Care Home: Carleton Court

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What the care home does well People are cared for by staff who have an excellent understanding of the needs of older people. Staff work in a team which is professional, pro-active and cohesive. The attitude and manner of staff in the home is excellent. Staff undertake detailed assessments of people before they enter the home, this helps staff udnerstand the person and their individual needs. People have access to a range of activities which are facilitated by different staff each week. Staff are well trained. With 95% of carers having achieved an NVQ Level 2 or above in Care. People are cared for by staff who are safely recruited, this helps protect people from harm. What has improved since the last inspection? A new call bell system has been introduced, this means people using the service can easily call for assistance which staff respond to effectively. There are more staff available at the tea-time meal. This means that people have their food and drink served in a timely manner and appropriate assitsance can be given where needed. The assistant manager has completed the Registered Manager`s Award, this means that people can be assured that this person is competent and skilled in her role. The home have purchased a range of furniture including chairs, beds, bedroom windows, a dishwasher, fridge freezer, cleaning trolley and a new water heater. This helps to improve the environment and enhances the bedrooms for people using the service. People have their medication dealt with in a robust manner, this helps prevent errors occurring. What the care home could do better: Whilst staff clearly recognise the needs of people using the service and their individual risks, this could be recorded in a more effective way. The training records could be more up to date. This will help ensure people have received the correct training within an agreed timescale. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Carleton Court 108 Carleton Road Pontefract West Yorks WF8 3NQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Bell     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Carleton Court 108 Carleton Road Pontefract West Yorks WF8 3NQ 01977702635 01977690744 rod@walker6031.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Carleton Court Care Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Carleton Court continues to provide accommodation and personal care for 25 people over the age of sixty-five. Set back in its own grounds Carleton Court has a large drive with parking to the front and a very large walled garden to the rear. There is a large reception through the main entrance at the front, which leads to the office, dining rooms, lounges and bedrooms. There is a passenger lift provided along with assisted bathing for those who require support. Most of the accommodation provided is in single bedrooms, however, there are two very large bedrooms for those who wish to share. Regular activities are organised including outings, tips to the theatre and eating out. The care provided by the home is based on ordinary living principles and the people who live there are encouraged and supported to do as much for themselves as possible and maintain their independence. The home is run on Christian values and there are Care Homes for Older People Page 4 of 24 Over 65 25 0 Brief description of the care home regular services held in the home by clergy from different denominations. The home is situated on a main bus route and there are local shops nearby. Pontefract town centre and all services and amenities are only a few minutes journey from the home as are the M1/M62 link roads. The fees charged in April 2009 were from £398-£408 per week. Hairdressing, chiropody and newspapers/magazines are charged in addition to the fees. The Provider gives a service user guide to enquirers at initial contact. This provides information about the service and the role of the commission. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We went to the home without telling them that we were going to visit. This report follows the visit that took place on Friday 3rd April 2009. The visit lasted from 12:30 until 16:30. 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. Care Homes for Older People Page 6 of 24 The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include- Reviewing information that has been received about the home since the last inspection. The annual quality assurance assessment. This is information which details what has happened during the past 12 months. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. At the site visit one inspector spent 4.0 hours at the home. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager at the end of the inspection. The weekly fees range from pounds. Additional charges are made for chiropody, hairdressing and newspapers. The home has a copy of the latest inspection report, the Statement of Purpose and Service Users Guide. These are readily available and are discussed with people. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. Care Homes for Older People Page 8 of 24 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. Care Homes for Older People Page 9 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 have their needs effectively assessed prior to admission. Evidence: The three pre-admission assessments looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. The Annual Quality Assurance Assessment states a new six page format indicating in great detail significant need but also preferences and deferences. Prospective users visit, stay for lunch or tea and can be involved with activities. This helps ensure a smooth transition. The home does not offer intermediate care. The assistance manager was aware of the categories of registration and how peoples Care Homes for Older People Page 11 of 24 Evidence: needs may differ depending on the persons medical, social and psychological history. Care Homes for Older People Page 12 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs met in an extremely dignified manner, with staff really understanding how to care for older people. Evidence: Three care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as at risk had a care plan in place describing how that risk was to be managed. Improvements have taken place regarding the care plans and the risk assessments and staffs knowledge confirmed that they understood the risks people faced on a day to day basis. The nutritional assessments had been developed but still need to be recorded in more detail with a clear assessment in place. The assistant manager was keen to develop these. Care Homes for Older People Page 13 of 24 Evidence: People were observed looking clean and well cared for, attention had been paid to ensuring teeth, hair and nails were attended to. The home was aware of how to report accidents and injuries with one person stating we always go to hospital on a daily basis when one of our residents is in hospital. This was confirmed by one person using the service, this helps reassure the person concerned and their families. Throughout the visit the attitude and manner of staff was observed, it was evident that staff have an excellent rapport with people using the service. On many occasions staff were overheard using a pleasant, gentle tone of voice with people, this was evident also with visitors and with other staff members. The assistant manager was very aware of the philosophy of the home and treated people like an extended family. This worked well and the atmosphere in the home was calm and relaxed with all staff been approachable, professional and friendly with everyone they came into contact with. Staff know how to treat people with respect and dignity and this was consistently confirmed throughout the day. The home have a robust medication system in place. Since the last inspection improvements have been made regarding auditing the system, stock balances and training of staff in this area. The medication cupboard is currently stored in the office, it would be beneficial if a separate room was available to carry out medication duties, this was discussed with the assistant manager. However, the medication trolley and cabinet are kept secure and daily temperatures are taken. Staff record when creams and ointments are opened and are familiar with the need to destroy