Inspection on 01/08/08 for Charlton Lodge

This inspection was carried out on 1st August 2008.

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

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 Lodge 31/08/07

Charlton Lodge 13/09/06

Charlton Lodge 06/02/06

Charlton Lodge 08/09/05

Charlton Lodge 21/12/04

Charlton Lodge 21/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Charlton Lodge Orchard Way Tiverton Devon EX16 5HB Lead Inspector Dee McEvoy Unannounced Inspection 09:20a 1 & 7 August 2008 st th 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 Lodge DS0000039224.V361871.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 Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charlton Lodge Address Orchard Way Tiverton Devon EX16 5HB 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) 01884 253319 01884 253319 http/www.devon.gov.uk Devon County Council Mrs Tina Bartin Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 30. 31st August 2007 2. Date of last inspection Brief Description of the Service: Charlton Lodge is a care home providing personal care and accommodation for 30 people over 65 years of age. The home is a detached purpose built property owned by the local authority, Devon County Council (DCC). It was refurbished in 2004 when many rooms were made bigger and facilities improved. The building is set over two floors, with access to the top floor by shaft lift, it has all single bedrooms with shared bathrooms and toilets. The home has three lounge areas and pleasant grounds. It is situated centrally in Tiverton, close to local shops and amenities. Some people at the home stay long term but the home does offer a short stay respite service and an intermediate care service. Up to ten people can be accommodated for intermediate care at any one time with the aim of helping them to regain their independence so that they can return to their own homes. The home also has a flat equipped with kitchen, large bed/sitting room and a bathroom where people can develop their independent living skills with the appropriate support. The home offers easy access for people with mobility problems, the entrance is level with an automatic door, there is a passenger lift to the first floor, and there are plenty of aids and adaptations to assist mobility, such as grab rails. Fees currently set at £556.57 per week. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports and The Service Users’ Guide and Statement of Purpose, is available to prospective residents and all documents can be found in reception. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit we sent a number of confidential surveys to people living there, to staff and outside professionals to hear their views. We received completed surveys from 6 people living at the home and four relatives. One survey was returned from staff and two from outside professionals. The comments and responses we received have helped us to form the judgements we have reached in this report. This unannounced inspection took place as part of the normal programme of inspection. The site visit was undertaken over two days, involving one whole day and an afternoon. As a way of judging the service overall, during our visit, we (the commission) spent time talking with people who at Charlton Lodge. Most people living at the home were seen or spoken with during the course of our visit and 10 people were spoken with in depth to hear about their experience of living at the home. We spoke with care and ancillary staff, visitors and the manager. We looked at the care and accommodation offered to four people living at the home and observed the care and support provided by staff. We also looked at a number of records the home is required to keep, including assessment and care plan files, daily reports, staff recruitment and training records, and records of money held by the home on behalf of people living there. What the service does well: People had some very positive things to say about life at Charlton Lodge. We asked people what the service did well, they told us, “The care and attention we get is very good”, “The place is nice and clean”, “I feel safe here. There is always someone around which is very reassuring” and “It is comfortable here”. Relatives were happy with the overall care provided, one told us, “Mum is well cared for and I like the friendly atmosphere”. Outside professionals were also happy with the service provided, one told us, “They are very caring for the Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 6 clients and try to ensure they are happy with their care and their home at Charlton Lodge”. One visiting GP told us, “Everyone is well cared for here”. The home operates a valued and successful intermediate care service. One outside professional said this service was “an indispensable part of the community and patient care”. The intermediate care service helps to prevent admissions to hospital and may speed up discharge from hospital. People admitted to the home for intermediate care are well supported and encouraged to regain independence. The majority of people using this service return home where possible. Charlton Lodge also provides respite care, which helps to ensure that relatives benefit from a break in their caring role. Good information is available to people to help make a decision about whether this home would suit their needs. A good admissions process ensures that the home can meet people’s needs. Care is generally well planned and delivered in a way meets people’s needs and preferences. People’s health needs are generally well met, one GP told us, “Of all the places I visit this home is in the top group. It’s really pretty good here”. People told us that the daily routines were flexible and that they could make choices in their daily lives. