Inspection on 28/08/08 for The Charlton Centre for Alzheimer`s and Dementia Care

This inspection was carried out on 28th August 2008.

CSCI found this care home to be providing an Poor service.

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 Charlton Centre for... 19/08/09

The Charlton Centre for... 25/02/09

The Charlton Centre for... 26/02/08

The Charlton Centre for... 31/10/07

The Charlton Centre for... 19/10/06

The Charlton Centre for... 29/11/05

The Charlton Centre for... 11/08/05

The Charlton Centre for... 20/12/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE The Charlton Centre for Alzheimer`s and Dementia Care Carlinghow Hill Batley West Yorkshire WF17 0AE Lead Inspector Tony Brindle Key Unannounced Inspection 28th August 2008 10:00 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 DS0000059693.V370803.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. DS0000059693.V370803.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Charlton Centre for Alzheimer`s and Dementia Care Carlinghow Hill Batley West Yorkshire WF17 0AE Address 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) 01924 473333 01924 444344 ivor@charltoncare.com Charlton Care Homes Ltd Mr Ivor Charles Foster Care Home 67 Category(ies) of Dementia (67) registration, with number of places DS0000059693.V370803.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 67 26th February 2008 2. Date of last inspection Brief Description of the Service: The Charlton Centre for Alzheimer’s and Dementia Care (previously known as Carlinghow Nursing Home) is registered to provide a service for up to sixtyseven elderly people with dementia who require nursing care. The home is a large detached stone built property that was converted into a care home from the former Batley General Hospital. The home has three floors connected by a passenger lift. The home is situated on Carlinghow Hill close to Nightingale Cottage Nursing Home, its sister home. Local amenities are within ten minutes’ walking distance. The home is well served by public transport. There is ample parking space at the home. In August 2008, the fees ranged from £464.00 to £1,786.35 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 Guide. DS0000059693.V370803.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero (0) stars. This means the people who use this service experience poor quality outcomes. This unannounced visit started at 10:00 hours and ended at 17:00 hours. There was the opportunity to speak to people living at the home as well as the acting manager, the owner and care staff. Five people’s records were seen and included assessments, care plans, daily and medical records and the record of activities. Five staff records were also seen and included, application forms, references, police checks, training and supervision records. A sample of people’s medications and finances were checked and a look around the home was undertaken. The Annual Quality Assurance document for the service was not available as it had not been completed and returned to the Commission in time for the inspection. The records held by the Commission show that over the last six months, the service has had a lot of support from external agencies. The local mental health trust had provided a nurse to work in the home and give advice and support to the staff about dementia care nursing, and the local authority had had their Contract Compliance staff going into the home on a weekly basis monitoring practice. Following the deaths of four people at the home, the local authority had a number of Safeguarding meetings to ensure that people were safe. The circumstances surrounding these deaths were referred onto the Police, and at the present time, they are undertaking an investigation. Following the Safeguarding meetings, the local authority put Safeguarding Plans in place for everyone living in the home to ensure that people received the correct care. At the time this site visit took place, the local authority were considering deploying one of their owner Group Managers into the home to provide extra management support. The records held by the Commission show that over the last six months, the service has had a lot of support from external agencies. The local mental health trust had provided a nurse to work in the home and give advice and support to the staff about dementia care nursing, and the local authority had had their Contract Compliance staff going into the home on a weekly basis monitoring practice. Further to this, the local authority have had Safeguarding Plans in place for everyone living in the home, and at the time this site visit took place, the local authority were considering deploying one of their owner Group Managers into the home to provide extra management support. Since the registered manager went on sick leave in February 2008, a “crisis DS0000059693.V370803.R01.S.doc Version 5.2 Page 6 manager” has been in place. This person is an independent management consultant. This person’s role, as described by the owner of the service, has been to bring about improvements in the service and to raise standards. One of the unit managers has been working as the Acting Manager. The Commission have undertaken two random visits to the home since the last key inspection in February 2008. We would like to take the opportunity to thank the crisis manager, the owner and their staff team for their hospitality, and people using the service and their relatives for their patience and co-operation throughout the visit. What the service does well: What has improved since the last inspection? What they could do better: People’s health and welfare is