Care Home: Carlton Care Home

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What the care home does well All areas of need were fully assessed so that people are assured their needs can be met at the home. Care plans gave detail of how staff were to help people with personal care and people told us their privacy and dignity were always respected. Comments in the returned survey form were: "They make me feel cared for"; "They take very good care of me" and "Nurses and care staff are very good." Activities were tailored to individual needs and preferences and included assisting the gardener with planting vegetables, a Rock and Roll evening, strawberries and cream whilst watching tennis on television, and a visit from a local church group. Individual diet requirements were detailed in care plans and the cook was flexible to meet people`s needs and preferences, having discussions with them individually each day. There was a clear complaints procedure displayed and evidence that any complaints or concerns were taken seriously. A clean, safe and well maintained environment is provided. There were a sufficient number of trained nurses available and qualified care staff. Recruitment procedures ensured people were safeguarded. Overall, we found that the home was well managed and run in the best interests of the people who live there. What has improved since the last inspection? The external area had been developed to provide a well laid out enclosed rear garden that was safe and accessible to everyone. Some new decking was in place with a sun canopy and we saw people sitting there. The entrance of the home had been improved since the last inspection with a new double glazed stained glass front door and further changes had been made within the building. Two of the shared double bedrooms had been converted to three single rooms and two bathrooms had been improved to provide wet rooms for accessible showering. People said they preferred these to the previous baths. What the care home could do better: We did not need to require any action to be taken to meet regulations, but we have made the following recommendations for good practice: Monitor medication records regularly to ensure good practice is consistently followed so that there is clear evidence that people are always offered their medication as prescribed by a doctor. Monitor the temperature of the clinic room so that all medication is stored at atemperature that preserves it in good condition. When a shared place becomes vacant, they should give the remaining person the opportunity to choose not to share and offer double rooms only to those who make a positive choice to share with each other. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Carlton Care Home 398 Carlton Hill Carlton Nottingham NG4 1JA     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: Meryl Bailey     Date: 3 0 0 6 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 25 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 25 Information about the care home Name of care home: Address: Carlton Care Home 398 Carlton Hill Carlton Nottingham NG4 1JA 01159619959 01159873889 sally.flavill@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Josephine E Flavill care home 29 Number of places (if applicable): Under 65 Over 65 29 old age, not falling within any other category Additional conditions: 0 Carlton Hill care home is registered to rovide personal care to male and female service users who fall within the following categories: Old age, not falling within any other category (OP) 29 The maximum number of persons to be accommodated at Carlton Care home is 29. To accommodate one servcie user with physical disabilities under the PD or PD(E) category. To accommodate two service users aged over 60 years. Date of last inspection Brief description of the care home Carlton Hill Care Home provides care for Older people requiring nursing or residential care. The home consists of a large extended two-storey house. A passenger lift is provided. There are a mixture of single rooms and double rooms, some of which have en-suite facilities. The range of fees are: £319.00 TO £532.00 Care Homes for Older People Page 4 of 25 Care Homes for Older People Page 5 of 25 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 focus of inspections undertaken by the Care Quality Commission is upon outcomes for people using the service and their views on the service provided. This process considers the providers capacity to meet regulatory requirements and minimum standards of practice and it focuses on aspects of service provision that need further development. We reviewed all of the information we have received about the home since the last report of our key inspection, which took place on 24 July 2006. Annual assessments have shown us that the quality was maintained. Prior to this inspection visit we sent out survey forms to a sample of people currently living at the home and some of the staff and we have used their comments to inform our judgments. Services are required Care Homes for Older People Page 6 of 25 to fill in a form called an Annual Quality Assurance Assessment (AQAA), in which the registered manager identifies from their own quality monitoring what the service does well and what they need to improve. We received a comprehensive AQAA form in November 2008. We considered this in planning the visit and deciding what areas to look at and the information has been taken into consideration within this report. We carried out the inspection visit with one inspector. It was unannounced and took place on one day in the daytime, including lunchtime. The main method of inspection we used during this visit is called case tracking which involved us choosing a sample of people who live at the home and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We looked at staffing records and other records connected with the running of the home. A partial tour of the premises included all shared areas and a sample of bedrooms. What the care home does well: What has improved since the last inspection? What they could do better: We did not need to require any action to be taken to meet regulations, but we have made the following recommendations for good practice: Monitor medication records regularly to ensure good practice is consistently followed so that there is clear evidence that people are always offered their medication as prescribed by a doctor. Monitor the temperature of the clinic room so that all medication is stored at a Care Homes for Older People Page 8 of 25 temperature that preserves it in good condition. When a shared place becomes vacant, they should give the remaining person the opportunity to choose not to share and offer double rooms only to those who make a positive choice to share with each other. 