Inspection on 15/12/08 for Charlton Park Care Centre

This inspection was carried out on 15th December 2008.

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

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 14/12/09

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Charlton Park Care Centre Park Farm, Off Cemetery Lane Charlton London SE7 8DZ Lead Inspector Maria Kinson Unannounced Inspection 15th December 2008 and 6th January 2009 09:25 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 Park Care Centre DS0000068284.V374132.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 Park Care Centre DS0000068284.V374132.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 Manager post vacant 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.V374132.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 16th June 2008 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. The fees charged by the home range from £579.24 - £629.24 per week. This does not include additional charges such as chiropody and hairdressing. This information was supplied to the commission on 15.12.08. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by two inspectors over two days, in December 2008 and January 2009. The Inspectors spent one day on each of the two floors. In the period since the last inspection a new manager, deputy manager, administrator and several new care staff had been appointed. During the inspection we spoke to five visitors, four members of staff and two residents. We received written feedback about the service from one relative. On 15/12/08 we issued an immediate requirement notice. The notice stated that staff without a CRB check must be supervised. The registered provider sent a written response on 30/12/08 that indicated they would comply with the requirement. What the service does well: Staff visited people that wanted to move into the home to see what support they required. Health problems were monitored and advice was obtained from other professionals, if necessary. Family and friends could visit the home at any time. Relatives said staff were kind and caring and always informed them about important issues. Some residents were able to make decisions about where and how they spent their time. Staff respected people’s decisions. The dining rooms were nicely laid out and people said they liked the food provided in the home. Complaints were recorded in a file and were investigated promptly. Staff were aware that they must report allegations to senior staff or the manager. People could bring some of their own furniture and possessions into the home and arrange their room to suit their needs. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 6 Staff had access to a varied and relevant programme of training. Regular checks were carried out to monitor the homes performance and to obtain feedback about the service. An assessment was carried out to establish what support residents needed to move and if staff should use any equipment. All of the transfers that we observed were carried out in a professional and safe manner and residents were reassured if necessary. The building was well maintained and safe. What has improved since the last inspection? What they could do better: Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 7 Staff wrote room numbers on some medication packets. Handwritten entries on medication charts were not always checked and countersigned by a second member of staff. These issues could result in drug errors. Records about the management of wounds and pressure sores and about the action that staff were taking to protect people from developing pressure sores was variable. We saw both good and poor practice in relation to these issues. Record keeping practices must be consistent. Unexplained injuries were not always investigated. Staff must try to establish how the injury occurred so that they know what action to take to protect the resident. The paintwork and tiles in some of the bath and shower rooms were chipped and some of the bathrooms were cluttered. The kitchen and dining area on the first floor unit was grubby in parts. This area requires a deep clean. There was one trained nurse on duty on the ground floor unit. The nurse had to administer medicines to thirty one residents, undertake nursing tasks, update records and care plans, liaise with other professionals and relatives and supervise seven care staff. The skill mix of staff must be reviewed Some improvements in the home’s recruitment practices were noted but two of the files we looked at did not include information about the applicant’s mental and physical health and some references were not checked to ensure that they were genuine. Staff without a CRB check, were not properly supervised. Valuable items were stored securely but there were no records to show what items were kept in the safe. The security arrangements were unclear. The front door was not always locked. The manager should provide clear guidance for staff about this issue. 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 Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 8 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.V374132.R01.S.doc Version 5.2 Page 9 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): 3 and 5. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People could view the home and facilities before they moved in. Staff carried out a care needs assessment to establish what support people require. EVIDENCE: The registration certificate was displayed in the reception area. Staff carried out a care needs assessment before people moved into the home. We looked at information that was obtained during the pre admission assessment. The four assessments that we looked at were for people that had recently moved into the home. The assessment form included information about the person as an individual and about the support they required. Information was obtained from the prospective resident and other people that were involved in their care, such as hospital staff or relatives. The Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 10 assessments that we looked at provided adequate information about the person’s physical, mental and social care needs. The home also received information from other professionals such as care managers. People that expressed an interest in the service were encouraged to visit the home to view the facilities and speak to staff. Some of the relatives that we spoke to said they visited the home because their family member was unwell or very frail. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was some variation in the standard of record keeping. Although staff were usually able to meet peoples needs they did not always document their actions in the care plan. The management of medicines had improved but the home had not addressed a previous requirement that could compromise resident’s safety. People told us that staff were kind and maintained their privacy and dignity. EVIDENCE: Staff reviewed the information that they had obtained about residents needs when people moved into the home. This ensured that changes were identified and recorded. Information that was obtained during assessments was used to formulate a care plan. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 12 We looked at four care plans for three people that had recently moved into the home and for one person that had lived in the home for several years. The first set of records that we looked at included a comprehensive set of care plans that addressed all but one of the residents needs. The resident was assessed to be at ‘very high risk’ of developing pressure sores. Although there was no care plan to show what action staff should take to protect the resident’s skin, the resident did have a pressure relieving mattress and cushion. This is a repeated requirement. We have sent the home a warning letter about this issue. See requirement 2. Care plans provided some information about people’s preferred routines and likes and dislikes. For instance one plan stated what time the resident liked to go to bed and advised staff to leave the residents bedroom door open as they disliked closed spaces. The second file was for a resident that had lived in the home for nine days. The resident had some care plans but staff had not assessed if the resident was at risk of developing pressure sores. The resident was frail. The third file contained plans to meet all of the residents care needs including wound care. The size and appearance of the wound was recorded and the plan stated how often staff should dress the wound and what dressings they should use. The tissue viability nurse provided advice and there was information about this in the plan. The resident was nursed in bed to assist the sore to heal and had a pressure relieving mattress. The fourth file contained various care plans but the plans did not address all of the residents needs and were not always followed. For instance there was no care plan to show what action staff should take to meet the resident’s hygiene needs. The care plan about the resident’s nutritional needs stated that staff should review the plan every week and refer the resident to the GP and a Dietician. There was no evidence that this was taking place. See requirement 3. We were told by a staff member that the resident had a small pressure sore. There was no information about this in the residents file but the resident did have a pressure relieving mattress and was being repositioned regularly. This is a repeated requirement. We have sent the home a warning letter about this issue. See requirement 1. Care plans were reviewed regularly. Progress notes provided information about the support that residents received and changes that staff observed. Residents were registered with a GP and staff supported residents to access Dental, Optical and Chiropody treatment when required. Referrals to other healthcare professionals were arranged by the GP. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 13 We looked at three medication charts on each floor to see how the home managed medicines. The medicine policy and procedure was reviewed in 2008. Medicines were stored appropriately and the medicine room was clean and tidy. Records about receipt, administration and disposal of medicines were mostly satisfactory. All of the medicines that we looked at were properly labelled and in stock and there were no gaps on any of the charts that we looked at. Some of the information that was recorded on medication charts was handwritten by staff. This information was not always checked and counter-signed by another member of staff. See requirement 4. We identified during previous inspections that staff were writing resident’s room numbers on medication containers. This was still taking place. We found room numbers on fourteen medication containers, on the first floor unit. This is a repeat requirement. We are seeking further advice from the enforcement team about this issue. Medicines that required special storage arrangements were kept securely and records were kept about their use. The GP had agreed a list of medicines that the home could purchase and give residents without a prescription. Good records were kept about the receipt and use of these medicines. Staff ensured that people’s privacy was maintained and addressed people in a respectful manner. We saw staff adjusting residents clothing to maintain their dignity and knocking on residents doors before entering. One relative told us that their family member was “treated with kindness and respect”. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a varied programme of activities. Relatives said they could visit their family member at anytime and were told about important issues. Residents were consulted about where and how they wanted to spend their time. Food was nicely presented and looked appetising. EVIDENCE: The home had two part time activity staff. The weekly programme of activities was displayed on the notice board. The programme included activities that some residents particularly liked such as bingo, sing-along, ball games and arts and crafts and there were other sessions to celebrate significant events. The home arranged for some local students to work alongside activity staff and was trying to renew links with a local school. A number of outside entertainers had visited the home and there were regular church services. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 15 The activity organiser had designed a form for relatives to complete about residents interests and hobbies. Staff said it often took time to establish what activities residents liked, particularly if they had dementia. Staff kept records about activities and stated which residents took part. We looked at the activity records for five residents. The records showed that people participated in a wide range of activities on a regular basis. The home has its own mini bus and some of the residents on the ground floor unit said they had been on a Christmas shopping trip, which they enjoyed. The service had an open visiting policy and some residents were planning to visit their family over the Christmas period. We spoke to five groups of visitors during the inspection. Most people were happy with the standard of care provided in the home and said staff were “very kind”. Relatives said they were informed about significant issues such as accidents and one relative said staff “telephone immediately” if their family member was unwell. One resident told us that she liked to spend her time in the lounge but returned to her room when she had visitors. She said staff respected her decisions and always asked her what clothing she wanted to wear and what food she wanted to eat. At the time of the inspection staff were clearing the kitchen so that a new floor covering could be laid. A temporary kitchen was located in the garden. This work did result in a few difficulties during the serving of the meal on Epsom. The circumstances surrounding this issue were exceptional and no requirements have been made in relation to this issue. We observed lunch being served on both units. Residents selected what they wanted to eat from the menu or were offered a choice when the meal was served. The meal looked and smelt appetising and the people that we spoke to said it tasted good. One resident said breakfast was “lovely” but said they had difficulty eating lunch after such a hearty breakfast. The dining areas looked welcoming. Tables were laid with fanned napkins, salt and pepper and people were offered a selection of juices. Pureed foods were served separately and people were supported to eat if necessary. Food that was transferred from the dining to residents bedrooms was covered. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 16 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures for managing concerns and complaints were followed. Staff worked in partnership with other agencies to ensure that allegations of abuse were investigated but did not always take prompt action to investigate unexplained injuries. EVIDENCE: The complaints procedure was displayed in the reception area and information about how to make a complaint was included in the Service User Guide. Complaints were recorded in the complaints file. Some of the information that we looked at was difficult to follow and it was not always easy to establish if the complainant was told about the homes findings. The regional manager agreed to support the new manager to establish a clear system for recording complaints. The home had received six complaints in the period since the last key inspection. The records that we looked at showed that complaints and concerns were acknowledged in writing or by telephone and written or verbal feedback was provided. In some instances the manager had arranged to meet the complainant to obtain more information or to explain what the investigation had revealed. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 17 Staff were aware that they must report allegations or concerns to senior staff or the manager. Records showed that some of the staff attended a safeguarding adults training session in 2008 and a further training was due to take place in January 2008 for new staff. We looked at some of the recent accident forms for Epsom House. The forms included adequate information about the date, time and circumstances of the accident, where known, but it was not always clear if staff took any action to prevent a reoccurrence or investigated unexplained injuries. For example one resident was recorded as having unexplained bruising to their face. The section on the accident form that asked staff to record the action they had taken to prevent a reoccurrence was crossed through as if it was not relevant. See requirement 5. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, comfortable and welcoming. EVIDENCE: The home looked very festive. Some of the residents that we spoke with said they were looking forward to spending time with their family at Christmas. We visited all of the shared areas such as lounges, dining rooms, bath and shower rooms, toilets, satellite kitchens and two bedrooms on each floor. The building was well maintained and warm. We did not identify any significant health and safety issues but the paintwork and tiles in some of the bath and shower rooms on both floors were stained and chipped in parts. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 19 Some of the bathrooms were cluttered with boxes, pressure relief cushions, linen trolleys and hoists. This made the rooms look rather cold and uninviting. See recommendation 1. The pipe covering in the bathroom opposite room 20 was hanging down from the ceiling. The manager said he would ensure the issue was addressed. In the period since the last inspection the reception area was redecorated and some comfortable new lounge chairs were purchased. Bedrooms were arranged to suit individual needs and some residents had personalised their rooms by displaying personal photographs and pictures and bringing some of their own furniture into the home. The home was clean and tidy overall but some areas such as the dining room and kitchen area on the first floor unit require a deeper clean to remove stains and ground in food particles. See requirement 6. Hand washing facilities were good and clinical waste was stored in lidded bins to prevent odour. Most of the staff had completed infection control training. Work was in progress to convert a storeroom into a hairdressing room. All of the plumbing and electrical work was complete but the room has to be painted. There were call bells in all of the rooms that we visited. A sign was placed above the call bell unit to remind staff to ensure that the call bell was placed where residents could reach it. Some of the residents on the ground floor unit spent long periods sitting in wheelchairs. The manager said this was because some residents were at risk of sliding out of the lounge chairs or liked to sit in their wheelchair. The manager should obtain non slip mats/cushions or purchase a supply of more suitable chairs. See recommendation 2. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers were satisfactory but there were not always sufficient trained nurses on the ground floor unit. Recruitment practices had improved but information about staff member’s physical and mental health was not always obtained. The arrangements for supervising staff without criminal record disclosures were unsatisfactory. Staff were supported to develop new skills and keep up to date with current practice. EVIDENCE: There was one nurse and seven carers on duty on the ground floor unit when we arrived. The trained nurse did not complete the morning medicine round until 11am which left very little time before lunch for routine tasks. The care staff that we spoke with on this unit said the nursing staff were usually approachable but said there were occasions when they seemed to be under a lot of pressure and “stressed”. Some new nurses had been recruited but preemployment checks were still in progress. The off duty roster showed that there was often only one nurse on the ground floor unit. The skill mix on this unit was inadequate. See requirement 7. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 21 On the second day of the inspection the manager told us that one of the nurses from the second floor unit had moved to the ground floor unit until the recruitment checks for the new staff were complete. There were two trained nurses and seven care staff on the second floor unit when we arrived. The ratio of staff to residents was satisfactory. 50 of care staff had a National Vocational Qualification in Care (NVQ). We looked at the recruitment files for four new members of staff. All of the files included proof of identity, a recent photograph, two written references, a POVA first or criminal record (CRB) check, evidence of registration with the nursing and midwifery council where relevant and an application form. Two out of the four files that we looked at did not include evidence that the applicant was physically and mentally fit for the role and two references were not checked to ensure that they were genuine. This is a repeated requirement. We have sent the home a warning letter about this issue. See requirement 8. Two staff that had a Protection of Vulnerable Adults (POVA) check, but were still waiting for their enhanced CRB disclosure, were not supervised. One of the staff members had worked several night shifts. This issue was also identified during the previous inspection. An immediate requirement was issued in relation to this issue. We received a written response on 30/12/08 that indicated that staff without CRB checks would be supervised. See requirement 9. The company provides a comprehensive programme of training for staff. The programme was often adjusted to meet staff needs and to address concerns that were identified during inspections and audits. In the period since the last inspection, some members of staff had attended fire safety, moving and handling, food hygiene, infection control and medication training sessions. Some staff had also attended local authority training sessions which they said were informative. Staff were satisfied with the training arrangements. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager knew what improvements had to be made in the home and had the support of the staff team. There were systems in place to improve the quality of care provided in the home but there needs to be closer monitoring of requirements. Health and safety issues were well managed. There were not enough safeguards in place to protect resident’s valuables. EVIDENCE: In the period since the last inspection the company had appointed a new manager, Richard Nevins. Mr Nevins started work at the home in October 2008. The manager has a diploma in nursing studies and the registered Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 23 managers award (RMA). The manager was supported by a new deputy manager. Four requirements from the previous inspection were not met. The new manager had started to develop systems to monitor compliance with these issues but more work was needed in this area. We spoke to four members of staff during the inspection. They said the new manager was approachable and supportive. Staff told us that the manager visited the units throughout the day and spent time talking to residents and staff. One staff member said the atmosphere had improved and staff felt less stressed than they had in the past. The manager had got to know some of the regular visitors and was seen talking to relatives as they arrived in the home. The home had systems in place for monitoring the quality of care and services provided in the home. The regional manager visited the home regularly