Inspection on 25/02/09 for The Charlton Centre for Alzheimer`s and Dementia Care

This inspection was carried out on 25th February 2009.

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... 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... 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 15/11/2009.

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-Wills Key Unannounced Inspection 25th February 2009 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 The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.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 Manager post vacant Care Home 67 Category(ies) of Dementia (67) registration, with number of places The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.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 11th November 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. The provider informed the Commission for Social Care Inspection that the fees range 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. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.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 stars – poor service. 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. Two inspectors from CSCI visited the home. A regulation inspector and a member of the enforcement team. Whilst at the home we explained to the senior company manager her rights and responsibilities, and also our powers. This was done under Code B of the Police and Criminal Evidence Act (PACE). Whilst at the home we photocopied a number of documents held at the home as evidence. We gave the senior company manager a receipt detailing everything we had copied. There was the opportunity to speak to people living at the home as well as a senior company manager, the acting manager, and the care staff. Four people’s records were looked at. Three staff records were also seen. A sample of people’s medications were checked and a look around the home was undertaken. The Annual Quality Assurance document for the service was not available at the time of the site visit, as it had not been completed and returned to the Commission. A request for this document to be completed and returned to us was made on 16/6/08. The records held by the Commission show that over the last twelve months, the service has had a lot of support from external agencies. The local primary care trust has provided a nurse to work in the home and give advice and support to the staff about dementia care nursing, and the local authority seconded a manager to work at the home for two days a week. Local authority Contract Compliance staff have been going into the home on a weekly basis monitoring their contract. 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. Since February 2008, three key inspections and three random inspections have taken place at this service. At one point during the past 12 months, statutory requirement notices were given to the provider relating to poor practice at the home. At a compliance visit, these were found to be complied with. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 6 At the time of the site visit, the manager was on sick leave, and a unit manager had been asked by the company to act as the manager of the home. We would like to take the opportunity to thank the people living at the home, management and the staff team for their hospitality, patience and co-operation throughout the visit. What the service does well: What has improved since the last inspection? What they could do better: Significant development in areas such as the assessment of risks, care planning and medication practice need to take place so that people’s health and welfare are not put at risk. The inadequacy of the systems in place, mean that we can not be sure that people’s health and personal care needs are being effectively met, therefore considerable progress is needed in this area of care provision. Greater attention needs to be paid to the provision of activities on offer to people in the home so that their recreational, social and leisure needs are effectively met. Improvements in the attitude of staff towards people living there need to take place so as to ensure that people’s dignity is respected. Greater attention needs to be paid to the systems operated by the service in relation to fire safety, with particular reference to the positioning of fire The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 7 extinguishers so that people can access them in the event of a fire, and the provision of satisfactory door closures systems or door guards on bedroom doors. The environmental improvements made on one unit are overshadowed by an unpleasant odour. Attention needs to be paid to ensuring that staff undertake NVQ training, and that effective leadership and management is provided to ensure that the training staff receive is effectively put into practice. Despite significant management and clinical input for a range of people and agencies, significant developments still need to take place in relation to the management systems operated at the home with particular reference to day to day management, risk management, care planning, quality monitoring and auditing and effective leadership. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.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 The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.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 senior company manager explained that no admissions had been made to home since the start of 2008. 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 had obtained an up to date copy of any local authority or healthcare specialists care needs assessment. The The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 10 senior company manager explained that new people looking to move in the Charlton Care Centre would be given the opportunity to visit the home, and would be given the chance to meet the staff and other people living at the home, and visit the different parts of the building. Information contained within the records, and the policies and procedures held by the service supported these comments. The senior company manager added that there are systems for people to receive a written statement of terms and conditions or a contract, which includes 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. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although some minor improvements have taken place in this area of care provision, poor assessment of risks, inadequate care planning and poor medication practice means that people’s health and welfare are being put at risk, and due to the inadequate systems being in place, we can not be sure that people’s health and personal care needs are being effectively met. EVIDENCE: We checked the files of four people living at the home. The files contained information by way of assessments relating to people’s needs in areas such as personal care, diet, weight, mobility, medication and mental state. One person had a detailed assessment of their needs, but when we tried to find the relevant care plans that would give the staff details of how to meet these needs, the care plans were found to be only partially completed, and did not give sufficient details as to how the person’s needs should be met. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 12 Information contained within the records showed that some risk assessments had been completed relating to people’s needs in areas such as falls, diet and pressure area care. However, it was pointed out to the senior company manager that the risk assessments were not comprehensive, satisfactory, up to date, accurate or detailed. We explained that this was particularly worrying as the risks for one person related to feeding and choking issues, and the other had risks relating to challenging behaviour. We found that some of the plans were satisfactory, giving detailed information as to how people should be supported by the staff. One plan in particular was very well written giving details of how to support a person if they leave the home to go shopping for example. The plan was clear, detailed and written from the perspective of the person. However, we compared the assessment of one person with the care plans that had been written. We found that the assessment gave details of very specific needs in nine areas of this person’s life. When we looked at the care plans we could only find two, and these two care plans did not address the major issues as highlighted within the assessment. This person lives on the unit that specially caters for people with challenging behaviour, however, no care plans had been devised that showed how the staff should respond to specific needs such as verbal abuse, the throwing of items, memory loss and isolation, all of which had been highlighted as specific care needs in the person’s assessment. It was explained to the senior company manager that that due to the lack of detailed information contained in the care plans, it was difficult to determine if appropriate systems were in place to monitor this people’s psychological and physical health with a view to ensuring that people received the right level of intervention and support. The acting manager explained to us that one person living on Birch Unit has a tendency to collect all the fire extinguishers during the day, and therefore they had been placed behind a desk at the nurse’s station. When we tried to locate an appropriate risk assessment relating to this, one could not be found. It was pointed out that this was particularly worrying, as removing fire extinguishers by either people living at the home or the staff could, in the event of a fire potentially put people in danger. It was explained to the senior company manager that appropriate action needed to be taken by the management of the service to deal with this issue so that people’s lives were no being put in danger. Also we pointed out that the person who removes the fire extinguishers needs to be given the opportunity to engage in some other meaningful activity as detailed within their care needs assessment. We found information in people’s files to show that nutritional screening and weight gain or loss monitoring is taking place. However, the records of one person said that there was a need to closely monitor their weight loss, and ensure they were receiving the right nutrition, but their weight chart showed they had gained weight. It was pointed out to the senior company manager The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 13 that close monitoring of this aspect care provision for this person was not taking place, and that their records had not correctly been updated. Staff on one of the units talked about how they support people with oral hygiene, however, information about this could not be found within the care plans we looked at or the daily records that are completed by the staff. One staff member spoke about how people are supported with their pressure area care by way of equipment and regular monitoring. The information supplied to us verbally by the care staff was supported by way of information contained within some the care plans that we looked. We found pressure area care risk assessments, and care plans detailing the type of equipment people should use. Information about visiting healthcare professionals who deal with pressure area care was also found within the care plans we looked at. We explained to the senior company manager and the acting manager that as a specialist service catering for people with needs in the areas of dementia care and challenging behaviour, risk assessments and care plans such as those mentioned above, should and must be in place. The acting manager said that sometimes in order to create a detailed care plan it takes time as there is a need to get to know a person. We pointed out that over quite a considerable period of time (12 months), the Commission had made a number of requirements pointing out the need for accurate and detailed risk assessments and care plans, and added that the people living at the home were not new to the service, as no new admissions had taken place over the past 12 months. We checked the medication systems on both units at the home. We checked the records, counted medication and spoke to the staff about medication issues. The records were found to be in good order, with signatures in place and running totals of the medication held by the service. However, we pointed out that when hand written entries are made on the medication records, and then they need to be