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Inspection on 14/05/10 for Charterhouse Residential Care Home

Also see our care home review for Charterhouse Residential Care Home for more information

This inspection was carried out on 14th May 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff treat people with kindness and consideration and appear to have good relationships with them. At the time of our visit odours in the home were being sufficiently well controlled.

What the care home could do better:

Care plans must be securely stored. Work on care planning must be completed to provide staff with reliable, up to date, clear and specific direction on how to meet individual needs. The plans, risk assessments and reviews should be dated so that a clear pathway of planning, action and review is established. There must be regular monitoring of people`s weight, nutrition and hydration where their needs indicate this. People`s privacy and dignity should be better protected when using the toilet facilities. The moving and handling procedures used for one person who is currently assisted with ahandling belt and rotating stand must be reviewed and revised with reference to professional advice. All mattresses and bedding should provide a comfortable sleeping arrangement for people living in the home.. Fire doors must not be held open in a manner which impedes their automatic closure in the event of a fire. Staff recruitment is a matter of serious concern as recruitment practices are unsafe and place people living in the home at risk. The registered providers must carry out all the checks and safeguards required by law when recruiting staff. Work on staff training should be completed within the previously set timescale Where outbreaks of infectious diseases occur, these should be reported to the Health Protection Agency and professional advice and guidance sought in how to manage this safely. Events adverse to the welfare of people living in the home must be reported to the Commission in accordance with regulation. Risk assessments must be carried out to ensure the safety of staff when engaged in their work. In particular, this must include any staff member who is pregnant.

Random inspection report Care homes for older people Name: Address: Charterhouse Residential Care Home Second Drive Dawlish Road Teignmouth Devon TQ14 8TL zero star poor service 15/09/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Graham Thomas Date: 1 4 0 5 2 0 1 0 Information about the care home Name of care home: Address: Charterhouse Residential Care Home Second Drive Dawlish Road Teignmouth Devon TQ14 8TL 01626774481 01626774481 margaretbrett@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Stephan Barry William Brett,Margaret Louise Brett Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 20 Number of places (if applicable): Under 65 Over 65 20 20 20 20 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 0 0 0 1 5 0 9 2 0 0 9 Charterhouse provides accommodation and care for a maximum of twenty people in the registration categories of old age, dementia, physical disabilities and mental illness. Care Homes for Older People Page 2 of 20 Brief description of the care home The home does not provide nursing care. A partnership of Mr Stephan Brett and Mrs Margaret Brett are registered as the service providers. A manager has been appointed to manage the home on a day to day basis but the Care Quality Commission has not received a completed application to register this person. Charterhouse is a large detached period property set in landscaped gardens. It is less than a mile from the town, which has a good beach, railway station and frequent bus services. The fees range from £330 to £468 a week. Extra costs include private hairdressing, private chiropody and items of a personal nature. Information about the home including a copy of the last inspection report can be obtained on request from the Home. Care Homes for Older People Page 3 of 20 What we found: We performed this random inspection of the home in response to concerns that we had received. These concerned the homes environment, staffing and some aspects of care. As this was a random inspection for a specific purpose, we did not review the requirements and recommendations made during our last key inspection of the home. However, reference is made to some of these in this report. Our visit to the home lasted for about six hours. During this time we looked at a sample of care plans, staff records, staffing rotas and the homes system for administering medicines. We spoke with four staff, met with several people who live in the home and had a brief conversation with Mrs Brett, the registered provider. We toured the premises to look at specific issues raised in the concerns raised with us. Personal and Health Care: During our visit we saw that staff treated people with kindness and patience and that people living in the home had good relationships with the staff. We met some people who were living in the home individually and saw others sitting in a group in the lounge. All seemed clean and reasonably well groomed and we noted only transient odours that were dealt with promptly by staff. On three occasions we passed a toilet door on the ground floor where the door was open and a person was inside using the toilet. This indicates a lack of effective monitoring and does not protect peoples privacy or dignity sufficiently well. Peoples individual care plans were stored on shelves behind the reception desk and were