Care Home: Carlton House (30)

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What the care home does well The home continues to take all of the necessary action to ensure that the service users are well cared for, have their health care needs met and are provided with all of the assistance that they require. The service users are actively encouraged and supported to continue with their preferred activities, to maintain friendships and relationships and to fulfil the personal and social care needs. Service users continue to be treated with the appropriate degree of dignity and respect and clearly view the home as their own. One service user told us at the inspection, "This is the best home I`ve ever had". Another said, "The staff are really very good to us here". When talking about the food at Carlton House a resident told us, "The food is good, I like it." What has improved since the last inspection? The service user guide has since the last inspection been updated and written in a clear way so that it is relevant and so that everyone can understand it. The home has kept within its approved registration category and does not admit any person who has needs that the home is not able to meet. This includes the need to carry out pre placement risk assessments and to ensure that care plans are drawn up even for short term care. What the care home could do better: CARE HOME ADULTS 18-65 Carlton House (30) 30 Chatsworth Road Croydon Surrey CR0 1HA Lead Inspector David Halliwell Key Unannounced Inspection 26th September 2008 09:30 Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton House (30) Address 30 Chatsworth Road Croydon Surrey CR0 1HA 020 8688 7801 020 8688 7801 akuffoe@aol.com/ceakuffo@yahoo.co.uk 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) Dr Emmanuel Owusu Akuffo Mrs Celia Erica Akuffo Mrs Celia Akuffo Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Carlton House (30) DS0000025763.V371762.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 15 27th April 2006 Date of last inspection Brief Description of the Service: Carlton House is a privately owned home for 15 people with learning disabilities, at present there are twelve service user’s residing at the home whose ages range from fifty upwards. Carlton House comprises of two large houses made into one with connecting corridors. It is situated in a residential area a few minutes walk from the centre of Croydon and the main railway station. There is off street parking for a number of cars. There are eleven single rooms and two twin rooms. The Manager told us that the weekly fees at the time of this inspection are £440 per week. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The stars quality rating for this service is good. This means that people who use these services experience good quality outcomes. They said that they like to be called residents. A completed AQAA was received prior to the inspection. No enforcement activity has occurred since the last inspection. This was an unannounced inspection visit for Carlton House and was carried out over 1 day. The Inspection covered all the key standards in the National Minimum Standards for Younger Adults. The inspection involved a tour of the home, a review of all the homes records and formal interviews with 2 staff, the Manager and the Deputy Manager. 5 residents were spoken with formally and more informal interviews were conducted with 2 other residents as a part of the tour of the home. 3 staff and 3 residents’ files were inspected as was the policies and procedures manual for the home. 5 new requirements have been made as a result of this inspection and 8 new recommendations have also been made. Feedback on the requirement and recommendations was given verbally to the Manager and the Deputy Manager at the end of the inspection visit. The residents and staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The agencies Registration Certificate with the Commission for Social Care Inspection was seen displayed appropriately in the main hall. There have not been any changes in the ownership or management of Carlton House since the last inspection. What the service does well: The home continues to take all of the necessary action to ensure that the service users are well cared for, have their health care needs met and are provided with all of the assistance that they require. The service users are actively encouraged and supported to continue with their preferred activities, to maintain friendships and relationships and to fulfil the personal and social care needs. Service users continue to be treated with the appropriate degree of dignity and respect and clearly view the home as their own. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 6 One service user told us at the inspection, “This is the best home I’ve ever had”. Another said, “The staff are really very good to us here”. When talking about the food at Carlton House a resident told us, “The food is good, I like it.” What has improved since the last inspection? What they could do better: Specific areas where required improvements have been identified in this report are: 1. Care plans - recordings of the monitoring and implementation of the work carried out in order to meet the care plan objectives could be more developed so that it is clear how well the objective is being achieved and what work remains in order for it to be fully met 2. Risk assessments should be carried out for each resident so that they can be as independent in the home as their abilities will allow. 3. All care staff should now receive refresher training in the safe handling and administration of medicines. 4. A bound “complaints record book” must be set up to record all complaints that are made about the home and it’s services. 5. All staff should receive the formal protection of vulnerable adults training with L. B. Croydon. 6. All staff files must be reviewed and action taken to ensure that they are in good file order and containing the necessary information as described in Standard 34. 7. Criminal Record Bureau (CRB) checks must be renewed every 3 years and be appropriate to Carlton House. 8. All staff should receive a basic level of training and this should be refreshed on a regular basis. 