Inspection on 31/08/07 for Charlton Lodge

This inspection was carried out on 31st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Charlton Lodge 01/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Charlton Lodge Orchard Way Tiverton Devon EX16 5HB Lead Inspector Dee McEvoy Unannounced Inspection 09:30 31st August 2007 & 4 September 2007 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.V343988.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.V343988.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/adoption.htm Devon County Council 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.V343988.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: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 30. 13th September 2006 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. Some residents 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 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. Fees currently set at £556.57 per week. Commission inspection reports are available from the home’s office. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home, their relatives, staff and outside professionals, prior to our unannounced site visit. Completed surveys were received from 4 residents; 7 relatives and 7 staff and 3 health and social care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. We spent 15 hours at the service, over a period of two days. There were 29 people living at the home at this time, with one short stay vacancy. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to four people. This including one person admitted to the home for short stay respite care and another person admitted for reablement care, with the aim of helping them to regain their independence so that they can return to their own home. Most people living at the home were seen or spoken with during the course of our visit and seven people were spoken with in depth to hear about their experience of living at the home. Time was also spent observing the care and attention given to people by staff. During our visit we met and spoke with one relative, three health professionals and two care managers. 16 staff, including the manager and care and ancillary staff were also spoken with, individually or in a small group. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Finally the outcome of the inspection was discussed with the registered manager What the service does well: When we asked people living at the home this question their comments included, “Staff are real angels”, “It’s like home and you have your privacy”, “The care is good and staff are kind” and “Everything!” Relatives told us, “The care is good and they fight people’s corner”, “To give me peace of mind that my mother is looked after and cared for in the way she Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 6 deserves” and “I think Charlton Lodge go that extra mile to make people feel as comfortable as they can”. This home provides an effective and valued intermediate care service. People admitted to the home for intermediate care are well supported and encouraged to regain independence and return home where possible. Health and social care professionals recognise this service as important as it can prevent admission to hospital or may speed up discharge from hospital. It also offers respite care, ensuring that relatives benefit from a break in their caring role. Good information is available to people considering a permanent move to the home, to help them make a decision about whether the home will suit their needs. People referred to the home through health or social services have a comprehensive assessment of their needs completed by someone who is suitable trained. The home works closely with health professionals to ensure that people’s health care needs are well met. Health professionals contacted by us said they were satisfied with the overall care provided at the home. One GP told us, “They care for people very well” and a community nurse said, “People appear well cared for”. People told us that staff treated them respectfully and were “kind and polite”. One relative told us, “They always treat Mum with love and respect, which is very important”. Family and friends are encouraged to visit regularly and to take an active part in the home and the care of their loved-ones where appropriate. One relative told us, “I can visit any time.” On the whole people enjoyed the food at the home, there is always a choice of food and people’s dietary needs and preferences are taken in account. The home listens to people’s concerns and complaints. People told us they knew how to make a complaint and records showed that action was taken to address people’s concerns. The home was clean and odour free throughout, and people told us it was “always” like this. Individual rooms were personalised and comfortable and people were generally happy with their private accommodation. Most staff have the skills and competencies to care for people at this home and staff receive regular supervision, which supports them to do their jobs well. The manager is experienced and has an open and inclusive approach, which ensures that people are encouraged to “have their say” about how the service is developing. What has improved since the last inspection? Aspects of the management of medication have improved. Medicines are now kept in a room, which maintains the correct temperature required for the safe storage of medicines. The home has a comprehensive policy and procedures in place to ensure the safe handling of medication. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 7 Information relating to staff recruitment was available for the most recently employed member of care staff, showing that robust recruitment procedures are in place to protect people living at the home. Where bed rails are used, risk assessments have been completed to take into account any potential risks. People have been consulted about the use of this equipment and we saw that individuals had consented to using bed rails where identified. A manager has been registered with the Commission since the last inspection, which confirms their fitness to be in charge of this home and ensures the longterm management of the home. What they could do better: Eight requirements have been made as a result of this inspection, three relating to health and safety training issues. One requirement is outstanding from previous visits. Some areas of the management of medicines must be addressed so that practices are safe and peoples’ wellbeing is ensured. The home supports people to manage their own medicines, which is commended but adequate risk assessments must be completed and safe storage must be provided for people keeping medicines in their rooms. Some people living at the home, relatives and staff felt that activities and occupation at the home could be improved. Activities need to be personfocussed and better planned. The home must help people get involved in more activities and outings and provide stimulation appropriate to their individual preferences and capabilities. In order to fully protect people living at the home from the risk of harm or abuse all staff must receive the appropriate training. Radiators should be properly guarded to fully reduce the risk of people burning themselves. In order to maintain good health and safety practices staff require mandatory training in manual handling, food hygiene and infection control. Nine recommendations have been issued to ensure good practice and standards are maintained. People living at the home should have a detailed care plan describing how their individual needs should be met, to help staff to provide consistent care. Staff should ensure that people are always consulted about decisions that affect their daily lives and that where possible individual’s choices and wishes are respected and acted upon. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 8 We have recommended that specialist equipment be freely available to meet the needs of people in a timely way. In order to maintain good infection control staff should be aware of the policies and procedures at the home. Some policies and procedures need to be updated so that staff have appropriate information to guide them. In order to ensure that the routine at the home is flexible and that people’s needs are met in a timely way and in a way that they prefer, it is recommended that staff deployment between 12.00 and 14.00 be reviewed. To ensure that staff have the skills and competencies to continue to meet the diverse needs of the people living at the home, staff should have training relating to people’s needs. An overview of staff training and needs will ensure that suitable training can be planned. The home has a good system in place to ensure that people’s finances are protected. However, to ensure that accuracy is maintained we have recommended that two signatures be obtained for every transaction. 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.V343988.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.V343988.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, 2, 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 about the home and this is shared whenever possible with people considering a stay at the home. People benefit from good admission and assessment practice, which ensures that the home is able to meet their needs. The intermediate care service successfully supports people to regain their independence and to return home where possible. EVIDENCE: We talked to people about their admission to the home and most people told us that they had chosen Charlton Lodge for various personal reasons, such as being close to their family. Two people told us that the home had a ‘good reputation locally’ and that they liked the home when they came to visit. They told us that they had received enough information about the home before moving in, to help them decide if it was the right place for them. One person Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 11 told us, “This is the best place for me” and another said, “I am settling in well and have been made very welcome”. The home has good written information about the services it provides, although two people responding with CSCI surveys felt they did not have enough information about the home before they moved in. People admitted for short stay or intermediate care may not see this information until they arrive at the home. This is due to the nature of the service, which provides a ‘rapid response’ to people’s needs at short notice. A copy of the Statement of Purpose is kept in people’s room and the reception area, along with the latest CSCI report. Two care managers spoken with told us that people considering a move to the home are given information about the services it offers. The manager told us that people are welcome to visit the home before making a decision to move in and they can come for lunch or tea in order to get “a feel of the place”. Two people responding with CSCI surveys said they had not received a contract, outlining their rights and responsibilities and what they can expect of the service. The manager said that the home is issued with an individual service contract for each person by social services and that people moving to the home are given a statement of terms and conditions of their stay. These could not be found on individual files during our visit. The manager was to review this to ensure that people were fully aware of the terms of their stay. All referrals to the home come via social services. Two care managers responding with surveys felt that assessment arrangements ensured that accurate information was gathered and that the right service was planned and given. One told us, “The manager does gather lots of information prior to the service beginning and requests a care plan from care management team”. Another wrote, “Although people are sometimes placed at short notice, the manager is very insistent on following correct practice and receiving assessments and care plans prior to admission”. We looked at the assessments of four people, including two admitted for short stay respite or rehabilitation care. Information available was generally good and allows for care plans to be developed. Once admitted to the home, staff complete a basic assessment relating to people’s needs. The manager does not currently visit people to assess their needs prior to them being admitted but would like to be able to do this for people considering a permanent move to the home. Charlton Lodge provides intermediate care and a short stay/respite service for people requiring recuperative or rehabilitative care. A separate unit is sited on the ground floor and a small team of staff are allocated to care for and support these people. Various professional people are involved in the care of people on this unit and evidence was seen of Occupation Therapist (OT) and Physiotherapist intervention in the care plans. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 12 Health and social care professionals involved with this service recognised the important role the home played in helping people regain their skills and independence, and enabling people to be discharged from hospital in a timely way. The service can also help to prevent admissions to hospital. 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. One GP told us, “This is an excellent service”. Two care managers spoken with said, “This is an essential service as it helps people to get out of hospital and home again”. We spoke with two people currently on the unit, one told us, “I have been involved in all the plans to get me home and I’ve had a home visit with the OT and physiotherapist to see how I am managing”. This person added, “I feel my overall health has improved greatly since being here.” Another person described the support she had received and told us, “I would recommend it to a friend. It’s quite good here”. Other comments included, “I have had a really lovely stay here” and “They’ve been wonderful”. Charlton Lodge DS0000039224.V343988.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. People’s health needs are well met and staff respect their privacy and dignity. However a lack of detail in some care plans may lead to inconsistencies in care and a risk that some people may not receive all the care they need in their preferred way. Some areas of the management of medication are not satisfactory and could put people at risk. EVIDENCE: We talked to people about the care they received and whether it was suited to their needs. Most people told us they were very happy with the care provided, one person told us, “The care is marvellous”, another said, “Life here is lovely. I am getting the care I need”. One relative spoken with told us, “The care is very good. My wife always looks nice.” CSCI surveys received from people living at the home and their relatives show that people “always” or “usually” receive the care they need. Surveys from health and social care professionals’ show that they receive good feedback Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 14 about the standard of care provided and one GP responding with a survey said that people’s care needs were “always” met by the service. The format used for care planning is generally good, identifying basic needs, the individual’s ability or strength to self-care and basic action to be taken by staff to meet people’s needs. There is a lack of specific detail though, which could result in people’s needs not being fully understood or met by all staff. For example, one assessment clearly stated that this person “finds chewing difficult” but this was not mentioned in the care plan. We spoke with this person who said that she could “generally manage” the meals provided but told us that her appetite was “poor”. One person was identified as being at risk of urinary infections, but there was limited guidance for staff to follow to ensure this could be prevented, action instructed staff to “give plenty of fluids”. There was no explanation of what “plenty” meant and no record of fluids offered or taken to ensure that this was happening. Other areas of care not fully detailed related to poor sight and hearing, one lady we met was partially sighted and needed some support and guidance to move around safely. This was not mentioned in her care plan to ensure staff consistently provided the help she needed. Daily notes referred to one person being verbally aggressive but no guidance was available to inform staff about why this might be happening or how to respond to these incidents. Currently the home is not developing specific care plans for people with diabetes, which would be good practice. Although some staff demonstrated an understanding in this area, there are no clear guidelines to ensure an agreed range of acceptable results for blood sugars to ensure all staff know what to do should levels fall outside of the range. This is particularly important for people who are managing their own insulin administration and therefore do not see the community nurse daily. One care plan instructed staff to give glucose tablets if the blood sugar was “very low”, but staff were not sure what “very low was”. Care plans also lacked information about how peoples’ social, emotional and spiritual needs are to be met (Refer to standard 12). The manager reviews care plans and every three months reviews of care are held with people living at the home and their relative, where appropriate. One relative told us, “I feel involved in my wife’s care”. Two people living at the home confirmed that they had seen their care plan and that things were discussed with them. One person said they were not interested but felt happy with their care. Four staff responding with CSCI surveys told us they were “always” given clear instructions about people’s care needs, three felt this was “sometimes” the case. Staff spoken with during our visit also had mixed comments about the information available to guide when caring for people. Three staff felt that care Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 15 plans contained enough information for them to deliver the appropriate care and two did not. Most staff felt that care plans allowed enough time to deliver the care needed, although two staff felt they did not (refer to standard 27). The manager is currently reviewing the format of care plans and is developing a much more person centred approach to care planning. Daily records are kept and some had good details about the care delivered, some daily comments were unhelpful and judgmental for example “Snappy mood today”. On the whole plans of care included risk assessments for most areas of care where there may be a risk. These include moving and handling assessments, risks of falls, slips and trips, risks of choking and risks posed by behaviour, such as smoking. Where bed rails are used, risk assessments were in place and consent from people had been