potentially being out at risk by way of poorly written care plans that do not reflect their individual care needs. People’s health and welfare are being put at risk because of inconsistencies in the way that risks are assessed. People have been put at risk by the introduction of potentially dangerous or unrecognised restraint techniques. Opportunities needed to be provided for people to engage in creative and meaningful activities that are linked to their interests and capabilities. Greater attention needs to be paid to the way some meals and snacks are presented, DS0000059693.V370803.R01.S.doc Version 5.2 Page 7 the food choices that are available to people and the manner in which they are supported to eat their meals. In certain areas of the home, people’s living environment could be enhanced by way of signage, redecoration and improvements in the layout of furniture, as these improvements would help people get around the home, promote independence and create a more stimulating living environment. Work to comply with the Fire Officer’s report would further enhance people’s living environment. Clear leadership is needed to ensure the staff team put into practice what they have learnt through training. Better leadership, clearer record keeping and improvements in the way in which risks are assessed and managed would further enhance the outcomes for people using the service. 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. DS0000059693.V370803.R01.S.doc Version 5.2 Page 8 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 DS0000059693.V370803.R01.S.doc Version 5.2 Page 9 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 (6 - Intermediate Care services are not provided) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are satisfactory systems and procedures in place to ensure that when followed, people’s needs would be assessed appropriately prior to admission, and opportunities would be available to people to visit the home. EVIDENCE: The crisis manager explained that no admissions had been made to home since the start of year, and this was due to the fact that the Local Authority had put a hold on admissions to the home following a contract compliance visit, which found a number of breaches in the contract. She explained that these needed to be rectified before admissions recommenced. She added that at a recent Contract Compliance visit, the Local Authority officers had indicated that improvements had been made at the home, but work needed to continue in order to bring about further improvements. Once these had been made, then a DS0000059693.V370803.R01.S.doc Version 5.2 Page 10 decision would be taken about reinstating admissions. A discussion with a Local Authority office following this site visit, confirmed this. At the last key inspection, the evidence indicated that prior to admission, people’s needs were assessed either by the manager of the home or another nurse, and that these assessments usually took place where the person was living, either their own home, in hospital or another care setting. The records showed that the service obtains an up to date copy of any local authority or healthcare specialists care needs assessment. The crisis manager explained that new people looking to move in the Charlton Care Centre would be encouraged to visit the home, and would be given the opportunity to freely meet the staff and other people living at the home, and visit the different parts of the building. These comments were supported by way of appropriate policies and procedures that were seen to be available to staff. The crisis manager added that there are systems in place, which would mean people being given a written statement of terms and conditions or a contract, and this would include information about fees, liability, and the overall care provided by the service. A copy of a standard contract was seen and found to be satisfactory. DS0000059693.V370803.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements in the way medication is dealt with in the home have taken place, and people do have care plans that reflect their basic needs. However, people’s health and welfare is potentially being put at risk by way of poorly written care plans that do not reflect their individual care needs. People’s health and welfare are being put at risk because of inconsistencies in the way that risks are assessed. EVIDENCE: Observations made on one unit found that some of the staff members were undertaking an observation of people’s mood and behaviour on a 15 minute basis, which was then recorded on a tick sheet. As this was being carried out, very little social interaction took place between the staff member and the various people being observed. When the unit manager was asked about what DS0000059693.V370803.R01.S.doc Version 5.2 Page 12 the observation information was being used for, and how the collection of the data had brought changes to the care and support people were being offered, he explained that the data had not really been used to influence the care and support people were receiving, but had been useful in a few instances to determine what factors had influenced people prior to an incident or violent outburst. One staff member who was spoken with indicated that they spend a lot of time walking around observing people and ticking a tick sheet in order to provide information and data that isn’t really used, and felt that their time could be better spent supporting people, talking to people and generally providing care to people. This point was discussed with the crisis manager who agreed that there was a need to evaluate the use of the observation tool in