to assess the conduct of the home and there were regular audits to assess the homes performance. Satisfaction surveys were sent to relatives to obtain feedback about the service. An improvement plan had been developed for the home. Issues identified during inspections and audits were included on the plan. The administrator was new and advised us that he would be leaving soon. A number of residents had very little funds. It was not clear if this was because the administrator did not have access to the banking system or because no one had told resident’s relatives that their family member’s funds were running low. We checked the money records on the computer for three residents. There were clear records about money that was received in the home and information about how their money was used. The records about valuable items could not be located. The administrator said money records and any money held in the home was checked and handed over to him when he started working in the home but there was no handover of valuable items. See requirement 10. There was a new administrator in post when we returned to the home on 06/01/09. We checked health and safety and fire safety records at the last inspection in June 2008. During this inspection we assessed what action the home had taken to address the concerns that we identified in the previous report. Some of the fire safety records were difficult to follow as a number of different files and records were used to record the same or similar information and were kept in different locations. Fire safety records should be kept in a dedicated file/book and should be stored in one place. The fire safety risk assessment was reviewed and updated in 2008 and the fire alarm was tested regularly to ensure that it was working properly. The records indicated that there had been three recent fire drills including one which involved some of the staff that worked night duty shifts. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 24 Bedrails were checked regularly to ensure that they were properly fitted and safe. Staff completed an individual moving and handling assessment for each resident. Assessments provided clear guidance for staff about the number of staff and type of equipment that should be used to move people safely. We observed staff supporting people to walk and assisting people to transfer from a wheelchair into a more comfortable chair in the lounge. All of the transfers that we observed were carried out in a professional and safe manner and residents were reassured if necessary. Wheelchair footplates were used to support resident’s feet. We received a telephone call from a person that viewed the home for a relative. The caller was concerned about the security arrangements as they were able to enter the home by the front door unchallenged. This issue was discussed with the manager at the time of the call and was assessed during this inspection. The front door was set to automatically open on the first day that we visited. The manager and administrator were in their offices just off the reception area. On the second day that we visited the doors were closed and people had to press the bell to be let in. The manager should provide clear guidance for staff about when the doors can be left open and when they should be locked. See recommendation 3. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 25 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 2 3 3 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 2 X X 3 Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 26 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 12 Requirement A plan of care must be developed to show what treatment staff are providing for people with wounds. Repeated requirement. The previous timescale of 26/08/08 was not met. We sent the home a warning letter about this issue. If residents are assessed to be at risk of developing pressure sores, staff must develop a care plan to show what action they are taking to minimise this risk. Repeated requirement. The previous timescale of 26/08/08 was not met. We sent the home a warning letter about this issue. Staff must be able to evidence that information in care plans is followed. Hand written entries on medication charts must be checked and countersigned by a second member of staff. Unexplained injuries must be investigated and where possible strategies to prevent a DS0000068284.V374132.R01.S.doc Timescale for action 09/03/09 2. OP7 12 09/03/09 3. 4. OP15 12 13 06/04/09 06/04/09 OP9 5. OP18 13 09/03/09 Charlton Park Care Centre Version 5.2 Page 27 6. 7. 8. OP26 OP27 OP29 13 18 19 9. OP29 19 10. OP35 17 reoccurrence should be recorded. The first floor dining room and kitchen must be deep cleaned. The home must provide adequate nursing staff on each shift. Adequate information and checks must be obtained and carried out before new staff are permitted to work in the home. Repeated requirement. The previous timescale of 26/08/08 was not met. We sent the home a warning letter about this issue. Staff with a POVA first check, but without a full CRB check must be supervised at all times. (We gave the home an immediate requirement letter about this issue). The home provided a written response on 30/12/08. Adequate records must be maintained about valuable items that are stored for residents. 06/04/09 09/03/09 09/03/09 16/12/08 09/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP19 OP22 OP38 Good Practice Recommendations The bath and shower rooms should be redecorated. These rooms should not be used as a store rooms. The home should provide suitable seating for all residents. Clear guidance should be issued to staff about when to lock the automatic front doors and when the door can be left open. Charlton Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Park Care Centre DS0000068284.V374132.R01.S.doc Version 5.2 Page 29 - 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. 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