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. 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 25 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 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive assessments are carried out so that people are assured their needs can be met at the home. Evidence: There was a clear Service User Guide and people told us they, or in some cases the relatives, had received information about the home before they moved in. We looked at the files of three people. One of these had moved directly from hospital and had not had chance to visit first, but the others had made a visit to the home. We saw clear assessments that had been carried out by the manager who visited people wherever they were prior to moving into the home. All areas of need were fully assessed and social histories were included. There were also copies of letters that had been sent to confirm that the persons needs could be met in the home. Care Homes for Older People Page 11 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is well planned so that peoples health and personal care needs are met in a respectful manner. Evidence: We looked at a sample of three files of people living in the home and found comprehensive care planning that covered all areas of daily living. Personal care, diet, mobility, sleep, continence, communication and relative involvement were all included. There were also plans about physical and mental state where these were appropriate. The plans included clear directions for staff about what care was needed and actions they need to take. Each plan was reviewed at least once a month. People had signed agreements to the plans and reviews. There were risk assessments for use of the hoist, falls, radiators, bed height and door locks. Diets were detailed and the Douglas tool was used to assess the risk of developing pressure sores. Appropriate actions and directions were given to reduce risks. Staff told us they read the care plans and made use of a communication book and daily records so that they had up to date information. There was also a daily report given each day by the nurse to the care Care Homes for Older People Page 12 of 25 Evidence: staff at the start of every shift. In addition to daily records there were records of visits from community nurses and doctors and of out patient hospital appointments. Medication was stored securely, but the clinic room was very hot, even though there was a fan in use. Room temperatures were not taken to monitor whether they were kept under 25 degrees centigrade. There was a refrigerator to keep items that needed storing in very cool temperatures and that was fully monitored. We observed a nurse preparing and administering some medication and she followed good practice. However, we saw there were several gaps in the recording on the current Medicine Administration Record sheets (MARs). Also all the instructions were handwritten and not signed and verified as true copies of what was prescribed. The manager said some gaps were left when a person was out for the day and others had not been initialed when certain medicines were not needed at that time. There were no codes used on a regular basis to show the reason for medication not being given. The manager assured us that everyone had received their medicines and there had not been any errors. The manager and provider accepted that the records were not giving a clear account of what was given and took immediate action to improve this area. On the day following the inspection visit they started a new system with codes. All nurses signed that they understood and the providers submitted new charts to Commission. People told us that staff and managers were very respectful and relatives said that they were always made very welcome at the home. Care plans gave detail of how staff were to help people with personal care and people told us their privacy and dignity were always respected. We observed good practise when people were being moved using a hoist. Staff were careful to ensure people knew what was happening and kept them covered at all times. Comments in the returned survey form were: They make me feel cared for; They take very good care of me and Nurses and care staff are very good. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a lifestyle that matches their preferences and enables them to have control over their lives. Evidence: Social histories were included in preadmission assessments so that staff would know peoples interests and preferences. During the inspection visit we observed one person making a bookcase with a little help and an additional worker was reading a book to another person. Some people we sitting outside and others were watching television. People told us that on another occasion they had had strawberries and cream whilst watching tennis on television. There were records of other activities which recently included an entertainer on 8 June 2009, a visit from a local church group on 16 June 2009 and the Stanza choir on 17 June 2009. Some people remembered a Rock and Roll evening and a Cheese and Wine evening. Some were part of the dominoes group and ten people had been involved with assisting the gardener with planting vegetables. People often took part in a quiz, a hairdresser visited regularly and people had also had hand massages. There were several visitors and a record was kept of all visitors to the home. Care Homes for Older People Page 14 of 25 Evidence: Individual diet requirements were detailed in care plans. People ate their lunch in the dining room or small lounge. We observed one carer assisting a person with their meal and talking respectfully at the same time. There were menus in the kitchen, but the cook used these only as a guide and was flexible to meet peoples needs and preferences. On the day of the inspection visit she had changed the meal to suit the hot weather, giving people a choice of jacket potato and salad. People confirmed that the cook always speaks to people individually about what they would like to eat. There were clear records of food alternatives served and of temperature checks. We saw homemade shortcakes and muffins that the cook had prepared. People said they always liked the food and choices available. Its always good here. Care Homes for Older People Page 15 of 25 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. Any complaints or concerns are taken seriously and people are safeguarded from abuse. Evidence: There was a clear complaints procedure displayed and contained in the