Care Home: Carlton House

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What the care home does well Residents and their representatives are unanimous in their opinion that the home is well run and the staff are very committed and caring. We have included their comments in the relevant sections of the report. All potential users of the service have their needs assessed and are invited to visit and spend time in the home before deciding to move in. Residents who are self-funding have contracts that detail the home’s charges and what is covered. Each resident has an individualised care plan which provides guidance for staff about how the person prefers to be supported and there is a wide range of stimulating activities for them to choose from. Staff ensure that residents’Carlton HouseDS0000039315.V377062.R01.S.docVersion 5.2healthcare needs are met by referrals to the G.P and, where appropriate, to other specialist healthcare professionals. The environment is attractive and homely and very clean. Everyone we spoke to said they were very pleased with the meals provided. There is a thorough system in place for recruiting and training staff to ensure that residents’ best interests are safeguarded. Residents’ views are sought at regular meetings about how the home is run. The home is well maintained and regular health and safety checks are carried out to ensure the safety of residents, staff and visitors to the home. What has improved since the last inspection? The home has complied with all the requirements made at the last key inspection. There have been great improvements in how the home monitors, accounts for and administers medication. New carpets have been provided and the patio in the garden has been re-laid to make it safer for the residents. Waste-bins in toilets and bathrooms have been replaced with ones that can be operated without the need to touch them by hand. This helps to control the potential spread of infection. What the care home could do better: We were concerned about the absence of an appropriate sign by a fire exit. There also appeared to be some confusion about whether some specific areas are designated as safe fire exits. We have made a requirement to seek and implement professional advice about this important matter. Key inspection report CARE HOMES FOR OLDER PEOPLE Carlton House Carlton House 2 The Avenue Hatch End Middlesex HA5 4EP Lead Inspector Tom McKervey Key Unannounced Inspection 4th August 2009 09:15 DS0000039315.V377062.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton House Address Carlton House 2 The Avenue Hatch End Middlesex HA5 4EP 020 8428 4316 020 8907 5777 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) Farrington Care Homes Ltd Jayaliya Gunatunga Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 24 26th August 2008 Date of last inspection Brief Description of the Service: Carlton House is a large detached property situated in a residential area within the Royston Park estate in Hatch End. It is owned by the Farrington Care Homes Ltd organization, a privately-owned company. The organization owns two other homes in the local London region, and is expanding nationally. The home is about five minutes walk from a superstore, bus routes, and a local-line railway station. The Hatch End shopping parade is about ten minutes walk away. The home has a forecourt with parking space for about eight cars. There are no parking restrictions on the road outside the home. Accommodation for residents is provided on the ground and first floors. Access upstairs is by lift or stairs. The home has two double rooms and 20 single rooms. Three single rooms have en-suite facilities. The home has a large number of toilets available. It has three interconnecting lounges and a dining room. At the rear there is an accessible garden. The Service User Guide, which details the services provided by the home, is available for viewing within the entrance hall. There was one vacancy at the time of the inspection. Prices for the home range from £547 to £569 per week, depending on single or double occupancy. There are additional charges for such things as hairdressing, private chiropody, and personal phone lines within bedrooms. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 5 Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Three Stars. This means the people who use this service experience excellent quality outcomes. This unannounced inspection took place on the 4th of August 2009 and was completed in six and a half hours. The lead inspector was accompanied by the Commission’s pharmacist, Jane Shaw who examined the medication standards; her findings are included in the main body of this report. The manager was present throughout the inspection and the proprietor came to the home in the afternoon. The inspection consisted of visiting all areas of the home, discussions with the manager and the proprietor and the staff. Interviews were held with residents and relatives. A district nurse, who was attending to residents during the inspection, was also spoken to. The manager sent us the home’s Annual Quality Assurance Assessment before the inspection. This document gives us information about what the home does well and identifies areas where improvements are needed. It also gives us numerical information about who is living and working in the home. Prior to the inspection we sent out questionnaires to residents, staff and professionals to obtain their views about the home. We received sixteen responses from residents, eight from staff, and one from a district nurse, a community psychiatric nurse and the local G.P. Reference to these documents is made in various sections of this report. We also examined case files, staff records and several documents relating to the running of the home. What the service does well: Residents and their representatives are unanimous in their opinion that the home is well run and the staff are very committed and caring. We have included their comments in the relevant sections of the report. All potential users of the service have their needs assessed and are invited to visit and spend time in the home before deciding to move in. Residents who are self-funding have contracts that detail the home’s charges and what is covered. Each resident has an individualised care plan which provides guidance for staff about how the person prefers to be supported and there is a wide range of stimulating activities for them to choose from. Staff ensure that residents’ Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 7 healthcare needs are met by referrals to the G.P and, where appropriate, to other specialist healthcare professionals. The environment is attractive and homely and very clean. Everyone we spoke to said they were very pleased with the meals provided. There is a thorough system in place for recruiting and training staff to ensure that residents’ best interests are safeguarded. Residents’ views are sought at regular meetings about how the home is run. The home is well maintained and regular health and safety checks are carried out to ensure the safety of residents, staff and visitors to the home. 