obtained to use this equipment. CSCI surveys showed that most people responding “always” had their medical needs met. Health and social care professionals told us in their experience individual health care needs are “always” properly monitored and attended to. One GP we spoke with during our visit said, “They look after people well” and “I have confidence in them to look after very sick people”. The GP felt that the surgery was always contacted appropriately about any concerns. Another GP wrote, “There are a wide range of conditions in Charlton Lodge and the carers try to look after everyone well.” A community nurse told us she had no concerns about the service and that people appeared well cared for. However a senior community nurse felt that communication could be better and that staff should be able to deal with minor injuries, such as scratches or minor cuts. This was discussed with the manager during our visit. People receive good support from relevant health care professionals including G.P, district nurse, community mental health team and chiropodist, which ensure their heath needs are met. Nutritional assessments were not consistently completed for people to ensure that these needs are met, but regular weights are kept for most people. Those looked at show that people either maintain or steadily gain weight following admission. We looked at the management of medicines within the home. We found that two people are being supported to manage their own medication, which is to be commended. However, this decision was not clearly risk assessed or documented in the care plan. The storage arrangements were not secure. One person had their insulin on their bedside table, rather than locked securely away in their room to protect others. This was discussed with the individual Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 16 and the manager, and it was agreed that alternative arrangements would be found. We also observed that during the medication round the medicines trolley was sometimes open and left unattended. Once brought to the manager’s attention steps were taken to rectify this immediately. Since the last inspection the home has moved the medicines storage area to a different room. This has enabled them to maintain the temperature of the room within the temperature range specified by the medicine manufacturers. The storage of medicines was generally good, including medication requiring refrigeration. Fridge temperatures were recorded regularly and showed that medicines were stored correctly. Medication with a limited life once open had been dated to ensure it was used within the correct timescale. One controlled medicine was checked and found to be stored correctly, with accurate records kept. Medication administration records (MAR) showed that variable dose medicines were not accurately recorded with the dose of medicine that had been administered to people. Care plans did not direct staff when to use as ‘required medicines’, such as sedatives, laxatives or pain killers. This could result in people getting these medicines inappropriately. MAR charts looked at showed that hand written entries had not been signed by two people to verify the accuracy of the entry. When staff receive instructions from GPs about changes to people medication this information is not verified by two people to ensure accuracy. Since the last inspection the home has obtained comprehensive policies and procedures for the handling of medicines to ensure practice within the home improves and is safe. People told us that staff respected their privacy and dignity. One person told us, “I can’t criticise anything. Staff are polite and respectful, kindness it’s self here”. Other people echoed this; one gentleman said staff ensured that his privacy and dignity were upheld, especially when receiving personal care. Other comments included, “Most staff are polite and respectful” and “staff are so kind and make our lives comfortable”. During our time at the home staff were heard to address people in a courteous and friendly way and staff were seen to knock on people’s bedroom doors before entering. Visiting health professionals said they always could see people in private. Charlton Lodge DS0000039224.V343988.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 adequate. This judgement has been made using available evidence including a visit to this service. The routines at the home are not always flexible and people’s preferences and expectations with regards to social and recreational needs and interests are not met sufficiently to ensure that they enjoy a full and satisfying lifestyle. People benefit from contact with their family and friends, which is encouraged and supported by the home. The meals offered provide choice, variety and meet nutritional needs. EVIDENCE: The routines at the home are not always flexible and due to staffing arrangements do not enable people to receive the care and support they need when they want it. For example, during a two-hour period over lunchtime (between 12 & 14.00) it is difficult for people to use the toilet with assistance, as staff take a lunch break during this time (refer to standard 27). People told us they usually “had to” use the toilet before or after lunch. Staff explained that they assist people to use the toilet before lunch and again after 14.00 but also added that if necessary staff from other units or the manager are called to help. One person told us this wait had resulted in them being incontinent which was distressing and unnecessary. People did tell us that they could choose when to get up and when to go to bed. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 18 Surveys received from people living at the home showed that three people felt there were “sometimes” activities available, which they could participate in, one person said there were “always” activities to take part in. One person wrote, “Because of my disability I find it hard to join in with activities as they are mostly downstairs and I live up-stairs”. We spoken with several people at the home about the kind of activities they were offered. We were told that an outside entertainer comes in on occasion and there was a regular service held at the home by a local church. There is no programme of activities to inform people of what is planned. One person told us they enjoyed the bingo sessions, which were held “sometimes” and a number of people attended a bingo session during our visit. Care plans contain very little relevant information about people’s interests and hobbies. Where reference was made it was general comments like, “To have stimulation” or “Keen on socialising and looking forward to going out”, and “Likes doing little jobs”. We spoke with one person and they expressed an interest in being involved in activities and said they would really like to visit the garden at times but she was not aware of any organised activities and felt staff didn’t have the time to take her out. Another person told us they weren’t sure what activities were available and added, “I get bored and fall asleep”. Several people told us they would like to get out and about more often. One person said they hadn’t been out for over a year but would like to go shopping for clothes and other personal items. Another suggestion from a person we spoke with was to organise “film afternoons”. We looked at the records kept of been offered to people. Records month, regular hand massage and said they enjoyed. Other than that, or when visitors came. the social stimulation and occupation had showed between two and four entries a nail care are offered, which several people entries were mainly relating to watching TV Comments recorded from care reviews also showed that people would like more meaningful activities, suggestions included regular outings to local places, such as the park, shops or seaside. Staff too felt that more could be done to provide suitable activities for people, one said, “We just don’t have the time to get people out very often, we would like to be able to do more”. Two care managers felt that one improvement would be more activities and more trips out for people. We were told that the home had made a very special effort to help a couple celebrate a significant anniversary, we were told, “The home put on a tea party with cakes and flowers. Very special!” Relatives told us they were “always” or “usually” kept informed of important issues relating to their relative at the home. One person wrote, “Phone calls alert me if he has to visit the hospital or GP”, another wrote, “They keep me up to date”. We spoke with one relative during our visit, who told, “I always feel Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 19 welcome and visit regularly”. Another relative told us they were invited to stay for lunch and tea and this was very much appreciated. Care managers told us that the home involves families as much as possible and that this encouraged “team work” between the home, the family and care managers. The majority of people returning CSCI surveys told us that staff listen and act on what they say. One person felt that some staff do this but others did not. One person we spoke with told us that although there were no restrictions at the home, they felt “restricted”, adding, “I have to ask to go anywhere. I would love to go out into the garden but this has not been offered and I don’t like to ask”. People told us they liked the food at the home “always” or “usually”. Their comments included, “The food is very good and there is always a choice”, “Can’t grumble about the food” and “It’s really wonderful”. One person told us they didn’t like meat and that the kitchen always ensures that other options are available. There is a chalkboard on each unit, which tells people what the main meal of the day is and what alternatives are available. The menus are varied and provide a balanced diet. We spoke with the catering staff; they are an experienced team and know people’s likes and dislikes. The cook is also aware of people’s dietary needs, such as those people who require a diabetic or soft or pureed diet. We saw fresh bowls of fruit on each unit for people to help themselves to and people had fresh drinks available during the day. Lunchtime was generally a pleasant and sociable time. People were served individually and we heard staff explaining what was available and offering people a choice. One person told us, “It’s like a 1st class hotel!” We saw staff assisting people in a tactful way where necessary. One relative did raised concerns about lunchtime and felt that people who were very frail did not get the food suited to their needs, for example smaller portions and assistance to cut up food where necessary. Staff told us lunchtime was a busy time; during the lunchtime period there is only one care staff on each unit supported by a domestic (refer to standard 27). There are no meals/snacks routinely offered after tea in the late afternoon. Hot drinks and biscuits are offered but one person told us, “I feel hungry at night sometimes”. This person said they had asked staff in the past if they could have something else to eat but was told by staff after tea “that’s it”. This was discussed with the manager, who told us that anyone could have something to eat if they ask and are hungry. Care staff spoken with also confirmed this, and said that they had access to the kitchen if people wanted a sandwich or other snack. The manager is going to discuss this at the next residents’ meeting and make sure that people are aware they can have sandwiches/snacks if they wish. Charlton Lodge DS0000039224.V343988.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 can be confident that their complaints will be listened to and staff understand the principles of adult protection, which helps to protect people from abuse. Additional protection will be offered to people living at the home when all staff receive the appropriate training. EVIDENCE: All people responding with CSCI surveys and those people spoken with during our visit said they knew who to speak with should they have a concern or a complaint. One person told us, “I would speak with the head person. They would listen to me”. Other people said they would speak with the manager or staff if they had any concerns or problems. Most people were confident that the manager and staff would listen and act on their concerns. One relative told us that the manager speaks with visitors regularly and will listen to any “concerns or grumbles”. We were told, “You can have your say”. The majority of relatives responding with surveys told us they were aware of how to make a complaint, one wrote, “Inside the home I can take any complaint to the manager. This has not arisen”. Relatives said that complaints were “always” or “usually” responded to appropriately, one wrote, “Any complaint however minor is reported to the office, who in turn try their utmost to deal with it in the best way possible”. Health and social care professionals told us that the home “always” responds appropriately if any concerns about people’s care are raised, one wrote, “No concerns raised about the service. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 21 Suggestions and requests regarding individual clients are always considered and carried out where possible”. The home has a comprehensive complaints procedures and the manager keeps a good record of any complaints or concerns received and how they were responded to. All care staff responding with surveys said they aware of adult protection issues. Care staff spoken with showed a good understanding of various types of abuse and all were aware of their responsibility to report any concerns. Staff were aware of which agencies to contact outside of the home too, should they have any worry that their concerns not being acted on. One staff member said she had not received the required adult protection training since being employed at the home 11 months ago, although she was an experienced carer and knew about the reporting process in order to protect people. The manager said that training with DCC was book for later in the year. The manager is aware of her role when a concern or allegation is brought to her attention and uses the Devon Multi-agency Protection of adults Alerter’s guide for reference and guidance. Charlton Lodge DS0000039224.V343988.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, 22, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This home provides a clean and comfortable place for people to live; though they are not adequately protected from risks presented by hot surfaces. 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 were happy with their accommodation and one person told us, “I like the lounge up-stairs and have a lovely bedroom which accommodates my needs”, another said, “I have a beautiful room with nice furniture”. Bedrooms are of a good size and those visited were personalised by pieces of furniture, pictures and photos. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 23 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 twice a week to carry out some safety checks and make minor repairs. Staff told us that they generally had access to the equipment needed to help people with their mobility. Staff on the first floor said that only one hoist suited the needs of one person on that floor and this hoist was shared with the other units, meaning they had to go and get it when it was needed. This caused delays when delivering care. The person requiring this hoist said one improvement they would like to see was “another hoist, so I don’t have to wait too long”. As seen at previous inspections most radiators and hot pipes are guarded to prevent people getting burnt, although the tops of radiators are still not covered, as the homes own risk assessments indicate they should be. One member of staff said there was a risk of people getting burnt as some people use the radiators in the corridor when walking. All people returning surveys told us the home was “always” clean and fresh. Despite being short of domestic staff during our visit, the home was clean and fresh throughout and domestic staff spoken with took pride in their work. The laundry was clean and well organised and managed by an experienced person. Several people told us they were happy with the laundry service provided. People’s own clothing is taken care of, ironed and hung up. Some domestic staff have not received the necessary training and information to keep them safe whilst working. For example, the laundress had not received infection control training or seen any policies and procedures relating to her role. A domestic spoken with was also working without this training and information. Although both were aware of how to handle infected material, such as laundry, neither had been given information about things like MRSA but felt that this was necessary to help them do their jobs safely. The manager is aware that some staff require mandatory training and some is “booked” through DCC training department (refer to standard 38). We were told that all staff have access to policies and procedures and that a file was kept in the staff room. This could not be found on the first day of our visit but was available on the second day. The manager will ensure that all staff have the opportunity to look at relevant policies to ensure safe practice is maintained. Charlton Lodge DS0000039224.V343988.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. The deployment of staff is not meeting the needs and preference of the people living here but people can be confident that staff are suitable skilled to meet their needs. The procedures for the recruitment of new staff are robust and therefore protect people living at the home. EVIDENCE: Most people spoke highly of the staff, comments included, “They are all very pleasant and kind”, “Staff are easy to talk to” and “The night staff are lovely”. Two people told us that ‘some staff are better than others’. When people have raised concerns about staff attitude or approach these have been dealt with through the complaints procedure and records showed that issued had been resolved. Two people returning surveys told us staff were “sometimes” available when needed, one felt staff were “usually” available and a fourth thought staff were “always” available when needed. One person wrote, “Sometimes it is a bit difficult for me when they tell me I have to wait. I am unable to do it myself”. Several people spoken with said it was difficult to get assistance at times, particularly between 12 and 14.00. Others described waiting for assistance at other times, but usually only up to 10 minutes. The home has a print out of how long it takes staff to answer the call bell; records show that most calls are Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 25 answered swiftly, within 10 minutes. One record showed that someone had waited 25 minutes early in the morning. There