Inspection on 14/12/09 for Charlton Park Care Centre

This inspection was carried out on 14th December 2009.

CQC 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 CQC 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 Park Care Centre 15/12/08

Charlton Park Care Centre 16/06/08

Charlton Park Care Centre 19/12/07

Charlton Park Care Centre 11/06/07

Charlton Park Care Centre 27/02/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Charlton Park Care Centre Park Farm, Off Cemetery Lane Charlton London SE7 8DZ Lead Inspector David Halliwell Key Unannounced Inspection 14th December 2009 09:00 DS0000068284.V378567.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charlton Park Care Centre Address Park Farm, Off Cemetery Lane Charlton London SE7 8DZ 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) 020 8316 4400 020 8316 4422 charlton.park@fshc.co.uk Four Seasons (No 7) Limited Mr Richard Nevins Care Home 66 Category(ies) of Dementia (34), Old age, not falling within any registration, with number other category (32) of places Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 32) 2. Dementia - Code DE (maximum number of places: 34) The maximum number of service users who can be accomodated is: 66 27th November 2009 Date of last inspection Brief Description of the Service: This home is located in Charlton, within walking distance of local bus routes and Charlton village. The home consists of a 31-bedded unit for older people that require nursing care on the ground floor and a 35-bedded unit for older people with dementia that require nursing care on the first floor. All of the bedrooms are single occupancy with a private toilet and washbasin. Laundry and kitchen facilities are provided on site. There is a garden at the rear of the property and parking bays in the area in front of the home. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The stars quality rating for this service is 1 star. This means that people who use these services experience adequate quality outcomes. They said that they like to be called residents. No enforcement activity has occurred since the last inspection. This was an unannounced inspection visit and was carried out over 1 day. The Inspection covered all the key standards in the National Minimum Standards. During the course of this inspection we met the Care Services Director; the Regional Manager; a peripatetic Manager and the Home’s Manager. We had interviews with 6 care assistant staff and discussions with 14 residents. The inspection involved a review of all the agencies records, 6 staffing files and 5 resident’s files were inspected as well as the policies and procedures manual for the agency. 12 requirements have been made as a result of this inspection including 1 repeat requirement outstanding from the last inspection. Enforcement action may follow if this new requirement is not met within the timeframe. 9 recommendations have been made. Feedback on the requirements and the recommendations was given verbally to both all the senior Managers mentioned above at the end of the inspection visit. The Senior Managers and all the staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The agencies Registration Certificate with the Commission was seen displayed appropriately in the main office. There have not been any changes in the ownership of this Agency since the last inspection. What the service does well: Staff carried out an assessment before people moved into the home to determine what support they required. Residents had access to community health care services. Relatives were able to visit their family members when they wanted and were able to play an active role in their family members care if they wished. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.2 Page 6 People could choose where and how they spent their time and staff encouraged people to make decisions for themselves where possible. Complaints and concerns were recorded and were investigated promptly. The home kept good records about peoples money and valuables. What has improved since the last inspection? What they could do better: The following areas have been identified as a result of this inspection: Standard 3 We recommend that the Manager requests comprehensive referral information from any agency that wishes to refer their client to live at Charlton Park. Standard 7 It is required that care plan reviews are more detailed in their review of care plan objectives. Standard 9 Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.2 Page 7 It is required that the Manager ensures that all out of date medications are withdrawn and not used for residents. Equally no medication should be used for any person other than for the person for whom it was prescribed. Standard 10 It is required that the Manager ensures all staff including agency staff know who the residents are that they are to be working with and that they have a good knowledge of the residents needs. It is required that the Manager ensures that staff support the residents in such a way that the residents’ appearance in terms of dress and general tidiness is a priority. This would contribute greatly to the residents’ feelings of well being and help them to feel dignified and respected by the staff who are there to support them. Standard 12 It is recommended that adequate information and time be given to residents and staff in order that they can attend the social activities if they choose to do so and where necessary leave the activities if they wish to. Standard 15 The organisation of the lunch and evening meals needs a complete review. This is a requirement. At the last inspection on 27th November 2009 a requirement and a recommendation was made concerning the same issues. There was a timescale set for there achievement by 13th December 2009. Clearly at the time of this inspection on 14th December 2009 the requirement had not been met. Enforcement action may be taken if this new requirement is not met within the timescale. Standard 18 It is required that the Manager ensures that all care staff receive SOVA and whistle blowing refresher training by an authorised external training agency preferably