Inspection on 29/11/05 for The Carlton Nursing Home

This inspection was carried out on 29th 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 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 15/06/06

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 Sally McSharry Unannounced Inspection 29th November 2005 08:35 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.V265239.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. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 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.V265239.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 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 Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on 29 November 2005. The inspector spoke with some service users, visitors and staff. A brief tour of the building was carried out. Two care plans were audited. Staffing levels were assessed and staff training records checked. The inspector also looked at health and safety records and checks. Not all the national minimum standards were assessed during this visit. A selection of the core standards were assessed and the progress made to address the requirement and recommendations made following the last inspection was checked. What the service does well: What has improved since the last inspection? What they could do better: Routine maintenance and health and safety checks in the home are poor. There has been little redecoration since the last inspection. Some curtains are not hung properly and some furniture is worn and shabby. The cooker is in need of repair and the oven cannot be used. There is no hot water supply to some sinks and the hot water supply to other sinks in service user areas is too hot and presents a danger to the service users. Items of old or unused furniture are inappropriately stored in bathrooms and fire escape areas. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 6 The fire alarm system has not been checked weekly as required and hot water temperatures are not being monitored adequately. There is a small staff team and although there are sufficient staff on duty in the home, there are few staff to cover holidays, sickness and training. Staff are receiving basic training however they must receive training related to caring for service users with dementia. Formal staff supervision should be introduced. The registered provider continues to fail to carryout monthly monitoring visits at the home and is not providing a copy of such visits to the CSCI. This is a legal requirement and must be addressed. Some of the issues identified above were brought to the attention of the registered provider on the day of the inspection and must be addressed with in seven days of the inspection. A further monitoring visit will be carried out to ensure action has been taken; failure to do so may lead to enforcement action being taken. 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.V265239.R01.S.doc Version 5.0 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.V265239.R01.S.doc Version 5.0 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): EVIDENCE: These standards were not assessed during this visit. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 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 and 8. Service user’s health, personal and social care needs are set out in an individual care plan. Service users health care needs are being met. EVIDENCE: Each service user has an individual care plan. The care plan identifies the service users physical, mental and social needs. Individual risk assessments are carried out and all care records are reviewed monthly. Care records show clear evidence of GP, district nurse and other health care professional in put where needed. Daily records reflect the care provided but are brief. Relatives who were visiting at the time of the inspection confirmed that the staff keep them informed of the service users health, wellbeing and any changes to the care provided. The Carlton Nursing Home DS0000062776.V265239.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 and 15. Service users have access to a range of activities that satisfies their needs and have unlimited contact with family and friends. Service users have access to choices in their lives. Meal menus are currently limited due to a problem with the cooker. EVIDENCE: Staff were seen interacting with service users well. Relatives said that staff spend time with the service users and that a regular programme of activities are offered. Visitors are welcome at the home at anytime. Visitors at the home at the time of the visit confirmed they are made to feel welcome and that they are offered hospitality whilst at the home. Service users and visitors were complimentary about the meals provided. The cooker is now in a poor state of repair. Four knobs are missing on the control panel. Catering staff are unable to safely use the ovens, therefore service users are not being offered roast dinners or home baking as is normal at the home. The cooker must be repaired or replaced as a matter of urgency. At the time of the visit the inspector left an immediate action requirement/feed back letter for the registered provider requiring the cooker be repaired or replaced with in seven days. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 11 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): 18. Service users are protected from abuse, however clear guidance should be included in the whistle blowing policy. EVIDENCE: At the last two inspections it was recommended the whistle blowing policy be reviewed to make it more relevant to the care home. This has not yet been carried out and remains a recommendation of this report. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 12 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, 20, 21, and 26. The environment of the home is not well maintained. There is access to internal and external communal facilities. There are insufficient and some unsafe washing facilities. The home is generally clean. EVIDENCE: The home is not being maintained to an acceptable level. There has been little redecoration since the last inspection and although the home was generally clean it is looking shabby. Curtains are of a poor quality and some were not fixed to the curtain rail properly. Some old furniture has been removed since the last inspection. However the wardrobe and cupboards in room 18 were in a poor state of repair and need to be repaired or replaced. There was inappropriate storage of old unused beds in the first floor bathroom and shower room. Some old furniture and cardboard boxes were stored in the fire escape stairwell. All these items must be removed. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 13 There were no curtains at the window of the ground floor bathroom and although the glass is obscured, it is recommended privacy curtains be fitted. Some hand sinks in the toilet and en suite areas did not have water coming out of the hot water tap. The hot water in other en suite sinks was very hot and above the 43 degrees centigrade required. An immediate action requirement/ feedback letter was left at the time of the inspection requiring the registered provider provide sufficient hot water to all sinks that is thermostatically controlled to 43 degrees centigrade. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 14 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): Sufficient staff are available to meet the needs of the current service users, however the small size of the staff team makes it difficult to cover staff vacancies. Staff are trained to meet the basic needs of service users, further training in dementia related illnesses must be provided. EVIDENCE: There are sufficient staff on duty to meet the needs of the current service users. Separate domestic, laundry and catering staff are provided. There is only a small staff team at the Carlton Nursing Home, which causes some problems when covering sickness, holidays and allowing staff to be absent from the home to attend training. Arrangements must be made to enable staff to attend the recommended three paid days training a year. There is evidence of some mandatory training having taken place, such as movement and handling training, fire training and basic food hygiene training. Training specifically related to the client group is limited. One member of staff attended a course on managing challenging behaviour in January 2005 and although staff did enrol on a distance learning course on positive dementia care they have not completed the course. Staff must be given the time to attend training. Training on dementia care must be provided. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 15 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, 36, and 38. The home has an experienced registered manager who is working to obtain the Registered Managers Award. The registered provider is failing to provide the CSCI with a monthly management report as required. Staff supervision is not taking place. The health, safety and welfare of service users and staff are not promoted or protected. EVIDENCE: The registered manager was not on duty at the time of the inspection. At the last visit the manager was working toward achieving the Registered Managers Award. Her progress will be monitored at the next inspection. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 16 The registered provider continues to fail to monitor the service the home is providing on a monthly basis. An immediate action requirement letter was left on the day of the last inspection regarding this matter and one report was received by the CSCI from the registered provider. This however was the only report received. A second immediate action requirement letter was left at the home at this visit. Failure to provide copies of monthly monitoring visits as required under Regulation 26 of The Care Homes Regulations 2001 will result in enforcement action being taken. There was no record of formal staff supervision taking place. During this inspection documentation showed that inappropriate health and safety checks have been carried out. Weekly fire checks and tests had not been carried out since 01/11/05. The registered provider has also failed to respond to West Yorkshire Fire Safety Officer’s report dated the 29 July 05 and the CSCI’s letter regarding this report dated 17 August 05. An immediate action requirement/feedback letter was issued by the inspector about the two fire safety issues at the time of the inspection. Issues regarding inappropriate storage and the control of hot water temperatures have already been raised in Standard 21 of this report. Not all the records could be located during this inspection, however there was no evidence that staff have received first aid training, therefore it remains as a requirement of this inspection. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 1 X 1 X X 1 X 3 STAFFING Standard No Score 27 1 28 X 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X 1 X 1 The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 18 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. 2. 3. 4. Standard OP38OP15 OP19 OP21 OP21OP38 Regulation 16(2)14 (1)&15(1) 23 (2) 23 13 Requirement The cooker must be repaired or replaced. The wardrobe must be repaired or replaced. Hot water must be available to all sinks. The hot water outlets in all service user areas must be thermostatically controlled to 43 degrees centigrade. The water temperature must be checked and recorded weekly to ensure it remains at 43 degrees centigrade. Items inappropriately stored in the first floor bathroom, shower room and fire escape stair well must be removed. A privacy curtain must be fitted to the ground floor bathroom window. There must be sufficient staff employed to cover holidays, sickness and to enable staff to attend training. The registered persons must ensure that staff working at the care home receive training appropriate to the work they are DS0000062776.V265239.R01.S.doc Timescale for action 06/12/05 31/12/05 06/12/05 06/12/05 5. OP21OP38 12 12/12/05 6. 7. OP24 OP27 16 & 23 18 12/12/05 31/12/05 8. OP30 18 31/03/06 The Carlton Nursing Home Version 5.0 Page 19 9. OP33 26 10. OP38 13(4) 11. OP38 23 (4) 12. OP38 23(4) to perform and suitable assistance, including time off, for the purpose of obtaining further training appropriate to such work. The registered provider must produce a regulation 26 report each month. A copy must be given to the registered manager with a copy forwarded to the Commission for Social Care Inspection. The time scales of 11.08.04, 31.05.05 and 01.08.05 have not been met. Failure to meet and sustain this requirement may lead to enforcement action being taken. There must be a member of staff trained in first aid on each shift The time scales of 11.08.04, 31.05.05 and the 30.09.05 have not been met. An action plan must be provided stating how and when the issues identified in the Fire Safety Officers Report dated 29 July 2005 will be addressed. The registered provider must ensure that weekly fire safety tests are carried out weekly. 06/12/05 31/12/05 06/12/05 06/12/05 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. Refer to Standard OP18 OP19 Good Practice Recommendations The whistle blowing policy should be reviewed to make it relevant to the care home. The dining room looks bleak and it is recommended that this area be redecorated, a new floor covering be provided and new curtains. DS0000062776.V265239.R01.S.doc Version 5.0 Page 20 The Carlton Nursing Home 3. 4. 5. 6. OP19 OP29 OP24 OP36 A programme of redecoration and refurbishment should be implemented. All staff should have a contract of the terms and conditions of their employment. Curtains should be properly hung on the curtain rail. All care staff should receive staff supervision at least 6 times a year. The Carlton Nursing Home DS0000062776.V265239.R01.S.doc Version 5.0 Page 21 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. Extracts may not be used or reproduced without the express permission of CSCI The Carlton Nursing Home DS0000062776.V265239.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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