Inspection on 15/06/06 for The Carlton Nursing Home

This inspection was carried out on 15th June 2006.

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 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 01/05/07

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 Key Unannounced Inspection 15th June 2006 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.V296194.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.V296194.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 Miss Vanda Jane Parr Care Home 17 Category(ies) of Dementia - over 65 years of age (17) registration, with number of places The Carlton Nursing Home DS0000062776.V296194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 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 15.6.06 that the fees range from £440.84 to £493.84 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.V296194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit carried out by two inspectors. The inspectors arrived at the home at 9.30am and left at 2pm. During this visit the inspectors spoke to some of the service users, visiting relatives, some of the staff and the home’s management. The inspectors read care records, audited a sample of medications, reviewed staff recruitment and training records, and carried out a tour of the building. Prior to the inspection visit a pre-inspection questionnaire was sent out to the manager of the home. This was to enable inspectors to contact the relatives, social workers, and GPs of service users to ask their views on the service provided. However it is disappointing that this information was not returned to the Commission. The manager of the home was asked during this visit to complete the form and return it to the Commission within two weeks, in order that the information could be used to inform future inspections. There were sixteen service users living at the home on the day of this inspection visit. Other information used as part of the inspection process included notifications from the home to the Commission for Social Care Inspection about deaths, illnesses, accidents and incidents at the home and copies of the monthly management visit reports produced by the provider. The inspectors would like to thank everyone for their assistance during the inspection process. What the service does well: What has improved since the last inspection? The Carlton Nursing Home DS0000062776.V296194.R01.S.doc Version 5.2 Page 6 Fire safety has improved with the issues with the fire system having been rectified. Weekly tests of the fire system are now carried out. The hot water provision is now satisfactory throughout the home. Monthly management visit reports are now completed and forwarded to the Commission. The cooker has been replaced. Items are now stored appropriately. 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 Carlton Nursing Home DS0000062776.V296194.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.V296194.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Service users are assessed fully to ensure the home can meet their needs prior to admission. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Records of assessment carried out prior to admission were examined for two service users. These also included copies of Community Care Assessments and input from the multi disciplinary team where appropriate. Service users can also visit the home prior to admission where this would be beneficial, dependant on the specific needs of individuals. This was confirmed by a visiting relative who stated that their relative did visit the home a number of times prior to admission. The Carlton Nursing Home DS0000062776.V296194.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Service users have a care plan which sets out their needs, however these are not always up to date. Health care needs are met. Medication is generally dealt with appropriately. Service users are treated respectfully and their privacy maintained. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Two service users care records were examined. These had plans of care which set out their needs and how to meet them. Reviews of these plans had not been carried out in order to ensure the plan was up to date, therefore some of the information was inaccurate. Records of the daily care provided related to the care plan. One relative spoken to on the day of the inspection confirmed that they are involved in care planning and reviews for their relative. The Carlton Nursing Home DS0000062776.V296194.R01.S.doc Version 5.2 Page 10 Medication records were examined and were found to be accurate. Correct codes were used and administration methods were seen to be safe. Policies and procedures are in place regarding medication, however a specific form of medication was found to be stored incorrectly. This was remedied at the time of the inspection. The manager agreed to include this in the medicines policy. Throughout the inspection service users were observed to be treated with respect and dignity by staff. Service users were spoken to in a kind manner and their needs determined in a discreet and appropriate way. This was confirmed by two visiting relatives. One visitor stated that they have never heard a member of staff say a bad word about a service user even though there are sometimes difficult circumstances to deal with. The Carlton Nursing Home DS0000062776.V296194.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Service users’ social, cultural, religious and recreational interests and needs are satisfied. Service users’ are able to maintain contact with family, friends and the local community. Service user choice is promoted. Meals provided at the home are of a good standard. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: During the visit individual service users were seen to be participating in various activities including singing, dancing, listening to the radio and having their nails filed. Visitors were also seen to come and go to the home throughout the day. The hairdresser was also at the home, and some service users were seen to be enjoying having their hair done in the hairdressing room. The Carlton Nursing Home DS0000062776.V296194.R01.S.doc Version 5.2 Page 12 Staff spoken to said that other activities included playing dominoes and taking individuals service users out to the local garden centre. One service user was taken out for the afternoon by their relative during this visit. Although the manager stated that there were no service users who were actively practising any religion, she stated that this would be pursued and access obtained to the relevant people should any service user express any interest. The manager confirmed that in the past a priest visited a service user on a regular basis. Links with the community are maintained; one service user goes to a local hairdressing salon, and links are made through visits to the garden centre. Due to the mental health problems suffered by the service users 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 service users get up, go to bed and what they eat. 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 home made Shepherd’s pie and brussel sprouts, followed by home-made chocolate sponge and custard. The food served looked and smelled appetising. The meal was served in a relaxed and unhurried manner, with service users being assisted in a discreet and individual manner by staff. Staff should be commended on the way in which they serve and assist service users with their meals. The Carlton Nursing Home DS0000062776.V296194.