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 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. Carlton House DS0000039315.V377062.R01.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 Carlton House DS0000039315.V377062.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential users of this service can be confident that their needs will be thoroughly assessed and they can visit the home to assess its suitability before they decide to move in. EVIDENCE: We examined in detail the case files of the last four residents who were admitted to the home. The files contained evidence that the residents’ needs had been thoroughly assessed by the manager before admission, with further ongoing assessments as the residents settled in. Pre-admission visits to the home had been made by the residents or their representatives to assess the Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 10 home’s suitability. The information in the case files stated the person’s G.P, next of kin, ethnicity, religion and preferred method of communication. Several residents fund their care privately. We noted that they had signed contracts which detailed the fees they paid and what the fees covered. Those residents who were funded by the local authority, were visited by the placement officer six weeks after admission and their care is reviewed annually thereafter. The placement officers were satisfied that the home was continuing to meet the person’s needs. The manager informed us that, on the day of the inspection, a meeting was being held by the local authority to consider a resident’s continued placement in the context of the Mental Capacity Act, Deprivation of Liberty Safeguards, because the resident had expressed a wish to leave the home. The resident’s next of kin and an advocate were attending this meeting. This resident told the inspector during the inspection that they were now content to stay in the home. A relative stated in our survey; “I have recommended this home to friends and family”. A resident commented; “It is called a Care Home and is well named. Any requests, (within reason), are quickly satisfied. The staff are always cheerful and warm towards the residents”. Carlton House DS0000039315.V377062.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were assessed. People using the service excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they receive excellent, individualised health care and their wellbeing is assured by safe, thorough medication procedures. Residents are treated respectfully and with dignity by staff. EVIDENCE: We sent out surveys before this inspection. We received completed questionnaires back from the G.P, district nurse and a community psychiatric nurse, (CPN). All the professionals’ feedback was positive about the home. The CPN commented; “Excellent feedback from my clients, - kind staff, polite with good customer care. The manager and staff listen, and aim to do their best for the residents”. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 12 We also received sixteen responses from residents, some of which were completed by relatives on residents’ behalf. These are examples of the comments made; “Staff are very kind and caring and always available to talk to”; “The home is very clean, the food is excellent and the staff are very friendly and warm”. However, in one survey that we received after the inspection, a relative was critical and said they had to keep reminding staff to clean their relative’s nails. The manager’s attention is drawn to this matter. This person was also concerned about how staff cared for another resident who continually shouts. They stated that the staff remove this resident to their room when their behaviour disturbs other people. The manager confirmed that this resident does occasionally disturb other people and when other measures fail, they are taken to their room where staff play music CD’s which relaxes them. The manager told us that the resident was moved from a double to a single bedroom, which had also helped to improve the resident’s behaviour. The manager stated that this person’s next of kin were fully aware of the care plan and agreed to it. We contacted the next of kin who confirmed that they were aware and were kept informed about their relative and were satisfied that the staff were supporting their relative appropriately. We looked at five care plans at random. We found there was good detail, regarding the person’s individual needs and there were guidelines for staff about how to support the resident in accordance with their wishes. This included personal care, mobility, nutrition and leisure preferences. The care plans were signed by the resident or their representative to ensure that they were aware of what was written about them. We noted that there were risk assessments documented, particularly regarding falls and the risk of pressure ulcers. At the time of the inspection we were informed that no residents had pressure ulcers. Monthly reviews of the care plans are carried out to reflect any changes in needs. The residents, relatives and district nurse who the inspector spoke to, all expressed a high level of satisfaction about the care the home provides. We noted that a member of staff was supporting a resident in the bathroom and the door was closed to protect the resident’s privacy and dignity. All residents are weighed each month. We saw documentation about two people who had lost weight. The G.P and dietician were approached for advice, which was followed and these residents had regained some weight. There were good records of healthcare appointments with the G.P, hospital, dentist, chiropodist and optician. A CPN also visits the home for residents who have mental health problems. We saw a resident who had a bad fall on the patio area, which resulted in facial bruising. This accident was fully recorded in the accident book. On the day of the inspection, this person returned from a hospital appointment for xray which showed no serious injury had been sustained. At the last key inspection, there were concerns about some medication issues. These were followed up by a random inspection which included the Commission’s pharmacist. It was noted at that that time, that this had improved, but we wished to ensure that this improvement was maintained. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 13 This is the pharmacist’s report at this inspection; “The home had printed MAR charts (Medication Administration Records) for all the residents. Medication was stored securely in the trolley in a small locked clinical room and the home administered the medication from both a Monitored Dosage System and original packs. The recording of medication showed no omissions in the records of receipts, administration or disposal. When residents went into hospital the reason was stated and when they were discharged there were accurate records of newly prescribed medicines. There was evidence of review of medication by the GP and entries were clearly signed and dated and discontinued medicines were deleted. We counted several samples of medication:- short courses of antibiotics, calcium tablets, anti-psychotics, laxatives and pain killers. All the samples could be reconciled with quantities received and signatures for administration. We were therefore satisfied that medication was being administered as prescribed. The home was monitoring pain for one gentleman and there was evidence of the potency of the prescribed painkiller being increased by the GP so that he was more comfortable. The physiotherapist visited every two months and a pressure relieving mattress had been supplied as well. Two of the residents were able to go away for short holidays with relatives. The pharmacist supplied the medication in a separate dosette box for these breaks. The relatives of one of the residents had been trained to administer insulin by the district nurse who visited daily to test the blood sugar and administer injections. We looked at the manager’s medication audits. These were carried out every week. We were also told that the MAR’s were checked daily at handover and staff also carried out random stock checks. These checks have undoubtedly significantly raised standards in the home. Staff undertook regular training and many were currently taking a distance learning course to further develop their knowledge on medication. There was a file of patient information leaflets and a BNF for staff to refer to for information on medicines. Overall therefore we were very pleased with the standards achieved by the home”. We noted that residents and/or their representatives wishes regarding end of life care was documented in the case files we saw. The manager said that peoples’ wishes to remain in the home for end of life care, rather than go to hospital, were respected, in which case, support was available from Macmillan nurses if required. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were assessed. People using the 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 who live in the home can be confident that they can choose from a good range of stimulating activities and their religious preferences are respected. Residents are very satisfied with the food the home provides and they are able to maintain contact with their relatives. EVIDENCE: The residents’ surveys we received stated that the home always respects peoples’ choices about what activities they wish to join in. People can choose from a range of organised activities put on by the activities coordinator and sessions provided by an occupational therapist, such as discussion about current topics, poetry reading and quizzes. We noted that there were one-toone activities for some residents where this was more appropriate. Outside entertainers also visit the home. Some residents are independent enough to go out by themselves, while others prefer to spend time in their rooms reading or Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 15 watching television. We noted that, whatever activity was engaged in, was recorded in residents’ case files. There was evidence that residents’ spiritual needs were provided for, which at the time of this inspection, included Christian and Muslim observance. The visitors’ book is used to record visits by relatives and we spoke to three people who were visiting during the inspection. Relatives told us that there were no unreasonable restrictions on visiting and the staff always welcomed them with offers of cups of tea. Residents can choose to have a telephone in their room to keep in touch with relatives; (there is a charge for this service). We visited the kitchen which was well stocked with food and the records we looked at, showed that food was stored and cooked at appropriate temperatures. The home was awarded 4 stars by the local authority environmental health officer at a recent inspection. The menus we saw, showed a good variety of meals with a choice of the main meal. The residents told us that they enjoyed the food in the home and they had plenty to eat. Special diets were provided following the advice of the dietician. We observed two residents being helped by staff to eat. This was done sensitively and at an appropriate pace. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives can be very confident that concerns and complaints are taken seriously and acted on promptly. The home has appropriate systems in place to ensure that residents are protected from abuse. EVIDENCE: The surveys we received indicated that residents were very satisfied about the service they received. They were aware of how to make a complaint or raise any concerns. This was confirmed by those people we interviewed during the inspection. All the staff surveys indicated that they knew what to do if a concern is raised, which was also confirmed in the discussions we held with them. We noted that three complaints were logged in the past year. The last issue related to a resident who had lost a mobile phone. We were satisfied with the records that showed that all complaints had been fully investigated promptly and resolved satisfactorily. Staff records showed that almost all staff had attended training on detection of abuse and having fully explored this issue with them, we were satisfied that Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 17 they had a thorough knowledge and awareness of their responsibilities regarding reporting incidents of abuse. We recommended to the manager that she readdress the Whistleblowing procedure at the next staff meeting as some staff appeared unfamiliar with this term. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 25 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that they live in a clean, homely and well-maintained environment. There are good infection control measures in place to protect their health and safety. EVIDENCE: The manager stated in the AQAA that the home has purchased a new carpet shampoo machine and replaced several carpets. Since the last inspection, the patio has been repaired to make it more level. We visited all areas of the home, including eight bedrooms and the communal areas. The standard of decoration was very good throughout the home and Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 19 there was adequate furniture and fittings to make residents comfortable. We noted that there were appropriate restrictors on windows and the hot water in bedrooms and bathrooms was at an acceptable temperature. There were appropriate adaptations in bathrooms and toilets to support people who have mobility problems. Lighting throughout the home is domestic in style, helping to give a homely feel. The gardens were well maintained with attractive furniture for residents to sit outside and enjoy good weather. Several residents and relatives commented in our surveys that the home always smelled fresh and was very clean. This was confirmed by our findings during this inspection. The washing and drying machines in the laundry area were working properly and disposable gloves and aprons were readily available. Training records showed that most staff have had infection control training. New staff were booked to attend this training in the near future. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives can be confident that they are supported by staff who are well trained and supervised and who enjoy their work. Residents’ best interests are protected by thorough staff recruitment procedures. EVIDENCE: In the surveys we received, residents and relatives expressed confidence in the care staffs’ abilities to meet their needs. They also said that staff were always available for support when needed. The staff rotas showed that there are usually four carers on duty in the morning, three in the evening and two staff on waking night duty. The home also employs separate cleaning, laundry and catering staff. In discussion with staff, they said this level of staffing was sufficient for them to meet peoples’ needs. We checked the recruitment records of four staff who started working at the home since the last inspection. We found that these contained satisfactory references, proof of identity and work permit details where necessary. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 21 We saw evidence that all new staff have a period of induction and training records show that all staff undergo training in mandatory health and safety subjects; for instance, food hygiene and manual handling. There were also records of training on dementia care and protection of vulnerable people from abuse. The staff to whom we spoke told us that they have regular one to one supervision which they valued as a good opportunity to discuss work related issues and their ongoing development. According to the AQAA, ten staff have attained the National Vocational Qualification at level 2 or above. This meets the required standard of 50 achievement. In the surveys we received, all staff said that their induction covered everything they needed to know to do their job when they started. They also said they valued the amount and quality of the training provided by the home. One member of staff commented; “We work well as a team and there is a good atmosphere. It is a pleasure to come to work”. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 37 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that the home is run by a qualified and experienced manager. Residents’ and staffs’ views are respected about how the home is run. The home is generally safe, but appropriate signs must be in place to ensure that everyone is aware of the escape routes in case of fire. EVIDENCE: Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 23 The manager has been in post since 2005. She has previously had a number of years’ experience as a senior staff member within the home and has completed the NVQ level 4 in management and care. In our discussions with residents, visitors and staff, it was evident that the manager is held in high regard and they are confident in her ability to run the home effectively. The manager is supported by a deputy and two senior carers who share the management tasks. Before the inspection, the manager sent us the home’s AQAA. This document could have contained more detailed information about the service, and the inspector pointed out to the manager where this could be improved. There was a relaxed atmosphere in the home and the staff appeared to be very happy and cheerful as they went about their work. We saw minutes of residents and staff meetings which showed that everyone is informed about developments in the service and can have an input into how the home is run. We were satisfied that all the requirements made at the last key inspection had been complied with. All the records and documents we required to carry out this inspection were well structured and easy to read. We noted that a senior manager visits the home monthly and we saw the reports of their last two visits. The reports included various care checks, discussions with residents, relatives and staff. Where necessary, recommendations for improvements were recorded and followed up at the next monthly visit. We saw fire safety records that included fire training for staff. There were records of weekly fire alarm checks and regular fire drills. We were satisfied that staff knew how to react in the event of a fire in the home. We were concerned however, that there was not an appropriate sign over a door on the ground floor corridor which we were told was a fire escape. There appeared to be some confusion about whether some exits where designated fire exits. We are making a requirement for professional advice about fire regulations relevant to the home be sought and any recommendations to be implemented. We saw annual service checks for portable appliances, gas and electric systems, the passenger lift, mobile hoists, and legionella prevention within the hot water systems. There was a current employer’s liability insurance certificate on display. Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 24 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X 3 2 Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 OP38 Regulation 23(4)(b) Requirement Professional advice must be sought to determine specific escape routes in the event of fire and their recommendations must be implemented. Timescale for action 31/08/09 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 Refer to Standard OP18 Good Practice Recommendations The manager should go over the Whistleblowing procedure at the next staff meeting to ensure that they are familiar with the term Carlton House DS0000039315.V377062.R01.S.doc Version 5.2 Page 26 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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