not secure. Staff told us that the shelves had been measured for doors to be fitted that could be locked. This is the subject of a requirement from our last inspection, the timescale for which expires in June 2010. Staff told us that Mrs Brett recently took the care plans away to update them. She does not provide hands-on care and did not consult with the care staff about each person. We saw that Mrs Brett had written the plans but these were undated. The level of information in the care plans was limited as to the specific tasks to be carried out by care workers. Information was not easy to find in the files. Staff confirmed although a communication book was used daily, the care plans were not generally referred to as they were not necessarily accurate or reliable. Two plans we looked at were for people who were frail and had significant health problems. These did not show evidence of the regular dietary and weight monitoring that their individual conditions might suggest were required. A care plan showed that one person had been weighed in March 2010. It was not clear how this would have been achieved as the person required significant support in moving and handling and the home has only standard bathroom scales and no sitting scales. This person was being moved by staff with the use of a handling belt and rotating stand. Staff told us that at times the person cannot stand correctly on the turntable and two staff Care Homes for Older People Page 4 of 20 have to take their full weight to get them into the correct position. The size and layout of the persons room would not accommodate a hoist. This was, in any case, not in working order and stored in an upstairs room. At the start of our visit this person was in their room and repeatedly calling for attention. There was no call bell to hand. This had been replaced by a pressure mattress that was plugged into the call bell socket. Staff told us that normally the person would be in the lounge for most of the day. We also heard that when they were moved to the lounge, the person continued to call occasionally in the same way. The level of staffing meant that there was little time for individual social attention. Staff told us that due to this behaviour they had made a request for the persons medication to be reviewed. We saw from the medication records that a prescribed dose of Risperidone had been increased, apparently to manage this behaviour. We looked at the care being provided to another person. Staff told us that they needed support to manage their continence. Recent medical investigations had shown that the person may be suffering from a serious medical condition but it had been decided not to do further investigations or perform any invasive treatment. There was no mention of this in the care plan. Environment: In our tour if the premises we noted that the home was sufficiently clean and that any unpleasant odours were dealt with promptly. Staff told us that the hall and dining room had been redecorated in the last year. Otherwise there had been little decoration and maintenance. Bedrooms appeared in general good order, although some decorations, carpets and furnishings appeared tired and due for renewal. We sat on the bed in room 3 and found this to be very hard and could feel the bed base through the mattress. The person occupying this room was described in their plan as frail. We checked whether the person had developed any sores. Staff told us that their skin condition was good and that they did not suffer from any skin related issues. The ground floor toilet appeared very shabby. There was a large patch of wallpaper that was peeled off the wall, and the vanity unit around the washbasin was in poor repair. The edging strips were missing and the chipboard beneath had swollen where it had become wet. This meant that the basin/vanity unit could not be kept hygienically clean. Paper towels and liquid soap were available in the downstairs toilet, and a supply of disposable gloves. In discussion with Staff we were told there was a good supply of disposable aprons in the cupboard in this room, and more on the first floor. We saw staff using gloves for personal care but the use of disposable aprons was not always evident The laundry appeared reasonably tidy with clothing hanging up to air. There were no bags of unwashed laundry waiting to be washed. Both washing machines were working and appeared to be in good order. The floor has recently been repainted and carpet tiles removed. During our visit, we found four fire doors held open inappropriately. One was held open with a soft toy and the others with wooden wedges. One of these was a door in the corridor next to the kitchen. This was fitted with a hold-open device which was not working. An immediate requirement was made for them to be removed and we have Care Homes for Older People Page 5 of 20 reported the issue to the Fire Service who regulate these matters. Staffing: On the day of our visit thirteen people were living in the home who required varying degrees of support. At least one required two people for moving and handling tasks such as getting in and out of bed. In the morning, there were three carers, a cook and a cleaner on duty. One of the carers had been working in the home for two weeks and was said to be under the supervision of other staff. A senior carer was in charge of the home. Staff told us that the manager had recently left and that there had been recent staff shortages. Our discussions with staff and examination of two recent