhancing their independence. There are no grab rails outside the French windows, which might reduce the risk for this person when accessing the garden. The inspector advised that the home consults a physiotherapist or occupational therapist on this issue, and carries out their recommendations, if any. It is planned to refurbish all residents bedrooms, and Mrs Bishop is in the process of consulting residents individually about their preferences. Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not fully assessed at this inspection, but action is advised regarding the homes current registration. EVIDENCE: The home is currently registered to provide care for one named person who also has a physical disability. This condition of registration will be removed when that person moves on. A second person with physical disabilities was admitted to the home since then, although the reason for admission was requiring support due to a learning disability. Prior to this persons admission, the home asked an Occupational Therapist to assess the premises against this persons needs, and then carried out all her recommended adaptations. This persons needs are being well met at present, but the environment is not ideal for someone with severely restricted mobility. The inspector advises that the condition of registration should be amended to cover a second named person. Mr Gunaratne is going to write to the CSCI about this. Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x X X X x Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 1 3 2 2 LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X x CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Charlton House Score X X X x Standard No 37 38 39 40 41 42 43 Score X X X X X X x DS0000008082.V272959.R01.S.doc Version 5.0 Page 20 yes Are there any outstanding requirements from the last inspection? 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 YA10 Regulation 13 & 18 Requirement A policy must be drawn up on residents access to their records. This was not discussed at todays inspection but will be carried forward to the next. This requirement was first made on 23/3/05. The bolts at the top of bedroom doors must be removed as a matter of urgency Safety locks must be fitted to toilets as soon as possible to preserve residents privacy and dignity. A physiotherapist or occupational therapist must be consulted about the provision of grab rails outside the French windows, and their recommendations, if any, carried out. The smell of urine in the toilet opposite Room 7 must be eradicated. Timescale for action 08/03/06 2. 3. YA26 YA27 23 23 15/02/06 15/02/06 4. YA29 23 08/05/06 5. YA30 23 08/03/06 Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The care plan of one particular resident should be updated to include his recent habit of swearing and the strategies that staff are adopting to manage this. Charlton House DS0000008082.V272959.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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