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Inspection on 23/11/05 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 23rd November 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

The home is pleasantly presented and the residents rooms are personalised with items of their choice. The home also benefits extensive coastal views from the gardens and some of the resident`s rooms. The grounds and gardens continue to be well maintained. All the residents asked said they really appreciated the garden and views. The way the home is managed enables the residents to maintain their optimum independents. The staff team have a genuine rapport with the residents they care for Charterhouse.

What has improved since the last inspection?

The residents survey questionnaire has been completed. As a result of this new ways of exploring the residents views regarding activities has been introduced. The programme of repairs, decoration and renewals has continued since the last inspection. The dining room has new furniture, which adds to the homely feel of the environment for the residents.

What the care home could do better:

The way medication, which is no longer, required by the residents, is handled did not follow good practice guidelines at the time of the inspection. The manager provided proof that medication no longer required had been returned prior to the completion of this draft report.

CARE HOMES FOR OLDER PEOPLE Charterhouse Residential Care Home Second Drive Dawlish Road Teignmouth Devon TQ14 8TL Lead Inspector Rachel Proctor Unannounced Inspection 23rd November 2005 10:30 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 Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 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. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Charterhouse Residential Care Home Address Second Drive Dawlish Road Teignmouth Devon TQ14 8TL 01626 774481 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) margaretbrett@btinternet.com Margaret Louise Brett Stephan Barry William Brett Margaret Louise Brett Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20), Old age, not falling within any other category (20), Physical disability over 65 years of age (20) Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th June 2005 Brief Description of the Service: Charterhouse Residential Home is a registered Care Home that provides personal care for up to 20 people over the age of 60. It is able to accommodate elderly people and those with a physical disability such as mobility problems perhaps through arthritis or as a result of a fall. The home also has the category of DE (Dementia) so as to meet the needs of those with minor memory problems. The home is not registered to provide nursing care. The home is a large detached property situated on a quiet road about half a mile from the centre of the Devon seaside town of Teignmouth. It has been adapted to cater for some disabilities having a shaft and stair lift to aid residents to move freely between each floor. There are also assisted bathing and toilet arrangements using mobile hoists. The home has mainly single room accommodation with en-suites. Although there are two double rooms, both with en-suites, available for those who prefer to share. There is a lounge, a conservatory (sun room) and a separate dining room that are used daily by the residents. The Home has well kept grounds and being in an elevated position enjoys good views of the town, sea and surrounding countryside. There is a resident pheasant and squirrel in the grounds that provide visual entertainment and relaxation when they feed on the patio. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The commission for social care inspection has introduced key standards to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. This was an unannounced inspection, which took place on the 23rd November 2005 between 10:30 a.m. and 2:40 p.m. A tour of the home was completed and some records were inspected. The inspector spoke to residents and staff during the inspection. The lunchtime meal was shared with the residents. What the service does well: What has improved since the last inspection? What they could do better: 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. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 6 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 Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, The residents at Charterhouse can have confidence that their changing care needs will be assessed by a caring staff team who have their best interests at heart. EVIDENCE: Three residents care plans were viewed during the inspection. One of these residents had been admitted recently. Each resident had a full assessment of their care needs documented. The newly admitted resident had a copy of this social services assessment /care plan and the shared assessment completed by the community psychiatric nurse. The manager continues to use a computer-generated assessment and care plan for the residents. The three care plans seen had been reviewed monthly or sooner if the residents care needs changed. One resident asked said the staff at Charterhouse had helped them to settle in and discussed the care they needed with them. This resident’s assessment had been documented and reflected the areas the resident said they required assistance with. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 The staff at Charterhouse are meeting the individual residents health and personal care needs in a way they would do themselves if they were able. However keeping discontinued medication may put the residents at risk of receiving medication they no longer need. EVIDENCE: The care plans provided for the residents give clear information for the staff regarding the individuals care needs. Three of the residents spoken to during the inspection said the staff enabled them to maintain as much independence as they were able and only assisted with the things they were unable to do for themselves. How independence is promoted was recorded in the three plans of care viewed. The information contained in the residents care plans indicated they had been asked about their care, their personal choices and preferences. The residents likes and dislikes and the way they like to be addressed had been recorded. All the residents spoken to during the inspection told the inspector that the staff are friendly and supportive towards them. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 9 Each resident had their photographed attached to the plan of care. The residents at Charterhouse are of varying cognitive abilities; the residents all appeared to be interacting well together and with the staff team. The home has a locked medication trolley, which contains the residents medication. The assistant manager advised that a system is in place for residents to be assessed for self-medication. The medication records and medication was checked for two of the residents. These have been completed as required. The assistant manager advised that none of the current residents require controlled drug medication. The inspector checked the storage box and records kept in the controlled medication box. The records being kept were for temazepam and diazepam all of the drugs contained in this storage box were for residents who were no longer at the home. One box of Temazepam had passed its expiry date. Records of the number of tablets held tallied with the medication in the storage box. However these have not been recorded on separate pages and all the medication had been listed on one page without the name of the resident they were prescribed for. This was pointed out to the assistant manager during the inspection; she advised that this medication would be returned to the pharmacist as soon as possible. This was confirmed by the deputy manager prior to the completion of the draft report. A discussion with the manager on 14th December confirmed that medication no longer used by the residents is returned to the pharmacy. She also advised how controlled drug records would be keep in future should any of the residents require this. A record of medication returned to the pharmacy had been completed the returns have been date stamped by the supply pharmacist receiving them. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15, The residents can have confidence that the staff team will consider their personal choices and aspiration when activities are planned EVIDENCE: Since the last inspection a resident’s suggestion list for the activities they would like had been pinned to the notice board in reception. However none of the residents had written anything on this. A second notice asked for suggestions of what should be kept in the home shop, the residents had completed this. Three of the residents asked said they were satisfied with the activities provided. The residents were still enjoying the company of the budgie; one resident said they made sure he was looked after, but he hadnt started to talk yet. A fish tank containing several fish has been provided in the lounge. All the residents spoken to during the inspection said they enjoyed the gardens of the home especially the view of the sea. The residents who had chosen to stay in their own rooms said they were able to choose to do this. Some residents had chosen to eat their lunchtime meal in their own rooms. The residents told the inspector that they were free to spend time in their own rooms in private or socialise in one of the two lounge areas. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 11 The inspector joined the residents in the dining room for the lunchtime meal. The residents were eating their meals at their own pace and the lunchtime meal was unhurried. The residents spoken to during lunch said they enjoyed the meals provided. They also commented that the meals are always enjoyable and attractively presented and there is a choice if they dont like whats on offer. Very little wastage was seen at this lunchtime meal. The dining room had been refurbished since the last inspection. Circular tables for the residents provided a homely feel to the dining room. Five circular tables were being used for 10 of the 17 residents who had chosen to eat lunch in the dining room. The dining tables were attractively presented with tablecloths, napkins and place settings. The residents asked said they liked the way the dining room had been changed to give the dining room a homely feel. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, The residents can have confidence that any concerns they raised will be dealt with sensitively by the staff team who care for them. EVIDENCE: The residents spoken to told the inspector that they knew who to speak to if they had any concerns. They also said they felt they would be listened to and any concerns they had would be dealt with sensitively by the staff. The complaints procedure is clearly displayed in the reception area of the home. The statement of purpose also contained the complaints procedure. The complaints procedure gave information about who to complain to and the timescales for responding to complaints. This also contained the name and address of the commission and the ombudsman. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,24,26 Although a suitably qualified occupational therapist has not assessed the home this has not prevented the residents from having access to equipment that helps them maintain their optimum independence. The laundry floor still needs sealing to allow it to be easily cleanable, to reduce the risk of cross infection. EVIDENCE: Charterhouse been adapted from a large private detached house set within its own grounds. The home is attractively presented, clean and fresh and free from odour. The refurbishment programme started by the current owners has continued with more of the resident’s rooms have been decorated. During the inspection the residents were using the large lounge, sun lounge and the dining room. The sun lounge has access to a patio terrace overlooking the front garden. The gardener was working in the garden during the inspection. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 14 The home is registered for 20 residents, however the manager has chosen to use the existing shared rooms for single occupancy rooms, this has reduced the available spaces to 17. Each of the resident’s room’s had been personalised with items of their choice. Risk assessments are in place for the use of lockable doors to resident’s rooms. These are not provided at present. At the previous inspection the owner confirmed that it was planned to provide locks for residents rooms for the residents who would benefit. There is a small laundry area set away from the resident’s rooms. The laundry flooring is made of concrete that has been painted. As at the last inspection the paint on the floor had started to peel this could make the floor difficult to clean. The owner advised that the plans to extend the laundry area and give the staff more room to work were on track. He also advised that the disinfecting washing machine purchased was too big to fit into the existing laundry and he was waiting the completion of the new laundry building before this was installed. The home has been adapted over several years to provide accommodation for older people who require care. A shaft lift and stair rider is provided for residents who are unable to use the stairs. An assessment of the home by a suitably qualified occupational therapist had not been undertaken. However the adaptations provided for the residents were meeting their needs at the time of the inspection. The home was fresh and clean in all the areas accessible to the residents during the inspection. The residents asked said the home is always clean and fresh. A cleaner was cleaning the resident’s rooms and bathrooms during the inspection she advised that the home is cleaned daily. The attention to detail the cleaner gives has ensures the home environment pleasant for the residents. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, The residents are cared for by a friendly supportive staff team who have the resident’s best interests at heart. EVIDENCE: A rota covering a four-week period for staff duties was available. This showed the capacity the staff were employed in and the hours they worked. The number of staff provided appeared to be meeting the needs of the residents. A record of staff meetings and residents meetings held was provided. Suggestions the residents had made at the meeting on the 27th of September had been implemented. The assistant manager confirmed that staff were receiving statutory training for manual handling, infection control, health and safety and adult protection. She further advised that the present training records are kept within the individual staff files. A list of staff with the dates they had attended fire lectures and the date the next fire lecture was due were provided. The assistant manager advised that at present only herself and one senior carer had achieved an NVQ level 3 in care. The registered manager is the first level general nurse. The assistant manager commented that all new staff go through the in-house induction programme when they start work and training for basic care such as manual handling is provided during this period. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 16 Distance learning courses through South Devon College had been applied for and a list of staff who attended the courses and the next sessions booked were provided for inspection. The assistant manager advised that staff from abroad had been appointed who had qualifications in care from their own countries. However their qualifications had still to be accredited against the UK system. She went on to say that she felt their qualifications from their own country would be equivalent to NVQ level 2 in care. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 The way Charterhouse is managed by the manager continues to ensure that the resident’s best interests are safeguarded. EVIDENCE: The manager is a first level nurse with experience in the care of older people. She has continued to facilitate improvements to the environment that have benefited the residents. New staff have been recruited since the last inspection. The assistant manager confirmed that they had received an induction to the home, which included safe working practices such as manual handling training. A key worker system is in place and each staff member has residents allocated to them. Three residents asked said the manager/owners are always very helpful and they liked living at Charterhouse. The inspectors saw an information folder containing reference material relating to the disease is associated with old age. Clear lines of accountability are in place. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 18 The inspector was shown the results of completed residents questionnaires. These indicated that residents would like more varied activities. The assistant manager advised that as a result of this residents meeting are taking place and a list for residents to add activities they would be interested in had been posted on the notice board. The residents asked confirmed that they were satisfied with the activities provided. A folder containing information about the activities provided for residents was available. Risk assessments continue to be an integral part of the care planning process for residents. These included manual handling and residents use of the hot water in the hand washbasins in their rooms. Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X 2 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement All medication no longer required for the residents must be returned/disposed of in line with good practice Timescale for action 01/12/05 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 OP22 OP24 OP26 Good Practice Recommendations The home should ensure the premises and facilities are assessed by an occupational therapist with specialist knowledge of the service uses needs. The home should provide locks for service uses bedrooms that are accessible to staff in the emergency, and within a risk management framework On replacement of the washing machine this should have the specific programming ability to meet disinfection standards. The laundry floor should be easily cleanable Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Charterhouse Residential Care Home DS0000053232.V258391.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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