rotas indicated that the current staffing pattern was for there to be two carers with a cook and cleaner between 8:00am and 2:00pm. This included the deputy manager or senior carer. Between 2:00pm and 8:00pm two carers are on duty. After 8:00pm two carers are on duty, one of whom would sleep in. The rota showed that Mrs Brett was on duty between 10:00am and 4:00pm Monday to Thursday. Staff told us that an assistant had been employed to prepare the tea time meal. During our visit we saw that staff did not appear rushed though there was little time for individual social attention. It is evident from this pattern that there would be periods when both the staff on duty would be supporting individuals so that other residents would be left unsupervised. We attempted to examine the records for three staff. One of these records was for the staff member under supervision when we visited. There was no file about this person available in the home for examination nor any records concerning this persons employment. We spoke with the person who confirmed that they had worked in the home for two weeks. This included sleeping in duties which were also shown on the rotas we saw. During our visit we saw that the person was not always with other staff who were often called away to meet other needs. They were therefore left alone with people living in the home. In our conversation with the person they told us that they had completed neither a criminal records check nor an ISA First check which provides information on potentially unsuitable staff. When we spoke to Mrs Brett on the telephone she confirmed that this was the case. The person told us that they had not worked for two years and that they were unable to provide the proof of identity necessary for these checks to be completed. They confirmed that they had supplied two references. One of these was a close relative who had been contacted by Mrs Brett. The Person had not received a structured induction. A second member of staff confirmed they had worked in the home for seven weeks and had worked as a carer, including evening and sleeping in duties. Notes on the persons file indicated that they had commenced duties on 22nd March 2010. An application for an ISA First check was seen in the file. This was dated 15th April 2010. There was no record of a criminal records check or the results of the ISA First application. No written references were found in the file. The person told us that Mrs Brett had taken up telephone references but there were no records of this. Care Homes for Older People Page 6 of 20 We looked for records concerning the recently employed tea time helper. The only references to this employee we could find were a note on the file hanger in the filing cabinet referring to a start date of 3rd May 2010 and two written references. The above issues relating to staff employment are a matter of serious concern since such practices are both contrary to regulation and can place people at significant risk of harm. There were outstanding requirements regarding staff training from our previous visits. We recent saw correspondence regarding a distance learning course in dementia. There were also a number of commercially produced training CDs for staff training in topics such as moving and handling, safeguarding people from abuse, health and safety and challenging behaviour. As far as we could gather from staff, these had not yet been used. The deadline of our previous requirement relating to this matter expires in June 2010. Health and safety: We found notes in the staff communication book that stated there had been an outbreak of diarrhoea and vomiting in Early May 2010. This had involved twelve people living in the home and some staff. The staff we spoke with were unsure as to whether this had been reported to the Health Protection Agency and appropriate advice sought. We checked with the agency who confirmed that they had received no such report. We also checked our own records to see if it had been reported to us as required by regulation. It had not. The cleaner told us that disinfectants had been used to clean the home after this outbreak but there was no evidence that a thorough deep clean had taken place. One staff member told us that they were pregnant and were involved in moving and handling tasks. At the time of our visit, there was no risk assessment in place in compliance with health and safety legislation. What the care home does well: What they could do better: Care plans must be securely stored. Work on care planning must be completed to provide staff with reliable, up to date, clear and specific direction on how to meet individual needs. The plans, risk assessments and reviews should be dated so that a clear pathway of planning, action and review is established. There must be regular monitoring of peoples weight, nutrition and hydration where their needs indicate this. Peoples privacy and dignity should be better protected when using the toilet facilities. The moving and handling procedures used for one person who is currently assisted with a Care Homes for Older People Page 7 of 20 handling belt and rotating stand must be reviewed and revised with reference to professional advice. All mattresses and bedding should provide a comfortable sleeping arrangement for people living in the home.. Fire doors must not be held open in a manner which impedes their automatic closure in the event of a fire. Staff recruitment is a matter of serious concern as recruitment practices are unsafe and place people living in the home at risk. The registered providers must carry out all the checks and safeguards required by law when recruiting staff. Work on staff training should be completed within the previously set timescale Where outbreaks of infectious diseases occur, these should be reported to the Health Protection Agency and professional advice and guidance sought in how to manage this safely. Events adverse to the welfare of people living in the home must be reported to the Commission in accordance with regulation. Risk assessments must be carried out to ensure the safety of staff when engaged in their work. In particular, this must include any staff member who is pregnant. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 20 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered persons 10/06/2010 should rewrite the Statement of Purpose and include all of the information that is required by the Care Homes Regulations and recommended in the National Minimum Standards to be included. This is the ensure that people considering using the service and their representatives have the information they need about the home and the service provided. 2 1 5 The registered persons 11/06/2010 should rewrite the Service Users Guide and include all of the information that is required in the Care Homes Regulations and recommended in the National Care Standards in it. This is to provide the people who live at the home with the information they need about what they should expect from the service. 3 7 15 The registered persons must 30/12/2009 ensure that the residents care plans are regularly Page 9 of 20 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action reviewed. Monthly reviews are recommended. This is to ensure that peoples care plans can be adjusted to meet their changing needs. 4 7 13 The registered persons must 11/06/2010 ensure that unnecessary risks to the health and safety of the residents are identified and so far as possible eliminated by carrying out individual risk assessments and producing written guidance on how the risk can be eliminated or reduced. This is to protect the people who use the service from harm. 5 7 12 The registered persons must 11/06/2010 ensure that the home is conducted so as to promote and make proper provision for the care of the residents. This includes identifying and recording peoples individual needs and drawing up care plans to provide guidance on how to meet peoples needs. We recommend that needs assessments and care plans are reviewed at least once a month. This is to ensure that peoples individual needs are identified and can be met. 6 8 18 The registered persons must 30/12/2009 ensure that the staff receive the training they need to Page 10 of 20 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action carry out their duties safely. This refers specifically to training in continence control and continence management, lifting and manual handling, dementia care, medication administration, safeguarding and managing aggressive behaviour. This is to ensure that peoples assessed needs can be met safely. 7 9 13 The registered persons must 11/06/2010 ensure that the medicine trolley is chained to a solid wall, that the keys are carried by the most senior person on duty and that any spare keys are not left in an unlocked drawer. This is to ensure that medicines are kept safe and secure. 8 12 23 The registered persons must 11/06/2010 ensure that the external grounds are suitable for or safe for use by the people who use the service. This is to ensure that people can use the gardens when they wish to do so. 9 12 23 The registered providers 28/11/2009 must ensure that the external grounds are suitable for and safe for use by the people who use the service. Care Homes for Older People Page 11 of 20 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is to ensure that people can use the gardens when they wish to safely. 10 19 12 The registered persons must 11/08/2010 ensure that the home is safe for the residents by fitting radiator covers. This is to remove the risk of people scalding themselves. 11 19 12 The registered persons must 11/06/2010 ensure that each of the residents has a call bell that is accessible from their bed and from their chair to enable them to call for staff assistance if they need to. This is to ensure that people have access to staff assistance at all time. 12 19 23 The registered provider must 01/11/2009 provide accessible call bells in all of the bedrooms. This is to ensure that people have access to staff support at all times. 13 22 13 Suitable arrangements must be made to provide a safe system for moving and handling residents. To protect the residents and staff from harm. 14 27 18 Having regard to the size of the home and the number and needs of the residents, suitably qualified staff must be employed in sufficient 27/03/2009 27/03/2009 Care Homes for Older People Page 12 of 20 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action numbers to meet the needs of the residents at all times of the day and night. To ensure that the needs of the residents can be met. 15 27 18 The registered persons must 28/10/2009 ensure that enough staff are employed at all times to meet the assessed needs of the residents. This is to ensure that the people living at the home have the care they need. 16 27 18 The registered persons must 11/06/2010 ensure that there are enough staff on duty at all times to meet the needs of the residents. This is to ensure that the people living at the home have the care they need. 17 30 18 The registered persons must 11/06/2010 ensure that the staff have access to the training they need. This training should include Health and Safety, Medication administration, First Aid, Food Hygiene, Infection Control, Manual Handling, Continence Care, Dementia Awareness and Safeguarding Adults. This is to ensure that the staff have the knowledge and skills to do the work that is expected of them. Care Homes for Older People Page 13 of 20 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 18 30 18 Ensure that the staff are 15/03/2009 given training that is appropriate to the work they are to perform. To ensure that the staff have the skills they need to meet the needs of the people who use the service. 