Care Home: Carlton House

What the care home does well 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 people working at the home all about and the support they need.One relative told us `This home suits mum perfectly, its just right for her`. Staff spoken to are enthusiastic and like working at the home.They are keen to ensure that the people at the home receive high standards of care. Comments from people and their relatives during the visit included `The staff are all lovely, kind and look after everyone really well` and `The girls are wonderful`. When we spoke with the staff they were clear about how to maintain people`s dignity and uphold their rights, they know the needs of the people in the home well. We saw that staff are sensitive to people`s needs when undertaking any personal care tasks and are sensitive and patient when dealing with the people who have dementia. Meal provision in the home is good.People are offered a variety of meals at each mealtime and special diets are catered for. Staff are well trained and this gives them the expertise they need to support the people living at the home. What the care home could do better: The registered provider also owns and manages another home in the area. Some of the records to support the management of Carlton House were held at the `sister` home, such as the RHF calculations, survey analysis, invoices for the plumber and copies of notifications sent to the commission. It is important that any records or information relevant to Carlton House is kept on site, so it is readily available and supports the management of this service. They need to consider how people with mobility problems can be weighed effectively to ensure any issues are identified quickly and support can be accessed in a timely way. The registered provider needs to confirm with the commission what action she is going to take to provide a registered manager for the service. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Carlton House 267 Hainton Avenue Grimsby North East Lincs DN32 0LA one star adequate service The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Lyons Date: 0 4 0 2 2 0 0 9 Information about the care home Name of care home: Address: Carlton House 267 Hainton Avenue Grimsby North East Lincs DN32 0LA 01472360878 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 Katrina Peerbux care home 10 Number of places (if applicable): Under 65 Over 65 10 10 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 0 Carlton House is registered to take 10 persons with residential care needs; these beds are also registered for people with needs associated with dementia. The home is a detached house situated in a busy residential area of the town; it is close to the town centre and on local bus routes. Accommodation is provided on two floors; there is chair lift access to the first floor. There are four single rooms and three shared rooms; one bedroom is provided on the ground floor. The home has one lounge, one dining room and an outside courtyard. The home has a pleasant, homely inclusive atmosphere. The home is owned by Mrs Katrina Peerbux. The acting manager is Mr A Peerbux. Information about the home and its services can be found in the statement of purpose Care Homes for Older People Page 2 of 11 Brief description of the care home and service user guide, both these documents are available from the manager of the home. Care Homes for Older People Page 3 of 11 What we found: The staff have worked hard to make improvements to the care plans since the last inspection visit. Three of the care plans were looked at which showed that they had all been reviewed recently, all assessments had been updated to reflect peoples current needs, new care plans had been put in place which clearly describe the actions staff need to take to meet the individuals health, care and social needs. The plans are person centred to some extent although there is room for improvement in how they describe peoples preferences within the care they receive and their lifestyle. Daily records have improved, staff record how the person has been throughout the day, the records include information about how the health and personal care needs have been met and also more information about how the individual has spent their day and what they have enjoyed doing. Records show that the care plans are regularly evaluated. Systems in the home to monitor peoples weights properly have improved. Staff weigh people each month and record the weight in the care records, the registered provider told us that these records are checked each month and any concerns would be followed up. Records and discussions with the registered provider also evidenced that none of the current individuals nutritional needs had changed since the last inspection visit. New stand on style weighing scales have been provided. One of the individuals mobility needs have changed and they are now unable to use this type of equipment; the registered provider confirmed that she is currently looking into how this individuals weight can be monitored accurately although records show that their nutritional intake is being monitored very closely and their general condition is stable. There was evidence that the home had previously accessed support for this person from the community dietetic department and this support had been discontinued following assessment in 2008. At this visit we looked at how the home handles and stores medication. Each persons care files contains a copy of their prescription and a care plan to support their needs around medication. Records show that staff check all medications received by the pharmacy and make sure that the correct medication has been delivered. Checks on current Medication Administration Records (MARs) and a selection of records over the last six months