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. Several people described the atmosphere at the home as warm, friendly and welcoming. People were happy with the food served at the home. People told us the food was generally very good. Most people feel confident that their complaints or concerns will be addressed. The environment is clean, comfortable and safe. People were very happy with their accommodation. There are enough staff on duty to make sure people’s needs are met. People spoke highly of the staff team. Staff morale is good and they feel well supported by the management team; several staff told us how much they enjoy their work. People benefit from living in a home that is well managed, and that encourages them to share their views and opinions about the service provided. Overall, health and safety is well managed. What has improved since the last inspection? The home has or is working towards meeting the requirements and the recommendations made at the last inspection. Aspects of care planning have improved with diabetic care plans helping to ensure that people receive the care they need. Areas relating to the management of medicines have improved, for example medication is kept securely and risk assessments and safe storage are now in place for people Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 7 who choose to manage their own medication. The medication records have also improved. More activities are being organised for people and they have been consulted about the type of activities and outings they may like (see ‘what they could do better). This will help to ensure that people have stimulating and interesting daily lives. The environment has been made safer for people by fitting covers to the tops of radiator. This reduces the risk of burns. Many staff have received the up-dated training they need to do their jobs safely and well, for example most have now received adult protection training to ensure people are safeguarded from abuse. Staff working the kitchen have had food hygiene training to ensure that standards are maintained. Other staff have received mandatory training updates such as moving and handling and infection control (see ‘what they could do better). Fire safety has also improved by having a fore risk assessment and emergency plan in place. What they could do better: One requirement and six recommendations for good practice have been made as a result of this inspection. The management of medication must improve to ensure people’s health is not adversely affected. The home must make sure that people get the medication they are prescribed. Systems must be in place to ensure that stocks of prescribed medicines are always available. Some care plans do not have enough detail to guide staff about individuals’ needs and how to meet them. Care plans should be expanded to clearly show how identified individual needs, such as skin care, will be met by staff at the home. We have asked the home to ensure that staff maintain people’s privacy and dignity at all times, and that social activities continue to be developed so that everyone at the home has the opportunity to enjoy leisure time, including outings. We have recommended that complaints be recorded accurately with evidence of the outcome and whether people are happy with the response to their complaint or concern. In order to ensure that people living here are protected from abuse or harm, we have recommended that all staff are provided with up to date training in Adult Protection. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 8 Although many staff have received up-dated mandatory training, several staff still need training up-dates such as moving and handling and infection control. 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. The summary of this inspection report can be made available in other formats on request. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is available to people about this service so that they know what to expect and overall people benefit from a good assessment process, which ensures that the home can meet their needs. The intermediate care service is valued and successfully supports people to regain their independence and return home where possible. EVIDENCE: The home gives people detailed information about the services it provides. Copies of the Statement of Purpose and Service Users Guide were seen in most bedrooms we visited. There are also copies in the reception area, along with the most recent CSCI report. One person said they had read the Statement of Purpose and said it had helped them understand what to expect at the home. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 11 Most people told us they had received enough information about the home before moving in. People admitted for respite or intermediate care may not receive a lot of information about the home due to the nature of admission for short stay, which provides a ‘rapid response’ to people’s needs at short notice. We talked to people about their admission to the home. Some people told us they had decided to stay at Charlton Lodge after spending time on the intermediate care unit, one person said, “I choose to stay here permanently. I have lots of freedom and there are no strict routines…it suits me”. Another person said they liked the “friendly atmosphere” when they first came to visit and another told us the fact that the home had easy access for frames or wheelchairs was very important when making their decision about moving in. Two people spoke with us about their admission to the home, one told us, “I was made to feel welcome on arrival” and another said, “From the start I felt welcome and have settled in well”. We looked at four files to see how people’s care and support needs are assessed before they moved in. As social services or health care professionals make all referral to the home, a variety of information is gathered from them before people move in. On occasion the information provided to the home is not as detailed as it could be. We were told that the manager or deputy managers will request further information if needed. Since the last inspection the manager now visits people who are considering a move to the home to get to know them, to provide information about the home, to answer any questions, and to carry out an assessment. We saw that the home had gathered good information about a range of individual personal and health care needs. This process helps to ensure that people are given relevant information about the service and that the home can meet people’s individual needs. Charlton Lodge provides a successful intermediate care and short stay/respite service for people requiring recuperative or rehabilitative care. A separate unit is sited on the ground floor, with it’s own facilities, such as dining area, sitting room and bathrooms. People admitted here stay for short periods of time. They are supported to regain their independence and confidence by a number of health professionals, such as physiotherapists and occupational therapists. We spoke with several people staying on the unit. All were very positive about their stay. One person told us how they had improved over the weeks and they were now planning to go home, we were told, “The care here has been very good. I got the help I needed and now I’m going home!” Another person said, “I have had a very good stay. It has been good for me”. Positive comments were also received from health professionals, one wrote, “All clients I deal with in the service only have positive things to say. I only observe positive care”. Other comments included, “they welcome & look after Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 12 all intermediate and short stay clients” and “I feel it works very well and the intermediate care unit is an indispensable part of the community and patient care”. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved care plans provide the staff team with most of the information needed to enable them to support people in a way they prefer. People’s personal care needs are well met, however, unless people received their prescribed medication their health and welfare cannot be assured. People feel they are treated with respect. EVIDENCE: People living at the home told us they “always” or “usually” receive the care they need. One person told us, “It is very good…almost like home”, another said, “I feel safe here, there is always someone around to help. It is very reassuring”, a third wrote, “I always feel I can come to carers for care and support”. Other comments included, “I am feeling stronger. The care so far has been very good” and “I have nothing to grumble about”. Relative’s feedback was generally very positive; they told us the home “always” meets the needs of their relative. One visitor told, “Mum appears to be well cared for and happy”, another wrote, “Charlton Lodge is a very caring care home… Most grateful to them”. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 14 We looked at four care plans to help us judge how care is planned and delivered. Since the last inspection, the manager and care staff have worked to improve the quality of information in care plans. Three of the four care plans were completed using the new style format, which provides good information to staff about people’s abilities, and assistance needed to complete activities of daily living, such as personal care. They also describe people’s preferences, including preferred routine, likes and dislikes relating to food and important information about people’s past life and occupation, providing staff with an understanding of the individual. We saw that some people had signed their care plan to indicate they had been involved in the process. Other care plans had been signed by relatives to acknowledge their involvement. There were some areas of care that had not been captured in one care plan. The Medication administration records (MAR) and cream chart showed that cream is applied regularly to one person’s “sore areas”. There is no indication of where this area is, what condition the skin is actually in or when the cream should be applied. This was discussed with the manager and a deputy manager to ensure that consistent care is delivered. Since the last inspection diabetic care plans have been introduced, which is good practice. These detail some of the care required to ensure people with diabetes receive the support they need. Since the last inspection, 25 staff have received some training from the Community Nurses about diabetes to help them understand this condition and recognise when people may need referring to the GP or nurse specialist. We saw that appropriate moving and handling assessments and plans had been completed and we saw staff using appropriate moving and handling techniques when needed. Risk assessments were in place and generally identified areas, which may cause harm to people, for example, poor mobility, falls, aggression and the use of equipment. Staff told us they were “always” given up to date information about people’s needs. One staff member told us, “Care plans have all the information we need”, and “We have time to read care plans and they are accessible”. Another member of staff talked about the valuable information shared during the shift handover, and said that any changing needs are discussed with staff. Staff spoken with had a good knowledge of people’s care and support needs, and their individual abilities and personalities. People living at the home told us they “always” or “usually” receive the medical support they need. Visiting health professionals told us the home “always” or “usually” seeks advice when necessary and acts on advice given with regards to people’s care and support. Health professionals seemed confident that Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 15 people’s needs were met. One visiting GP told us, “The home communicates well with us and contacts us appropriately when needed”. We were also told by the GP, “I have no concerns about Charlton Lodge and would be happy to live here myself!” Records showed that outside professionals visit people regularly, for example GP, community nurses, chiropodist, and other specialists. People are also supported to attend out patient clinics. Care plans do consider some people’s dietary needs for example some people need to have a diabetic diet or low fat and salt diet. One person who’s care we looked at had osteoporosis, but there was no mention of any special diet this person may need, for example a diet high in protein and calcium. People’s weight is monitored regular to alert staff to any problems; records looked at showed that people either maintained or gained weight at the home. People who may be prone to pressure sores have the necessary equipment to help reduce this risk. We looked at the way the home stores and administers medicines. The home is to be commended for supporting and encouraging people to manage their own medication where possible. Risk assessments have been completed to identify where people are able to manage their own medication and secure storage is available in their bedrooms to keep medicines safe. The storage of medicines is generally good; the storage and management of controlled drugs is satisfactory and medicines needing refrigeration are kept at the appropriate temperatures. We looked at the Medication Administration Records (MAR). These records showed that one person had not received medication as prescribed for 8 days as it was ‘out of stock’. We discussed our concerns with the manager, who said that medication had been ordered but had not arrived at the home. A relative had also raised their concerns with us about medication not being available at the home. The home does not have a system in place to follow up requests for prescriptions or medicines to ensure people are getting their medication as prescribed. By the second day of the inspection the necessary medicine had arrived and the manager