the L.B Greenwich. This is to help ensure that staff are adequately trained in order to protect residents from abuse. Certificated evidence will be required for inspection. Standard 19 It is strongly recommended that for those bedrooms that are sparse and not personalised a much greater effort is made to make them feel homely and welcoming. It is required that appropriate actions are taken to eliminate the strong smell of urine on the ground floor in order to ensure that residents live in a well maintained environment that they are not ashamed to be in. Standard 27 Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 8 It is recommended that the Manager reviews the current staffing levels to ensure that there are sufficient numbers of staff to meet the needs of the residents. Standard 28 It is a requirement now that sufficient numbers of staff are enrolled on NVQ level 2 training courses. Standard 29 It is recommended the Manager ensures that all staff CRB checks are renewed every 3 years. Standard 30 It is required that the Manager ensures that for each new member of staff the induction programme as set out in the induction book be completed as the induction proceeds and that it is kept on staff files appropriately. Relevant sections of the induction should be signed and dated by the Manager and the Employee. We recommend that the Manager ensures that all staff are asked to review the key policies and procedures for the home and to sign to say that they have done so. It is recommended that the Manager reviews how the delivery of training is being provided to staff and ensures that a more effective method is found. It is required that the Manager ensures certificated evidence is held on staffing files that supports staff attendances at training events. Standard 33 It is recommended that the frequency of residents meetings needs to be increased to 4 times annually so that the access for residents for discussing issues is improved. Standard 36 It is a requirement that: All care staff including RGN and RMN staff members are supervised once every 3 months. Supervision notes should be taken, kept on staff files and copied to staff for their information. It is recommended that those staff who will undertake supervisory roles attend a proper training course that enables them to carry out their roles effectively. Standard 38 The fire risk assessment was last carried out in 2007 and this should be done annually. This is a requirement. If you want to know what action the person responsible for this care home is Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 9 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 10 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 Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 does not apply to this home. Quality in this outcome area is good. Prospective residents’ needs are assessed before a decision is made to move into Charlton Park. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 3 We inspected 8 of the resident’s files over the course of this inspection and found that for all these people their needs had been assessed before moving into the home. The assessments, we were told, are usually carried out by the Manager or another senior member of staff. Standard assessment formats had been used that identify the person’s physical, mental and social care needs and any other useful information such as their current medication programme. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 12 Pre-admission information had only been supplied for 3 of the 8 residents whose files we inspected. This information could be provided by the referring professionals (those agencies who requested placements at Charlton Park for their clients). We recommend that the Manager requests comprehensive referral information from any agency that wishes their client to live at Charlton Park. This will aid the process of ensuring that Charlton Park can properly meet the needs of the prospective residents. The files we inspected were in good order generally and the information was easy to find. What this all means is that new service users are being admitted to Charlton Park with a full assessment of their needs having been carried out. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 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. Service users may be assured that their health and social care needs will be set out in an individual care plan and that their health needs will be met. The policies and procedures for the administration of medication should help protect them. Residents in the home feel that they are treated with dignity and respect. EVIDENCE: Standard 7 Inspection of 8 of the resident’s files showed that for these residents a care plan has been drawn up that sets out how their individual needs are to be met. Standard format care planning documentation has been used that is appropriate and “fit for purpose”. The quality of the information recorded on the care plans has improved since the last inspection and care plans were seen at this inspection to provide more Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 14 useful information together with action plans that staff can implement to meet the residents identified needs. Many of the people living in this home are unable to tell staff what they like or dislike and so it is essential that the quality of the care planning information and action planning is comprehensive and is maintained by regular reviews with all the key stakeholders involved in the resident’s life. It is equally important that staff have a thorough knowledge of the residents care plans with whom the staff are to provide care and support. All the information required under Schedule 3 of the National Minimum Standards was seen on the 8 files we inspected and this means that these residents’ health, personal and social care needs have been set out as required in an individual plan of care. Care plan reviews are carried our regularly every month however on inspection of 8 files we found that these reviews lack sufficient detail, sometimes only a signature or brief comment was recorded as the review. Reviews