9. Training certificates should be available for all staff training and held on file. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 7 A new staff training matrix would be helpful as a management tool 10. that identifies future staff training needs and that logs training already undertaken by staff. 11. Supervision must be held regularly and detailed supervision records maintained for all staff. 12. Quality assurance feedback information should now be analysed by the management team so that any patterns or trends are identified that may help the service to build on and improve their services. It would be useful if this information were included in the business and annual development plan for the home. 13. Water legionella tests – now needs testing. 14. Hot water temperatures are not being checked adequately. It is required that all hot water outlets are checked regularly and records kept of each check to ensure that hot water temperatures come within the acceptable range. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 & 5 were inspected at this inspection. People using this service experience good quality outcomes in this area. Prospective service users may be assured that their needs will be assessed and that they will also have an individual written contract. EVIDENCE: Standard 2 – The Manager told us that there has been one new resident admitted to Carlton House since the last key standards inspection in April 2006. We inspected 3 of the 12 resident’s files, one of which was the personal file for this new resident. We found on each file an assessment of needs had been carried out by the home. These assessments have been based on information supplied by the referring professionals, usually care managers, and by the staff’s own assessment of the persons needs. The needs assessment format includes the assessment of social care needs and the resident’s cultural and religious needs. The needs assessment process includes where ever possible the resident’s own wishes and preferences and views about what has been written down in the assessment. This tool provides a useful way of comprehensively ensuring all the residents or prospective residents’ needs are taken into account at the assessment stage. This is also supported by what the Manager said in the home’s Annual Quality Assurance Assessment (AQAA). “New service users are admitted on the basis of full assessment by a competent person…….” Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 10 Standard 5 - All residents’ files that were inspected included a written statement of terms and conditions that had been signed by the residents. The document included information about the fees charged, the room provided and arrangements for reviewing needs and progress and updating care plans. The Manager told us that new residents are also given an information pack relating to Carlton House that includes a wide range of information regarding the service and that this is issued to all residents on admission. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9 were inspected. People using this service experience good quality outcomes in this area. All service users had a care plan in place that comprehensively addresses their needs and is reviewed. Service users are supported and encouraged to take responsibility and make decisions about their lives. Wherever possible service users are supported to take responsible risks as part of an independent lifestyle. EVIDENCE: Standard 6 –We inspected 3 of the 12 residents’ files, spoke to 5 of the residents and interviewed 2 members of staff as well as speaking with the Deputy Manager and the Manager. All of the documents set out under Schedule 3 of the NMS were seen by us on the files inspected. Care plans are based on the needs assessments referred to in the previous section of this report. All the care plans inspected were seen to be reviewed monthly, the date of the review being recorded on file. The care plans Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 12 described how the resident’s needs are to be met together with both short and long term goals for review. Care plan objectives were seen to include the person’s religious and cultural needs where such a need had been identified. It was clear from the care plan records held on the files that all the appropriate people are usually involved in the care plan reviews including the resident and their relatives where appropriate and social work or care manager staff from the referring authorities. Each resident was also seen to have a “My Plan” in place and these plans reflect the person centred approach that is taken towards meeting the residents’ needs by staff at Carlton House. The Deputy Manager informed us that after the initial placement of a new resident an intermediate care plan is drawn up before the 6-week review. After the 6-week review, the care plan is revised and then reviewed monthly. From this inspection of 3 residents files it could be seen that care plan objectives have been drawn up to meet each of the resident’s identified needs. However it is recommended that recordings of the monitoring and implementation of the work carried out in order to meet the objectives could still be more developed so that it is clear how well the objective is being achieved and what work remains in order for it to be fully met. The care plan objective may need to be revised as a consequence. This will aid monitoring and review of care and support to residents and will help to deliver continuing and effective care to them. Standard 7 – Staff were seen by us over the course of this Inspection to be interacting with the residents in a friendly and helpful manner and to be respecting the rights of residents to make their own decisions. Staff interviewed also indicated their awareness of the resident’s rights to make decisions about their lives wherever possible and that staff assistance should be focused on supporting this right wherever possible. The Deputy Manager and staff said that they have regular meetings and we saw the minutes of these meetings that are held every month. The AQAA says that residents are provided with details about advocates who