Inspection on 06/02/06 for Charlton Lodge

This inspection was carried out on 6th February 2006.

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

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

Other inspections for this house

Charlton Lodge 01/08/08

Charlton Lodge 31/08/07

Charlton Lodge 13/09/06

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 Stephen Spratling Unannounced Inspection 6th February 2006 10:00 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.V273944.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 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 Devon County Council Lorna Priest Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th September 2005 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. 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. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector arrived at the home unannounced and was greeted by one of the homes deputy managers. He spent 4 ½ hours at the home during which time he spoke with nine residents, four care staff and one of the housekeeping staff. He also spoke briefly with a visiting GP and looked at a variety of records maintained at the home. A limited number of National Minimum Standards were examined through this inspection and the reader should also see the inspection report dated 8th September 2005 for a fuller picture of the service. What the service does well: What has improved since the last inspection? What they could do better: To help ensure the safety of residents and staff suitable beds should be supplied for residents who need nursing in bed and/or help in and out of bed. Some radiators not fully covered should be fully covered to reduce the risk of residents burning themselves. Checks on new and agency care staff need to be done more thoroughly before they are allowed to work in the home. The risks associated with residents managing their own medications should be properly assessed before this happens. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. EVIDENCE: Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8&9 Good monitoring and links with community health professionals help residents to maintain good health. The home has generally good systems for the management of medication retained by the home, however incomplete systems for supporting residents who wish to self medicate potential place them at risk. EVIDENCE: Residents told the inspector that they are helped to contact GPs and other health professionals if they are unwell. A local GP visiting the home told the inspector that he considers that the care at the home is good, that he receives appropriate and timely referrals and that staff carry out the care he prescribes for his patients. Three care plans, briefly looked at, all contained reference to service users health care needs and how they should be monitored and met by staff. One seen contained detailed guidance provided by a Community Psychiatric Nurse. Medications are securely and properly stored. Proper records are kept of controlled drugs stored and administered in the home. Three medication administration charts sampled showed that medications are properly checked Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 10 into the home and in all but one episode properly recorded when administered. Where residents retain their own medication staff closely monitor this to ensure they are managing safely however a system for properly risk assessing residents capacity to manage their own medications was not in place. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 Residents enjoy choice, sufficient access to activity and stimulation, and good food at this home. EVIDENCE: Residents said that they are free to choose where they spend their time and that they are free to come and go from the home as they choose. They described a variety of activities usually occurring in the afternoons, including quizzes, bingo, a regular visiting pianist, picture games and a regular church service held in the home. Residents said they were content with the level of activity available in the home. All residents spoken with described the food provided in very positive terms, with one person saying that it’s “marvellous”, all confirmed that they are offered choice at every meal. The kitchens are currently being refurbished meaning catering staff are working in less than ideal circumstances, despite this none of the residents spoken with had detected a decline in the standard of food provided. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents can be confident that staff would act to protect them if they were being miss-treated. EVIDENCE: Two of the care staff spoken with had attended training about recognition and reporting of abuse/miss treatment of residents, within the past year, two others had received training but over four years ago. All demonstrated an adequate awareness of their responsibilities to report any mistreatment of residents. In the home office the inspector saw the local authority guide to help staff know how to recognise and report abuse. All residents spoken with said they feel staff are gentle and respectful and that they never have concerns about how staff treat them or other residents. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 25 Resident’s are not adequately protected from risks presented by hot surfaces and the lack of adjustable beds may mean some residents do not get care delivered in the safest way possible. EVIDENCE: In the last inspection report the inspector wrote “Most radiators and hot pipes are guarded to prevent residents getting burnt though the tops of radiators are still not covered (as previously recommended) meaning there remains a risk that residents could burn themselves (see standard 38). Most of the beds in the home are at a fixed height; three staff said that this can make providing care to immobile residents difficult, suggesting that they need height adjustable beds.” On this inspection the inspector saw that no progress on these issues has been made. The homes own environmental risk assessment says that hot surfaces should be covered and though largely done this job is still to be completed. Staff continue to express concern that it is difficult to care for very frail residents on ‘divan’ beds. The staff described trying to care for one resident who needs moving and handling with a hoist which they can not do properly as they can not get the hoist under their bed properly. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 Residents receive the help they need from kind staff who are supplied in sufficient numbers and who know how to care for them properly. Residents cannot be assured that they are protected properly by the homes recruitment procedures. EVIDENCE: All residents spoken with spoke highly of the care staff and expressed confidence that staff know their jobs and provide consistently good care in a respectful and gentle manner. All confirmed that they get help when they need it and none considered that they are made to wait to long when they need/request help. Staff spoken with said they felt that there are generally enough staff on duty most of the time though said they often feel pressured between 7am and 10am, some staff agreed this pressure maybe reduced by changing some of their established work patterns. On the morning of the inspection were 6 care staff and the deputy manager. The inspector looked at the recruitment records for three members of staff all of whom had started in post during 2005. They all contained reference to a satisfactory Criminal Records Bureau (CRB) check having been received, though all had been received after the person had started work at the home and none of the files contained evidence of a POVA 1st (protection of vulnerable adults 1st check) having been done. One did not have adequate identification available and though all had references, which had been obtained prior to them Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 15 starting in post, one of the references seen had not been signed by the person who wrote it and there was no evidence that this had been noted or addressed. Regarding agency staff used at the home the inspector saw evidence that one agency supplies written confirmation that satisfactory CRB and other required checks have been done on each individual supplied but two other supplying agencies do not provide that confirmation for each individual supplied. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Residents benefit from living in a home, which is well managed and can be confident that their views will be listened to and acted upon. Satisfactory accounting systems help to ensure their money is properly managed. The safety of some residents is being compromised by failure to identify and manage risks adequately in all areas. EVIDENCE: The home manager has established clear systems to aid the smooth running of the home. She has many years experience as a manager, is a registered nurse and has achieved NVQ 4 and the registered managers award. The manager is supported by four assistant managers and there is always a manager on duty to support care staff. The home holds some money for service users and clear accounts for credits and debits of this money are kept and include two signatures, they could not Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 17 be checked against money held as sums greater than £50 are placed in a home ‘suspense account’. Forms where residents had signed to confirm they know their money is held in a none interest baring account were also seen. Service users indicated that staff listen to and respect their views. The deputy manager said that they collect resident’s views about the service through care plans reviews which are done monthly and bi-annual questionnaires and that suggestions/criticisms are then addressed as they arise. The home also has an open system for hearing resident’s complaints. To help ensure quality and safety in the home, weekly environmental checks are recorded; the inspector saw weekly checks of the state of furniture and checks to ensure call bells are working. He also saw maintenance records showing that window restrictors and hot water temperatures are checked monthly. In one room bed rails/cot sides were in use to reduce the risk of a resident falling out of bed, however as a pressure relieving overlay mattress was being used on the divan bed the height from the mattress to the top of the rail was reduced increasing the potential for the resident to fall over the side of the rail; a risk assessment had been completed regarding the use of the rail however this assessment did not take into account the raised level of the mattress. As mentioned in standards 24 & 25 risks regarding the moving and handling of some residents in bed and some hot surfaces have not been adequately addressed. Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X 2 2 X STAFFING Standard No Score 27 3 28 X 29 1 30 X 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.V273944.R01.S.doc Version 5.1 Page 19 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 OP24 Regulation 16 (1) (c) Requirement The registered person must having regard to the size of the care home and the numbers and needs of service users (c) provide in rooms occupied by service users adequate furniture…equipment suitable to the needs of service users… (where service users need assistance to position in bed, to get in and out of bed or nursing in bed they should be provided with a suitable bed (e.g. a height adjustable bed so that staff can do this safely) The registered person must ensure that all parts of the care home to which service users 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) Where a person is employed by someone other than the DS0000039224.V273944.R01.S.doc Timescale for action 06/05/06 2 OP25 13 (4) 06/05/06 3 OP29 19 06/04/06 Charlton Lodge Version 5.1 Page 20 4 OP29 17(2&3) registered person (e.g. an agency care worker) The registered person must not allow that carer to work in the home unless they have obtained from the employer of that care worker (the agency) written confirmation that all information specified in paragraphs 1 to 7 of Schedule 2; has been obtained and that they are satisfied that it is satisfactory. Previous timescale of 08/11/05 Not met The registered person must maintain in the care home all the records specified in Schedule 4 (6).. and they must be available for inspection in the care home by a person authorised by the Commission to enter and inspect the care home. Previous timescale of 08/11/05 Not met 06/04/06 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 OP9 Good Practice Recommendations Where residents wish to manage their own medications a full risk assessment should be completed before they do to ensure that any risks associated are identified and appropriately managed. Where bed rails are used risk assessments should take into account all potential risks (e.g. height of mattress) and suitable control measures put in place (e.g. a more suitable bed provided). 2. OP38 Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Charlton Lodge DS0000039224.V273944.R01.S.doc Version 5.1 Page 22 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!