medications which have expired. Three medication charts were examined and these were well completed with staff signing and using correct codes if tablets had not been administered. Staff were aware of how to deal with controlled drugs, and had some homely remedies available if needed. Care Homes for Older People Page 14 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 able to participate in a range of activities where autonomy and choice is encouraged. People receive good quality food and drink served in pleasant surroundings. Evidence: The home have a flexible approach to activities, every day a different carers is nominated to facilitate an activity. This could be arts and crafts, entertainment, trips out, or one to one sessions. There is a weekly exercise class held by a professional person and beauty treatments are offered to everyone. The home have forged links with the local community through the church and schools. Staff are aware of the Mental Capacity Act and the recently introduced Deprivation of Liberties (this looks at Independence of people and the risks involved). The manager often takes people out for something to eat and drink this may last all afternoon depending on the needs of the person using the service. Visitors are welcomed into the home at a range of times. This was confirmed in the visitors book. Staff discussed equality and diversity and how they meet peoples needs regarding their age, sexuality, gender, religion and cultural needs. People can choose where they have their food and drink served, some people prefer Care Homes for Older People Page 15 of 24 Evidence: snacks with their relatives in their own room. Other people eat in the dining room. There is a pleasant atmosphere with a range of wholesome food on offer. There are now more staff available for the tea-time meal and this has improved the outcome for people. Peoples likes and dislikes are recorded and recognised and staff are keen to ensure people have enough to drink to prevent dehydration. Jugs of juice and water were observed in the home. People said they enjoyed the food provided, and staff have completed food hygiene training. Care Homes for Older People Page 16 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 confident their concerns will be listened to and dealt with effectively, and staff are alert to signs of abuse. This helps protect people from harm. Evidence: The home have a complaints procedure in place. The annual quality assurance assessment states a copy of the policy and procedure are given to people proposing to use our service on admission. This is also displayed in the entrance area of the home. People spoken with all said they would have no hesitation in speaking to the any member of staff if they had any concerns. People also said that staff talk to them on a regular basis throughout the day. The home have received three complaints in the last 12 months. None of these were upheld, but all were fully investigated. Staff have received abuse awareness training, and those staff spoken with were very familiar with the different types of abuse, the term whistle-blowing and the action to take if an allegation of abuse is made. Staff were aware of the involvement of social services, The Commission and the police. People in the home looked safe and well cared for. Care Homes for Older People Page 17 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 live in a clean, comfortable and well maintained environment. Evidence: The atmosphere of the home is pleasant and odour free. There are enough communal areas for people to use and access for wheelchairs is available. Equipment for bathing, moving and handling and aids to improve mobility are all in place. There is a rolling programme of redecoration which is clearly documented and during the past 12 months new items of furniture for bedrooms, lounge areas and the kitchen have been obtained. People using the service are consulted regarding he decor the home and their individual rooms. Staff receive infection control training and were observed using hand washing techniques, and wearing protective clothing. The laundry area is separate from the main building and is kept clean and tidy. Laundry is washed and ironed and a labeling system is in place to prevent items of clothing going missing. People were observed wearing clean and well ironed clothes. Care Homes for Older People Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 cared for by competent, effective and safely recruited staff. Evidence: People are cared for by enough staff to meet the individual needs of older people. The home has permanet staff who have worked in the same home for many years. Agency staff are not used. There are a mix of age ranges with currently 18 female staff and no males.The manager and assistant manager have completed an NVQ Level 4 in care and management. Four members of staff are completing an NVQ Level 3 in care and 95 of staff have achieved an NVQ Level 2 in Care. This helps to promote consistency in care practices and offers people a good standard of cared by well trained staff. Staff receive induction training which is equivalent to Skills for Care This includes orientation to the home, health and safety, care practices and the expectations of the management of the home in the role of carer/catering staff/domestic or maintenance. There are regular staff meetings where improvements are discussed regarding the skill mix, number of staff on duty and areas where more staff are needed. For example during peak times. The recruitment procedure of the home meets all current standards. Two written references are obtained, a police check and a Protection of vulnerable adults check prior to a new member of staff starting work. Recruitment files checked confirmed this information. This helps protect people using the service from harm. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the interests of people using the service. Consideration is given to safety, welfare and the quality of service that people receive. Evidence: The registered manager as stated in the Annual Quality Assurance Assessment has twenty two years experience working in social care. Staff spoke about his leadership style and his openness, and approachability. The assistant manager is extremely knowledgeable about this client group, she is passionate about caring for people and has plenty of support from the rest of the care team and ancillary staff. The quality assurance system includes having meetings for people using the service, their relatives and for staff. Views and opinions are sought on a daily basis from people using the service. Senior care meetings are held every two weeks in addition to staff meetings. Questionnaires are examined by the management team and action is taken where improvements are needed. A range of audits regarding care planning, medication, and health and safety are in place. Care Homes for Older People Page 20 of 24 Evidence: People discussed how their finances are handled. People can keep money in the home in a secure place. Well maintained records confirmed this, and staff are aware what constitutes financial abuse and are keen to offer an advocacy service for people who may not have a next of kin to deal with their finances. Staff also discussed the role of Power of Attorney. Health and safety in the home was discussed. A fire risk assessment is in place and staff have received fire training, with fire alarm testing taking place weekly. Staff receive moving and handling, infection control, food hygiene and first aid training as mandatory. The records for these could be more up to date (along with the nutritional assessments). However, this relates to record keeping rather than staff not receiving the training. During the past 12 months temperature control valves under sinks and radiator thermostat controls for central heating have been replaced in peoples bedrooms. This ensure people have water distributed at the correct temperature and people can adjust the temperature of their room if needed. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 37 37 Training records should be more up to date. Records regarding nutritional assessments need to be more detailed. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@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) Commission for Social Care Inspection (CSCI). 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