would be able to act on their behalf if necessary and we saw details posted on the notice board in the main hall of the home. This means that residents may be represented by an advocate where the need arises. Residents that we spoke to said they were aware of this support service and one of the residents who uses an advocate said, “I find them helpful because I can’t always find the words. It is a useful support”. This means that residents make decisions about their lives with assistance as needed. Standard 9 – A completed risk assessment was seen on one the resident’s files inspected, both as a pre-admission assessment tool and also post admission. However this was not the case for the other 2 resident’s files inspected and it is recommended that risk assessments are carried out for each resident so that Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 13 they can be as independent in the home as they are able. The Deputy Manager told us that risk assessments are mostly used to assist residents to be appropriately supported to take risks that are a part of helping them to lead as independent a lifestyle in the home wherever possible. The risk assessment seen had been agreed with the resident and the relevant professionals. When all residents have been risk assessed they will then be assured that they will be supported to take risks where ever possible as part of developing a more independent lifestyle. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assured that they will be able to take part in appropriate activities within the unit. They will be supported in maintaining and developing appropriate relationships and that their rights and responsibilities will be respected in their daily lives. They are also assured that they will be offered a healthy, varied and nutritious diet. EVIDENCE: Standard 12 - During the course of this inspection visit we spoke to 5 of the residents in order to assess whether they found that their lifestyles experienced within the home and the support they receive from staff assists them in satisfying all their needs. All of the residents told us that they are happy and that are able to do the things that they wish when they want to. One resident said, “I go to the day centre every week with other residents from here. We enjoy that”. Another resident agreed and said, “Yes, in fact we Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 15 were at the day centre just this morning and I also go to another day centre in the week as well”. Care plans that we saw support the views reflected by residents that they are able to see their families and friends as they wish and this was also supported by the views of 2 visiting care professionals to the home who were also interviewed by us during the inspection visit. Standards 13 and 15 – The location of Carlton House is close to the town centre of Croydon and this assists residents, where they are able, to use public transport. Those residents who do go out of the home and who were interviewed said that this is often how they get out and about to go shopping or to see their friends and families. Some residents said that they do go to church and make use of day centre provision in and around Croydon. The Manager said that all residents are registered to vote and are encouraged to use their votes. Residents confirmed that they are supported and enabled to vote. There are no specific visiting times and friends and families are encouraged by the Manager and staff to attend the home. A record of visitors is kept in the main hall and we were asked to sign the record on the days of the inspection. Standard 16 – Policies seen by us to be established within the unit ensure that residents’ rights to privacy, respect and dignity are respected. Residents who were interviewed also confirmed that they felt staff respected these rights. Residents said that their mail is unopened, their preferred form of address is used by staff and staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner. The Manager told us that all residents wear their own clothes. The staff induction process was reviewed by us and was seen to include the core standards of recognising and meeting the resident’s rights to: • Privacy • Dignity • Independence • Rights • Fulfilment • And choice. These core standards are also included in the Unit’s Statement of Purpose. There is a specific area for smokers outside of the main building. Standard 17 – Food menus were shown to us, they were varied and choices are provided; residents assist in the drafting of the food menus and the Chef Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 16 told us that she attends residents meetings so that residents can feedback about food planned and provided. No complaints about the meals arose during the inspection in fact all those residents interviewed said that they like the food provided at Carlton House. It was noted that a wide range of meals were listed which cater for the multicultural needs and wishes of the residents. The Manager said that a dietician is used in some cases where there is a specific need but not as a general rule. At the time of this inspection we saw two mealtimes and the food was seen to be presented in a fresh attractive way that was enjoyed by the residents. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users receive support in the way they prefer and require. Service users’ healthcare needs are met by linking into community service such as GPs and clinics. The service’s medication policies and procedures protect service users in the administration of medicines. EVIDENCE: Standards 18 and 19 – The Manager informed us that all residents have access to other healthcare professionals including GPs, a chiropodist who visits every 3 months, a dentist and a dental nurse who visit also once every 3 months, physiotherapists, and an optician who visits six monthly. The Manager said that if the need arises for the residents to see these professionals earlier then this is arranged without a problem. 