are generally three care staff on each unit between 07.00 and 11.00 but during our visit this number was reduced due to sickness and holiday. The manager will use bank or agency staff when needed and some domestic staff are also redeployed as care staff. Staff on two units told us the morning was busy and that most people needed two staff to provide their care safely. They felt that care could be given appropriately when they had their full compliment of staff. The manager told us that one new member of staff has been recruited since the last inspection; all recruitment is organised centrally by DCC. We looked at these recruitment records to ensure that practice was thorough and protected people living at the home. The file contained all the necessary information, including a completed application form, two references and Criminal Record Bureau (CRB) check. Surveys received from staff showed that they had received induction training to help them understand how the home works and how to care for people safely. One wrote, “I have only been employed here for 10 weeks and feel that I have reached all my goals for training to be a care assistant.” Most staff said they had received enough support when they first started and that they received relevant training to help them do their job. Two people responding felt they did not receive the training and support needed. Records show that new staff receive a structured induction. Three care staff spoken with told us they had good support and training to enable them to care for people well, one told us “The training opportunities are good”. Two other care staff felt they did not receive relevant training, one said, “I have been disappointed with the training so far”. We were also told that although community nurses come to the home to provide training on issues like catheter care and diabetes, some staff were unable to attend as they were working. Three of the seven staff returning surveys felt they were asked to care for people outside of their area of expertise. This seemed to relate mainly to caring for people with mental health problems. One staff member felt that training in this area would help staff to “care for people properly”. Staff training records were not up to date, making it difficult to assess individual training needs. Health and social care professionals’ felt that staff “always” or “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, one wrote “I visit the home weekly, and by what I have seen the staff are very kind & do their job to a high standard.” Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 26 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. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 27 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, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed and people can be confident that their views will be sought and acted on. The systems in place safeguard people’s finances. Health and safety of the building is good, but there are inadequate training opportunities for staff, which could place people at risk. EVIDENCE: Since the last inspection a new manager has been registered with the Commission. Tina Bartin has worked as the acting manager of the home for over a year. She is experienced and has obtained the registered managers’ award. She is also a qualified NVQ assessor. She is keen to develop her skills and competencies further and is planning on completing NVQ 4 in care. She undertakes other periodic training to up-date her knowledge and skills. Staff Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 28 spoken with were generally very positive about the inclusive and approachable style of the manager. Comments from staff included, “She is great. She listens to us and does her best for us”, “She has an open door and I have confidence in her” and “She has been brilliant”. Most staff felt well supported by the manager. Two staff spoken with were less positive about the management at the home, feeling they couldn’t easily go and speak with the manager or deputy managers. People living at the home, relatives and health and social care professionals expressed their confidence in the manager. People we spoke with knew who the manager was and told us that they could speak with at any time. One relative us told, “You can speak with Tina and she will listen”. One social care professional told us the home was “well managed”, and a health professional described the “good atmosphere” at the home and the “good people” running the service. People’s views are sought about the quality of the service provided. An annual survey is carried out for all people living permanently at the home and people admitted for intermediate care are also included. The majority of responses from the last audit showed a good satisfaction rate. Where negative comments are returned individuals are contacted by DCC to look at ways of improving people’s experience of the service. One relative told us, “They are always looking to improve the lives of the people in any way possible”. Residents’ meetings are held, although these have been infrequent. The manager is planning more regular meetings. Minutes from the last meeting held in July show that people are asked for their views and ideas and are included in how the ‘comfort’ fund should be spent. Staff meetings are also held and offer staff an opportunity to talk about their work and the developments at the home. The home looks after small amounts of money for some people. The system was looked at and two personal accounts were audited. Money and records are kept securely in a locked space. Access is limited to the manager and deputy managers. Each account is kept separately and records and receipts are kept. Two signatures have been obtained for most transactions but not for all, which would be good practice and ensure accountability. Balances were checked and were found to be in order. All staff surveyed said they received regular supervision, which provides an opportunity to discuss aspects of practice and training and development needs. Five of the seven staff responding with surveys felt they had enough support to do their job well. The manager is aware that some mandatory training is needed to ensure staff work safely and maintain good standards. All training is organised through Devon County