Inspection on 03/01/07 for Charlton Kings Care Home

This inspection was carried out on 3rd January 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Charlton Kings Care Home 15/02/06

Charlton Kings Care Home 31/08/05

Charlton Kings Care Home 02/03/05

Charlton Kings Care Home 27/06/04

Charlton Kings Care Home 02/03/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Charlton Kings Care Home Moorend Road Charlton Kings Cheltenham Glos GL53 9AX Lead Inspector Ms Eleanor Fox Key Unannounced Inspection 3rd January 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 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.V314755.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 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 to twenty-five elderly people. A further major extension is just being completed, which will provide accommodation for an additional nine people. The recent building work has considerably enhanced the facilities offered at the home. The property is situated in Charlton Kings, on the outskirts of Cheltenham, within easy reach of local amenities. Bedrooms are located on the ground and first floor, with access by stairs, a stair lift or a shaft lift. All bedrooms are currently single occupancy although couples may be accommodated if requested; the rooms have either en suite facilities or a hand washbasin. 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 provider supplies information about the home, including the most recent CSCI report in a readily accessible folder in the front hall of the home. Current fees range from £600 to £650. Hairdressing, chiropody and any personal items are charged extra. Costs are available on request. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the home and takes into account the views and experiences of people using the service. One inspector undertook this unannounced inspection of Charlton Kings Care Home over two days in January 2007. During the visit, she chose the care of four of the residents for particular scrutiny. She spoke to each of these people, where possible in the privacy of their bedrooms, read all their relevant care records and observed their interaction with members of staff. The inspector read selected personnel and recruitment records and examined training and complaints files. She also walked around the property, including the recently completed extension, and observed the service of a mid day meal during her visit. She spoke with some of the staff who were on duty on these days, checking their understanding of some of the home’s policies and procedures. Finally, she had the opportunity to talk to the proprietor, the manager and the home coordinator, particularly in relation to general management issues. All were open and most cooperative in providing information as requested. CSCI surveys were distributed to residents, relatives and members of staff working at the home. Eleven were returned from residents although in the majority of cases, a relative or named member of staff completed the form for them; four completed surveys were received from staff and two comment cards were sent in from relatives and advocates. Many of their opinions are reflected in the content of this report. What the service does well: The people living at this home are treated with friendly respect by the staff. In the completed surveys and during conversations with the inspector, the residents and their families spoke very highly of the carers, describing them as, “extremely kind”, “always attentive”, and “understanding and patient.” The home provides a varied programme of activities and entertainments to suit the individual tastes of the residents. These have been developed following discussion with and input from the people living at Charlton Kings Care Home. Residents are also offered a good standard of home cooked food. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 6 There are robust management policies and procedures in place to ensure that the residents’ rights are safeguarded. There is also a good focus on monitoring and improving the services offered to the residents in this home. 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.V314755.R01.S.doc Version 5.2 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.V314755.R01.S.doc Version 5.2 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): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A satisfactory assessment process plus the provision of most of the necessary contractual information, enables prospective residents to make an informed decision regarding their admission and gives them assurance that their needs will be met. EVIDENCE: Observation of the records relating to those residents who were chosen as part of a case tracking exercise showed that each prospective resident or their advocate is provided with the terms and conditions for admission to the home. Signed copies of the documentation were seen in the files. However, further precise details about costs must be provided, particularly in relation to any additional services. This has been discussed with the proprietor and manager and will now be addressed. Assessments are undertaken on each prospective resident; completed records relating to these visits were seen in the care files. It was evident that, where Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 9 possible, a thorough assessment is undertaken to ensure that the home is able to meet the prospective resident’s needs. The home also retains the Social Services Assessments or reports supplied by any individuals previously responsible for providing care to this person. All are used for reference during the admission processes. When emergency admissions are arranged, relevant information is supplied to the home on the day of admission with further details sourced as soon as possible. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although the care documentation does not always fully provide the staff with the guidance they require to care for the residents’ needs, good care is delivered to the people living at this home. Some minor improvements in the medication administration systems are required to ensure that residents are not put at any risk of potential errors. Residents are treated with courtesy and respect. EVIDENCE: Care plans are prepared for each person based on a general assessment of the resident’s care needs. The initial assessment does not include any comment about the resident’s skin condition and it is recommended that these details be added to the home’s documentation. The care records relating to the four selected residents were read in detail on this visit. It was evident in most cases that the resident had been involved in Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 11 the preparation of these plans, having signed the completed documentation plus any subsequent reviews. However, in some cases, care plans had not been prepared to address all the resident’s identified care needs, particularly in relation to pressure area care and nutritional requirements. These shortcomings were discussed with the manager and will now be addressed. It is also recommended that reviews of care plans should be undertaken once a month to ensure that any changes in condition are identified in a timely fashion. In one case, the resident’s condition had altered but the care plan did not reflect the recent changes. It was noted that there had been an improvement in the risk management processes undertaken at the home; well constructed and detailed risk assessments had been prepared where appropriate. Any visits from medical and care personnel are documented, as is any advice or instructions provided. A District Nurse visited the home to attend to residents during the inspection; a record was made of the treatment she had given. It was also recorded in the selected care files that residents had received recent chiropody and ophthalmic care. During the inspection one person returned from hospital where she had been referred for treatment for a medical condition. The medication administration systems relating to the four selected residents were observed on this occasion. Medication storage and staff training on these topics were also checked. Medications are ordered and stored correctly. Photographs of each resident are provided to aid identification. A recently published pharmaceutical reference book has been obtained to aid staff when administering medications. It was observed that handwritten medications had not been signed by the person making the record and countersigned by another witness, as is required. However, the handwritten records were written in clearly legible writing and provided appropriate instructions to staff carrying out the administration procedures. Those members of staff responsible for administering medications have had or are undertaking formal training in the processes. The management of those residents who wished to take responsibility for their own medications was also addressed appropriately. Members of staff were observed speaking to residents in a polite but friendly manner. Interaction between the staffing team and the residents was particularly positive during the service of the lunchtime meal when there was cheerful conversation and gentle encouragement, as required. All personal care appeared to be given behind closed doors. Carers were also observed knocking on doors prior to entering bedrooms. One resident wrote, “This home gives me much better care and attention than I thought was possible.” Another said, “Everyone is so kind and attentive. I am so lucky to be here.” Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 12 A relative wrote,” The staff are very kind, patient and gentle. They always treat my mother in the same predictable manner and will give her a kiss and a hug – which means so much when you are used to living in a family.” Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Opportunities are provided for varied and stimulating activities to occupy the residents and thus improve their quality of life. Residents are facilitated to maintain any links they wish with family, friends and the local community, thus adding interest to their lives through social contact. They are also enabled to exercise choice in their daily lives. A good variety of meals ensure residents receive a nutritious and balanced diet. EVIDENCE: During conversation, residents confirmed that they are able to get up and retire when they wish and to spend their days how they would like, within their own capabilities. The home employs an activities coordinator who arranges a variety of activities to suit individual tastes and preferences. One person particularly likes the trips out and another enjoys the entertainer who attends the home very regularly. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 14 Everyone spoke positively about the variety of events that had been arranged over the Christmas period. It is recommended that records should be maintained of residents’ particular interests and preferences, and that residents’ participation in any form of activity is also recorded. In this way the home may be assured that individual needs are being addressed appropriately. It was confirmed that residents are consulted during residents’ meetings about their individual requests. Family and friends are welcome to visit whenever the resident wishes. Families are invited to attend special events when they are arranged at the home. The majority of relatives who spoke to the inspector and who responded to the questionnaires were extremely supportive of the home and the staff working there, one person writing, “I like the ethos and atmosphere of the home. The staff members make big individual efforts to do a good job.” Staff were observed offering residents choice during the day, particularly about food, how they spent their day and about the care they received. One resident also confirmed that she had chosen the distinctive colour scheme for her bedroom. The preparation and service of the main mid day meal was observed during the visit. The majority of the residents ate their meals in the main dining room; some chose to remain in their bedrooms. A good standard of food was offered and most people appeared to enjoy what they were eating. The meal appeared to be a congenial time with a lot of conversation at the individual tables and with the staff who were serving the food. Discussion with the catering staff on duty showed that any particular catering needs or requests had been communicated and were addressed. One person has specific dietary requirements. Arrangements are in place to ensure that this person’s needs are met; she confirmed that these were addressed to her satisfaction. Although one person commented that the food was sometimes “not cooked enough”, in the main, all those who responded to the surveys or spoke to the inspector were very positive in their comments. One person wrote, “The meals are excellent. The cook is to be commended”. The kitchen was clean, tidy and well organised. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints system enables residents and their families to feel assured that their views would be listened to and acted upon. Residents are offered a good level of protection against abuse. EVIDENCE: The complaints procedures are well advertised in the home, providing residents and their families with clear guidance on the processes to follow if they wish to raise a concern. There have been no formal complaints to the home during the last year but arrangements are in place to record these if they occur. However, it was noted that some of the residents and their families have identified issues relating to the recent extensive building alterations. Staff do appear to have made every effort to keep any disruption and inconvenience to the people living at the home to the minimum; this has been particularly appreciated. The home provides a fully documented policy to address all forms of abuse. The policies are readily available for staff to read. These matters are addressed during National Vocational training and the majority of staff employed at Charlton Kings Care Home have also received recent formal training on this important subject. POVA (Protection of Vulnerable Adults) legislation is correctly followed at this home. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current extensive improvements to the home will soon provide the residents with a very good standard of accommodation. EVIDENCE: The major building works are now nearing completion and, although some of the residents are still experiencing varying degrees of inconvenience and disruption, when the final improvements have been finished these people will be living in greatly improved, pleasantly decorated and appropriately furnished accommodation. The residents are already enjoying the benefits of the new spacious internal communal facilities. During the inspection a list of maintenance repairs and decoration were identified for action within a limited time frame. These related to various areas in the new extension and in the original home, which required repair. The Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 17 inspector will revisit the home to check compliance within the mutually agreed timescales. All the staff who responded to the survey and many of those who spoke to the inspector commented that the staff would greatly appreciate the provision of a dedicated staff room where they may take a break from their duties. During a walk around the building the inspector visited eight of the residents in their own bedrooms. It was evident that each person had had the opportunity to personalise their rooms with photographs, small items of their own furniture and other treasured possessions. With the exception of one occasion it was necessary for the inspector to sit on the resident’s bed, as there was no alternative chair available – one resident apologised for the lack of a seat. As this could pose a significant infection risk, additional readily available seating should be provided for residents’ visitors. One person also requested a mirror for her room; the proprietor agreed to provide this immediately. Residents are advised in the service user guide that they may have locks installed on their bedroom doors if they wish. Although the majority of the home was commendably clean despite the ongoing building work, there was evidence of mildly offensive odours in just a few areas of the home on both days of the inspection. Relatives and two of the residents who completed surveys for CSCI also commented upon this problem. The home has already attempted to address this issue by providing alternative flooring in selected bedrooms but further action is necessary. The laundry room was tidy and well organised. A dedicated member of staff takes responsibility for laundry duties; it was evident that this person was observing good infection control protocols. It was also noted that residents’ personal clothing was ironed prior to return to each person’s bedroom. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive care from a stable workforce but improved recruitment processes and the completion of some additional training would help to ensure residents are fully protected. EVIDENCE: On the first day of the inspection there were twenty-seven residents living in the home, two of whom were in hospital. The manager and the home coordinator were on duty with five carers to look after the residents. A cleaner, the laundry assistant, the cook, the maintenance technician and the activities coordinator were all also on duty that day. Four carers were scheduled to be on duty in the evening with two carers working overnight. In recent weeks, the staffing complement has been reviewed and amended slightly to meet the changing needs of the home. The majority of people who responded to the questionnaires felt that there was normally an adequate number of staff on duty to care for the residents although there were a few isolated comments that the home is sometimes short of staff. Of the thirteen care staff employed at the home, two have achieved a National Vocational Qualification, (NVQ) Level 2 in Care and a further two people, an NVQ, Level 3 in Care. Five carers are undertaking NVQ training at the current time and others have made a commitment to commence the course. The home Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 19 is working towards achieving the standard that at least 50 of care staff should be trained to NVQ, Level 2 or equivalent. Personnel files relating to the staff employed since the last inspection were read in detail. In each instance, the prospective employee had completed an application form providing details of his or her employment history; appropriate records had been made of the interview processes and there were staff photographs on file. