CARE HOMES FOR OLDER PEOPLE
Charlton Kings Care Home Moorend Road Charlton Kings Cheltenham Glos GL53 9AX Lead Inspector
Sharon Hayward-Wright Unannounced Inspection 15th February 2006 11:45 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 Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 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 Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Charlton Kings Care Home Address Moorend Road Charlton Kings Cheltenham Glos GL53 9AX 01242 521812 01242 517773 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 Ltd Mr Richard David Royle Care Home 25 Category(ies) of Learning disability over 65 years of age (3), Old registration, with number age, not falling within any other category (25) of places Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. To complete the management part of NVQ 4 by September 2005. To complete the care part of the NVQ by September 2006. Date of last inspection 31st August 2005 Brief Description of the Service: Charlton Kings Care Home is a large detached Edwardian family house that has been adapted and extended to provide personal care for older people. It is situated in Charlton Kings, on the outskirts of Cheltenham. Local amenities are close by. The home has added additional bedrooms onto the home increasing the number of service users they are able to care for. All bedrooms are single occupancy and have either en suite facilities or a hand washbasin. Bedrooms are located on the ground and first floor, which is accessed by stairs, a stair lift or a recently fitted shaft lift. The communal space consists of three lounges and a dining room with patio doors leading into the garden and a recently added conservatory that is accessed through a new lounge. The Registered Provider had greatly improved the environment for service users. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours on one day in February 2006. Eight service users were spoken with to gain their views on the home; the Registered Manager, and three staff members were also spoken to. Staff were observed going about their duties and interacting with each other and service users. The requirements and recommendations issued at the last inspection were followed up and records relating to medication, care documents, training, staff personnel files, quality assurance, service users monies, and maintenance were inspected and a part tour of the home took place with a number of service users rooms inspected. All requirements issued at the last inspection and follow up visits have been addressed. What the service does well:
The meals in this home are good offering both choice and variety and catering for special dietary needs. All service users spoken with praised the food provided. The systems for service user consultation in this home are good with a variety of ways service users views are sought and they are acted upon. The Registered Manager is supported well by his senior staff in providing clear leadership throughout the home with all staff observed demonstrating an awareness of their roles and responsibilities. Staff demonstrated their morale is good resulting in an enthusiastic workforce that works positively with service users to help improve their quality of life. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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 Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Satisfactory systems are not place to ensure prospective service users needs are assessed and assurance is given to them that the home can meet their needs. EVIDENCE: The care of three service users was examined in detail. Two of these had recently been admitted to the home. One service user did not have a pre admission assessment and the other had one that was not completed in full. The home must be able to confirm that they can meet the needs of a proposed service user and an assessment of their needs must be undertaken by someone who is suitably qualified or trained and a copy kept in the home. The Registered Manager is going to review the format used by the home to ensure a comprehensive assessment is undertaken. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 9 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 There is a clear and consistent care planning system in place, however the information provided does not always reflect service users current needs. Service users are able to access health professionals as needed. The home has made good progress with regard to the arrangements for medication to ensure the service users medication needs are being met. EVIDENCE: Three-service users care was examined in detail. One service users care plans were current. One of the other service users did not have any care plans as she had been admitted to the home on the 19/1/06. A copy of Social Services care plans were in place, however the home must devise care plans for new service users on admission so the staff have the information needed to be able to care for this individual. The remaining service user had care plans in place to address their physical needs but not for their mental health needs. A detailed risk assessment is needed in relation to their mental health needs. A falls risk assessment was in place for one service user but needs to be reviewed, as the last review was September 2005. Ongoing records are maintained and evidence of monthly reviews with the service user and family if required, were seen.
Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 10 Records of health professional visits are maintained. Each service user has their own storage box for dressings if they are being visited by the Community Nurse for wound care. Medication was not examined in detail only the requirements remaining from the last follow up visit. The Commission for Social Care Inspection Pharmacy Inspector has conducted a detailed medication inspection following the last inspection. The Registered Manager and staff have worked hard to meet the requirements issued at that inspection. At this inspection a number of recommendations have been repeated in relation to medications. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The meals in this home are good offering both choice and variety, and catering for special dietary needs. EVIDENCE: Standard 12 was not inspected but activities were taking place during the inspection. Standard 15 was not inspected in full only a requirement issued at the last inspection to undertake food delivery temperatures. The home has addressed this. A recommendation made at the last inspection has been repeated. Service users spoken with all complimented the food provided. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: No standards were assessed at this inspection, however a recommendation made for the home to obtain a copy of the Alerter’s Guide has been repeated. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 13 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): EVIDENCE: No standards were assessed at this inspection, however a recommendation made at the last inspection has been repeated. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 14 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): 29 & 30 Since the last inspection the standard of vetting and recruitment practices has declined with appropriate checks not being carried out and potentially leaving service users at risk. Training opportunities have been provided for staff to improve their skills but there are some staff who require updates. EVIDENCE: A personnel file of a new member of staff was examined; it contained all the required documents except for a full employment history and this must be obtained prior to the person starting work so that the home is able to explore any gaps. A requirement has been issued for the home to address this. Training was examined with the Registered Manager; he said some training is required for staff in moving and handling and food and hygiene. A number of staff have just completed a course in safe handling of medication. The home is still trying to source training in protection of vulnerable adults. It is recommended that the home complete a training matrix to easily identify what training is due for staff. The home is looking to appoint an outside training company to assist with their induction programme. This will be followed up at the next inspection. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 15 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): 33, 35, 36 & 38 The systems for service user consultation in this home are good with a variety of ways service users views are sought and they are acted upon. The home has a system for safeguarding service users financial interests, however inaccuracies with the system can place service users interests at risk. Systems are in place to ensure staff are appropriately supervised. On the whole the health, safety and welfare of service users and staff is promoted and protected, however the home is not up to date with some risk assessments and this potentially compromises their safety. EVIDENCE: The Registered Manager is about to send out quality assurance questionnaires to service users. Evidence was seen of service users and staff meetings taking place but the minutes of staff meetings were not examined.
Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 16 A suggestion box is available. The Registered Manager undertakes monthly audits of the home along side the Regulation 26 visit undertaken by the Registered Provider. The personal money of two-service users was examined. Ongoing records are maintained and the Registered Manager said receipts are given to the service user. One of the service users money was found to be missing £5. The Registered Manager said he would investigate this. The home must ensure that money totals and records tally. The Registered Manager said he is struggling to meet the recommendation of six times per year for staff supervision due to supporting staff through the NVQ 2 training and completing courses himself. It was suggested that sessions where he is supporting staff with their NVQ could be used a supervision, but he would also need to ensure that staff also receive the opportunity to have individual supervision sessions. Evidence was seen of servicing and checks undertaken on equipment in the home. Risk assessments are in place for parts of the environment, however the fire risk assessment was last reviewed in August 2004, this needs to be reviewed to ensure it is still relevant to the home. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 3 X 2 Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The Registered Person shall not provide accomodation to a service user at the home unless, so far as is practicable, the needs of the service user have been assessed by a suitably qualified or trained person. The Registered Person must ensure that any service user in the home has care plans in place. The Registered Person must ensure that service users care plans and risk assessments reflect their current needs. The Registered Person must obtain a full employment history as part of the recruitment process and obtain satisfactory written explanation of any gaps in employment. The Registered Person must ensure that records accurately reflect the amount of money held by the home for safekeeping for service users. The Registered Person must ensure that the fire risk assessments are reviewed at set
DS0000042519.V277647.R01.S.doc Timescale for action 28/02/06 2. OP7 15 10/03/06 3. OP7 15 10/03/06 4 OP29 7, 9 19 & Sch. 2 10/03/06 5 OP35 17(2) & Sch. 4(9) 10/03/06 6 OP38 13(4c) 30/03/06 Charlton Kings Care Home Version 5.1 Page 19 intervals to ensure the safety of the service users and staff. 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. 3. 4 5 6 7 8 9 Refer to Standard OP9 OP9 OP9 OP9 OP15 OP18 OP19 OP30 OP33 Good Practice Recommendations Any hand written entries on the MAR sheets are ‘PP’d for the GP making the alteration and checked and signed by a second person. The home should maintain records of the temperature of the medication fridge on at least a daily basis. The home should maintain records of the temperature of the room where the medication is stored. Regular audits to be documented to help demonstrate that medicines are being correctly administered. The home should devise a hazard analysis for the kitchen. The home should obtain a copy of the Gloucestershire Alterer’s Guide The home should consider providing a staff room. The home should devise a training matrix. The home should devise an annual development plan based on the outcomes for the service users. Charlton Kings Care Home DS0000042519.V277647.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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