Key inspection report CARE HOMES FOR OLDER PEOPLE
The Charlton Centre for Alzheimer`s and Dementia Care Carlinghow Hill Batley West Yorkshire WF17 0AE Lead Inspector
Liz Cuddington Key Unannounced Inspection 15:00 19 &20th August 2009
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DS0000059693.V377265.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.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 Beverley Dyrlaga Care Home 67 Category(ies) of Dementia (67) registration, with number of places The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.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 25th February 2009 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 care and accommodation for up to sixty-seven older people with a diagnosis of a dementia, who require specialist 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. Information about the home and the services provided are available from the home in the Statement of Purpose and Service Users’ Guide. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.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 one star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The provider informed us that the fees range from £521:52 to £900:00 per week, depending upon the level of people’s care and support needs. There are additional charges for hairdressing, newspapers, magazines and other personal expenses. The purpose of this inspection was to assess the quality of the care and support received by the people who live at Charlton Care Centre. The visit to the home was carried out over two days by two inspectors. The last key inspection was in February 2009 and there was also a random inspection in May 2009, to check that the home had complied with the requirements made in February 2009. The methods we used to gather information included conversations with the people living at the home, their relatives, the staff and visiting healthcare professionals as well as looking at care plans and examining other records. We received the homes self-assessment questionnaire before the inspection visit. We also received eight surveys from people who live at the home and five from the staff. These all gave us a lot of useful information about the home and helped us plan the visit. What the service does well:
The home is now being well managed and run in the best interests of the people who live there. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 6 The people who live at Charlton Care Centre said they are happy and the home has a welcoming atmosphere. We were told that the staff do what people want in the way people prefer. Everyone we spoke to said they are satisfied with the care and support the staff at the home offer. One person said they are very happy with the care their relative receives; the staff are ‘…all very caring…’ and they look after people very well. One person said that ‘The new unit manager on Cedar Unit…is excellent and very approachable.’ Another person said the staff ‘…take good care of me and are very friendly.’ One relative said that they were very happy with the care and the ‘staff are lovely, they keep me informed if (my relative) is not well.’ Another relative said ‘All the residents look really well looked after, better than they used to.’ Other relatives also said they are generally happy with the care people receive and felt that the staff seem to understand how best to support people. There is good and friendly interaction between the people who live at the home and the staff. There were enough staff on duty to make sure they have time to spend with people in conversation as well as supporting people to take part in individual and group activities. We spent a lot of time on both days, observing how people’s care and support needs were being met and how people and staff were interacting together. The staff have a calm and relaxed approach and everyone was given all the time they needed to eat their meals, choose what leisure activities to follow and make other decisions about their daily lives. Before moving into Charlton Care Centre, peoples care and support needs are assessed, to make sure that the home is able to meet their needs. Everyone said that staff listen to them, and act on what they say and people said they like the meals and enjoy the activities. One person said that their relative eats well at the home and enjoys the meals. The staff understand the needs and preferences of all the people who live at the home. Peoples health is looked after and the staff have the skills and experience they need to do this. The homes recruitment procedures are thorough, making sure that staff are safe to work with the people who live at the home. All the staff said they enjoy working at the home and felt they were well supported by their manager. They said the training is good and helps them to do their job well. One member of staff said the home offers ‘Good training’ as well as ‘Good communication and good working environment between care staff and nurses.’
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 7 The complaints and adult protection systems work well and people said they know and understand what to do if they have a concern. What has improved since the last inspection?