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person although one person had commenced duties before any results had been received. No member of staff may commence duties prior to the provision of a satisfactory POVA screen and the manager is also reminded that any member of staff must be fully supervised until a satisfactory CRB screening certificate has been received. Two written references had been provided for the applicants but in one case, no written reference had been obtained from the applicant’s most recent employer. These anomalies were identified for urgent attention. The records show that mandatory training is addressed in a timely manner. Members of staff working at Charlton Kings Care Home have also attended additional specialist training appropriate to their roles. In recent months, this has included Protection of Vulnerable Adults, Safe Handling of Medicines and Dementia Care training. Members of staff are not expected to contribute to the cost of training courses at this home. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are management systems in place to ensure that the financial interests, and the health, safety and welfare of people using the service are safeguarded. There is an evident commitment in the Home to improve the services for the benefit of the residents living there. EVIDENCE: The manager of the home has good experience in the care of elderly people. He has completed the Registered Manager’s Award and has been awarded a National Vocational Qualification, Level 4 in care. He also attends regular training workshops to assist him to undertake his duties. The deputy manager and the home’s coordinator support him in his role. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 21 The Home does have a focus on quality improvement. Any complaints, accidents or adverse incidents are monitored closely. During 2006, regular residents’ meetings have been arranged and minutes maintained of the discussions and any suggestions made. There is evidence that action has been taken to respond to comments made by the people living at the home. A residents’/relatives’ satisfaction survey was undertaken in 2006; completed forms were shown to the inspector and evidence provided that any issues identified were addressed appropriately where possible. Throughout this last year, the proprietor has been present in the home supervising the major construction work and everything else happening in the home. Although formal quality audits have only been intermittent during this busy period, he will resume these on a monthly basis in 2007, as required in Regulation 26. The home looks after the personal monies for some of the residents. These are kept in individual envelopes and are locked away securely. All transactions are fully documented. Checks of the files relating to four residents showed that these are all maintained accurately. However, it is recommended that a witness should countersign each transaction, as an additional safeguard. Records were provided to show that statutory maintenance/inspection of equipment and services is arranged in a timely fashion. Where faults are identified, these are rectified as necessary. Water temperatures are checked at outlets on a monthly basis; in recent months these have remained within safe levels. An Environmental Health inspection was undertaken in September 2006; issues highlighted for improvement have now been corrected. Fire prevention processes are addressed particularly well at this home. Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 22 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x 2 x 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 23 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 OP2 Regulation 5 Requirement Each resident or advocate must be provided with specific information about the fees charged. This must also include any additional costs. Care plans must be provided to address residents’ care needs, particularly in relation to pressure relief and nutritional care. The person making the record in the drug administration documentation must sign any handwritten amendments. The maintenance and decorative requirements identified during the inspection must be addressed. All parts of the home must be kept clean and free from offensive odours. Correct recruitment processes must be followed at the home, in particular that: 1. A written reference must be obtained that relates to the applicant’s last period of employment, which involved work with DS0000042519.V314755.R01.S.doc Timescale for action 28/02/07 2. OP7 15 (1) and (2) 28/02/07 3. OP9 13(2) 01/02/07 4. OP19 23 (2) (b & d) 16 (2) (k) Schedule 2.3 31/01/07 5. 6. OP26 OP29 31/01/07 31/01/07 Charlton Kings Care Home Version 5.2 Page 24 19(11) vulnerable adults. 2. All new staff must be supervised prior to the receipt of criminal record screening information. 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. Refer to Standard OP7 OP7 OP9 OP12 Good Practice Recommendations The care planning assessment documentation should include a record about the resident’s skin condition. It is recommended that reviews of care plans should be undertaken once a month to ensure that any changes in condition are identified in a timely fashion. A witness should countersign handwritten records in the medication administration sheets (unless written by a doctor). It is recommended that records should be maintained of residents’ particular interests and preferences. Residents’ participation in any form of activity should also be recorded. The home should consider providing a dedicated staff room where employees might take a break from their duties. Additional readily available seating should be provided for residents’ visitors. It is recommended that at least 50 of care staff should be trained to NVQ, level 2 or equivalent. It is recommended that a witness should countersign each transaction relating to residents’ personal monies. 5. 6. 7. 8. OP19 OP24 OP28 OP35 Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 25 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Charlton Kings Care Home DS0000042519.V314755.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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