Service User Guide. A file contained records of complaints. A new type of complaint record was being used with space to include the outcome, which had not always previously been included. There was evidence, though, that people were satisfied with how complaints were handled. The eight people who completed our survey forms told us they all knew how to make a complaint and who to speak to if they were unhappy about anything. No one had contacted the Commission about any concern or complaints about the home. There were records to show that the recruitment procedure included pre employment checks and all staffed had received training about safeguarding people, the Whistle blowing policy and the Mental Capacity Act. There was a copy of the local area Safeguarding Adults procedures. Care Homes for Older People Page 16 of 25 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 excellent 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 safe and well maintained environment. Evidence: There were various sitting areas, which allowed people a choice to sit quietly, meet with visitors or engage in activities with other residents. There was a well laid out enclosed rear garden that was safe and accessible to everyone. Some new decking was in place with a sun canopy and we saw people sitting there. The entrance of the home had been improved since the last inspection with a new double glazed stained glass front door and further changes had been made within the building. Two of the shared double bedrooms had been converted to three single rooms and two bathrooms had been improved to provide wet rooms for accessible showering. People said they preferred these to the previous baths. There were still some double rooms, shared by people who had been together for some time, but most people had there own bedroom and those we saw were very clean, well decorated and personalised. An enclosed rear garden is accessible to people with mobility problems and provides a safe outside space. All areas of the home were clean and hygienic with arrangements for regular disposal of clinical waste and the laundry, though small, held sufficient washing and drying machines. There were records to show that all staff had been trained in Infection Control and the laundry and housekeeping staff had received additional training. Care Homes for Older People Page 17 of 25 Care Homes for Older People Page 18 of 25 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 excellent 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 a sufficient number of competent staff. Recruitment procedures ensure people are safeguarded. Evidence: There was a nurse and three care staff on duty to care for the current 23 people living at the home. Domestic staff were in addition to this. Staff told us there were nearly always sufficient people on duty. When regular staff were not available, temporary staff were employed to cover some shifts. People living in the home said that they only had to wait a few minutes at the most when they asked for assistance. The provider and an office manager were also present in the home on most days. Out of a total of thirteen permanent care staff, ten had completed a National Vocational Qualification (NVQ) in care at level 2. All nurses were registered with the Nursing and Midwifery Council and kept their training up to date. Nurses had completed Train the Trainer courses in Moving and Handling and Safeguarding Adults. They were also starting further similar courses to train people in the Mental Capacity Act. New staff were registered with Skills for Care for Induction Training. We looked at a sample of three staffing records in detail and found that each of the staff had been checked by the Criminal Records Bureau and there were two references Care Homes for Older People Page 19 of 25 Evidence: for each of the staff before they were employed at the home. Staff told us they received regular training in addition to their NVQs and we saw certificates of training that had been given. All staff were up to date with the mandatory health and safety training. Six of the staff had commenced Equality and Diversity Training and another two were currently doing training in Palliative Care. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there. Evidence: The Registered Manager and the Assistant Manager had both completed Business and Management Studies through Castle College The Office Manager had completed the short Management Course which included recruitment and absence management. The registered manager is a registered nurse with 32 years experience with older people. The Annual Quality Assurance Assessment (AQAA) form was comprehensively completed and sent to the Commission prior to this inspection. It gave us all the information we asked for and has assisted in judging the quality of the service. The quality assurance programme for the home included questionnaires for service users and relatives and also for professionals and staff. Subjects covered in these were Menu choices, activities and outings. Peoples requests were incorporated into the entertainment programme, and information gained was also used to provide personal Care Homes for Older People Page 21 of 25 Evidence: favourite dishes. The manager and provider also met regularly with relatives. A small amount of money was looked after securely for each person and we saw evidence of clear records of transactions. All staff had been trained in Health and Safety, Moving and Handling, Infection Control and Fire Safety. The AQAA form gave us the dates of servicing of equipment, which has all been serviced within the last year. There was folder containing risk assessments. Records of accidents were completed and presented to the manager to ensure action was taken to eliminate or reduce risks. Care Homes for Older People Page 22 of 25 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 23 of 25 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 9 Monitor medication records regularly to ensure good practice is consistently followed so that there is clear evidence that people are always offered their medication as prescribed by a doctor. Monitor the temperature of the clinic room so that all medication is stored at a temperature that preserves it in good condition. When a shared place becomes vacant, give the remaining person the opportunity to choose not to share and offer double rooms only to those who make a positive choice to share with each other. 2 9 3 23 Care Homes for Older People Page 24 of 25 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). 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. 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