for each person showed that staff had signed for all medications administered and had used appropriate codes to support why the medication had not been given. All medication was safely stored in the medication trolley or in the medication cupboard. A new medication fridge had been provided in the office, this was securely locked and records show staff monitor the temperature daily. We looked at the controlled medication register which showed that two staff had signed when new stocks of controlled medication had been received and administered. It was noted that one individual living in the home is prescribed medication to support the management of their behaviour on an as needed (p.r.n) basis. It is good practice for written guidance to be in place for staff to support when this type of medication should be given, this could provide more continuity in the overall management of the individuals behaviours. The registered provider told us that three of the newly recruited care staff had recently completed a distance learning course on the safe handling of medications and were currently awaiting their certificates, one further staff member was working through the course. There was evidence that the registered provider had audited the medication systems regularly. Overall, good improvements have been made with the Care Homes for Older People Page 4 of 11 storage and recording of medications which better ensures the safety of the people who live in the home. At the key inspection in July 2008 we found that many areas of the home were in need of redecoration and refurbishment, a revised maintenance plan was provided following this visit which identified a comprehensive programme of renewal at the home. At this visit there was good evidence that many improvements had been made to the facilities and in the main the timescales for work to be completed had been met. Six of the seven bedrooms have been redecorated and new furniture and carpets provided where needed.The remaining bedroom is scheduled for redecoration this month. The dining room has been redecorated and the fireplace removed to provide more space and to protect peoples safety. During the visit a new carpet in the dining room was laid, new furniture installed and people were observed to be enjoying their evening meal in very pleasant surroundings. People spoken with said that they thought the new dining facilities were very nice and lovely. There was good evidence that the staff had taken action to improve the management of malodours in the home. The registered provider told us that all individuals had had their continence support reviewed, care records showed that the home had liaised with the community continence adviser and a number of individuals have had the type of products they require reviewed. The home had also reviewed the type of cleaning products they used and introduced new ones, in addition to this the home had purchased in July 2008 a new carpet cleaner. We spoke to some relatives during the visit who told us that they visit the home regularly and did not consider that the home had any malodours. The carpets in the lounge, hall, stairs and upstairs landing were also due to be replaced over the next few days. It was noted that the linoleum flooring in the laundry had room had worn through in one area causing a potential trip hazard, the registered provider confirmed that this area of flooring was also scheduled to be replaced this week. The registered provider has produced a new maintenance and renewal programme for this year, which details all work to be completed each month. From observations during the visit and discussions with people, staff and relatives there was evidence that there were sufficient numbers of staff rostered to meet the needs of the people living in the home. Since the last inspection, recruitment of staff to the home has been more positive with all care vacancies filled, although one of the more recent staff members has decided to return to community work and this position is being advertised. The registered provider told us that staffing levels had been reviewed and increased in line with calculations from the Residential Staffing Forum dependency tool, records supported this. At the time of the visit there were eight people living in the home and levels of three staff in the morning, two staff in the afternoon and two staff at night (one waking staff) were being maintained. Checks on staff rotas evidenced that these levels had been maintained since the last inspection, although the home had experienced some difficulties covering some of the shifts during the five weeks in November and December when the acting manager had been on sick leave. Some cover had been provided by staff and the registered provider had worked in the home for two days each week. There are no ancillary staff employed at the home, alongside care duties staff are responsible for catering, cleaning and the laundry. Staff spoken to said that the staffing levels in the mornings were much better, they had more time to spend with people giving them one-to -one support and more activities and social events were taking place. People and relatives spoken with during the visit were very complimentary about the staff, comments included staff are Care Homes for Older People Page 5 of 11 wonderful and look after everyone here really well and We cant fault the staff, they are very kind and patient with Dad. Since the last inspection the registered provider has put in place a more comprehensive in house induction programme for all new staff, following this they complete the Skills for Care common induction standards to assess their competence, which is signed off by the registered provider on completion. Examination of training records for three staff employed since the last inspection evidenced that