order to establish how the data was going to be used to improve outcomes for people. It was explained to the crisis manager that on the unit, staff were seen to be spending lots amounts of time on tasks such as cleaning, laundry and taking people to the toilet, which are all valid tasks. However, in between undertaking these tasks, very little interaction took place between the staff and the people living on the unit. The crisis manager explained that the staff have had training in person centred care principles, and are encouraged to interact with people, but she acknowledged that clear leadership is needed on a day-to-day basis in order that these principles and practices become the norm. Some good examples of person centred practice was observed with staff members involving people in decisions or giving them a say in how they would like their care to be delivered. One staff was seen to work very sensitively with a person who was distressed, another was observed to thoughtfully engage with a person who was confused. The crisis manager said that she had no doubts about the motivation and commitment of the care and support staff, and this was supported through observations and discussions with them. Information held within the records at the home showed that people do have their own care plan. A detailed look at the plans found that they contain information about people’s life history, and only record simple health and personal care needs. There was little or no evidence to show that the individual had been involved in the development of their plan, and the information contained within the plans did not adequately reflect people’s diverse needs, their current situation or any future plans they may have. The care plans of two people living on different units, with very different needs were compared, and it was found that both individuals had almost the same care plans. This was discussed with the crisis manager who explained that as part of the ongoing improvement plan within the home, a series of generic care plans had been devised and given to everyone living in the home, and there was an expectation that staff would individualised the plans in due course in order that they would reflect people’s specific needs. However, it was pointed out to her, that the individualising of the care plans had not taken place, and DS0000059693.V370803.R01.S.doc Version 5.2 Page 13 she acknowledged that further work had to take place in order to ensure that the care plans were individualise and person centred. The plans that were looked had been signed by members of staff, but had not been signed by the people receiving the care, or their representative. The crisis manager explained that it is the responsibility of the staff on each unit to get either the person themselves, or their relatives and representatives to agree and sign care plans. There was evidence within the care plans to show that internal reviews of people’s care had taken place, and the crisis manager explained that in recent months, people’s care has been externally reviewed with the involvement of the local authority. It was noted that there were inconsistencies in the way care plans of people with similar needs had been internally reviewed, with some being reviewed in great detail while others only briefly. When this was discussed with the crisis manager she explained that this was down to the ways in which individual staff undertook reviews, and acknowledged that this highlighted a training need. Information held within people’s files showed that risk assessments had been undertaken and the findings of those assessments had been recorded, with information written down to show the staff what actions they need to take to either eliminate or reduce those risks. However, it was noted that one assessment for an individual said that they needed to sit “bolt upright in a chair when eating” so as to reduce the risk of choking. When this person was observed over lunchtime, it was clear that they were not sitting in the correct position as detailed with the assessment, as the chair being used was in appropriate for the task of sitting “bolt upright”. This was discussed with the crisis manager who said she would look into the issue as a matter of urgency, and try and find another chair, and speak to the speech and language therapist. One person’s file was found to be contain a risk assessment associated with aggressive behaviour but this didn’t provide an intervention plan for staff to follow. It was pointed out to the crisis manager that there was an “advisory care plan” in place, which was not signed by the author and this gave advise to staff about how to deal with aggression, particularly if the person grabbed out. The “advisory care plan” described a “thumb or finger curl technique” which could be used by the staff to release the person’s hold. When this was discussed with the crisis manager, she explained that a physiotherapist from the hospital had shown her the technique but had said he was unable to provide training to the staff, or to show them directly, and she added that the physiotherapist had advised her that she would have to do show the staff what to do. The crisis manager explained that there was a photographic sheet in the care plan showing the staff how to release a person’s thumb using the curl technique, and she added that she had shown staff how to do this. DS0000059693.V370803.R01.S.doc Version 5.2 Page 14 A discussion took place with the crisis manager about this, and it was pointed out to her that any physical intervention needs to be taught by an accredited trainer, as they will be familiar with the all the