Inspection on 01/05/07 for The Carlton Nursing Home

This inspection was carried out on 1st May 2007.

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

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

Other inspections for this house

The Carlton Nursing Home 02/10/07

The Carlton Nursing Home 15/06/06

The Carlton Nursing Home 29/11/05

The Carlton Nursing Home 11/07/05

The Carlton Nursing Home 24/03/05

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Carlton Nursing Home 25 Greenway Milnsbridge Huddersfield West Yorkshire HD3 4RZ Lead Inspector Helen Battle Unannounced Inspection 1st May 2007 09:30 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 The Carlton Nursing Home DS0000062776.V323386.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. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Carlton Nursing Home Address 25 Greenway Milnsbridge Huddersfield West Yorkshire HD3 4RZ 01484 655511 01484 655511 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) Carlton Nursing Homes Ltd vacant post Care Home 17 Category(ies) of Dementia - over 65 years of age (17) registration, with number of places The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for one named service user under 65 years assessed as requiring EMI nursing care/DE. 15th June 2006 Date of last inspection Brief Description of the Service: The Carlton provides both personal care and nursing care to service users over the age of 65 suffering from dementia. The bedroom accommodation is on the first floor of the home, which is serviced by a passenger lift. The bedrooms are all single rooms, some of which have ensuite facilities. The communal space is on the ground floor and consists of two lounge areas and a separate dining room. The home is within easy reach of Huddersfield. There is limited parking within the grounds of the care home adjacent to The Carlton. There is some on road parking. The Provider informed the Commission for Social Care Inspection on the 01/05/07 that the fees range from £470.00 to £511.97 per week. There are additional charges for hairdressing, newspapers, and magazines. Information about the home and the services provided are available from the home in the statement of purpose and service user’s guide. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this full inspection a visit to the home took place. The inspector visited the home unannounced from 09.30hrs to 14.30hrs. Whilst at the home, key documents such as care assessments, care plans, daily records and the staff records were looked at, and so were all the rooms and garden. 5 members of staff were spoken with. Two visitors were spoken with. The home had been asked to complete a pre-inspection questionnaire. This was returned to the Commission prior to the visit taking place. Surveys were sent out to relatives of ten people living at the home, and to GPs and social workers. At the time of writing this report, responses had been received from eight relatives and two GPs. The comments in all the surveys were positive about the standard of care provided by the staff at the home. Comments from relatives included: - Staff seem very attentive and caring to the residents needs. - The staff are very caring, my relative always clean and tidy, food is good, home is clean. - The also care about relatives. - My relative is now part of the family there. - We as a family can visit whenever we want to. - Staff are so patient. - Always treated with kindness and respect. - Overwhelming support from staff when our relative was in hospital. One GP commented that the home provides attentive nursing care with difficult to manage patient problems. Another GP commented that staff appear caring in attitude and have a close relationship with residents. Other comments regarding the environment of the home was not positive. Comments included: - Should be more flexibility as regards watching TV. - some of the furniture, crockery etc could be replaced. - it could do with decorating and a coat of paint here and there. - would like to see a summer room or conservatory. - more usable treatment / examination room could be made available near sitting room. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 6 The inspector would like to thank all the staff and people living at the home for their hospitality and co-operation during this visit. 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. The summary of this inspection report can be made available in other formats on request. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People are properly assessed before moving into the home with the assurance that their needs will be met. EVIDENCE: This home does not provide intermediate care. The records of a person recently admitted to the home was examined and contained evidence of a pre admission assessment carried out by one of the staff nurses. A copy of a Community Care Assessment was also in place. Responses in surveys from relatives indicated that family members are able to visit the home prior to admission in order to make an informed choice about whether the Carlton is suitable to meet their relatives needs. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit. The level of care people need, which includes their health, personal and social cares needs are clearly highlighted within their care plan. EVIDENCE: The care plans of two people living at the home were examined. These were clear documents, which included risk assessments regarding tissue viability, falls, mobility, nutritional status and continence. Clear plans were in place regarding the mental health needs of people. The daily records examined were variable in the detail recorded. One person’s daily records gave a clear indication of the level of support and care delivered on a daily basis, however the other person’s did not. Entries were vague and did not reflect the current condition of the person or any care given. There needs to be more consistency and detail in all the daily records. This shortfall in record keeping is not a reflection of the actual care provided by staff at the home. The people living at the home on the day of this visit, looked well kempt, comfortable and relaxed. People responded well to the staff and it was evident from observing staff The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 10 interaction with people living in the home that they knew each individuals likes, dislikes and needs. Feedback from two relatives spoken to on the day of this visit was positive. Staff have also built good relationships with relatives, who stated that they felt comfortable approaching staff. The lines of communication between staff and families is good. The healthcare needs of people are met, evidence was seen of involvement from GPs, optician, dentist and other healthcare professionals where needed. The medication of two people was checked and all were found to tally with the records held. Records were clear and accurate, and medication was stored correctly. Systems are in place to ensure safe administration of medication. A staff signatory list is in place. During this visit staff were observed to maintain the privacy and dignity of people. Staff approached and spoke to people in an appropriate manner. Feedback from relatives was extremely positive about the staff and the care delivered. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. The lifestyle at the home appears to satisfy the needs of the people living there, and encourages the involvement of family and friends. EVIDENCE: During the visit individual people were seen to be participating in various activities including listening to the radio, looking at newspapers and receiving visitors. Visitors were seen to come and go to the home throughout the day. The hairdresser visits the home every two weeks. Staff spoken to said that other activities included playing dominoes and taking individuals out to the local garden centre. A small number of people are taken out by their relatives on a regular basis. Although there are no people who are actively practising any religion, this would be pursued and access obtained to the relevant people should any service user express any interest. Due to the mental health problems suffered by the people who live at The Carlton, it is very difficult to ascertain their views or how individuals make choices. Choices are, however, promoted as to what time people get up, go to bed and what they eat. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 12 There is a four week menu in place at the home which demonstrated that a nutritionally balanced and varied diet is offered. The lunchtime meal on the day of the visit was sausages, mashed potato, carrots and roast potatoes followed by Bakewell tart and custard. The food served was sampled by the inspector and was warm and tasty. People living at the home appeared to enjoy the meal and were assisted in an appropriate manner. Where possible people are encouraged to maintain as much independence as they can. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 13 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, 18. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People cannot be confident that their complaint will be dealt with effectively and that they are not adequately protected from abuse. EVIDENCE: Only four members of staff have received training in adult protection issues. The adult protection policy and procedure in place at the home is not up to date and does not give adequate information for staff to refer to. The complaints procedure is not displayed at the home and on three different documents in the policies and procedures file, three different timescales were given for the provider to respond to complaints. There were no up to date details of how to contact the provider or the Commission for Social Care Inspection. It was reported that there had been no complaints received at the home since the last inspection. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 14 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, 26. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit. The home is safe but is not well maintained. The standard of decoration and furniture in the home is poor, however the home is clean and free from any unpleasant odours. EVIDENCE: The standard of decoration in the majority of the home is poor. Double glazing panes of glass throughout the home were damaged and therefore service users are unable to see out of them due to condensation. The bathrooms require decorating. Two toilet chairs were seen to be rusting and the fabric at the back of these chairs was split. This issue was also raised in the last inspection report. Curtains in some of the bedrooms are extremely thin and do not darken the room sufficiently to promote sleep in the longer days. Furniture in the dining room is stained and worn and looks shabby. Comments in three of the relatives surveys indicated that the decoration and furniture is not of a satisfactory standard. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 15 Since the last inspection, the dining room and the main hallway have been painted, however the rest of the building is in need of investment. The fabric of the building and the lack of decoration and renewal of furniture over a period of time is of concern. There needs to be sustained effort in improving the environment for the people living at the home. The state of the environment does not reflect the standard of care provided. The home was clean, tidy and free from any unpleasant odours. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 16 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, 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People’s needs are met by trained and qualified staff who have undergone a thorough recruitment process before they are allowed to work in the home. EVIDENCE: Up to date training records were not available at the time of this visit. Staff stated that they had received training and that they felt that the input regarding training had increased over the last few months. It was reported by staff that five people had commenced dementia care training, and that four others are to commence in August 2007. All staff are reported to have received movement and handling training within the last twelve months. Eight members of staff have achieved the NVQ level 2 award in care and two others are currently working towards this qualification. Three members of staff have also achieved the NVQ level 3 award in care and three others are currently working to wards this. It was reported that first aid courses have been requested, however it has not yet been confirmed that staff will be able to attend them. Three members of staff have attended a palliative care course. Evidence of all this training was not available and therefore it is not possible to clarify this. Whilst observing staff during this visit, there were no issues raised in the quality of the care provided. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 17 Staff do receive induction training and records of this were seen for three members of staff. This was confirmed by two members of staff spoken to during the visit. The recruitment records of three members of staff were checked and all were found to contain the required checks and documentation. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 18 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, 33, 35, 38. People who use the service experience poor outcomes in this area. We have made this judgement using a range of evidence including a visit. The home is not well managed, people are generally kept safe by health and safety practices; they are not involved in making improvements as part of the home’s quality assurance system. EVIDENCE: There is no manager at the home currently. This post is vacant and the provider is trying to recruit to the post. A senior carer is presently overseeing the day to day running of the home. It was reported that a new operations manager post has been developed within the company and this manager attended the home during this visit. It is imperative that an appropriate person is identified to manage the home as soon as possible in order to address some of the issues raised in this report and to move the service forward. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 19 Monthly management visit reports by the provider are documented and forwarded to the Commission. The environmental health officer visited the home in December 2006 and made some recommendations to improve the systems at the home. Weekly checks of the fire system and emergency lighting system are recorded as being carried out. Any issues which need rectifying are recorded. Hot water temperatures were also seen to be recorded on a weekly basis. An issue was raised during this inspection regarding the propping open of fire doors in the lounge area of the home. This was reported to be done for the benefit of the people living at the home as they tend to get unsettled and feel claustrophobic with the doors closed. If this is the case, then automatic door closures must be fitted to these doors in order to protect people in case of a fire. The records of two people’s personal monies were examined. It was not possible to determine whether these tallied with the amounts held, as peoples individual monies are not always accessible by all staff. This is not acceptable. People who have money kept for safekeeping should be able to have access to it at all times. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 20 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 3 9 3 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 1 17 X 18 1 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 1 The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 21 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 OP16 Regulation 22 Requirement Timescale for action 31/05/07 2. OP18 13(6) 3. OP19 23(2) 4. OP30 18 A complaints policy and procedure must be developed and made available for any service user or person acting on the service user’s behalf. The registered person shall make 31/08/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The previous timescale of 30.06.06 has not been met. The registered person shall 30/09/07 ensure that (b) the premises to be used as the care home are of sound construction and kept in a good state of repair internally and externally. (d) all parts of the care home are kept clean and reasonably decorated. Previous timescale of 15/09/06 not been met. The registered persons must 31/08/07 ensure that staff working at the care home receive training appropriate to the work they are DS0000062776.V323386.R01.S.doc Version 5.2 The Carlton Nursing Home Page 22 5. OP38 13(4) 6. OP38 23 to perform and suitable assistance, including time off, for the purpose of obtaining further training appropriate to such work. The previous timescales of 31/03/06 and 30/09/06 has not been met. There must be a member of staff trained in first aid on each shift The time scales of 11.08.04, 31.05.05, 30.09.05, 31.12.05 and 30/09/06 have not been met. Fire doors must not be wedged open. An appropriate automatic device should be fitted. 31/08/07 31/05/07 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. 4. 5. 6. Refer to Standard OP18 OP29 OP29 OP31 OP35 OP36 Good Practice Recommendations The whistle blowing policy should be reviewed to make it relevant to the care home. All staff should have a contract of the terms and conditions of their employment. Interview notes should be recorded. A suitable person should be identified to manage the home. Service users should be able to have access to their personal monies at all times. All care staff should receive staff supervision at least 6 times a year. The Carlton Nursing Home DS0000062776.V323386.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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. 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