could be carried out less frequently than at present, perhaps every other month but or earlier if the needs of the resident changes. Any review that is carried out should identify how the residents needs have changed (if they have) and should measure the progress of care plan objectives in the care plan. It is required that care plan reviews are more detailed in their review of care plan objectives. Standard 8 Nutrition screening records had been completed on the files we inspected and the supporting food and fluid balance charts have improved since the last inspection. The weekly and monthly weight records had information clearly recorded and it was easy to identify variations in an individual resident’s weight. Supporting risk assessments for manual handling, skin integrity and continence were all completed satisfactorily. At the previous inspection concerns were raised with the maintenance of clear records to do with the treatment of pressure sores and wounds. Improvements in this area of record keeping were noted at this inspection. The Manager told us that a care and health assessment profile is undertaken at each new admission of a resident and that these profiles are reviewed monthly. We saw records on the resident’s files we inspected that supported this. We also saw where appropriate a risk assessment had been undertaken for pressure sores and ulcers. The Manager told us that a record is maintained of all health and social care professionals that visit residents and of any appointments that residents have with these professionals. We saw evidence of these records on the resident’s Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 15 files. We were also told that a chiropodist, dentist and optician make regular visits to Charlton Park. Since the last inspection improvements have been made with the way this service meets the healthcare needs of the residents. It is important that this progress is maintained. Standard 9 Charlton Park has a comprehensive medication policy and set of procedures. These procedures cover all the necessary areas of practice to be followed by staff when administering medications to the residents. At this inspection we reviewed medication administration practices on the first floor only. This was carried out together with 2 registered nurses. We were told that only RMN and RGN staff who have been trained are allowed to administer medications to the residents and a list of those staff was found in the front of the medication records folder. At the time of this inspection it was a new medication cycle so new medications had just been received. MAR charts (medications administered records) were reviewed and no gaps were found. MAR sheets had the residents photograph attached for ensuring the correct identity of the resident to whom medication is being given. Resident’s allergies had been recorded on the medication records where appropriate for the resident concerned. On inspection of the medical stores we found some out of date medications that were still being used. We also found that some medication creams were being used for residents other than for those who the medication had been prescribed. In addition to this other prescription only creams were found in open wardrobes. These should have been safely stored. It is required that the Manager ensures that out of date medications are withdrawn and not used for residents. Equally no medication should be used for any person other than that person for whom it was prescribed. We saw records that were being kept for medication fridge temperatures. The records indicate that medications are stored at the correct temperatures. We undertook a medication stock check and found that the records accurately reflected the actual medications held. This included the controlled drugs which were all accurate. Standard 10 This standard is to do with the residents and whether they feel that they are treated with respect and that their rights to privacy are being upheld. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 16 A member of the inspection team spent some time observing the daily life in this home between staff and residents. Observations that we noted of staff interactions with some of the residents was less than positive, some of the points noted include: 1. A member of staff did not know the name of a resident who needed help, 2. Another member of staff did not know about a different residents healthcare needs and so was unable to provide the appropriate support that they needed, 3. A resident needed to go to a toilet and had been left unattended, a toilet could not be found where the light was working, 4. Another resident left the lunch time session without explanation, no member of staff monitored the situation and no food was offered to the resident in their room, 5. Staff were hard pressed and seemingly to busy to deal with all the needs of this very needy client group. In general we found that residents’ appearances needed improvement with more attention being paid to the clothes that they wear, the state of their hair and with their spectacles and hearing aids. Some clothes were found to be marked with black marker pen, some detailing only the room number. Some toiletries were marked in the same way. The home smelt of stale urine and this was unpleasant for residents and visitors alike. It is required that the Manager ensures all staff including agency staff know who the residents are that they are to be working with and that they have knowledge of the residents needs. It is required that the Manager ensures that staff support the residents in such a way that the residents’ appearance in terms of dress and general tidiness is a priority. This would contribute greatly to the residents’ feelings of well being and help them to feel dignified and respected by the staff who are there to support them. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Service users are likely to find that the lifestyle they experience at Charlton Park matches their expectations and their preferences and satisfies their social, cultural, religious and recreational interests. Residents are encouraged to maintain contacts with their friends and families and service users are helped to exercise choice and control in their lives wherever possible. The meals and food provided to residents is well balanced, reasonably healthy and varied, the way it is delivered to the residents needs to be improved. EVIDENCE: Standards 12 & 13 We were told that there is a new Activities Co-ordinator now in place at Charlton Park. At the inspection we were able to meet this new member of the staff group. She told us that she has been at Charlton Park for 5 weeks. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 18 During the course of the inspection a number of activities were organised for residents, one involved music and the other, reading from a book. The Activities Co-ordinator was enthusiastically trying to involve the residents and she was successful in engaging a number of the residents who had seemed to be quite sleepy beforehand. We saw 2 timetables of activities for the week and also some planned and special Christmas events. We also saw a plan for further activities which it is planned to integrate into the activities timetable. In the morning a school choir visited the unit and sang Christmas carols to the residents. The residents seemed to enjoy this and some joined in with the singing. In the afternoon an entertainer visited the unit singing to the residents and playing the piano. Care needs to be taken to ensure that all residents are included in ongoing activities in the home. This means that adequate information and time need to be given to residents and care staff in order that they can attend the activities if they choose to do so. Support staff should ensure that residents who wish to leave the activity, if they are not happy or are not enjoying themselves, are supported to leave. We noticed at this inspection a number of residents who were mildly distressed and were holding their heads as if to block out the sound of the music. For this reason it is recommended that adequate information and time be given to residents and staff in order that they can attend the activities if they choose to do so and where necessary leave the activities if they wish to. We were told that a record is kept of all activities that are provided. We saw evidence of these records. The Manager told us that church ministers visit the home on a regular basis and that families and relatives are always welcome to visit residents in the home within reasonable time limits. A record of visitors is kept in the main entrance hall. Relatives said they were able to visit at anytime and were always made to feel welcome. There were regular residents and relatives meetings. Relatives were encouraged to raise concerns and to provide feedback about progress with issues they had raised in the past. Standard 14 The Manager told us that there are no residents currently living at Charlton Park that have the capacity to manage their own financial affairs. However we were also told that if residents are assessed as having the capacity to do so they would be encouraged and supported in this respect. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 19 The Manager told us that residents are allowed to bring into the home some small articles of their personal possessions. We saw evidence in some of the bedrooms we inspected that residents had done so. Standard 15 The Manager told us that a 3 week rolling menu is provided and this is drawn up after consultation with the residents who are asked what they would like to eat. Any special dietary requirements are also taken into account and provision is made in the menu plan. The Manager informed us that a nutritional assessment is undertaken as a part of the residents needs assessments and any special needs are catered for in the menu planning. We saw both the 3-week menu plan and the daily menus and these menus provide a wide and healthy range of food for the residents. Significant improvements were noted in the serving of the mid morning and afternoon tea snacks. The trolley had a choice of hot and cold drinks, biscuits, fresh fruit and full fat yoghurts. Residents were assisted and mugs instead of cups were provided. In the kitchen areas there were crisps, chocolate bars all for residents to have when they wanted them. We were also present for the lunchtime meal and were able to speak to the residents at these times about the food. Some of the residents who we asked said that they like the food on offer to them and they confirmed that they do have a choice, others said it was not so good. One resident to whom we spoke is a vegetarian and she said she really enjoys the vegetarian options she is offered at Charlton Park. A relative talking about a resident told us, “They are always being dished up with things they don’t like. When I mention it to the Management they do usually respond with what I ask for”. Another resident told us, “ the food is not often good but it is sometimes”. One of the inspection team members observed the lunch time meal and they noted that a number of the meals were served up to the residents cold. As well as this there was no cutlery provided to some residents. This was pointed out to the staff concerned and the food was taken away for reheating. For other residents their meals were provided very late. Staff were not seen to ask residents if they were happy with their food nor were the frailer residents offered any help or assistance with eating their meals until a senior member of the staff group prompted them to do so. Residents were brought in and taken out throughout the mealtime, it was noted that this added considerably to the confusion for other of the more able residents. Some of the confused residents began to wander around the room at lunchtime and one resident became very aggressive with another resident because she did not want the food that had been served her. Staff were Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 20 reported to be unable to deal with this and made no intervention to prevent the distress it was causing to the resident who remained seated. Clearly the organisation of mealtimes needs a complete review. This is a