good practice techniques. The crisis manager was advised that she should ensure that the technique shown to her by the physiotherapist was one that was recognised as being good practice, and also that she should make enquires about accredited training for staff in physical intervention techniques. A risk assessment relating to a person’s moving and handling needs was seen, but on further investigation it was found that the person was fully ambulant, which led to a discussion taking place regarding the manner in which documentation is sometimes completed generically, rather than according to individual needs. The crisis manager agreed that this was an indicator that the staff were not thinking about meeting the needs of people in a person centred way. It was noted that in one person’s care plan, it was recorded that they needed bed rails but no risk assessment could be found. It is clear from observations of people living at the home, and through looking at information contained within their care plans, that for the majority of people their ability, to make decisions and influence the daily routines within the home is difficult due to their limited cognitive capacity. It was discussed with the crisis manager that this lack ability to influence the day-to-day routines within the home, needs to be compensated for, and that one of the best ways to do this is through creative care planning geared to people’s individual needs, wishes and aspirations. She agreed that this would be a good way forward. A CSCI pharmacist inspector again attended on this visit and conducted an audit of the systems in place for managing medications at the home. The pharmacist inspector found evidence of improved practice in the management of people’s medication. The records show that the medicines policy has now been updated and provides detailed information on the procedures for handling medication based on national guidance. However, it was noted that the policy should include specifics relating to the home such as the supplying pharmacy details and who collects waste medicines. This was pointed out to the crisis manager. The current Medication Administration Records (MAR) and a sample of previous months MAR were looked at on both the Birch and Cedar units. Information on the MAR showed that the recording of medicine administration had improved. It was pointed out to the crisis manager and unit manager that the problem with out of stock medication was being managed well, as the correct information about medications was being placed on the MAR, and it was highlighted that this means that people in the home can receive their medication as intended by the prescriber. DS0000059693.V370803.R01.S.doc Version 5.2 Page 15 The records show that there is now a system in place to record disposed medication on both units. However it was noted that on Birch unit, there was no facility to store the waste medicines before collection. The nurse in charge explained that they had a new waste collector and there was a delay in the supply of containers from the new collector. However a large medicine waste bin was found on the Cedar unit that could be used by Birch. It was noted that medication for one person had been stopped and the stock had been removed from the controlled drugs cupboard. No record of the disposal of this medication could be found in the home to demonstrate that the medication had been safely disposed of. The unit manager was asked to make enquiries about this, and successfully located a written record of the disposal, and the supplying pharmacy later confirmed that the medication had been returned to them for disposal. The crisis manager confirmed that the person in charge of ordering the monthly medication does not have sight of the prescriptions before a supply is made. It was pointed out that this means that there is no way of checking if any new medicines or dose changes are included on the prescription before the supply from the pharmacy arrives. It was explained to the crisis manager that as a point of good practice, this should be part of the home’s medication policy as problems with prescriptions can be addressed at this point rather than after the supply has been made. The date of opening on liquid medicines is not always recorded on the MAR. It was pointed out that this was of particular concern for one liquid medication that was found to be limited to one month’s use once opened. As there were a number of opened bottles in use and it was difficult to know if they had been in use for less than a month. It was explained to the crisis manager that this puts people at risk of receiving medication that may have deteriorated and may not be safe to use. Information within the records showed that medication reviews had taken place for a number of people, and as a result people had had their medical condition assessed and their medication amended accordingly. Good detailed records of these changes were found within people’s files, with copies of letters from healthcare professionals who were involved in the process. DS0000059693.V370803.