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Relatives are confident that any complaints will be listened to and acted upon. The complaints procedure is not easily accessible for visitors. Staff require training regarding adult protection to ensure that service users are protected from abuse. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The two relatives spoken to stated that they are comfortable in speaking to staff directly about any concerns and that any concerns are acted upon. The complaint procedure is available in the statement of purpose and in the policies and procedure file, however it is not displayed and therefore not easily accessible for all visitors. The manager agreed to display a copy of the complaints procedure. Staff have not had training regarding adult protection. It is imperative that this training be given to all staff in order to fully protect service users. A whistle blowing policy is in place but does not have the details of how staff can contact the manager and provider should they need to about any adult protection issues. These details should be added to the policy. The Carlton Nursing Home DS0000062776.V296194.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. The home is safe but is not well maintained. The standard of decoration in the home is poor. The home is clean and free from any unpleasant odours. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The issues regarding the fire alarm system and hot water provision, which were raised in the last inspection, have now been remedied. The standard of decoration in the majority of the home is poor. Two bedrooms were seen to have wallpaper coming off the walls. 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 The Carlton Nursing Home DS0000062776.V296194.R01.S.doc Version 5.2 Page 15 of these chairs was split. A recliner chair in the main lounge had damaged arms, where the material had worn away and the foam padding had come through. The dining room floor covering had split in two places, this could be both a tripping hazard and an issue for adequate cleaning. The manager reported that quotes had been obtained for the decoration work in the dining room and the hallway downstairs and that the work would be completed in the next two months. 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 service users. The state of the environment does not reflect the standard of care provided. The Carlton Nursing Home DS0000062776.V296194.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Service users’ needs are being met by the staff employed at the home, however, this is due to staff working extra hours to cover the rota. The recruitment procedures in the home are satisfactory. Staff are trained in some areas, however, there is a lack of training in some mandatory areas. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Staffing levels are in place at the home to meet the needs of the service users. These hours are only met at present by staff working extra hours and long shifts. This should not be sustained for a long period as it may have a negative effect on the staff team. Staff were observed to care for service users in a safe manner during the visit. Recruitment policies and procedures are in place to protect service users, however notes of interviews should be kept as good practice. The manager is currently recruiting staff to increase the numbers of the staff team. The Carlton Nursing Home DS0000062776.V296194.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. NVQ (National Vocational Qualification) training continues at the home with six members of staff having completed the NVQ level 2 care award. Three members of staff are due to commence level 3 and two more members of staff are due to commence level 2. Movement and handling training was given in February 2005 and staff are now having refresher training. Eleven members of staff have received dementia care training with more staff due to receive this training at the end of June 2006. Fire safety training was delivered to staff in October 2005. Regular fire drills are carried out at the home. Other training at the home such as health and safety, first aid and adult protection is not in place. This needs to be addressed within the timescales set in this report. The Carlton Nursing Home DS0000062776.V296194.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38. The registered manager is fit to be in charge of the home. The home is run in the best interests of the service users. The health, safety and welfare of service users and staff are protected. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The manager of the home is competent and runs the home in the best interests of the service users. This was confirmed by observation of her practice during the visit and by speaking to staff and visiting relatives. There have been limitations regarding administrative duties for the manager as over the past few weeks she has had to cover nurse shifts instead of having The Carlton Nursing Home DS0000062776.V296194.R01.S.doc Version 5.2 Page 19 supernumerary hours. This has been due to a vacancy for a nurse position, which is in the process of being filled. Fire safety has improved at the home and weekly checks of the fire system and emergency lighting system are recorded as being carried out. Any issues which need rectifying are recorded. The problem identified with the supply of hot water at the last inspection has also been rectified. Every sink was checked and had a supply of hot water during this visit. Hot water temperatures were also seen to be recorded on a weekly basis. Confirmation has been given to the Commission that work has been completed to meet the fire schedule set by the West Yorkshire Fire Service. The Carlton Nursing Home DS0000062776.V296194.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 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 2 17 X 18 2 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 2 The Carlton Nursing Home DS0000062776.V296194.R01.S.doc Version 5.2 Page 21 Yes 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. 2. Standard OP7 OP9 Regulation 15(2)(b) 13(2) Requirement The registered person shall keep the service user’s plan under review. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person shall make 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 registered person shall 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. The registered persons must ensure that staff working at the care home receive training appropriate to the work they are DS0000062776.V296194.R01.S.doc Timescale for action 15/07/06 30/06/06 3. OP18 13(6) 15/09/06 4. OP19 23(2) 15/09/06 5. OP30 18 30/09/06 The Carlton Nursing Home Version 5.2 Page 22 to perform and suitable assistance, including time off, for the purpose of obtaining further training appropriate to such work. The previous timescale of 31/03/06 has not been met. 6. OP38 13(4) 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 and 31.12.05 have not been met. 30/09/06 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. Refer to Standard OP16 OP18 OP29 OP29 OP36 Good Practice Recommendations The complaints procedure should be displayed in a prominent place. The whistle blowing policy should be reviewed to make it relevant to the care home. Interview notes should be recorded. All staff should have a contract of the terms and conditions of their employment. All care staff should receive staff supervision at least 6 times a year. The Carlton Nursing Home DS0000062776.V296194.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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. 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