Council as the provider of this service. The manager explained Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 29 that there were difficulties accessing training at times. Two training sessions, including food hygiene, had been cancelled at short notice recently but other dates are booked for later in the year. Staff told us and records showed that some staff require manual handling updates. During our visit we saw staff assisting people with their mobility needs in a confident way and used equipment appropriately. The manager told us that there was “always” a first aider on duty. Some staff are due first aid updates and we were told this had been booked through DCC. Some staff required food hygiene and infection control training to ensure that standards and best practice are maintained in this area. Domestic staff require infection control training (refer to standard 26) and staff dealing with food require food hygiene training. Fire safety equipment, for example fire extinguishers, had been regularly serviced and the fire log showed regular checks and maintenance on emergency lighting and fire alarm. All staff spoken with said they had regular fire safety training and they knew the procedure in the event of a fire. The home had not completed a recent fire risk assessment in line with fire regulations. The one on file dates back to 2003. The maintenance person told us that all windows on the first floor were restricted and windows checked during our tour of the building were safely restricted to prevent falls. Records show that regular checks and maintenance are carried out on window restrictors. Hot water is regulated to prevent injuries from scalds and the maintenance person keeps records of checks made regularly. The AQAA showed that maintenance and servicing of equipment, such as hoists, the lift and the call bell system is carried out regularly. Gas and electrical systems are tested and serviced as recommended according to the AQAA. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 30 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 1 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X 2 X X 1 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 1 Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES 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 the management of medicines. You must ensure that the medicines trolley is always secure when unattended. You must complete a risk assessment for people choosing to administer their own medication and provide safe storage. Handwritten MAR entries must be signed by two competent people to ensure accuracy. You must ensure that the actual dose given is recorded where medicines are prescribed as variable doses. You must consult with people about their social interests and make arrangements to enable them to engage in a range of activities inside and outside of the home. Particular consideration must be given to people less able to organise their own social activities. You msut make arrangements, by training staff or by other measures, to prevent people DS0000039224.V343988.R01.S.doc Timescale for action 16/10/07 2. OP12 16 (m) 27/11/07 3. OP18 13 (6) 27/11/07 Charlton Lodge Version 5.2 Page 32 4. OP25 13 (4) being harmed or suffering abuse or being placed at risk of harm or abuse. Appropriate training must to be given to all staff to ensure adult protection procedures are followed and people are protected. You must ensure that all parts of 27/11/07 the care home to which people have access are so far as reasonably practicable free from hazards to their safety. (Where risk assessments indicate that hot surfaces should be guarded this work should be completed i.e. tops of radiators currently unguarded should be guarded) Previous timescale of 06/05/06 & 06/12/06 not met You must ensure that staff preparing and serving food have received the necessary food hygiene training in order to maintain good standards in this area. 27/11/07 5. OP38 18 (1) 6. OP38 13 (5) 7. OP38 16 (2) (j) 8. OP38 23 (4) You must ensure that suitable 27/11/07 arrangements are in place for a safe system for moving and handling people. This includes staff training. You must ensure that staff have 27/11/07 training to help them maintain safe working practice in relation to infection control. You must take adequate 30/10/07 precautions against the risk of fire, this includes ensuring that an up to date risk assessment is completed. Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 33 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. Refer to Standard OP2 OP7 Good Practice Recommendations It is recommended that people receive a copy of the terms and conditions of their stay at the home in order to ensure they are aware of their rights and responsibilities. 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. Diabetic care plans should be developed to ensure that staff take the appropriate action when necessary. In order to ensure people’s good health and well-being, it is recommended that nutritional assessments are undertaken to ensure people’s It is recommended that people are helped to excercise choice and control over their daily lives. It is recommended that sufficient specialist equipment is available to meet people’s needs. It is recommended that all staff have access to and are aware of the policies and procedures in place to maintain good infection control. It is recommended that the deployment of staff between the hours of 12.00 and 14.00 be reviewed to ensure that people’s needs are met in a timely way. It is recommended that staff receive relevant training to help them care for people with diverse needs, such as mental health needs. It is recommended that staff training records are kept up to date to help identify when staff need up-dates or where other relevant training is needed or has been completed. It is recommended that two signatures be obtained for each transaction when dealing with people’s person monies to ensure accuracy and accountability. 3. 4. 5. 6. 7. 8. OP8 OP14 OP22 OP26 OP27 OP30 9. OP35 Charlton Lodge DS0000039224.V343988.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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.V343988.R01.S.doc Version 5.2 Page 35 - 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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