Since our last visit in February 2009, the home’s management team and the staff have made significant improvements to the way people’s health and wellbeing is supported as well as in all other areas of life at the home and the environment. Since the last inspection visit, the care plans have been improved and now cover each area of the individuals care needs, emphasising any special needs the individual may have. The plans now include better risk assessments and management plans covering anything the staff feel may put the individual at any risk. The medication administration is now safe and accurate, making sure people receive their medicines in the way it has been prescribed. Although there are still improvements to be made, the activities that are available for people have been improved and people now have a more interesting daily life. The menus have been revised twice during the past year and people said that they enjoy the meals; the portions are generous and the food is hot when it is served. The layout of the lounge/dining room on Cedar Unit has been improved to provide a separate dining area with tables that are laid for meals and where people can choose to sit and eat comfortably and at their own pace. The home has made a small room into a non-denominational ‘faith room’, where people can spend time quietly alone or with their family and friends. New door locks have been fitted to the bedroom doors which can be easily opened from the inside with a lever door handle, but which stop people from entering other people’s rooms from the corridor by mistake. New carpets, bedding, furniture and floor coverings have been provided during the past few months and the house is now a pleasant place for people to live. The garden outside Cedar Unit had been completed. This makes a safe and secure place for people to enjoy the fresh air and to use for outdoor parties and events.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 8 A second garden is being created for the people who live on Birch Unit. The structural work had been completed and it was ready for the planting and seating to be put in. The home is clean and well maintained and everyone we spoke to said the home is always kept fresh and clean. There is now plenty of training available for staff and they said the training is good and keeps them up to date. One member of staff said that ‘Training is given a lot more and care plans (have) been improved and person centred care is a lot better.’ What they could do better:
The home’s manager is aware that the care plans would benefit from being developed by all the staff team, not just the nurses. This is something the manager is planning to introduce and will include input from the care staff and all other members of staff. The plans should include background social and medical histories and each person’s original diagnosis should be easily accessible. The home needs to continue to develop the individual life histories, to help staff get to know people even better and plan activities and have conversations that remind people of the things they have enjoyed during their lives. One person said they would like to see more trips out and other activities, including more entertainers coming into the home, as well as providing more stimulation through the use of memory triggers, such as items from people’s past, and involving people in the creative arts. One relative felt that some of the agency staff did not show the same high level of commitment as the permanent staff. For similar reasons a member of staff also said that the home should ‘Recruit more permanent and bank staff to avoid using agency cover…’ The safeguarding policies and procedures need to show the procedures in the correct order, to make sure that any referrals are always carried out properly. To make sure the home has a well qualified staff team, it is recommended that at least half of the care staff achieve an NVQ qualification. Staff should have regular one to one supervision meetings with their line manager, to support them to plan their personal and professional development and give them the opportunity to discuss any areas of concern in a confidential setting.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 9 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 10 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 Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 does not apply People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they are admitted to the home, to make sure their needs can be met. EVIDENCE: We looked at the pre-admission assessments for some of people who live at the home. They were all completed in full, giving sufficient detail to enable the manager to determine whether the service can meet the person’s needs. This assessment, as well as Social Services needs assessments when available, forms the basis for the individual plan of care and support. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 12 People said that they were given enough information about the home before deciding to move in, and they had also received a contract. Where possible the home encourages people and their families to visit the home and talk to the people who already live at the home, their relatives and the staff. The home invites them to come and spend time at the home, share a meal and maybe take part in the days activities. This means that the home can get to know the persons needs and the individual has the information he or she needs to make a decision. When someone is returning to the home, following a stay in hospital, the manager visits them to assess their needs and make sure the home is still able to offer them the care and support they need. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are met and although there are still improvements to be made, the care plans reflect peoples care and support needs. People are protected by the medication administration systems. Staff treat people with respect, care and consideration at all times. EVIDENCE: From observation and discussions with staff and people living at the home, it was clear that the staff are aware of each persons needs and preferences. The staff make sure they provide the help people need in the way they prefer.