and deputy manager were looking at ways of ensuring there was a follow up system in place. Most people living here commented on the kind and friendly approach of the staff; people told us, “Staff are kind and pleasant”, “Staff are very helpful. They are respectful and you can have a joke with them”, “My requests are always answered” and “staff are very good to me”. During our visit most staff were friendly and respectful when delivering care or dealing with requests and questions. People’s personal care is well attended to, which promotes their dignity and improves their feeling of self worth. People were dressed in their Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 16 own clothes and were well groomed; attention to their personal care was good. Visitors and visiting health professionals told us they could see people in private. During our visit two staff were heard to discuss people’s bathing routine in front of several people in a sitting room; this does not promote individual’s privacy and dignity. This was discussed with the manager during our visit. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible and opportunities for social activities have improved. People enjoy a balanced diet which takes into account the likes and dislikes of individuals. People benefit from contact with their family and friends, which is encouraged and supported by the home. EVIDENCE: People’s preferred daily routine is recorded in their care plans to ensure staff are aware of favoured times for getting up and going to bed etc. We spoke with several people about the routines at the home, people told us that the routines were flexible and suited their needs. Comments included, “There are no restrictions here…”, “I have lots of freedom and there is no strict routine” and “No-one tells me what to do…” Since the last inspection, the manager has changed the staff availability over the lunch time period to promote flexibility and ensure that people’s needs are met during this busy time. We asked people about the social activities provided at home. People returning surveys to us had different things to say. Two people said there were “always” activities available for them to take part in; three said this was “usually” the case and one person said this was “sometimes” the case. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 18 Since the last inspection the manager has allocated 8 hours a week to member of staff to help improve people’s social opportunities. A programme of activities has also been established, for example, regular bingo and other games, pampering sessions, coffee mornings, skittles and occasional outings. People told us about some of the things they enjoyed doing, two people enjoy helping with simple domestic tasks such as laying tables and helping with the washing up etc. Both people told us this activity made them feel “useful” and kept them busy; staff encourage and support them to do this. Other people told us they enjoyed the bingo and musical events. Others had enjoyed occasional outings to town and told us they liked the pampering sessions, which include manicures and hand massages. One person attends the day centre at the home and told us they like meeting other people from outside the home. Two people told us they really enjoyed the regular visits from the hairdresser. A local church holds a regular service at the home, which several people attend and enjoy. Two people told us they would like to be able to get out of the home more, one person wrote, “Not always staff available to escort residents on walks outside the premises”. Another person told us, “I haven’t been out for a long time and I’m an outdoor girl”. People also told us about the parties the home organises to celebrate birthdays etc. During this inspection a big party had been arranged to celebrate someone’s 100th birthday – there was musical entertainment and food, and everyone appeared to have a lovely time. The home provides a welcoming and friendly approach when relatives and friends visit. We saw that visitors were invited to have a meal with their relative if they chose to. Surveys from relatives showed that they were “always” kept up to date with changes and they were encouraged to be involved in the planning of care and care reviews. One relative wrote, “The home always keeps me up to date with any medical problems”, and another wrote, “I feel that they will always do their up-most to follow through any worries or things you suggest to help my mother and also to put myself at ease”. One relative told us, “We can come and go as we please. We are always welcome and offered a cup of tea etc”. Five of the six people responding with surveys felt that staff listened and acted on what they said, ensuring that people have the opportunity to exercise some choice and control in their daily lives. One person told us, “Staff always respond to my requests”. Surveys showed that most people were happy with the food at the home, but one person said they “never” like the food. We spoke with this person during our visit – we were told that lunchtime meals were “good” but that they were “fed up” with sandwiches at teatime. These comments were discussed with the Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 19 manager and the cook. Other people living at the home were happy with the food, their comments included, “The food has been very good so far”, “Good quality food but we are given too much!” “The cooking is generally excellent. Lovely pastry” and “I am very satisfied with the food”. People returning surveys and those spoken with told us there was always an alternative offered if they did not like or want the main the meal. Special diets are catered for. We spoke with the catering staff, who were aware of individual needs, and likes and dislikes. We saw fresh bowls of fruit on each unit for people to help themselves to and people had fresh drinks available during the day. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s views and complaints are generally listened to and acted upon. People feel safe and well cared for. Staff are aware of the procedure to follow to protect people from abuse or harm but some would benefit from up to date training. EVIDENCE: Five of the six people responding to our survey were aware of the home’s complaints procedure and knew who to speak with should they have any concerns. Most people we met and spoke with during our visit were also aware of whom to speak with about concerns or worries. One person told us, “I have nothing to moan about but would speak with the manager if I had”, another said, “I would talk to Tina about my concerns, she would listen to me” and another said, “You can talk with the staff”. Relatives and health professionals responding with surveys told us that any complaints or concerns were always responded to appropriately. The AQAA shows that six complaints have been received by the home since the last inspection and that all were responded to within the agreed timescale. We looked at how the home records complaints and the action they take to respond to people’s concerns. Records were not entirely clear about the outcome of some complaints and records relating to the most recent complaint were not available. The manager agreed that the recording of complaints could be improved. The Commission has received one complaint about the home, Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 21 which was referred to Devon County Council to deal with using their complaints procedure. We saw several ‘thank you’ cards from people who had used the service or their relatives. All were very complimentary about the care provided. People living at Charlton Lodge told us they were well cared for, that they felt safe there and that staff treated them with respect. The manager told us that since the last inspection 75 of staff had attended up dated adult protection training to ensure they recognise poor practice or evidence of abuse, and that they understand the action to be taken should they have any concerns about peoples’ wellbeing or safety. The manager told us that further training for staff had been requested and was planned with Devon County Council later in the year. All staff spoken told us they had received up-dated adult protection training this year and all demonstrated a clear understanding of their responsibilities to report any concerns. The manager works well with outside agencies to make sure any allegations of poor practice or abuse are dealt with. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Charlton Lodge provides a safe, clean and comfortable home, with a good standard of décor and furnishings, which offers a pleasant environment for people to live in. EVIDENCE: Charlton Lodge is purpose built and provides a good standard of accommodation for people. There are pleasant communal areas and all bedrooms are single occupancy. The home is accessible throughout for people with mobility problems and a lift provides access to all floors. There are wellequipped bathrooms with various aids and adaptations to help people. People living here were happy with accommodation provided. People are encouraged to personalise their private bedrooms with their own furniture, and other items such as pictures and photographs. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 23 The home has a neat, accessible garden and two people said they particular enjoyed visiting the garden, when possible. Since the last inspection several benches have been placed around the garden so that people can enjoy this space in good weather. The home is generally well maintained and has access to maintenance personnel from DCC. A record is kept of any maintenance required and the maintenance person visits the home regularly to carry out some safety checks and make minor repairs. Since the last inspection the tops of radiators have been properly covered to reduce the risk of burns to people. A small team of cleaners work hard to ensure the home is clean. A tour of the building found the home was clean throughout and free from odour on the day of the inspection. People returning surveys to us said the home was “always” or “usually” clean and fresh. Staff told us they “always” have sufficient gloves and aprons to protect them and promote good infection control practice. The laundry is well equipped, clean and well organised. A red bag system is used for any soiled laundry ensuring staff are protected. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. Domestic staff told us that since the last inspection they had been given information to keep them safe whilst working, for example, information about MRSA. Policies and procedures have also been made available in the staff room for them to refer to. The manager told us that some infection control training had been organised for staff but they had been unable to attend as it was too far for staff to travel. We could see that the manager has requested alternative dates and venues for staff training, which are still to be confirmed. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are generally sufficient to ensure that peoples’ needs are met in a timely way. People benefit from having experienced, competent and friendly staff who have a good understanding of their needs. People are protected by the robust recruitment practice followed at the home. EVIDENCE: People returning surveys to us told us that staff were “always” or “usually” available when needed. During our visit people told us, “I don’t usually have to wait too long for attention”, “Staff are usually around when you need them”, “They are there to help me when I need them” and “There is always someone just around the corner when needed”. Since the last inspection the manager has improved the availability of staff at lunchtime to ensure people’s needs are met. Staff lunch breaks do not tend to coincide with lunchtime, which provides much more flexibility and support for people during this busy time. The home has also introduced a “floater”, a carer who will cover different floor to allow staff to have a break. One relative felt that staffing levels were not always consistence over the mealtimes and that people who needed help to eat may not get the help they need. During our visit we observed that people did receive the assistance they needed at lunchtime. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 25 Staff spoken with told us there usually enough staff on duty. One staff member told us, “We usually manage, it can be difficult with sickness or holiday though”; other staff members confirmed this. On the day of our visit there was no laundry person so care staff were involved in doing the laundry as well as providing care for people. People living at the home were generally very happy with staff attitude and approach, we received many positive comments, including, “They (staff) are mostly friendly and happy”, “Staff are friendly, helpful and very polite”, “Staff are very good really. Kind and pleasant” and “We have good staff. I have a nice relationship with them”. We looked at the files of two newly recruited staff to ensure that the home operates a robust recruitment procedure, which protects people. These contained all the required documentation including satisfactory police checks to ensure that people living at the home are protected from unsuitable staff. Staff surveys showed that they were well supported when they first started working at the home. We were told that the induction provided covered everything they needed to know “very well”. Staff spoken with during our visit said they felt well supported and that good training opportunities were available to them. Records at the home show that new staff receive a structured induction. Health professionals’ felt that staff “usually” had the right skills and experience to support individual health and social care needs. Relatives also felt that staff generally had the skills to care for people properly. We were told that over 50 of care staff had achieved a nationally recognised care qualification (NVQ 2 or above) to ensure that staff are competent to meet peoples’ general care needs. A number of staff have attended a one-day course relating to dementia care, and most staff have attended a training session with the district nurse about caring for people with diabetes. The manager is trying to organise other training sessions like this to support staff in their role. Staff told us that they were not expected to care for people outside of their area of expertise. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by an experienced and effective manager. There are good arrangements in place to involve people in the running of the home. Improved systems ensure that peoples’ personal monies are correctly managed. Health and safety is generally well managed but some staff need updated training to ensure that good practice is maintained. EVIDENCE: The manager is both qualified and experienced. She has obtained the Registered Manager’s Award and she has experience of managing a care home. The manager works hard to ensure people living and working at Charlton Lodge are happy and safe. She has an open and friendly approach. She is keen to develop her skills and knowledge further and is completing NVQ 4 in care. She undertakes other periodic training to up-date her knowledge and skills, such as a long distance dementia course and palliative care course. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 27 An assistance manager on each shift supports the manager. Two told us they have complete confidence in the manager and that the team works well together. People living at the home and other staff echoed this. One member of staff told us, “We have fantastic support from Tina”, another said “You can always go to Tina with any concerns, she is always ready to listen”. There is a quality assurance system to ensure that peoples’ views and wishes are sought and listened to. Annual satisfaction questionnaire are sent to people using the service, including those admitted for intermediate care. We looked at the reports from the most recent questionnaire. Overall responses were positive. Where negative comments are returned individuals are contacted by DCC to look at ways of improving people’s experience of the service. As part of the quality assurance system a representative from DCC visits the home monthly and produces a report about their findings. This report should help the management team by identifying any areas, which require improvement. The home assists some people with personal finances, and we looked at the system in place by reviewing three people’s records. We found that records clearly account for any purchases made on behalf of a people living at the home and receipts are kept. Transactions are signed by two people to ensure accuracy. We found that people’s cash is held in one ‘pool of money’, rather than separately, which would be good practice. However, by the second day of the inspection the manager and one of the assistance managers had changed the current arrangements and all personal monies are now kept separately. This is to be commended. Since the last inspection some of the outstanding mandatory training has been addressed. All staff working in the kitchen preparing food have received food hygiene training. Eight care staff have attended a moving and handling refresher course and an assistant manager has just completed a moving and handling trainers course which will allow the home to provide in-house updates for all staff; a date for this has to be confirmed. Several staff are due and have requested infection control training, although the manager has requested this through the DCC training department a date for staff to attend has not been confirmed (refer to standard 26). Fire safety is generally well managed, for example fire equipment such as fire extinguishers and fire alarm are serviced and tested regularly. The AQAA showed that maintenance of equipment and systems, such as gas and electrical systems, and equipment such as the passenger lift, and hoists were up-to-date. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 28 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 3 X 3 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13 (2) Requirement You must ensure that people are given their medication as prescribed and within the correct timescale. Timescale for action 01/10/08 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 OP7 Good Practice Recommendations It is recommended that care plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of people are met. In order to maintain people’s privacy and dignity, it is recommended that staff do not discuss people’s personal care needs in communal areas where others can hear their conversations. It is recommended that the home continue to develop stimulating and meaningful activities for all people living at the home, which meet with their preferences and capabilities. This should include opportunities to enjoy activities outside of the home. 2. OP10 3. OP12 Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 30 4. 5. 6. OP16 OP18 OP38 It is recommended that detailed records are kept of all complaints, which include the outcome of the complaint and whether the complaint was resolved. In order to ensure that people living here are protected from abuse or harm, it is recommended that all staff are provided with up to date training in Adult Protection. In order to maintain safe practice staff should receive moving and handling up-dates. Charlton Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Lodge DS0000039224.V361871.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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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