5 residents interviewed confirmed that they receive their care in the way they prefer. Those residents, who were able to, said that they decide themselves Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 18 about their daily routines and care staff interviewed also confirmed this. Staff interviewed said that residents keep in regular contact with their General Practitioner and clinical teams. The Manager said that all the residents are registered with dentists, opticians, chiropodists and community nurses in order to maintain their all round good health. This was confirmed by some residents and by information seen in their case files, which evidence it by the recording of their contact with these services. Records were seen by us that annual healthcare checks are routinely carried out by GPs thereby ensuring continuing good health. Standard 20 – At this inspection we looked at the home’s policies and procedures manual that contains all the appropriate policies for the control of medication. We reviewed the records for the administration of medication to 5 residents (MAR sheets) and these were seen to be appropriately completed and in line with the home’s policies and procedures. The Deputy Manager told us that all the care staff are allowed to administer medications to the residents. This was confirmed both by staff who we spoke to. The Deputy Manager also told us that she checks the MAR sheet records regularly to ensure that they are completed appropriately by staff, so far these checks have not revealed any errors. Inspection of the MAR sheet records showed that in every case photographs of each resident has been placed on the medication sheets so that all staff are sure that they are administering medication to the correct person. A check carried out at this inspection to review the management of the medicines remaining in the stores against the recorded levels proved correct and no errors were found in the system. The storage of medicines was seen to be completely appropriate and appropriate facilities and procedures for the storage and administration of drugs are in place. Training in medication for staff is a part of the agencies training plan and the members of staff interviewed said that they had received this training. The Manager told us that only trained staff are allowed to administer medicines to residents and that this training is refreshed every 2 years. However a review of the staffing files showed us that while staff had received training in the safe handling of medicines this training now needs to be refreshed for all staff. One of the staff file records showed that staff member had received the training in 2005 and in the other 2 files training had been received in 2006. It is therefore recommended that all staff receive refresher training in the safe handling and administration of medicines. At the time of this inspection none of the existing residents are able to administer their own medication. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 19 All this means that residents are being protected by the home’s policies and procedures for dealing with medicines. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. EVIDENCE: Standard 22 – the 5 residents, who spoke to us, all individually confirmed that they feel their views are listened to and acted upon. All the residents said that if they had a complaint they know the procedure to be followed and would do so if they needed to. They all said that they have had no complaints to make about the services they receive at Carlton House. Staff interviewed confirmed with us that the residents were aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The homes’ complaints policy was inspected and seen to meet the standards required of it. A copy of it is included in the information pack that is given to each resident upon their admission. We asked the Manager to see the home’s complaints record. We were told that no formal complaints had been made since the last inspection however a “complaints record book” has not been set up and it is recommended that this be done now. Standard 23 - The home has an adult protection policy that links directly into the L.B.Croydon’s adult protection policy. The Manager informed us that Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 21 although all staff have undergone appropriate POVA training in previous years they have not had recent training experience. Inspection of the training information held in the staff files inspected made it clear that only 1 member of the 3 staff whose files were inspected had received this training in the last 3 years. It is therefore required that all staff are enrolled for the next protection of vulnerable adults training course with L. B. Croydon over the year. It is good practice that all staff should undertake POVA refresher training at least once every 2 - 3 years on an authorised training course preferably offered by L.B.Croydon. 2 members of staff interviewed confirmed that they know what to do if an allegation of abuse is made and they showed awareness of the procedures to be followed. This means that these staff are aware of what abuse is and the safeguards in place for the protection of the residents should they need them. We saw the allegation of abuse record; no allegations had been made since the last inspection. The Manager confirmed this. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and evidence of this was seen on file, staff are asked to sign to say that they have read and understood the policies and procedures for the home. This all means that residents are being protected from abuse, neglect and self harm. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at Carlton House live in a homely, comfortable and safe environment. The home is also clean and hygienic. EVIDENCE: Standard 24 - We visited all areas of the home on this visit together with the Deputy Manager in order to assess whether or not it provides a safe and well maintained environment for its residents. The standard of décor was seen to be reasonable, it is clean and bright and residents are able to choose the colours and decoration for each of their bedrooms. Residents were seen to have their personal possessions arranged as they wish in their bedrooms and when we asked residents whether they are happy that they can choose to arrange their rooms as they wish they said they could. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 23 The communal areas such as the dining rooms and the lounges, bathrooms and toilets are also in a reasonable state of decoration and the overall impression provided is one of a well maintained home and clean home. The garden is accessible to the residents and is well kept and has a pleasant aspect looking over Lloyds Park. Standard 30 –The home has an infection control procedure and a review of the staffing files and other training information indicated that staff have all received training to do with infection control in April and May 2008. This is important so that staff know the required standards and what measures and controls need to be in place to achieve the standards. As has already been stated, at the time of this inspection the home was seen to be clean and tidy, hygienic and free from offensive odours. Systems are in place to ensure that the spread of infection is controlled and minimised. Laundry facilities are sited so that soiled articles are not being carried through the kitchen and hand washing facilities are appropriately provided to ensure staff can use them where appropriate. This helps to ensure the protection of the residents’ health and to ensure that the home is clean and hygienic. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 & 36 were inspected. People using this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from the clarity of staffing roles and responsibilities. They may be assured that they are supported by a competent, appropriately trained, qualified and supervised group of staff. The homes recruitment policy and procedures helps protect the residents but some practices need improvement. EVIDENCE: Standard 32 –Staff were seen to be friendly and approachable for residents and were seen to take time to deal appropriately and sensitively with residents questions. The Manager showed us a staff rota for the week of the inspection which showed which staff were actually working and which shifts they were working. Carlton House do have waking night staff on duty. The Manager told us that all the staff have now completed their NVQ training to level 2. This reflects positively on the management and on the staff Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 25 commitment at Carlton House in meeting the requirements of the Standards and in ensuring that residents are supported by competent and qualified staff. Standard 34 – The Deputy Manager told us that there have been no new staff recruited to the staff team since the last key standards inspection in April 2006. There is in place an appropriate recruitment policy. 3 staff files were inspected. Generally the files were in reasonable order however some of the information required under the Standard 34 was not in evidence. A requirement is made that all staff files be reviewed and action taken to ensure that they are in good file order and containing the necessary information as described in Standard 34. Criminal Record Bureau (CRB) checks must be renewed every 3 years and be appropriate to Carlton House. In all 3 files inspected there had been no CRB check carried out in the last 3 years. Staff interviewed did confirm that they do have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home and a copy was seen for reference on their staff files. Standard 35 - The Manager informed us that a structured induction programme is offered to new staff. However the Manager said that there have not been any new staff recruited since the last inspection and so it has not been used. The Manager said that the Agency does provide a good comprehensive training programme for staff that includes all the necessary areas of training to support staff in carrying out their roles effectively and efficiently. The Manager also said that staff will be attending a number of L.B. Croydon’s training courses over the next few months and a programme was shown to us. This programme shows that some staff will be attending some training over the next few months that covers: Person centred thinking Person centred planning Person centred approaches. However some further basic training for all staff should include the following areas: • Fire safety • First Aid • Food Hygene • Health and Safety • The safe handling of medications Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 26 • Safeguarding vulnerable adults (POVA) It is recommended that all staff receive this training and that it is refreshed on a regular basis. Training certificates should be available and it is recommended that certificates are gained for all staff training and held on file. This is valuable for the staff member in that it provides documentary evidence of the training input they have received and helps to document their CVs. It was agreed with the Manager and Deputy Manager that a new staff training matrix would be helpful as a management tool that identifies future staff training needs and that logs training already undertaken by staff. This is a useful tool in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. This is a recommendation. Standard 36 – The Manager said that care staff receive formal supervision on a regular basis and informal supervision more often, sometimes on a daily basis. We saw supervision records for staff that are held on their files. 2 members of staff who we spoke to said that do receive personal supervision and that they get copies of their supervision notes. Supervision records however showed that supervision takes place every 3 – 4 months. Supervision records were very brief and they did not contain sufficient detail where discussions had been had with key working staff about the work they are doing with residents in meeting their care plan objectives. The detail of those supervision records seen need to include sufficient detail to be a useful record. Supervision sessions should include the monitoring and review of work objectives, the training needs required by the staff member in order to carry out their work and any other issues that have arisen in supervision. Both the member of staff and the supervisor do now sign off these records and evidence of this was seen by us. It is required that supervision is held regularly and detailed supervision records maintained for all staff. By doing so it should improve the quality of supervision and support offered to staff and the quality of care delivered to residents. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. They may be confident that their rights and best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Standard 37 - The present Registered Manager of the home, Mrs Akuffo, is also one of the joint owners. Mrs Akuffo has previously been assessed as being a fit person to run the home at the time that she was first registered. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 28 It was evident to us at this inspection that the Manager is competent and has the necessary qualifications to ensure the home is well run and this was reflected in the feedback received from both staff and residents that we spoke to over the inspection period. This all means that residents do benefit from a well run home. Standard 39 – During this inspection we asked the Manager about the quality assurance process being used within the home and how this had been progressed over the year since the last inspection. This is important at it helps to assure residents and their representatives that their views underpin all service improvements and developments made by the home. The Manager explained that satisfaction questionnaires have been given out to visiting professionals, relatives and residents. A blank copy of the questionnaire was shown to us. The Manager also explained that the residents and staff meetings provide a forum for feedback about any aspect of the services provided for at Carlton House. In addition to this the reviews of care plans where often the referring agencies attend provides an additional source of feedback with regards to these services. It is now recommended that this information be analysed by the management team so that the individual feedback can be assessed in order to identify any patterns or trends that may help the service to build on and improve their services. It would be useful if this information were included in the business and annual development plan for the home. Standard 42 – We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. Up to date certificates were seen for: Boiler & Gas – 4.12.07 Fire alarms – 22.9.08 Emergency lights – 22.9.08 Fire extinguishers – 24.4.08 Electrical installation systems – 22.11.06 Portable electric appliances – 3.12.07 Water legionella tests – now needs testing Hoist tested – 15.7.08. All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Records were seen that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire extinguishers - weekly Emergency lighting – 6 monthly Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 29 Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked – none were recorded since the last inspection, the Manager confirmed this was the case. The Incident records were also checked and all had been dealt with according to procedures. Hot water temperatures are not being checked adequately. It is required that all hot water outlets are checked regularly and records kept of each check to ensure that hot water temperatures come within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. The Manager showed us a recently completed risk assessment for the building and another for the risk of fire. These are welcomed as it should assist in the prevention of accidents, raise awareness of the fire risks and what to do if a fire should arise and will inform the maintenance programme for the building. Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No. 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 YA20 Regulation 13 Requirement All care staff should now receive refresher training in the safe handling and administration of medicines. All staff should receive the formal protection of vulnerable adults training with L. B. Croydon. All staff files must be reviewed and action taken to ensure that they are in good file order and containing the necessary information as described in Standard 34. Criminal Record Bureau (CRB) checks must be renewed every 3 years and be appropriate to Carlton House. Supervision must be held regularly and detailed supervision records maintained for all staff. Hot water temperatures are not being checked adequately. It is required that all hot water outlets are checked regularly and records kept of each check to ensure that hot water temperatures come within the acceptable range. DS0000025763.V371762.R01.S.doc Timescale for action 01/12/08 2. YA23 13 01/01/09 3. YA34 17 01/11/08 4. YA36 18 01/11/08 5. YA42 23 15/10/08 Carlton House (30) Version 5.2 Page 32 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 YA6 Good Practice Recommendations Care plans - recordings of the monitoring and implementation of the work carried out in order to meet the care plan objectives could be more developed so that it is clear how well the objective is being achieved and what work remains in order for it to be fully met. A bound “complaints record book” must be set up to record all complaints that are made about the home and it’s services. Training certificates should be available for all staff training and held on file. All staff should receive a basic level of training and this should be refreshed on a regular basis. A new staff training matrix would be helpful as a management tool that identifies future staff training needs and that logs training already undertaken by staff. Risk assessments should be carried out for each resident so that they can be as independent in the home as their abilities will allow. Water legionella tests – now needs testing. Quality assurance feedback information should now be analysed by the management team so that any patterns or trends are identified that may help the service to build on and improve their services. It would be useful if this information were included in the business and annual development plan for the home. 2. 3. 4. 5. 6. 7. 8. YA22 YA35 YA35 YA35 YA9 YA42 YA39 Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carlton House (30) DS0000025763.V371762.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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