requirement. The quality of the food being provided from the kitchens is reasonnable, however it is the delivery and organisation of mealtimes that needs development. Staff must try to provide appropriate support to the residents and create a more relaxed experience by improved organisation, greater support and more structure at meal times. At the last inspection on 27th November 2009 a similar requirement was made. There was a timescale set for it’s achievement by 13th December 2009. Clearly at the time of this inspection on 14th December 2009 the requirement had not been met. Enforcement action may be taken if this new requirement is not met within the timescale. The aim is for care staff to provide assistance to residents where necessary and for staff to ask the residents if they need any help and then provide it appropriately. Meal times should be an unhurried and enjoyable experience for residents and for those who chose to eat in their bedrooms they should be enabled to do so. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the home will deal with complaints appropriately; information about the complaints procedure is readily available to all who may wish to express an opinion about the service. Service users cannot be assured that the processes in the home will protect them from potential abuse by staff or others. EVIDENCE: Standard 16 The Manager showed us the complaints policy and procedure for Charlton Park. This policy covers all the essential areas required for a complaints policy including a staged process with timescales and contacts for other agencies to contact in the event of dissatisfaction with the internal process of investigation. The Manager maintains a record or complaints book and we saw this. However the Manager told us that complaints had only been collected in the book since October 2009. Since that time 6 complaints had been recorded since the last inspection. The complaints procedure was displayed in the reception area and was also seen in some of the bedrooms. However some of the information on displayed needs changing to reflect the change of regulator to the CQC with the new contact details. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 22 Standard 18 The Manager told us that Charlton Park uses the L.B.Greenwich’s adult protection policy (POVA) and practice procedures. The policies and procedures manual for the home include a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process, which we were told that all new staff have to attend. The Manager said that since the last inspection there had been 7 POVA issues raised in the home. We looked at these issues and concerns to see if a trend or pattern could be identified. Most of the issues were concerned with injury through falls or to do with pressure sores. The Manager told us that SOVA/ POVA training is being provided for staff and we could see from the training plans that a training session had been made available to staff on the 16th December, a week or so prior to this inspection. The Manager said that nearly all the staff group have received this training and that those who have not yet done so will be doing so in the near future. Records seen by us evidence that 90 of the staff team have received POVA training. Staff were asked about their training and knowledge on dealing with abuse and whistle blowing. Overall the staff who we asked were unable to demonstrate sufficient knowledge of the policies and procedures to afford proper protection to the residents. Staff were asked about what action they would take if they witnessed an incident of verbal abuse towards a resident from a senior staff member. Not all those staff asked indicated that they would report it and they only had limited knowledge on external organisations whom they would contact. This was somewhat surprising given the very recent training event that had been held only the week before. Whistle blowing was not fully understood and one member of staff had no concept at all of what “whistle blowing” meant or entailed. It is required therefore that the Manager ensures that all staff receive SOVA/POVA and whistle blowing refresher training by an authorised external training agency preferably the L.B Greenwich. This is to help ensure that staff are adequately trained in order to protect residents from abuse. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that the house is safe and well maintained, that it is relatively clean and hygienic. The home has an effective infection control procedure. EVIDENCE: Standard 19 During this inspection we undertook a tour of the premises and reviewed all the areas of the home to assess the quality of the environment and décor. 5 residents’ bedrooms were inspected with the permission of the residents concerned. It was noted that bedrooms were of a variable standard, some being quite personalised and nicely decorated for Christmas and others looking rather sparse and empty. It is strongly recommended that for the latter category of bedrooms a much greater effort is made to make them feel homely and welcoming. It is important for residents to feel that this is their home, for Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 24 them to have the things in their rooms that they want and recognise and that helps to make them feel both cared for and comfortable and at home. Generally the home was found to be reasonably clean and hygienic however there was a strong smell of urine especially on the ground floor accommodation. It is required that appropriate actions are taken to eliminate this offensive odour to ensure that residents live in a well maintained environment that they are not ashamed to be in. The home has a maintenance man who carries out routine maintenance for the property on a regular basis and this is evidenced with the good state of repair and condition of the fabric of the home. At the time of this inspection he was seen by us to be busy painting bathrooms and it was planned for the dining room to be painted in the afternoon after lunch. We found the premises to be in a good state of repair and well maintained. We were told by the Manager that the Environmental Health Officer made a visit to this home in September 2009 and that their findings were both satisfactory and positive. Evidence in the form of a report was unavailable at the time of this inspection. Standard 26 The Manager showed us the home’s infection control procedure, which seems to be effective. We also spoke with the Manager who informed us that the home has a contract with a waste company to clear all the clinical waste from the home. Staff who we interviewed confirmed that they are issued with appropriate clothing and equipment for them to carry out their work appropriately. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and to enable easy cleaning. Laundry is not taken through areas where food is prepared. The home has appropriate sluicing facilities and these were seen by us to be fit for purpose. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users cannot be assured that the numbers of staff and the skill mix that they provide at Charlton Park will meet their needs. The recruitment policy and procedure does not fully support and protect the service users. Staff are being offered training appropriately and when the measures described below are achieved then service users will be able to be assured that the staff are fully competent to do their jobs. EVIDENCE: Standard 27 The Manager provided us with staffing rotas for both the Goodwood and Epsom units. The rotas show exactly who is working on each day and for the week. The Manager informed us that for the Goodwood unit there are always 7 care staff on duty during the day and evening shifts and 3 night duty staff. For the Epsom unit there are 5 care staff on duty during the day and evening shifts and 3 night duty staff. The rotas provided to us supported this statement. Given the number of residents (66 people in total when the home is full), the staff: resident ratio mix seems to be inadequate to satisfactorily meet the Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 26 complex health and social care needs of the residents. The Manager told us that the home also relies on agency staff in order to meet the current staffing structure set out in the rota. It is recommended that the Manager reviews the current staffing levels to ensure that there are sufficient numbers of staff to meet the needs of the residents. Standard 28 Training information provided to us by the Manager indicates that only 20 of the staff group have achieved their NVQ qualifications at level 2. We also inspected 6 of the staffing files and 3 of the staff concerned had not achieved an NVQ level 2 qualification. When we asked the Manager about this he confirmed it. The requirement that at least 50 of the staff group should hold an NVQ at level 2 by 2005 has therefore not been met. It is a requirement now that staff should be enrolled on NVQ level 2 training courses. What this all means is that since staff do not have sufficient training it cannot be said that the residents are in safe hands at all times. Standard 29 As a part of this inspection we inspected 6 randomly chosen staffing files held in the main office at Charlton Park. The home does have a recruitment procedure that was inspected and we also found a recruitment checklist that can be used to ensure that all the stages of the recruitment process have been followed. The documentation seen in the staffing files indicated that applicants are interviewed, application forms completed; appropriate forms of identification sought; two written references gained and enhanced Criminal Record Bureau (CRB) checks undertaken. The documentation regarding all these parts of the recruitment process are held on staffing files in the main office. We found that 2 of the 6 CRB checks were from 2004 and 2005. CRB checks should be renewed every 3 years and the Manager is recommended to ensure that all staff CRB checks are renewed every 3 years. Only 3 of the 6 staffing files inspected had employment contracts. All staffing files should have copies of the employees employment contract. Standard 30 Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 27 The home has an excellent programme of induction in place since 2007. This covers the following areas: 1. Guidance for new workers 2. Understanding the principles of care 3. Understanding the organisation and the role of the worker 4. Maintaining safety at work 5. Communicating effectively 6. Recognising and responding to abuse aqnd neglect 7. Development as a worker. The Manager told us that induction is ongoing for up to 4 – 6 weeks with observation, shadowing from an experienced staff member and ongoing assessment. Inspection of the 6 staffing files provided no evidence at all that staff had completed this induction training and the Manager was unable to provide any written documentation evidencing that staff had completed the induction programme. We were however told that staff do complete the induction programme. It is required that the Manager ensures that for each new member of staff the induction programme as set out in the induction book be completed as the induction proceeds and that it is kept on staff files appropriately. Relevant sections of the induction should be signed and dated by the Manager and the Employee. With regards to staff competency it is important that all staff are familiar with the home’s policies and procedures. We recommend that all staff are asked to review the key policies and procedures for the home, that they are provided with a chance to discuss them either via their supervision sessions, team meetings or other methods. It is suggested that staff then be asked to sign and date to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. The Manager explained that there is a good training programme provided for the staff group. We were given a training matrix by the Manager that indicated the following courses are offered to staff: 1. Medication administration, 2. 1st Aid, 3. Infection control, 4. Health and safety, 5. Fire safety, 6. Manual handling, 7. Food hygiene, 8. POVA, 9. Understanding dementia, 10. Care planning 11. COSSH Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 28 12. 