this is taking place. There was good evidence that the registered provider had taken steps to improve the overall management of the home. She told us that she had delegated some of the management duties to one of the senior care staff, who with her support and guidance had made good progress with improvements to administrative systems such as medication, care plans , quality assurance, staff rotas and staff training which we could see from checks of those records.The staff rotas now show that administrative time is scheduled each week for the acting manager and the senior care assistant. The registered provider has also spent much more time working in the home herself, although this time is recorded on rotas at the home she owns and manages, she should document this time on the rota at Carlton House. The registered provider now carries out regular formal supervision for the acting manager, checks on records confirmed this. Reports are completed to support Regulation 26 visits, these show that she reviews key areas of the homes management such as staff training, staff supervision, maintenance and quality assurance. Staff spoken with during the visit consider that the home is more organised and were clear about their managers roles and responsibilities. The home had been without a registered manager for three years, recruitment of a suitable manager during this time has proved unsuccessful. The acting manager does not intend to apply for registration. The Commission for Social Care Inspection (CSCI) considers that three years is an unacceptable length of time and we have written a letter to the registered provider requesting that she confirms what action she is going to take, as the continued absence of a registered manager at the home could affect her fitness as a provider. We saw that improvements have been made to further developing and embedding a more effective quality assurance system which more clearly identifies that staff, people who live in the home, their representatives and others have more opportunities to influence the running of the home. More regular audits have been carried out on areas such as care plans, medication recording and maintenance with positive results. Surveys have been issued to all the people who live in the home, their families and some health and social care professionals. There is evidence that findings from audits and surveys have been more thoroughly followed up. Regular meetings are held with staff and staff spoken with confirmed that they are encouraged to make suggestions about improvements to the running of the home. Meetings are held with people who live in the home however the last one was cancelled due to the acting managers leave although this being rescheduled. It was very positive to see that all the people living in the home had been consulted about the choice of decor for the refurbishment programme. An annual development plan was produced in September 2008 which detailed what improvements had been made to the home and what further improvements were planned, copies of the report had been given to all the people who Care Homes for Older People Page 6 of 11 live in the home and their families. We looked at supervision records for three staff which showed that they are now receiving regular individual meetings with the acting manager and are on track to receive the required number of sessions. Records also show that staff had received their annual appraisal. The registered provider told us that staff continue to receive some group supervision sessions however these now supplemented the individual programmes. Management have addressed the health and safety issue mentioned in the last report which has made the home a safer place for people. The hot water temperatures at outlets throughout the home are now monitored each week, the nature of the old building means the temperatures can fluctuate, staff are aware of this and records show that where the temperature has risen slightly above the maximum of 43 degrees Centigrade, the plumber has been called in to either adjust or replace the thermostatic valve. The plumber was visiting the home during the inspection attending to the hot water management as the recent check had identified a small number of raised hot water temperatures. Following completion of this work, the registered provider checked a number of hot water outlets which showed they were satisfactory. What the care home does well: What they could do better: The registered provider also owns and manages another home in the area. Some of the records to support the management of Carlton House were held at the sister home, such as the RHF calculations, survey analysis, invoices for the plumber and copies of notifications sent to the commission. It is important that any records or information relevant to Carlton House is kept on site, so it is readily available and supports the management of this service. Care Homes for Older People Page 7 of 11 They need to consider how people with mobility problems can be weighed effectively to ensure any issues are identified quickly and support can be accessed in a timely way. The registered provider needs to confirm with the commission what action she is going to take to provide a registered manager for the service. 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 2. Care Homes for Older People Page 8 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 11 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 8 Consider how people with mobility problems can be weighed effectively to ensure any issues are identified quickly and support accessed in a timely way. All records which support the management of the service should be held in the home. 2 37 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. 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