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities needed to be provided for people to engage in creative and meaningful activities that are linked to their interests and capabilities. People receive enjoyable food, however, greater attention needs to be paid to the way it is presented, the choices that are available to people and the manner in which they are supported to eat their meals. EVIDENCE: Observation made on the day showed that some of the staff make the effort to engage people in activities. The activities organiser was seen to speak to people on one unit and tried to engage people in an exercise activity that involved passing a balloon to each. People didn’t show any interest in this activity. The staff were seen to offer people a drink at 10.45am from a trolley that was well stocked with different fruit juices, tea, coffee, biscuits and fruit. Some DS0000059693.V370803.R01.S.doc Version 5.2 Page 17 people were offered toast that was served with butter and jam already on it. This toast was served on paper napkins. Staff were seen to be kind and sensitive with people, particularly when two people were having difficulty with each other, the staff distracted them and redirected them sensitively. People living on both units of the home were seen to have little to occupy them other than some music that was playing on a CD player. There were no magazines or newspapers available on one unit, however, on the other unit a newspaper was seen to be available. Staff were seen to spend small amounts of time chatting to people, and the interaction was seen to be positive. At mealtimes, tablecloths were seen to be on the tables but no condiments were available. Staff served drinks from large jugs into coloured plastic beakers. The meals were plated up for people, and some people were supported by using plate guards and adapted cutlery. The staff were seen to help and support people with their meal in a sensitive and discreet manner. However, one staff member that was supporting one person, had to go and help another. A nurse then took over, and stood over the person, gave them a mouthful of food, then moved on to do something else. This point was raised with the crisis manager who acknowledged that training and leadership was still required in this area of care and support. For those people who refused food, alternatives were given. One person who hadn’t sat down all morning was given sandwiches which they ate as they walked. The care plan of once person indicated that they should eat their food in a bolt up right position in order to eliminate the risk of choking. This person was seen to be sitting in a bucket chair, and not in an upright position. The staff realised that we were discussing this, and immediately tried to sit the person up, however, they were still not fully in a bolt up right position. This point was raised with the crisis manager, and she said she would look into the issue Obtaining verbal feedback from people living at the home regarding quality issues is quite difficult due to their individual capability levels. However people’s non-verbal feedback indicated that on the whole they were satisfied with the food they were provided with, and the meals were seen to be nicely presented and the variety on offer was seen to be satisfactory to meet people’s dietary needs. One staff member said that there are few opportunities for people to be involved in food shopping or the preparation of meals. However, sometimes when people go out for walks or a visit to the shops, small items of food are bought such as sweets. DS0000059693.V370803.R01.S.doc Version 5.2 Page 18 Some relatives who were visiting said that they thought the food was good, but added that they thought they should be more for people to do, at times suitable to them and not the staff. DS0000059693.V370803.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure for people to follow, and people know how to complain. People’s best interests are promoted by way of good staff training in the area of Adult Safeguarding, however, this has been put at risk by the introduction of potentially dangerous or unrecognised restraint techniques. EVIDENCE: A copy of the complaints procedure was displayed in the reception area. The records held by the crisis manager show that no complaints have been received since the last full inspection in February 2008. Two visitors who were spoken with said that they would be happy to make a complaint if they had one, and they added that they knew who to speak to about concerns about quality issues with in the home. The staff training files show that staff have recently had Adult Safeguarding training, and following a discussion with two staff member, it was clear that they understood the home’s Safeguarding policy, and were able to explain what abuse was, and what to do if they suspected it or witnessed it. The crisis manager explained that she keeps a file of all the incidents and accidents that go on in the home, and confirmed that if there is an suspicion of abuse, then a DS0000059693.V370803.R01.S.doc Version 5.2 Page 20 referral is made to the Local Authority. Information held within the records confirmed this. The crisis manager explained that several nurses and some care staff are currently suspended from working at the home, following a number of adult safeguarding referrals and investigations by both the local authority and the Police. She added that these investigations are on going, and their conclusions have not yet been reached. We explained to the crisis manager that we are in contact with all the agencies involved in these investigations and that we are aware of the nature of the allegations made against the staff. It was explained to the crisis manager that the use of an unrecognised restraint technique, as previously mentioned, could potentially put both the staff and the person living at the home at risk of harm. We added, that in encouraging the staff to use this technique without undertaking the proper checks on its impact was an indicator that the rights of people living at the home to be protected from potential abuse, had not properly been considered. DS0000059693.V370803.