doubled signed so as to reduce the risk of errors. The nurse on duty on Cedar Unit said that she would ensure this element of good practice was put into place. We also identified another issue whilst checking the medication. We noticed that a signature was missing from the record sheet, and asked the acting manager about this. He explained that he had been in the process of giving someone their medication but had been distracted by an incident on the unit. He had decided to deal with the incident, and placed the medication on the desk at the nurse’s station. He added that once the issue had been dealt with, he had intended to give the medication, and then sign the records sheet. We explained that placing medication on the table at the nurse’s station was very poor practice, as there was the potential for anyone to pick up the medication and take it. We spoke to two relatives of people living at the home who said that though their relative received personal care and support in a manner that was dignified and respectful. This included when there is a need for their relative to The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 14 have a consultation with a visiting health or social care professional, and when staff undertake tasks such as washing and bathing. One relative said that their relative always wears their own clothes, and that there has never been any problem with the laundry or the misplacing of clothing. When asked if the staff always address people in an appropriate manner using their preferred term of address, one relative said that this always happened. This was in contrast to the way a staff member described those people who require a soft diet as “the softs”, when they said to a colleague, “have we to put all the softs on this table at lunchtime?” The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 15 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Inadequate provision by the service provider and staff in relation to the activities on offer to people means that people’s recreational, social and leisure needs are not effectively being met, and despite some good practice at the home, improvements in the attitude of staff towards people living there need to take place so as to ensure that people’s dignity is respected. EVIDENCE: We spoke to one member of staff who said that people could exercise their choice in relation to different activities such as what to have for lunch, what to do during the day and when to go to bed. The staff member added that for most of the people living at the home, exercising choice was difficult due to their level of ability due to problems with dementia and other cognitive issues. We asked the activities co-ordinator what types of activities were on offer. They said that people could watch TV or a video, read the newspaper or if they fell up to it, do some baking. When asked if there was anything else on offer in relation to specific recreational or leisure activities based on people’s specific needs and interests, the activities co-ordinator said, ”that’s it really.” When we The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 16 looked at the care plans of people living at the home, we could not find any detailed information about the social, recreational and leisure needs of people, despite the fact that the assessments of people quite clearly stated there was a need to work creatively and sensitively with people in relation to social contact and activities so as to prevent isolation and a loss of interest in the world around them. The relatives who were spoken with explained that they can visit the home at anytime, and that they can see their relative in private if they would like to. We observed practice over lunchtime on both units. We noticed that on one unit a nurse on duty was supporting two people with their meal. The nurse was seen to be doing this well, however, they were seen to be directing the work of the other staff on the unit, explaining what should be done next, and how to do it. This could have been managed better by the nurse delegating the task of supporting people, so that people’s experience of mealtimes was do not affected by a staff member not being able to pay them their full attention. The meals that were offered to people were seen to be appealing, and served in an attractive manner. Drinks were offered, and those people who required a soften diet were presented with a meal that looked appealing. We noticed that the person who had previously not had their bib wiped to promote their dignity had it wiped and cleaned sensitively during the meal, and staff were seen to interact well with people, chatting and talking about events and meal they were having. As previously mentioned, we did observe a staff member described those people who require a soft diet as “the softs”, when they said to a colleague, “have we to put all the softs on this table at lunchtime?” We also observed a person living at the home asking a staff member what was for lunch. The staff said “No idea”, and walked away. Another staff member was asked, and they said “Not sure, I’ll have to have a look on the menu”. A few minutes later, the second staff member returned and told the person what was on the menu, however, by that time, it appeared that the person had forgotten that they had asked the question, and appeared confused as to why the staff member was talking to them. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 17 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are good systems in place to allow people to complain, and good systems for reporting suspected or alleged abuse and neglect, however, the shortfalls in risk assessments, care planning and the overall management of the home means that people’s health and welfare are potentially being put at risk as their needs not being met effectively. EVIDENCE: We looked at the home’s complaints procedure; we found that the procedure contained the right information such as the different stages the service would follow if a complaint was received. Furthermore, the procedure has the timescales for the process. We looked at the complaints records, and found that the service had not received any complaints over the last year. However, the records held by CSCI shows that a complaint was received by the service approximately six months ago. Information about the complaint had been forwarded to CSCI by a solicitor who was acting on behalf their client. The records held by CSCI show that the complaint was investigated by the service, and information was passed onto the firm of solicitors. We looked at the policies and procedures run by the service relating to the safeguarding adults from suspected or alleged abuse. We found that there are The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 18 written policies and procedures in place for staff to follow. We spoke to 2 staff members who were able to give a good account of the actions they would take if they suspected or witnessed any type of abuse. We explained to the senior company manager that as we were still finding problems with inadequate risk assessments and care planning, inadequate activity provision, inadequate quality monitoring and audit systems, and potential fire safety issues, we could not satisfactorily report that people’s health and welfare were being adequately promoted and protected. Information held by CSCI show that over the last 12 months, 2 police investigations have taken place looking into alleged poor practice. One investigation resulted in a court case, which came to an abrupt end after the judge dismissed the case following a procedural error. The second case is still being investigated. Information held by CSCI indicates that since 1/12/07, the total number of safeguarding referrals made to the local authority relating to people living at the Charlton Care Centre is 89. These referrals relate to issues such as falls, violent incidents, medication errors, scalding and the poor provision of food. It was explained to the senior company manager that this number was very high; however, we acknowledged that the home was being closely monitored not only by CSCI, but the local authority and the local primary care trust. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 19 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite some improvements to the general environment, people’s health and welfare are being out at risk as the systems operated by the service do not potentially comply with the requirements of the fire service. This is in particular reference to the inadequate positioning of fire extinguishers so that people can access them in the event of a fire, and the lack of provision of satisfactory door closures systems or door guards on bedroom doors. The environmental improvements made on one unit are overshadowed by an unpleasant odour. EVIDENCE: We spoke to the maintenance staff that said that there is a maintenance programme in operation. They explained that they are currently replacing the door handles and locks on the bedrooms on Cedar unit, and that bedrooms and communal areas are periodically redecorated. They added that the lounge and The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 20 dining area of Cedar unit had recently been redecorated, and new flooring added. The grounds of the home were seen to be tidy and accessible for people if they wanted to get out for a walk. One person who was spoken with said that they never get to go outside. A staff member said that people do if the weather was nice. The senior company manager explained that attention had recently been paid to the roof voids to ensure the building compiled with the requirements of the local fire service. We were given an invoice to show that the work had been completed, however, we asked the senior company manager to contact the fire service with a view to asking them to visit the home to check on the work. On having a look around the building we found that none of the bedroom doors on Cedar unit had either door closures or door guards on them. It was pointed out that in the event of a fire, if people were in these rooms, they could be overwhelmed by fire and smoke coming into the room from the source of the fire. Again, we asked the senior company manager to contact the fire service for advice about this issue. After our site visit, we also contacted the fire service to explain to them direct the situation we found. The fire service said that they would visit the home to look into the issue. The acting manager explained that the only action that had been taken was to remove all the fire extinguishers from the unit, and place them at the nurse’s station. It was explained that this was potentially very dangerous as in the event of a fire, people would potentially not have access to fire fighting equipment, and would need to go searching for it. On the whole the premises were found to be clean and tidy. However, whenever we visit Cedar unit we were confronted with an unpleasant smell. This was pointed out to the senior company manager who said that she would look into why there was an unpleasant odour. We found evidence of infection control measures such as washbasins, soap available for use and hand towels. Laundry is dealt with on site, and soiled articles and washing are not carried through food preparation areas, and do not intrude on people living at the home. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health and wellbeing are promoted by good recruitment practices, however, greater attention needs to be paid to ensuring that staff undertake NVQ training, and that effective leadership and management is provided to ensure that the training staff receive is effectively put into practice. EVIDENCE: Information held within the rotas showed that the staff team is made up of a mixture of qualified nurses (General Nurses and Mental Health Nurses), and social care staff. Domestic staff are also employed at the home. The senior company manager explained that the company had recently employed some nursing staff and that one had already started, and one was due to start the following week. She added that the use of agency staff had recently reduced. Information contained within the rotas confirmed this. The staff training recorded show that the numbers of social care staff with an NVQII qualification in care is below 50 . The senior company manager explained that new starters followed a certified induction and training course. Information held within the staff personnel and training files confirmed this. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 22 We spoke to a nurse who had recently been recruited who explained that they had attended an interview after completing an application form. Once they had been offered the job, the nurse confirmed that they had undergone a Criminal Records Bureau (CRB) check, and that their nursing status had been checked against the Nursing and Midwifery Register. Information held within their records confirmed this. We also found evidence that appropriate references had been taken up by the company. The senior company manager explained that there has been a rolling programme of training for staff over the course of the last year. This has included dementia care, health and safety, safeguarding adults, movement and handling, person centred care and medication awareness. Records held within the personnel files of 4 of the staff working at the home confirmed that they had attended courses such as those mentioned above. We explained that despite staff receiving training, some aspects of this training was not being put into practice and there was a need for good management and leadership as found observed some poor practice, and inadequacies in the risk assessment and care planning process. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 23 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 poor. This judgement has been made using available evidence including a visit to this service. Despite significant management and clinical input for a range of people and agencies, people’s health and welfare are still being put at risk due to poor risk assessments, poor care planning processes, and a lack of inadequate management systems relating to the day to day monitoring and control of the care and support systems in place for people living at the home. EVIDENCE: The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 24 There has not been a registered manager at the home for the past 12 months. The current manager (not registered) was on sick leave when we visited the home. The company has appointed one of the unit managers as the acting manager. We spoke to the acting manager who explained that he does not have any extra time or supernumerary time to devote to the position of acting manager so he tries to fit management of the home round his responsibilities as unit manager. He added that he sometimes stays at the home once he has finished his shift to spend some of his own time dealing with home management issues. The senior company manager explained that she routinely pops into the home on her way to work at one of the sister homes run by the company in Bradford. She added that there are two operations managers who visit the home from time to time. We explained to the senior company manager that the current management situation is not acceptable, as the acting manager does not have specific time to devote to management issues. The records held by CSCI show that over the past 12 months, this service has had significant management input from both the Local Authority and local Primary Care Trust (PCT): a local authority manager was seconded to work at the home 2 days a week for a number of months, and a mental health nurse was placed in the home from the PCT to advise on clinical issues. The records also show that local authority contracts officers have been making weekly visits to check on contract compliance issues. Information held at the home shows that the management do keep CSCI and other agencies informed of incidents at the home that adversely affects people living at the home such as accidents or incidents. The senior company manager gave us copies of the latest management reports, undertaken by the operations manager on behalf of the owner. We had made it requirement that these reports were forwarded to us, however, the CSCI records show that they have been sent to us as requested. The reports were found to give details of discussions the operations manager had with staff members, people living in the home and visitors. Other details include information of activities going on in the home such as lunch, or people watching TV. We explained to the senior company manager that despite the fact the CSCI had made a number of requirements and recommendations in its latest report (Nov 08), no reference was made by within the management report on how these requirements and recommendations were being progressed, and what action (if any) still need to be taken by the managements and staff to ensure that these requirements were met. Again, we explained that there was no reference within the management report to the action plan supplied to CSCI by the service, and how this action plan would be fulfilled, now that the manager of the home was on sick leave. We indicated that there was possibly a shortfall in the way these management visits were being undertaken, and that the information being supplied to bother the registered provider and CSCI was in a number of ways inadequate. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 25 The records show that up until December 2008 quality monitoring and audits systems in relation to aspects of care provision such as the medication and care plans had been taking place. However, these had not been completed for January and February 2009. The senior company manager was unsure if any external quality assurance system; based on the views of people who use and have an interest in the service had taken place. No records of such a quality assurance system could be found. A check on people’s personal monies could not be undertaken as the keys to the safe were not available, as the administrator for the home had gone off shift, and no one else had any keys. The senior company manager explained that if people wanted money for whatever reasons, then the staff would usually supply this, and claim it back when the administrator was on duty. Again, this was explained to be unsatisfactory. We found that fire safety checks do take place on a weekly basis, and that people living and working in the home do take part in routine fire drills. People were seen to use hoists correctly, and the records show that the hoists have been maintained and serviced. As previously mentioned, we found that the fire extinguishers on one unit were not located in the correct place, as a person