Inspection on 02/10/07 for The Carlton Nursing Home

This inspection was carried out on 2nd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

The Carlton Nursing Home 01/05/07

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 Key Unannounced Inspection 2nd October 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.V352015.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.V352015.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.V352015.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. 1st May 2007 Date of last inspection Brief Description of the Service: The Carlton provides both personal care and nursing care to people 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 18/10/07 that the fees range from £384.55 to £525.00 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.V352015.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 15.40hrs. 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. 4 members of staff were spoken with. One visitor was spoken with. The home had been asked to complete a questionnaire with information, for example about how the home is managed, incidents and events that have happened since the last inspection. This helps with assessing the performance of the home and 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 one relative and one health professional. The comments in the surveys were positive about the standard of care provided by the staff at the home. Comments from the surveys included: - I am quite happy with my relative’s care. He is always clean, well dressed and eats well. The home keeps people calm and loved which I find comforting. - Generally a caring attitude. 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: Assesses people fully prior to moving into the home to ensure their needs can be met. Carries out risk assessments and develops care plans for staff to follow and provide a consistent plan of care. Delivers a good standard of personal and nursing care. Treats the people who live at the home with dignity and respect. Supports relatives. The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 Page 6 Manages medication systems 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.V352015.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.V352015.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 three people relating to their admission to the home were looked at 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 relative’s needs. The Carlton Nursing Home DS0000062776.V352015.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 care needs are clearly highlighted within their care plan. EVIDENCE: The care plans of three people living at the home were looked at. These were clear documents, which included risk assessments regarding tissue viability (the risk of developing pressure sores), falls, mobility, nutritional status and continence. Clear plans were in place regarding the mental health needs of people. Care needs to be taken to ensure that where a risk is identified in relation to tissue viability, that a specific care plan is developed about this. The daily records examined were variable in the detail recorded. Some entries in daily records gave a clear indication of the level of support and care delivered on a daily basis, however others 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 The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 Page 10 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 interaction with people living in the home that they knew each individual’s likes, dislikes and needs. Feedback from one relative 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 three 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.V352015.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.V352015.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 lamb casserole, mashed potato, carrots and green beans followed by sponge and custard. Drinks were offered to people throughout the meal. 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. Tables were nicely set and staff sat with people, having conversations with appropriate banter and humour. People living in the home responded well to this and the atmosphere was relaxed and unhurried. The Carlton Nursing Home DS0000062776.V352015.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 good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People can be confident that their complaint will be dealt with effectively and that they are adequately protected from abuse. EVIDENCE: All staff have received training regarding safeguarding (adult protection) in September 2007. The adult protection policy and procedure in place at the home is now up to date and gives adequate information for staff to refer to. The local authority guidance in place at the home relates to the Calderdale area. Contact details were given to the acting manager for the Kirklees safeguarding co-ordinator. The complaints procedure is now displayed at the home and in the policies and procedures file. This has been reviewed since the last visit in May 2007. It was reported that there had been no complaints received at the home since the last inspection. The Carlton Nursing Home DS0000062776.V352015.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 good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. The home is safe and is well maintained. The standard of decoration and furniture in the home is much improved and the home is clean and free from any unpleasant odours. EVIDENCE: The has been a massive improvement to the interior of the home since the last inspection visit. Every bedroom has been decorated where required, new bedding and curtains purchased, tiles in ensuite bathrooms repaired and new flooring fitted where needed. Any damaged furniture has been repaired or replaced. Downstairs, the bathrooms and toilets have been decorated, new flooring fitted and new commode chairs purchased. The main lounge has got two new flat screen televisions, suitable for people living in the home to see, and the dining room has also had the floor repaired, new curtains and new furniture. The The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 Page 15 small lounge has also got new furniture and is more spacious and comfortable for people to use. The room that used to be used as a staff room was in the process of being decorated and is to become a treatment room for people living in the home. The hallway downstairs has been decorated and this has lightened the area making it feel more spacious. Locks have been ordered for each bedroom should any person living in the home be able to and want to use this. Floor and wall sensors have also been fitted in every bedroom to help alert staff if anyone gets up in the night and needs assistance due to the majority of people living in the home not being able to use a call system. The refurbishment of the home was long overdue and has had a positive effect on the surroundings for the people who live there. The Carlton Nursing Home DS0000062776.V352015.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 good 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: All staff have received movement and handling training in September 2007, and health and safety training in July/September 2007. There are three full time members of staff who have first aid certificates. The staff who have not already completed dementia care training are to commence this course on 18th October 2007. Eight members of staff have achieved the NVQ level 2 award in care and one other is currently working towards this qualification. Whilst observing staff during this visit, there were no issues raised in the quality of the care provided. Staff do receive induction training and records of this were seen for three members of staff. This was confirmed by staff spoken to during the visit. The recruitment records of two members of staff were checked and all were found to contain the required checks and documentation. The recording of interview was discussed with the acting manager and deputy manager and they agreed to formalise this process. The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence including a visit. The home is well managed, people are kept safe by health and safety practices; improvements are now being made as part of the home’s quality assurance system. EVIDENCE: Since the last inspection visit, an acting manager Mrs Bland has been identified to manage the home. Mrs Bland is a longstanding member of staff who knows the home and the people who live there well, and has worked tirelessly since commencing in the role as acting manager to improve the service. A deputy manager has also been recruited and is supporting Mrs Bland to move the service forward. Mrs Bland is currently working towards the Registered Managers Award. The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 Page 18 Monthly management visit reports by the provider are documented and forwarded to the Commission. 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. Since the last inspection automatic closures have been fitted to the doors which were seen to be propped open during the last visit. These are linked to the fire system so that the doors close if the alarm is activated. The records of people’s personal monies were not up to date. There were receipts for monies deposited and taken out, but these had not always been entered onto the records. The acting manager had already identified this as an issue and had developed a new system for managing people’s monies. A full audit was planned to be carried out within two weeks of this visit and the acting manager was asked to confirm this in writing to the Commission when completed. Staff supervision is to be commenced in the near future. The acting manager showed the inspector the format she has devised for this. The terms and conditions for staff have been reviewed and were to be given to all staff, however an error in the typing has delayed this. The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 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 2 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NO 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 OP35 Regulation 17(2) Sched 4. 9. Requirement A record must be kept of all money or valuables deposited by a service user for safekeeping or received on the service user’s behalf. Timescale for action 26/10/07 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. Refer to Standard OP7 OP29 OP36 OP29 Good Practice Recommendations Daily records should reflect the actual care and support given to an individual on a daily basis. 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. Interview notes should be recorded. The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 Page 21 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. Extracts may not be used or reproduced without the express permission of CSCI The Carlton Nursing Home DS0000062776.V352015.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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