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In certain areas of the home, people’s living environment could be enhanced by way of signage, redecoration and improvements in the layout of furniture, as these improvements would help people get around the home, promote independence and create a more stimulating living environment. Work to comply with the Fire Officer’s report would further enhance people’s living environment. EVIDENCE: The home was seen to be tidy, however, it was pointed out that one unit there was an unpleasant smell, and the staff and crisis manager explained that they believe it to be carpet. They explained that food is often dropped onto the floor DS0000059693.V370803.R01.S.doc Version 5.2 Page 22 during mealtimes, and at night the carpet is cleaned. However, the carpet is never left for long enough to dry, and as a result a damp smell is always present. One of the units is currently closed and is due to be refurbished. A second unit has had a complete refurbishment, and the owner confirmed that it is his intention to undertake a refurbishment of the third unit. One relative who was spoken with said “this unit needs a complete revamp”. A staff member agreed that the lounge area of the unit needed to be looked at as it didn’t provide a very stimulating environment for people. It was noted that a plaster wall needed to be decorated. The owner and maintenance worker confirmed that at present, essential maintenance is only done when a problem has already arisen. On one unit, memory boxes are used. These boxes are located near to people’s bedroom doors, and contain personal mementos such as photographs, and as described by one the staff, can provide an aid to reminiscence, way finding and interaction. It was pointed out to the owner and crisis manager that the use of such memory aids may well benefit the people living on the other unit, and putting them together provides an opportunity for personal interaction and engagement. It was noted that on one of the units, there is a distinct lack of signage to enable people to orientate themselves. It was explained to the crisis manager and owner that the use of good signage significantly contribute to the support of people’s independence and security. The crisis manager agreed that signs that are highly visible can be used to provide an effective and essential wayfinding function. The owner explained that he is looking into this, alongside eye-catching boards that can be used write up menus and any activities that are taking place. A look around people’s bedrooms showed that they have been given the opportunity to bring their own belongings into the home. The bathrooms were seen to contain sufficient and appropriate aids and adaptations to meet people’s needs. The crisis manager explained that the Fire Officer had recently undertaken an inspection, and had highlighted a number of areas where improvements to the building were required in order to comply with Fire Regulations. She added that she did not have the report to hand, and was asked to forward a copy to the Commission. DS0000059693.V370803.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a kind and caring staff team that have undergone training. However, clear leadership is needed to ensure the staff team put into practice what they have learnt through training. People’s best interests are promoted by way of a satisfactory recruitment procedure that ensures that the correct pre-employment checks are undertaken on new staff. EVIDENCE: Relatives who were spoken with said that they thought that the care being provided with satisfactory, but that at times people do have to wait for some time for staff support and attention. A number of people using the service said that the staff were very kind and caring. One person said, “I love all the staff”, another said “the staff are very good to me, they make me feel special”. Observations on the day found that generally, staff work in a sensitive manner with people, giving people time to do things, talking to people in a kind and caring way and being discreet about personal care issues. However, as previously mentioned, during lunch, some poor practice was observed with DS0000059693.V370803.R01.S.doc Version 5.2 Page 24 staff not providing people with the right level of support while eating their meals. The rotas show that there are currently sufficient numbers of care staff working during both the day and night. The service only has 3 permanent qualified nurses, and the rotas show that shifts that cannot be covered by the permanent nurses are covered by agency staff. The crisis manager said that she tries to get the same agency staff to cover shifts as this provides consistency for the people using the service. Information held within the rotas showed that on the whole, the same agency staff are used to cover shifts. When asked about why there is a high use of agency staff, the crisis manager explained that this is because there are currently a number of nurses under suspension, and that until their suspension is either lifted, or they leave the company, it is difficult to recruitment new nurses due to financial constraints. During the site visit, the owner arrived, and he explained that employment meetings would be taking place soon with the staff that are suspended, and after these have taken place, he will have a good idea as to the best way to ensure that the home has a permanent staff team. The crisis manager explained that over the last six months, a lot of time and investment has gone into staff training, and that all the staff have received a programme of statutory training, alongside other training such as dementia care. Information