19 30 18 The registered persons must 28/12/2009 ensure that the staff receive the training they need to enable them to carry out the duties that they are required to perform safely. This is to ensure that the people living at the home receive the care they need. 20 31 26 One of the registered 12/04/2010 persons must carry out monthly monitoring visits to the home and prepare a written report on the conduct of the home. This is to enable the service providers to oversee the management of their business. 21 33 24 The registered persons must 28/12/2009 establish and maintain a system for reviewing and improving the quality of care provided at the home. This should be done by consulting the residents and their representatives and by producing an annual development plan for the home. Page 14 of 20 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is to enable the people using the service and their representatives to influence the way the service develops. 22 33 22 The registered persons must 11/06/2010 establish a system for reviewing and improving the quality of care provided at the home. This should be done by consulting the residents and their representatives and by producing an annual development plan for the home. This is to enable the people using the service and their representatives to influence the way the service develops. 23 38 12 The registered persons must 11/06/2010 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the people who use the service. This includes: Ensuring that the premises are safe and suitable for the people who use the service. That sufficient numbers of staff are employed and that the staff receive appropriate training to carry out the work that is expected of them. That policies, procedures and codes of practice are in place to provide guidance for the staff. And, by providing Page 15 of 20 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action strong management and management oversight. This is to ensure that the service is able to provide a safe home for the people who use it. Care Homes for Older People Page 16 of 20 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 38 23 Fire doors must not be held 21/05/2010 open with devices or other objects that impede automatic closure in the event of a fire. The Registered Person must write to the Commission to confirm that all such object have been removed and that the home continues to comply with this requirement. This is to ensure that people living in the home are protected from the risk of fire Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The registered person must 06/11/2010 ensure that there is regular monitoring of peoples nutrtion, hydration, weight and skin integrity where individual needs indicate this is necessary This is to safeguard the health and welfare of people living in the home. 2 26 23 The ground floor toilet must 01/08/2010 be refurbished to ensure that effective levels of hygienic cleaning can be maintained Page 17 of 20 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to prevent the spread of infection in the home. 3 28 19 All staff must be employed in 28/05/2010 accordardance with the Care Homes Regulations 2001. In particular this must include criminal records and ISA First checks as well as other checks identified in the Regulations. This is to safeguard people from potential abuse by unsuitable staff 4 37 37 Events adverse to the 28/05/2010 welfare of people living in the home must be reported to the Commission in accordance with regulation. This is to ensure that the Commission can audit the providers compliance with regulation 5 37 17 All records required by regulation must be kept in the care home and made available for inspection. In particular this refers to staffing records. This is to ensure that the Commission can audit the providers compliance with regulation. 6 38 12 Any outbreak of an infectious 28/05/2010 disease must be reported to the relevant authorities and advice and guidance sought Page 18 of 20 06/06/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action on its management This is to protect the health and welfare of people living in the home. 7 38 13 The registered person must ensure that there are safe arrangements for moving and handling people which protect both using the service and staff. This is to reduce the risk of injury to people using the service and staff Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 06/11/2010 1 2 10 24 Peoples privacy and dignity should be preserved when they are using toilet facilities by ensuring doors are closed. People living in the home should be provided with a comfortable standard of bedroom furniture. Care Homes for Older People Page 19 of 20 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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