Inspection on 29/11/05 for The Charlton Centre for Alzheimer`s and Dementia Care

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 Charlton Centre for... 19/08/09

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

The Charlton Centre for... 28/08/08

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... 11/08/05

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

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

CARE HOMES FOR OLDER PEOPLE Carlinghow Nursing Home Carlinghow Hill Batley West Yorkshire WF17 0AE Lead Inspector Stephen French Unannounced Inspection 29th November 2005 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 Carlinghow Nursing Home DS0000059693.V270715.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. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Carlinghow Nursing Home Address Carlinghow Hill Batley West Yorkshire WF17 0AE 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 Charlton Care Homes Ltd Mrs Lindsay Hudson Care Home 83 Category(ies) of Dementia - over 65 years of age (34), Old age, registration, with number not falling within any other category (49) of places Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th August 2005 Brief Description of the Service: Carlinghow Nursing Home is registered to provide a service for up to forty-nine elderly people who require nursing care and up to thirty-one elderly people with dementia. 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. Carlinghow Nursing Home DS0000059693.V270715.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, which took place on the 29th November 2005. Two Inspectors conducted the inspection over a nine-hour period. During the inspection a tour of the home was conducted, this included a number of service users bedrooms and the outside of the building. A selection of service users, and staff files were examined and the homes policies and procedures were seen. Not all of the standards were assessed during this inspection as the core standards were assessed during the previous inspection. Some of the requirements and recommendations made during the last inspection had been actioned. Those which have not have been actioned have been made again. Service users receive a satisfactory standard of care but documentation examined during the inspection did not reflect this. The manager must ensure that care plans are detailed and specific in order to inform the staff of the actions they need to take to meet the needs of the service users. What the service does well: What has improved since the last inspection? The standard of cleanliness within the Willows unit has improved. A number of staff have commenced formal training in the care of service users with dementia. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 6 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. Carlinghow Nursing Home DS0000059693.V270715.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 Carlinghow Nursing Home DS0000059693.V270715.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): Not assessed during this inspection. EVIDENCE: Carlinghow Nursing Home DS0000059693.V270715.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): 7,9 Although each service user has a care plan these are not always detailed enough and do not identify some of the service users specific needs. Omissions of signatures on the medication records could place the service users at risk. EVIDENCE: Six service users care files were examined as part of the inspection. Care plans had been formulated from information obtained from the community care and pre-admission assessment. There were risk assessments in place for such things as moving and handling, nutrition and skin integrity. A moving and handling assessment did not specify which hoist the staff should use when moving the service user. Although there were skin integrity assessments completed, an individual care plan was not in place for service users identified as being at risk from developing a pressure sore. The risk of pressure damage was recorded within a care plan for mobility and was not detailed enough to inform staff of the measures they were to take to prevent further damage to the service users skin. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 10 It was noted that the service user or their relative did not sign a risk assessment completed for a service user who required the use of bed rails. A care plan, which identified a service user with nutritional difficulties, stated that the service user was to be weighed monthly but the last recorded weight was September 2005. Weight charts in all of the care files inspected were not up to date and staff should ensure that the service users weight is recorded at least monthly. Daily entries in the care files inspected were poor and did not give sufficient detail of how the service user has spent their day. It was noted that in one care file examined staff had wrote the daily record at 09.40am this is unacceptable and would not reflect the care given throughout the day. Qualified nursing staff are responsible for the administration of medication. There are policies and procedures in place for the administration, ordering, storage and disposal of medication. Three service users stock of medication was checked against the medication administration records held by the home and the balances tallied. Following the administration of medication to a service user the nurse signs the medication sheet to confirm that the service user has been given the medication. It was noted that there were omissions of signatures on the medication records checked. This is a dangerous practice and could result in the service user being over medicated or not receiving their medication. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Where possible service users are able to exercise choice in most things they do within the home. EVIDENCE: Care plans examined clearly evidenced that service users are allowed and encouraged to maintain their autonomy and that the choices they make are respected by staff. There was evidence that service users are able to choose what time they rise and retire and were they spend their day. Those service users who are able are allowed to manage their own financial affairs. Service users bedrooms seen during a tour of the home were personalised with the service users own belongings such as ornaments, pictures and small pieces of furniture. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 12 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 Staff receive training in the protection of vulnerable adults. EVIDENCE: The home has a policy on abuse and a copy of the Kirklees policy and guidelines on the protection of vulnerable adults. It was noted, by the Inspectors that leaflets on abuse are displayed in the reception area for anyone to look at and take. Staff receive training in relation to abuse and how to report suspicions of abuse. An update on this subject has been arranged for January 2006. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 13 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): 19,21,23,24,25,26 The outside of the home is in a poor state of repair. Internally it requires some minor redecoration and replacement of bathing facilities to ensure it is safe and comfortable for the service users who live there. EVIDENCE: As part of the inspection a tour of the outside and inside of the building was undertaken this included a number of service users bedrooms. The outside of the building particularly to the rear of the property is in a poor state of repair and maintenance. Window frames are in need of replacement and the outside of the building requires painting. A number of down pipes are corroded and there was a broken window on the first floor. There were clinical waste bins and general waste bins overflowing at the back of the home and pieces of old furniture that requires removal. There are a number of communal toilets and bathrooms in close proximity to service users bedrooms and lounges. The flooring in one of the bathrooms identified as requiring replacing during the last inspection has not been Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 14 actioned. Consideration should be given to replace the baths in both bathrooms as there are badly stained and the glaze is cracked. The shower attached to the bath identified should be replaced as it is broken and a denture sterilising tube was holding it together. Items of toiletries such as shampoo and denture cleaning tablets should be removed from the bathrooms or stored in locked cupboards to prevent accidental ingestion by service users. There was a noticeable improvement in the standard of cleanliness within the Willows unit. There were still a number of bedrooms, which had an odour of urine, and discussion took place between the inspectors and the manager about suitable flooring material, which may prevent odours occurring. The registered provider should consider replacing the corridor carpet in the willow unit as it is raised in parts and could present a tripping hazard. Service users bedrooms were personalised with small items. A number of rooms are in need of minor redecoration. The manager informed the inspectors that there were plans to redesign the layout of the home and he was waiting until this work is completed before redecorating all the rooms. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 15 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): 29 The home must ensure that prior to employing staff they must obtain the documents outlined in Schedule 2 of the Care Standards Act to ensure the protection of service users. EVIDENCE: Three staff details were checked for staff recently employed by the home. These files contained application forms, medical questionnaires, references from previous employers and proof of the person’s identity. Checks had been made with the Criminal records bureau to ensure staff did not have a criminal record. One file checked only contained one reference, which is unsatisfactory. The manager must ensure that two written references are obtained prior to a new member of staff commencing employment. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 16 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): 31,38 The manager is required to undertake the fit person process completed by the Commission for Social Care inspection in order to ensure he is a fit person to manage the home. The health and safety of service users and staff are promoted and protected. EVIDENCE: The acting manager was previously the deputy manager at the home. He is a qualified nurse with experience of nursing this particular service user group. He is waiting to be registered as the manager following completion of the fit persons process undertaken by the Commission for Social Care Inspection. He is hoping to develop the home into a centre of excellence for the care of people with dementia. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 17 Staff have received training in fire prevention and moving and handling. A number of staff have undertaken health and safety training. The fire alarm system is checked weekly and the last fire drill was held on the 29/11/05. Certification in relation to electrical equipment was in place and up to date. Service contracts are in place for specialist equipment such as hoists. A recommendation following the last inspection surrounding the prevention of cross infection to service users has not been actioned. Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 18 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 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 1 X 2 x 3 3 1 1 STAFFING Standard No Score 27 X 28 X 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x X X X X X 2 Carlinghow Nursing Home DS0000059693.V270715.R01.S.doc Version 5.0 Page 19 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 12 (1) a Requirement Care plans must be in place for service users identified as being at risk from pressure damage. They must have measurable goals and be specific in their detail in order to instruct staff what they are required to do to meet the needs of the service user. Risk assessments must be reviewed and if they identify a service user as being at risk then steps must be taken to reduce those risks. (Outstanding from previous inspection 30/9/05) The registered person must ensure the safe recording and administration of medication. (Outstanding from previous inspection 30/9/05) The building must be kept in good state of repair. Attention should be given to the windows, guttering and down pipes. The home must be kept free from offensive odours (Outstanding from previous DS0000059693.V270715.R01.S.doc Timescale for action 29/11/05 2. OP9 13 (2) 30/09/05 3. OP19 23 (2) b 31/12/05 4. OP26 16(2) k 31/01/06 Carlinghow Nursing Home Version 5.0 Page 20 5. OP29 19 (1) b 6. OP38 13 (3) inspection 31/10/05) The home must obtain the documents as specified in Schedule 2. (Outstanding from previous inspection 30/9/05) A policy must be put into place to ensure the disinfection of baths following there use. (Outstanding from previous inspection 31/10/05) 29/11/05 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Daily entries in service users care files should be reflective of the service users psychological and social well being. Service users should be weighed at least monthly. Moving and handling plans should include the type of hoist to be used. Daily entries in the care files should not be recorded until the end of the shift. The rubbish at the rear of the home should be removed. Consideration should be given to provide a more suitable floor covering for service users who have been identified as having problems with continence. Replace the flooring in the toilet identified during the inspection. Replace the two baths and shower tubing Consideration should be given to replace the corridor carpets in willow wing. Toiletries should not be left in the bathrooms. Clinical waste bins should be kept locked. 2. 3. 4. OP19 OP23 OP21 5. 6. 7. OP25 OP26 OP38 Carlinghow Nursing Home DS0000059693.V270715.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 Carlinghow Nursing Home DS0000059693.V270715.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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