held within the personnel files showed that staff had received statutory training along with other training, and that there is a satisfactory induction scheme in place. One staff member said that they were tired out with all the training, but that they had really enjoyed doing it. A discussion took place with the crisis manager and owner of the service about the need to ensure that once the staff are trained, they are given good leadership so as to make sure they put their training into practice. The crisis manager said that some of the senior care workers are very good at doing this, but added that further training is required to ensure consistent leadership is provided. Information held within the records at the home shows that the service has a satisfactory recruitment procedure. At previous inspections a number of gaps in the personnel information were identified: a check of the files found that these gaps have now been filled, and also showed that the correct employment checks had been carried out on new staff working at the home. DS0000059693.V370803.R01.S.doc Version 5.2 Page 25 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 32 33 35 38 Quality in this outcome area is adequate. Although improvements in the manner in which the service is managed have taken place, better leadership, clearer record keeping and improvements in the way in which risks are assessed and managed would further enhance the outcomes for people using the service. EVIDENCE: The home currently does not have a registered manager. The owner of the service explained that the registered manager had been on sick leave recently, but had subsequently resigned. Since the registered manager went off sick, a crisis manager from a management consultancy firm had been in place. DS0000059693.V370803.R01.S.doc Version 5.2 Page 26 The records held by the Commission show that over the last six months, the service has had a lot of support from external agencies. The crsis manager explained that the local mental health trust had provided a nurse to work in the home and give advice and support to the staff about dementia care nursing, and she added that the local authority had had their Contract Compliance staff going into the home on a weekly basis monitoring practice. Information held within the records at the home showed that following the deaths of four people at the home, the local authority had a number of Safeguarding meetings to ensure that people were safe. The crisis manager explained that the circumstances surrounding these deaths had been referred onto the Police, and at the present time, they (the Police) were undertaking an investigation. She added that following the Safeguarding meetings, the local authority had put Safeguarding Plans in place for everyone living in the home to ensure that people received the correct care. The records show that at the time this site visit took place, the local authority were considering deploying one of their owner Group Managers into the home to provide extra management support. The owner of the service explained that the management arrangements were soon to change. He said that the crisis manager was soon to leave, and that a new manager would take her place, adding that the new manager had a number of years experience working in the field of dementia care, and that they were qualified for the job. A discussion took place with owner about how he would ensure that recent improvements made at the home were not jeopardized by a change in the management arrangements, and the support from external agencies. He explained that the company’s operations manager would soon be returning to overseeing the Charlton Care Centre, adding that she will be involved in monitoring the service through auditing and management visits. The crisis manager explained that incidents do take place from time to time such as falls, or disagreements between people living at the home, but added that she felt there were sufficient risk assessments in place to ensure that risks are either reduced or eliminated. The records show that they are a high number of accidents and incidents, but also shows that these are properly recorded and reported. The training records show that staff have recent training in safe working practices. However, as previously mentioned, a lack in the attention paid to risk assessments and the use of potentially dangerous restraint techniques raises questions about safety issues and management oversight. The records show that there are satisfactory systems in place to protect people’s monies with policies and procedures for staff to follow, and a check made on the day found people’s financial records to be in good order. DS0000059693.V370803.R01.S.doc Version 5.2 Page 27 A discussion took place with the owner of the service about the need to provide with Commission with financial information, so that a judgement can be made about the home’s financial viability. The owner explained that he would provide this information to the Commission, and it was explained to him that we would write out to him again with a formal request for this. The records show that general health and safety checks on the fire system, equipment such as hoists and the lift and the water system take place periodically, and were found to be satisfactory. The crisis manager explained that the Fire Officer had recently undertaken an inspection, and had highlighted a number of areas where improvements to the building were required in order to comply with Fire Regulations. She added that she did not have the report to hand, and was asked to forward a copy to the Commission. DS0000059693.V370803.R01.S.doc Version 5.2 Page 28 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 X 2 X X X X 2 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 2 2 2 X 3 X 1 1 DS0000059693.V370803.