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 14 The staff said they are always kept up to date with peoples changing needs and these are reflected in the care plans. We looked at four care and support plans, to make sure that peoples health and personal care needs are being met in the way the person prefers. The plans cover each area of the individuals care needs, emphasising any special needs the individual may have. Three of the four plans did not include any background social and medical history and we had to search to find each person’s original diagnosis. There is information about how the staff should approach people and how to support each person individually and understand the different ways people have of communicating. There is also guidance for staff to help them identify any signs that someone’s physical or mental health is at risk. There is evidence of healthcare professionals’ involvement such as the GP, the care home liaison team, the psychiatrist and the dietician. Health care visits and treatments are recorded in detail and everyone who commented said that people always receive the healthcare they need. Our observations, over the two days we were at the home, confirmed that the staff are fully aware of everyones needs and are offering the level of care and support each individual needs. The plans include risk assessments and management plans where someone is at risk of falling, from using bed rails, becoming malnourished, injuring themselves or any other area the staff feel may put the individual at any risk. The manager said that people who live at the home and their families are being invited to go through their plan and agree any changes. When this happens the plans should be signed, wherever possible, to confirm their agreement. The home’s manager is aware that the plans would benefit by being developed by all the staff team, not just the nurses. This is something the manager is planning to introduce and will include input from the care staff and other members of staff. For example, if someones nutritional intake is at risk the catering staff could be involved in looking at how their nutrition can be improved by adjusting their diet. The housekeeping staff often spend a lot of time with people and they will be able to offer a view on the persons well-being and how this can be supported. The care staff also need to be involved, as they provide the majority of peoples day to day care and therefore have a wide knowledge of peoples care and support needs.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 15 The people we spoke with said they are satisfied with the care they receive and everyone who commented said they are looked after well. The medicines are kept safe and secure in locked cabinets and the medicine trolleys were locked when unattended. Most of the medicines are supplied by the pharmacy in a monitored dosage system, but some remain in the original packaging. We looked at the Medicines Administration Record (MAR) charts, which must show clearly the quantities of medicines received and in stock for each person. The medicines supplied in the monitored dosage system appeared to be administered and recorded accurately. We checked some of the medicines that were supplied in their original packaging, to make sure the numbers that had been signed as administered tallied with the amounts received and the quantities remaining. These medicines also appeared to have been administered and recorded accurately. Some people are prescribed nutritional supplements, to help them maintain their health. These are now being kept in the refrigerators in the small kitchens on each unit and each person is given them from their own supply. We observed the nurses on each unit when they were administering medication. Their practice was safe. Each person’s medicines were prepared and administered individually and the MAR chart signed after each dose. Medicines were administered in a way that respects people’s dignity. There are systems in place to ensure that all prescribed medicines are administered at the correct intervals. We saw evidence that the home has liaised with the psychiatrist and reached a written agreement about covert administration of medicines, where this procedure is necessary. This is where someone needs to take their medicines but is reluctant to do so and is no longer able to appreciate the importance of taking their prescribed medication. During the visit, all the staff were seen to treat people with respect and maintain their dignity. We saw staff speaking respectfully to people and giving them time to respond. The people who commented said that they receive the care they need and are supported to maintain their independence for as long as they are able. Everyone said the staff listen and act on what people say. One person confirmed this and said ...the staff are very good. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in a range of activities. People are offered a good choice of meals to make sure their dietary needs and preferences are met. EVIDENCE: The activities are organised by the activities co-ordinator with support from the care and nursing staff, and people take part or not as they wish. The staff spend time with people on one to one activities, as well as doing things people can enjoy together. They are gradually widening the range of activities that are available. As well as supporting people with individual activities such as doing puzzles, reading and conversation the group activities have recently included trips out to places of interest and barbeques.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 17 One person’s plan included a pen picture, which gave excellent background information about them and identified what social interests they have. These pen pictures, or life histories, are being developed with input from the individuals and their families. They help staff get to know people even better and plan activities and have conversations that remind people of the things they have enjoyed during their lives. The mealtimes are flexible, to suit people’s preferences, and there are always alternatives available if people do not want the choices on the menu. As well as a cooked meal at lunchtime, there is a choice of hot and cold dishes at teatime. People who eat a soft diet are offered their meals in an appetising way and staff assist people who need help in a calm and discreet manner, following the persons own pace. The menus have been revised twice during the past year and people said that they enjoy the meals; the portions are generous and the food is always hot when it is served. People are offered hot and cold drinks as well as fruit and other snacks throughout the day. On the first day of our visit the teatime menu included pie and peas, sandwiches, a choice of soup, apple pie and cream, ice cream and yogurts as well as juice and tea or coffee. People said they enjoy their meals. The people who live at Charlton Care Centre are able to do what they want, when they want. Our observations confirmed that the staff support people to live their life in the way they choose. The home has made a small room into a non-denominational ‘faith room’, where people can spend time quietly alone or with their family and friends. During the next few months, the home is going to contact local religious groups to invite them to come into the home and spend time with people. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are aware of how to raise a concern or make a complaint if they are dissatisfied with the service. The staff have received suitable training and understand the adult protection policies and procedures, which makes sure that people at the home are safe. The policies and procedures do not show the safeguarding procedures in the correct order. EVIDENCE: The home’s complaints procedure is displayed and is included in the Service Users’ Guide and Statement of Purpose. Any complaints or concerns are recorded in a complaints file. The actions taken and the outcomes are recorded. Where they are needed, improvements are made as a result of complaints investigations. Staff said they know what to do if anyone has concerns and the relatives we spoke with said they are aware of how to complain and who to complain to.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 19 Newly employed staff are made aware of the homes whistle blowing policies and procedures, to be used if they suspect abuse or see examples of poor practice. All the new staff take complaints handling, adult protection and whistle blowing training as part of their induction training. Almost all of the staff have received safeguarding adults training. Some of the staff explained fully what action they would take in the event of a safeguarding incident. This included making sure people were safe and reporting the incident and staff were aware of who is the lead authority for dealing with any incidents. All the appropriate policies and procedures are in place to guide staff. Although the safeguarding policy does include referring the incident to the local authority, it was not clear that this is the lead body who should be informed in the first instance. However a recent incident had been reported and handled correctly. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 25 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and well-maintained environment. EVIDENCE: The home is clean and well maintained and everyone we spoke to said that the home is always kept fresh and clean. The parts of the home that are in use are attractively decorated and the furniture is comfortable. The rooms are comfortably furnished and have a welcoming feel. There are sufficient, accessible toilets and bathrooms on all floors of the house. The house is spacious and there is plenty of room for people to walk around in safety.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 21 The lounge on Cedar Unit has been re-arranged to give a dining and a lounge area. This makes it a more comfortable room with attractive dining tables for meals and a more homely sitting area. The flooring has been replaced, to make it more attractive and hygienic. New door locks have been fitted to the bedroom doors which can be easily opened from the inside with a lever door handle, but which stop people from entering other people’s rooms from the corridor by mistake. The staff can open the doors from the outside if they need to. Each bedroom has a ‘memory box’ on the wall by the door. They contain a variety of items such as photos and keepsakes that remind people which room is theirs and give people and staff a subject for conversation. New carpets, bedding, furniture and floor coverings have been provided during the past few months and the house is now a more pleasant place for people to live. At present there are parts of the house that are not being used. These are gradually being improved and will be brought back into use when the number of people living at the home increases. When we visited the home, the garden outside Cedar Unit had been completed. This makes a safe and secure place for people to enjoy the fresh air and to use for outdoor parties and events. A second garden is being created for the people who live on Birch Unit. The structural work had been completed and it was ready for the planting and seating to be put in. Staff are employed to help look after the maintenance of the house and grounds as well as keeping the gardens tidy. Protective gloves, aprons and disinfecting hand rub are available for staff to use when necessary, to support the homes infection control measures. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet peoples needs. People are protected by thorough recruitment procedures, which ensure that staff are suitable to work with people who live at the home. Suitable training is provided to make sure staff have the skills and knowledge they require to be able to meet peoples needs. EVIDENCE: The staff rotas, and peoples comments, confirmed our observations that there were enough staff on duty to meet peoples care, social and leisure needs. In addition to the manager, there are two nurses and five support staff on duty during the day and evening, and three waking staff at night, including a nurse. There are also plenty of housekeeping, maintenance and catering staff on duty each day. These staffing levels seem to be sufficient to provide care and support for the people who currently live at Charlton Care Centre.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 23 The staff confirmed that staffing levels are adjusted to meet peoples needs. People who live at the home and their relatives said there are enough staff around and our observations confirmed this. The homes recruitment procedures are thorough, making sure that staff are safe to work with the people who live at the home. All new staff complete an application form and provide two written references. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks are obtained and no new staff begin work until these checks have been completed satisfactorily. There is now plenty of training available for staff and they said the training is good and keeps them up to date. The home keeps good records of staff training, which also shows when updates are needed. Staff have attended training courses on moving and handling, fire safety and other health and safety training. Courses are arranged for the nurses, to keep their clinical skills and knowledge up to date. Other training has also been provided in subjects such as dementia care, managing challenging behaviour and infection control. Over the coming few months, training courses including nutrition, pain management, report writing, medication and person centred care are being provided for the staff. All new staff complete induction training which meets the Skills for Care criteria. One new member of staff said they had received a comprehensive week long induction that covered all aspects of care. This gives them good basic training to help them do their job effectively, and provides a sound basis for taking a National Vocational Qualification (NVQ) course. Six of the seventeen permanent support staff have achieved an NVQ in care and one of the cooks is about to start an NVQ in catering later this year. To make sure the home has a well qualified staff team, it is recommended that at least half of the care staff achieve an NVQ qualification. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are still improvements to be made, the home is now safe and well managed, in the best interests of the people who live there. EVIDENCE: The manager has the necessary experience and qualifications to manage the home, in the best interests of the people who live there. The manager attends training to keep up her professional development.