13. Death and dying Customer service We were also shown lists of planned for training events through from November 2009 to the end of January 2010. All the basic training modules were included in these lists and in addition there were other training packages tailored to help staff better meet the particular needs of the residents living at Charlton Park. The training matrix indicated that there had been a reasonable take up by staff of this training with some exceptions where there was a distinct lack of take up noted, such as: 1. Understanding dementia 2. COSSH / Infection control 3. Care planning 4. 1st Aid 5. Health and safety 6. Customer service. Given the requirement we have made in this report for staff to receive POVA training and the information supplied in the training matrix that indicates training was offered to 13 staff in December 2009, it would seem to indicate that the training was in some way ineffective. It is therefore recommended that the Manager reviews how training is being provided to staff and ensures that a more effective method is found. Certificated evidence was not seen on the 6 staffing files inspected that supported staff attendances on the said training courses. It is required that the Manager ensures certificated evidence is held on staffing files that supports staff attendances at training events. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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 quality assurance system has not been fully implemented this year and so it is difficult to be absolutely clear that the home is being run in the best interests of the residents. The policies and procedures of this home regarding resident’s financial affairs ensures the protection of their financial interests – thus providing protection especially to those who cannot manage their own affairs any longer. Supervision practices are very poor and need development and improvement. EVIDENCE: Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 30 Standard 33 The home does have a quality assurance process. The Manager explained that the monitoring of this agency or quality assurance is carried out through formal and informal consultation with service users and from visiting relatives and professionals. Feedback forms are issued and questions asked focus on the key principles of the service e.g. privacy, dignity, independence, choice, rights and fulfilment. The information and feedback gathered from these sources is then analysed and forms the basis of an annual report. We were told that the report for 2009 is yet to be published but when it is it will be available on the internet. Minutes of resident’s meetings were inspected and meetings were also held with the resident’s families, relatives or representatives. It is recommended that the frequency of residents meetings needs to be increased to 4 times annually so that the access for residents for discussing issues is improved. Regulation 26 reports were seen to be comprehensive and included all that is required under the Regulation. Standard 35 Adequate procedures were in place to safeguard resident’s money. Individual records were maintained for each resident about their money and their transactions to do with their monies. We saw that receipts were kept for all purchases made on resident’s behalf and for the payment of services such as chiropody and hairdressing. We saw that regular audits are carried out and any discrepancies investigated appropriately. This all means that resident’s financial interests are being safeguarded. Standard 36 The Manager told us that over the last year the frequency of staff supervision has reduced and staff have not had the required levels of supervision. We inspected 6 staffing files and associated supervision documentation. This showed only 1 supervision session had been recorded over the last year for each of 4 staff and no supervision had occurred at all for 2 new staff whose files we inspected. We asked the Manager who should be delivering staff supervision and we were told that he alone carries out this function. We were given information that the total staff compliment is approximately 60 people. Clearly the supervision of over 60 staff is too onerous for one person. Good practice would mean 1 manager or senior supervising no more than 10 to 15 staff. This would mean that at least 4 senior staff would be needed to carry out staff supervision. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 31 Care staff should receive formal and individual supervision at least once every 3 months. The care staff we interviewed confirmed that they had not received regular supervision on an individual basis. Staff said that they had not received copies of their supervision records. Supervision records should include the monitoring and review of all aspects of care practices, the philosophy of care in the home and also career and training development needs. Areas of discussion should also cover the monitoring and review of any individual work objectives that the staff member is expected to carry out. The supervision record should detail any agreements made, revised work objectives, key areas of discussion and should be signed off by both the member of staff and the supervisor. Staff who are supervised should be given a copy of the supervision record which they may keep in their staff handbook file. For new staff supervision is especially important in the early days of their employment and should include the progress of their induction training. It is a requirement therefore that: All care staff including RGN and RMN staff members are supervised once every 3 months. Supervision notes should be taken and copied to staff for their information. It is recommended that those staff who will undertake supervisory roles attend a proper training course that enables them to carry out their roles effectively. Inspection of the documentation indicated that no staff had received an annual appraisal over the last year. We asked the Manager about this and he confirmed that it was the case that no staff had been appraised over the last year. What this all means is that staff are not being regularly or appropriately