living at the home was routinely picking them up and removing them and no appropriate action had been taken by the management of the service to adequately deal with this issue. The acting manager explained that the only action that had been taken was to remove all the fire extinguishers from the unit, and place them at the nurse’s station. It was explained that this was potentially very dangerous as in the event of a fire, people would potentially not have access to fire fighting equipment, and would need to go searching for it. We explained to the senior company manager that despite management input from not only the company’s two operations managers, but also from the local authority and PCT, significant improvements in the standards within the home had not come about, as we were still finding problems with inadequate risk assessments and care planning, a high number of safeguarding referrals, poor staff attitudes, inadequate activity provision, inadequate access to money for people living at the home, inadequate quality monitoring and audit systems, and potential fire safety issues. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 26 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 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 1 X 1 1 The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 27 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)(b) Requirement The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the people living there. OUTSTANDING REQUIREMENT FROM 17/11/08. The registered person must ensure that people living at the home have care plans that set out in detail the action which needs to be taken by the care staff to ensure that all aspects of their health, personal and social care needs are met. REVISED AND OUTSTANDING REQUIREMENT FROM 26/2/08, 24/4/08, 26/6/08 and 17/11/08. The registered provider must ensure that risk assessments are carried out and their implementation is closely monitored, so that any identified risks to people’s health and wellbeing are either reduced or eliminated. OUTSTANDING REQUIREMENT FROM DS0000059693.V374337.R02.S.doc Timescale for action 14/05/09 2 OP7 12(1) (a)(b) 15 14/05/09 3 OP8 12(1) (a)(b) 13(1)(a) (b) 14/05/09 The Charlton Centre for Alzheimer`s and Dementia Care Version 5.2 Page 28 4 OP9 12(1) (a)(b) 13(2) 5 OP12 12(1) (a)(b) 16(2)(n) 26/2/08, 24/4/08, 26/6/08 and 17/11/08. The registered person must make arrangements for safe handling, safekeeping, and safe administration of medicines received into the care home so as to promote people’s health and well-being. The registered person must ensure facilities are provided for the recreation of people living at the home, taking into account their needs, wishes and desires. The registered person must ensure systems are in place to prevent people living at the home being harmed or being placed at risk of harm. REVISED AND OUTSTANDING REQUIREMENT FROM 26/2/08, 24/4/08, 26/6/08 and 17/11/08. The registered person must ensure that following consultation with the fire authority, the building complies with the requirements of the local fire authority so that people’s health and well-being is protected and promoted. Particular reference needs to be paid to the location of fire extinguishers and door closure systems on bedroom doors. The registered person must ensure that a quality assurance and monitoring process takes places at least annually, based on seeking the views of the people who use the service, so as to measure the success of the service in meeting its aims and objectives. The registered provider must make sure that the monthly management reports relating to DS0000059693.V374337.R02.S.doc 14/05/09 14/05/09 6 OP18 12(1) (a)(b) 13(1)(a) (b) 13(6) 14/05/09 7 OP19 12(1) (a)(b) 23(4) 14/05/09 8 OP33 24 14/07/09 9 OP33 26 14/05/09 The Charlton Centre for Alzheimer`s and Dementia Care Version 5.2 Page 29 conduct of the home are forwarded to the Commission until further notice so that we can monitor the conduct of the home as part of our ongoing inspection processes. REVISED AND OUTSTANDING REQUIREMENT FROM 26/2/08, 24/4/08, 26/6/08 and 17/11/08. 11 OP37 17 The registered provider must 14/05/09 ensure that all records held at the home are kept up to date and accurate. REVISED AND OUTSTANDING REQUIREMENT FROM 17/11/08. 14/05/09 The registered person must ensure that people’s health, safety and welfare are effectively promoted by way of risk assessments, the elimination and reduction of those risks as far as possible by the implementation of appropriate systems, and the monitoring of those systems. REVISED AND OUTSTANDING REQUIREMENT FROM 26/2/08, 24/4/08, 26/6/08 and 17/11/08. 12 OP38 12(1)(a)( b) 13(1)(a) (b) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP10 OP22 Good Practice Recommendations All staff should use an appropriate term of address when talking to, or about the people living at the home. The registered provider should ensure that people’s living environment is enhanced by way of signage. These improvements would help people get around the home, DS0000059693.V374337.R02.S.doc Version 5.2 Page 30 The Charlton Centre for Alzheimer`s and Dementia Care 3 OP26 4 5 OP28 OP32 6 OP35 promote independence and create a more stimulating living environment. The registered provider should ensure that all areas of the home are kept free from unpleasant smells so as to enhance the living environment of people living in the home. The registered person should ensure that training in NVQ II or above continues so that at least 50 of the care staff at the home holds this qualification. The systems operated by the service in relation to the management of the home should encourage innovation, creativity and development so that outcomes for people living at the home are positive. The registered person should ensure that people living at the home have access to their own money throughout the day so as to promote independence and personal autonomy. The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Yorkshire & Humberside Region Citygate Gallowgate Tyne and Wear NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Charlton Centre for Alzheimer`s and Dementia Care DS0000059693.V374337.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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