Care Home: Carshalton Nursing Home

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What the care home does well Despite the fact that the home would not now meet the standards, people have always told us that they like living there. They tell us that the staff are very kind and caring and that it is like living in a family. A relative that we spoke with told us that he really looks forward to coming to visit, everyone is always so cheerful and kind. What has improved since the last inspection? There have been ongoing problems in the home for some time. Concerns were raised both by the local authority and by The Commission, placements were suspended and we have issued statutory notices regarding fire safety and the monitoring of the service by the registered providers. When we last visited, a new manager had just been employed and this seems to have given the staff leadership and direction. Documentation, policies and procedures have all been improved, the statutory notices have all been complied with and training for staff has been increased. Regulations have been addressed in order to ensure the safety of residents in the event of a fire. There is evidence that the registered providers visit regularly to ensure the smooth running of the service and the manager also sends then the results of her two weekly audits. Activities for residents have continued to improve and staff spend more time interacting and engaging with them. Some residents are able to go out, accompanied by staff, and the manager is looking at the possibility of some of them being able to attend day centres. A great deal of redecoration and refurbishment is taking place. Bedrooms and communal areas are being repainted, bathrooms are being upgraded and a new shower facility is being provided. New hoists and beds are being purchased. Our overall opinion is that the service is improving, resulting in better outcomes for the people who live there. What the care home could do better: All of our previous requirements have now been met and no new ones were issued at this visit. The information that we have received, tells us that the providers are aware of the need to continue to provide more activities and to allow the residents to influence the way that the home is run. They are going to continue with their redecoration and refurbishment plan in order to make sure that the home is a pleasant and suitable place for the people who live there. We will continue to monitor these issues at our inspection visits. Key inspection report Care homes for older people Name: Address: Carshalton Nursing Home 28 Salisbury Road Carshalton Surrey SM5 3HD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Ford     Date: 3 0 0 3 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Carshalton Nursing Home 28 Salisbury Road Carshalton Surrey SM5 3HD 02086692592 02086699558 sweethomes@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sweet Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 33) Dementia - Code DE(E) (of the following age range: 65 years and older) (maximum number of places: 10) Date of last inspection Brief description of the care home Carshalton Nursing Home is registered to provide care for up to thirty-three older people who may have dementia. Care Homes for Older People Page 4 of 25 Over 65 10 33 0 0 0 7 1 0 2 0 0 9 Brief description of the care home As an existing care home the facilities would not meet the requirements of a newly registered home. A large proportion of the accommodation is provided in what were previously designed to be shared rooms, without en-suite facilities and others are smaller than would now be acceptable. There is only one lounge/dining area and this is in the form of a conservatory, which despite fans, is sometimes uncomfortably hot. There is a shaft lift to ensure accessibility throughout the home and the conservatory overlooks the rear garden. There is limited off-street parking however, the home is in a quiet road and close to public transport links. At the time of this inspection we were told that fees range from £525- £850 per week. Any extra charges payable for services such as hairdressing would be discussed prior to admission. A copy of the homes Statement of Purpose, Service User Guide and the latest inspection report can be obtained from the homes Registered Providers or the latter can also be obtained from the Care Quality Commission from their website www.cqc.org.uk. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report follows an unannounced visit to the home. However, we have also taken into consideration other information that we have been given. This has included comments made by those who use the service and their relatives, staff and other health care professionals. The providers also sent us their annual quality assurance assessment (AQAA ) when we asked for it. This is a self assessment which tells us what they are doing in order to meet the aims and objectives of the home and also about their plans for the future. When we visited, we spoke with the manager, the staff and several, residents, asking them what it was like to live there. We walked around the home looking at improvements that were being made and we looked at various records and documentation that they are required to keep. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 7 of 25 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. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No one is admitted into the home without a full assessment being undertaken to ensure that their health care needs can be met. Evidence: The information that we have been given, tells is that no new resident would be admitted into the home without first having a needs assessment undertaken to ensure that the placement will be suitable for them. Concerns about the home have limited admissions recently and since we last visited there has only been one new resident and they came as an emergency respite placement. It was not therefore possible to see evidence of the pre-admission process. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are having their health care needs met in a way which suits them. Evidence: All of the residents were sitting in the lounge when we visited. They looked clean and well cared for and were dressed appropriately. Ladies had been helped to apply make up and had jewellery on, their hair was brushed and dentures and spectacles were clean. We spoke with a visitor, who told us that residents always looked well cared for and happy when he visited. He also said my wife has come on so well since she moved in, able to do much more now. All of the residents have an individual care plan which sets out the care and support that they need. We looked at a sample of them and were able to see that they have improved since our last inspection. A commercial system, Standex is in use although its presentation has has been adapted slightly to suit the needs of staff. Care plans are written in consultation with residents or their relatives if they are not able. They set out how residents prefer to be supported and entries have been made Care Homes for Older People Page 11 of 25 Evidence: by other health care professionals who have been consulted. There are risk assessments, moving and handling assessments and nutritional assessments in place. They are reviewed regularly to ensure that any changes are identified and the manager audits them on a monthly basis. To help staff understand about the residents, work is beginning with regard to documenting information about their previous lives and achievements. Their abilities to make a judgement, mental capacity is also being assessed. One person was referred for assessment in line with the Deprivation of Liberties Safeguard. We looked at the medication records which were all in order. The supplying chemist has recently been changed and they are also providing training for the staff. The use of as required medication is now being monitored and the medication procedures are audited by the manager every week. The manager has put a medication policy in with the administration records and there is a list of those who administer medication with their usual signatures. Relatives and other who visit have always been told how caring the staff are in this home. They have all worked there for some time and we were able to see how kindly they approached people. They think in a person centred way and provide personal care in private. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily life in the home generally suits the people who live there and the range of activities has been increased to provide them with interest and stimulation. They enjoy the meals that are served to them. Evidence: Previously we have raised concerns about the lack of stimulation and activities for the residents. The information that we have been given is that this is now being addressed. This is helped by the fact that staffing levels have been maintained even though the current occupancy rate is quite low. In addition to the music man who comes in every week, the staff are able to sit with residents and read or play one of the large selection of games available. Some of these, such as the playing cards, have been especially designed for people with limited dexterity or poor eyesight. The provider has purchased SKY TV and we noted that music is playing rather than programmes that had little interest for residents. One resident is Chinese and staff have been able to find programmes in her own language. We could see that there is a timetable showing a different activity scheduled for each day. We were told that residents particularly enjoy the weekly cookery session where they mix cakes which are then baked for tea. One of the completed survey forms we Care Homes for Older People Page 13 of 25 Evidence: received, suggested that perhaps staff could read to residents who could not see very well. Some people are able to go out accompanied by staff, to the local shops or to the pub for lunch and the manager is looking into arranging day centre sessions for some of them. A relative that we spoke with told us that he really enjoyed coming in to the home, the staff always made him very welcome. He particularly enjoyed the music sessions when he was able to have a little dance with the girls. People tell us that the food that is served is very good. There is always a choice and a record is now being kept detailing the meals that were served. Special diets can always be catered for. The management team are aware of the need to try and encourage resident to participate more in the daily running of the home, with regard to issues such as menu planning and the choice of activities. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure in place and any concerns would be dealt with promtly and effectively. Evidence: The home has a complaints procedure and this is displayed in the entrance hall. It is also in the Service User Guide which is in residents bedrooms. It is not available in any alternative format at the present time. The information that we have been given is that during the last year three complaints have been addressed according to the local authority safeguarding procedures. The Commission has not received any complaints directly. Previous inspections highlighted the fact that we were not being notified of any untoward incidents that occured in the home, which is a legal requirement. A Statutory Notice was issued and this has now been complied with, in full. The frailty of some of the residents might make it difficult for them to make a formal complaint however, all of the staff have received training in recognising and reporting suspected abuse. The manager is conversant with Deprivation of Liberties Safeguarding procedures. A relative that we spoke with told us that they were confident that any issues they raised would be sorted out by the manager and staff. Care Homes for Older People Page 15 of 25 Evidence: Recruitment procedures include clearance from the Criminal Records Bureau in order to ensure that residents are protected from those who have been judged as being unsuitable to be working with vulnerable adults. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Extensive work is currently being undertaken to improve the home and create a more pleasant environment for the people who live there. Evidence: The home is an older house which has been converted and it would not meet the standards expected of a newer build. Room sizes would not comply with the standards and there is only one communal space which serves as the sitting room, dining room and has a nurses station. Despite this, residents and their families have always told us that they actually like the fact that everyone sits together as it makes it seem more like a family home. For some time we have been raising concerns about the way the home was being maintained. However, since we last visited a refurbishment and decoration plan has begun. Bedrooms are being redecorated, have new curtains and we are told that new bed linen is also to be purchased. Fluorescent lighting has been replaced with fittings that are more domestic in style. All the bedrooms will now be for single occupancy and dividing curtains have been removed. Bathrooms are being upgraded and a new walk in shower room is being fitted. New blinds have been put up in the conservatory, a new television has been installed and we were told that flooring is to be replaced. New equipment in the form of an electric Care Homes for Older People Page 17 of 25 Evidence: hoist, has also been provided to help with moving and transferring residents. As occupancy levels are currently low, residents have been moved around a bit as their rooms have been decorated. Everyone is being kept informed of the situation those we spoke with seemed to be quite happy about it. The manager told us that they have been involved in the discussions regarding the colours chosen for their bedrooms. Despite the building work the areas currently occupied by residents were clean and tidy. In line with a previous requirement a new sink has been fitted in the laundry and there are measures in place to help control infection, these include protective gloves and aprons and antibacterial hand gel. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough suitably trained staff on duty to ensure that residents feel safe and secure. Recruitment policies prevent those who have been judged as unsuitable to be working with vulnerable adults from being employed. Evidence: Most of the staff in this home have been there for some time which helps residents to feel safe and secure and the staffing levels are being maintained even though occupancy levels have fallen. On the day that we visited there was one trained nurse on duty with three care staff in addition to the homes manager. There were also domestic and catering staff. This has enabled the manager to spend time bedding in new policies and procedures, supervising staff, and updating the care plans so that they reflect the support that residents currently need. It has also allowed care staff to spend quality time with residents who were enjoying having people to talk with and engage in various activities with them. The manager has been arranging training for staff who have been able to attend sessions relating to health and safety, fire safety, medication, mental health and dementia awareness. All of the care staff are qualified to at least NVQ level 2 and some are undertaking level 3. There are regular staff meetings and a supervision and appraisal system is now in place. Care Homes for Older People Page 19 of 25 Evidence: Since we last inspected the home two new trained nurses have been employed to work on the bank i.e to cover absence,sickness or annual leave. We were able to see that all of the necessary checks had been undertaken and that the home had obtained references for them. We were told that they have undertaken an induction programme to ensure that they are familiar with the home and its fire safety procedures. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements have improved and the majority of the concerns that were previously raised have been adressed. Evidence: Previous inspections raised concerns about the lack of organised management arrangements. There were no clear guidelines in place regarding the teams roles and responsibilities and there was no evidence that the providers were monitoring the home. Both the local authority and The Commission raised concerns about the home, placements were suspended and we issued statutory notices with regard to fire safety, visits by the providers and the notification of incidents. However, since our last inspection we have noted that there has been a marked improvement in all of these areas. A manager is in place, although we are still awaiting their application for registration, and this has provided direction and leadership for the staff. The statutory notices that we issued have been complied with and policies and procedures are being updated. Equipment and services are all being Care Homes for Older People Page 21 of 25 Evidence: maintained as necessary. We could see that the provider visits regularly and the manager undertakes two weekly audits. We are now being notified of any event which happens. The fire safety officer still has one outstanding issue which they have to check but this seems to have been addressed. A robust quality assurance programme still needs to be put in place, to ensure that those who use the service are able to influence its provision, however there has already been a meeting for residents and their relatives. Some money is kept on behalf of residents and we were able to see that records are accurate and well kept. They are checked regularly by the manager and another member of staff. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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