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DS0000059693.V377265.R01.S.doc Version 5.2 Page 25 One member of staff commented that ‘There has been a big change from institutionalisation to person centred care which the staff aim to provide.’ This confirms our view that the home’s management team have made significant improvements to the way people’s health and well-being is supported. The records and the staff confirmed that the staff are now starting to have one to one and small group supervision meetings with their line managers. Supervision meetings support staff to plan their personal and professional development and give them the opportunity to discuss any areas of concern in a confidential setting. The staff said that they are well supported and they work well together as a team. Regular staff meetings are going to be held and staff will be encouraged to make their views known and contribute to the running of the home. The manager is introducing a new ‘daily diary’ system and this will be the focus of the first meeting. Other meetings of smaller staff groups to discuss the new care planning systems will also be held. Peoples personal information is stored securely when it is not being used. The homes policies and procedures are up to date, which makes sure they provide relevant information to guide staff on how to act in every situation. The home supports some people to manage their money and accurate records are kept of all transactions made on their behalf. The monies are securely stored and people can now get money when the office is closed as the units keep a small float. All the regular health and safety checks for the home are carried out in a timely manner. These measures make sure that the health, safety and welfare of the people at the home is promoted and safeguarded. Following their most recent inspection, the Environmental Health Officer has awarded the homes kitchen a score of four stars out of a maximum of five, for hygiene and good kitchen practice. The requirements of the report are being dealt with. The home has a range of quality assurance systems in place, to help determine the quality of service the home offers. These include surveys for the people who live at the home, their relatives and visitors and the manager has an ‘open door’ policy so that people can call in to discuss the service that is provided. The information and comments people make are used to improve the quality of the service that is offered. The home’s management have been carrying out a series of ‘in depth’ audits throughout the home, to assess the quality of the service. These audits have resulted in a comprehensive action plan covering areas such as dignity in care, medication, care planning and housekeeping.
The Charlton Centre for Alzheimer`s and Dementia Care
DS0000059693.V377265.R01.S.doc Version 5.2 Page 26 Since the last key inspection visit in February 2009, the home has developed its own improvement plan and this clearly shows the changes for the better that have been made. A senior manager from the organisation visits the home regularly and compiles a report each month on their findings. The home’s manager lets us know about any significant incidents that affect the well-being of people who live at Charlton Care Centre. At present there are no people living at the home who are subject to a deprivation of their liberty authorisation, under the Mental Capacity Act 2005. The home is developing risk assessments and care plans that will help reduce the possibility of people’s liberty being restricted. We received the home’s annual self assessment. It contained information about the home and the services that are provided. It was very detailed and gave us a full picture of the service, the improvements they have made and their plans for the coming twelve months. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP18 OP28 OP36 Good Practice Recommendations The care plans should include background social and medical histories and each person’s original diagnosis should be easily accessible. The safeguarding policies and procedures need to show the procedures in the correct order, to make sure that any referrals are always carried out properly. The registered person should ensure that training in NVQ II or above continues, so that at least half of the care staff at the home hold this qualification. Staff should have regular one to one supervision meetings with their line manager, to support them to plan their personal and professional development The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Yorkshire & Humberside Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk
We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified.
The Charlton Centre for Alzheimer`s and Dementia Care
DS0000059693.V377265.R01.S.doc Version 5.2 Page 30 The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V377265.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