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement The registered provider must ensure that the care plans contain specific details of how the individual needs of each individual person are to be met, with particular attention to dealing with aggression, eating and posture, so that the care people receive is person centred and based on people’s individual needs, wishes, desires and preferences. OUTSTANDING REQUIREMENT FROM 26/2/08, 24/4/08 and 26/6/08. The registered provider must ensure that when risk assessments are carried out, their implementation is closely monitored, with particular attention to dealing with aggression, eating and posture, so that any identified risks to a person’s health and well-being are either reduced or eliminated. OUTSTANDING REQUIREMENT FROM 26/2/08, 24/4/08 and 26/6/08. DS0000059693.V370803.R01.S.doc Timescale for action 17/11/08 2 OP8 OP38 12(1)(a) (b) 13(1)(a) (b) 17/11/08 Version 5.2 Page 30 3 OP18 OP38 12(1)(5) 13(6)(7) (8) 4 OP19 23 4 OP33 26 The registered provider must 17/11/08 ensure that the use of any restraint technique does not put people at risk of harm or abuse, and that if restraint techniques are to be used, only those that are officially recognised are used, their use and circumstances is recorded, and training is sought from an accredited trainer so as to ensure that best practice is always being implemented within the home. OUTSTANDING REQUIREMENT FROM 26/2/08, 24/4/08 and 26/6/08. The registered provider must 17/02/09 ensure that the requirements of the latest Fire Officer’s report are acted upon so as to ensure people’s health and safety is promoted within the home. A copy of that Fire Officer’s report must be forwarded to the Commission (by 17/11/08) so we are made aware of the requirements made within it, and so that we can monitor the progress made by the registered provider. The registered provider must 17/11/08 make sure that a monthly visit is made to the home and a report regarding this visit is completed relating to conduct of the home so as to ensure that he is fully aware of how the home is operating. This report must be forwarded to the Commission until further notice so that we can monitor the conduct of the home as part of our ongoing inspection processes. OUTSTANDING REQUIREMENT FROM 26/2/08, 24/4/08 and 26/6/08. DS0000059693.V370803.R01.S.doc Version 5.2 Page 31 5 OP37 OP38 17 13 (2-4) The registered provider must ensure that all the care plan records and risk assessments records are keep up to date, and reflect the current needs and situation of all people living at the home so as to ensure people’s individual needs are effectively met on a day to day basis. 17/11/08 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 Refer to Standard OP9 Good Practice Recommendations The registered provided should ensure that staff the systems relating to medication are based upon best practice, which in turn if implemented, would enhance the outcomes for people living in the home. These include: • the medication policy should include specifics relating to the home such as the supplying pharmacy details and who collects waste medicines. A facility to store the waste medicines should be provided on both units. There should be a system in place to ensure that before collection staff working in the home should have sight of the prescriptions before a supply is made, as there is no way of checking if any new medicines or dose changes are included on the prescription before the supply from the pharmacy arrives. • • 2 OP12 The date of opening on liquid medicines should always be recorded on the MAR. The registered provided should ensure that opportunities are provided to engage people in creative and meaningful activities that are linked to their interests and capabilities in order to enhance the outcomes for people during the DS0000059693.V370803.R01.S.doc Version 5.2 Page 32 • 3 OP15 day. The registered provider should ensure that greater attention is paid to the way that meals are presented, and ensure that the choices are made available to people in order to enhance people’s experience of mealtimes in the home. Greater attention should be paid to the manner in which people are supported to eat their meals so that needs are met, and their experience of mealtimes is enhanced. The registered provider should ensure that in certain areas of the home, people’s living environment is enhanced by way of signage, redecoration and improvements in the layout of furniture. These improvements would help people get around the home, promote independence and create a more stimulating living environment. The registered provider should ensure that all areas of the home are kept clean, tidy and free from unpleasant smells so as to enhance the living environment of people living in the home. The registered provider should ensure that clear leadership is demonstrated to all staff working in the home so that an effective staff team correctly meets the needs of people using the service. The registered provider should ensure that there are effective quality assurance and quality monitoring systems in place so that views of people using the service can be sought, which would then enable a judgement to be made by the provider about the effectiveness of the service in meeting people needs and expectations. 4 OP19OP22 5 OP26 6 OP32 7 OP33 DS0000059693.V370803.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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