supervised nor are they receiving an appraisal. Standard 38 The Manager showed us the maintenance record for the home which details all the maintenance requirements and how and when they have been resolved. The home is maintained to a reasonable standard. Certificates were checked and seen for the following services that are installed in the home: • Fire protection and alarm system • Fire Extinguishers • Emergency Lights Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 32 • Fire extinguishers • Boiler and gas • Electrical systems check We were provided by the Manager with certificates which state that these systems have been checked by appropriate professionals since the last inspection and found to be satisfactory and fit for purpose in that they help to ensure the safety of the residents. Checks on the hot water outlets are also regularly checked and temperatures recorded. The records were seen and checked. All recorded temperatures came within the prescribed limits. Fridge and freezer temperatures are also checked daily and records taken, these were seen to date. The fire risk assessment was last carried out in 2007 and this should be done annually. This is a requirement. Records showed us that fire drills had taken place in October and November 2009. The Manager should ensure that all staff receive training on fire prevention and on the use of fire equipment. We found the employers liability insurance cover to be valid. Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 33 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 1 X 3 Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 34 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 OP7 Regulation 14 Requirement Timescale for action 01/02/10 2. OP9 13 3. OP10 12 4. OP10 12 It is required that care plan reviews are more detailed in their review of care plan objectives. It is required that the Manager 01/02/10 ensures that all out of date medications are withdrawn and not used for residents. Equally no medication should be used for any person other than for the person for whom it was prescribed. It is required that the Manager 01/03/10 ensures all staff including agency staff know who the residents are that they are to be working with and that they have a good knowledge of the residents needs. It is required that the Manager 01/03/10 ensures that staff support the residents in such a way that the residents’ appearance in terms of dress and general tidiness is a priority. This would contribute greatly to the residents’ feelings of well being and help them to feel dignified and respected by the staff who are there to DS0000068284.V378567.R01.S.doc Version 5.3 Charlton Park Care Centre Page 35 5. 6. OP15 OP18 16 13 7. OP19 23 8. OP28 18 9. OP30 18 10. OP30 18 11. 12. OP38 OP36 16 18 support them. The organisation of the lunch and evening meals needs a complete review. It is required that the Manager ensures that all care staff receive SOVA and whistle blowing refresher training by an authorised external training agency preferably the L.B Greenwich. This is to help ensure that staff are adequately trained in order to protect residents from abuse. Certificated evidence will be required for inspection. It is required that appropriate actions are taken to eliminate the strong smell of urine on the ground floor in order to ensure that residents live in a well maintained environment that they are not ashamed to be in. It is a requirement now that sufficient numbers of staff are enrolled on NVQ level 2 training courses. It is required that the Manager ensures that for each new member of staff the induction programme as set out in the induction book be completed as the induction proceeds and that it is kept on staff files appropriately. Relevant sections of the induction should be signed and dated by the Manager and the Employee. It is required that the Manager ensures certificated evidence is held on staffing files that supports staff attendances at training events. The fire risk assessment was last carried out in 2007 and this should be done annually. It is a requirement that: All care staff including RGN and RMN staff members are DS0000068284.V378567.R01.S.doc 01/03/10 01/04/10 01/02/10 01/03/10 01/02/10 01/02/10 01/03/10 01/02/10 Charlton Park Care Centre Version 5.3 Page 36 supervised once every 3 months. Supervision notes should be taken, kept on staff files and copied to staff for their information. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP12 Good Practice Recommendations We recommend that the Manager requests comprehensive referral information from any agency that wishes to refer their client to live at Charlton Park. It is recommended that adequate information and time be given to residents and staff in order that they can attend the social activities if they choose to do so and where necessary leave the activities if they wish to. It is strongly recommended that for those bedrooms that are sparse and not personalised a much greater effort is made to make them feel homely and welcoming. It is recommended that the Manager reviews the current staffing levels to ensure that there are sufficient numbers of staff to meet the needs of the residents. It is recommended the Manager ensures that all staff CRB checks are renewed every 3 years. We recommend that the Manager ensures that all staff are asked to review the key policies and procedures for the home and to sign to say that they have done so. It is recommended that the Manager reviews how the delivery of training is being provided to staff and ensures that a more effective method is found. It is recommended that the frequency of residents meetings needs to be increased to 4 times annually so that the access for residents for discussing issues is improved. It is recommended that those staff who will undertake supervisory roles attend a proper training course that enables them to carry out their roles effectively. 3. 4. 5. 6. 7. 8. OP19 OP27 OP27 OP30 OP30 OP33 9. OP36 Charlton Park Care Centre DS0000068284.V378567.R01.S.doc Version 5.3 Page 37 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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