Care Home: Cartlidge House

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What the care home does well It is very noticeable that the staff team at this home interact well with the service users in their care. Numerous examples of good communication were seen as were instances of service users being encouraged by the staff to join in with constructive activities. Although the records could be summarised to make them more accessible for the staff the assessment and care planning process is very thorough identifying medical, personal care, social, ethnic and religious needs. Equality and diversity for the service users were seen to be promoted throughout the home within the assessments, care plans and activities such as the religious service held on the morning of the inspection. What has improved since the last inspection? Ways of reducing the risks of such things as falls and problems with manual handling have now been considered for each of the service users and the results have been recorded in their records for all of the staff team to refer to for guidance. What the care home could do better: The recruitment processes must be improved as those adopted by this provider are unsafe as employment references are not properly obtained making it possible for unsuitable people to have access to the vulnerable people living at the home. CARE HOMES FOR OLDER PEOPLE Cartlidge House Charlton Street Oakengates Telford Shropshire TF2 6BD Lead Inspector Mike Moloney Unannounced Inspection 14th November 2007 09:30 X10015.doc Version 1.40 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 Cartlidge House DS0000020542.V346412.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 Older People. 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. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cartlidge House Address Charlton Street Oakengates Telford Shropshire TF2 6BD 01952 618293 01952 616149 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) Accord Housing Association Ltd Mrs. Jean Dickenson Care Home 54 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (18) of places Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate a maximum of 54 service users. The home may accommodate up to 54 Elderly Persons of whom 36 may be suffering from Dementia. This includes 2 intermediate care beds Date of last inspection 18th September 2006 Brief Description of the Service: Cartlidge House is registered to provide personal care to a maximum of 54 older people of whom 18 may have dementia. Owned by Accord Housing Association Limited, the Registered Manager is Mrs Jean Dickenson. The home is located in Oakengates situated within walking distance to the main shopping parade, and it is also accessible to the local bus and railway station. It is set in its own grounds with its own private secure garden. Internal accommodation is arranged over three floors in single bedrooms. It has a passenger lift which enables easy access to all parts of the home. Cartlidge House comprises of six individual units, each with its own lounge/dining room, bathroom, and small kitchen. Two of the six units accommodate people with dementia related illness, and another unit accommodates people for short-term stays in the home, for either respite care or for intermediate rehabilitation. Accord Housing makes Cartlidge House’s services known to prospective residents in their statement of purpose, and its brochure/service user guide. A copy of the most recent CSCI (The Commission for Social Care Inspection) Inspection report was also seen to be freely available for people to look at. The current fees charged vary between £362.10 and £405.07 per week depending on the care, support and accommodation required. Additional charges to service users are for hairdressing, toiletries, newspapers, and the charges incurred if a resident wishes to use a private chiropodist. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider which included a self assessment document that they are required by law to complete, records kept in the home, medication records, discussions with the staff team, tour of the premises, previous inspection reports and talking with as well as observing the care experienced by people using the service. What the service does well: What has improved since the last inspection? What they could do better: The recruitment processes must be improved as those adopted by this provider are unsafe as employment references are not properly obtained making it possible for unsuitable people to have access to the vulnerable people living at the home. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 6 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. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 7 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 Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Prospective residents and their representatives have the information needed to choose a home which will meet their needs They have their needs assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Looking at the documents relating to service users who had recently been admitted to the home it could be seen that their needs had been fully assessed. Such things as communication ability, emotional wellbeing, decision making ability, the ability to manage finances, personal care skills, hearing loss and mobility were amongst the things looked at when the home considered whether or not they could meet that persons needs. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. The health and personal care, which a resident receives, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three of the service user’s records were looked at in some depth when considering how the home met the personal and healthcare needs of the service users. Looking at the records it could be seen that their needs had been reviewed at least monthly by the care staff in consultation with the individual resident. Talking with the service users confirmed that the care plans had been agreed with them and their families and that a document known as ‘Getting to Know You’ was completed by the service users and their families with the help of the staff. This outlined the likes and dislikes of the individual as well their care needs and how they would prefer them to be met. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 10 The document can also contain a lot about an individuals social history with some of the files containing photographs of important family events such as weddings. As these are comprehensive documents it took some time to go through. A summarised version would be to the benefit of such people as temporary staff who may not have the opportunity to go through the main document with the thoroughness necessary to find out the service user’s main needs. Each file was seen to contain risk assessments about such things as falls, manual handling and skin care. These were seen to have been reviewed on a regular basis. Each of the six units had it’s own medication storage and records. The cabinets were seen to be appropriate and contained storage for controlled drugs. The medication records were looked at and found to be appropriately completed and up to date. Records showed and staff confirmed that only staff who had received appropriate training were allowed to give out medications. Details of any medical treatment needed and received by the service users were clearly laid out within their records. This was confirmed by talking with a number of the service users. Throughout the inspection all of the staff were seen to treat the service users with respect and dignity. They mostly talked with the service users rather than among themselves and often included them in conversations with other members of staff when it was appropriate to do so. The language used and the way that service users were spoken to showed an understanding of the communication needs of people with dementia. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. Residents are able to choose their life style, their social activities and keep in contact with family and friends. Social, cultural and recreational activities meet resident’s expectations and are designed to encourage their social independence. Residents receive a healthy, varied diet according to their assessed requirement and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of four of the service users were looked at when considering their daily lives and social activities. These confirmed that there were various activities available to the service users on a regular basis. During the visit a religious service was held in the main lounge during the morning and a bingo session took place during the afternoon. Staff on one of the units talked about outings to such places as Llandudno and Bridgenorth, dancing at a neighbouring care home and shopping for plants at a local DIY store. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 12 Talking with a number of the service users confirmed that there was a lot of things available for them to do and such things as cards and dominos were regular past-times for a number of people. These were activities that had been identified in their ‘Getting to Know You’ record. The records also contained the name by which the person preferred to be known. Another activity that was encouraged was knitting. One lady explained how the staff encourage her to do her knitting, something that she had always enjoyed, in order to keep her hands mobile. Listening to her and the staff talk about this it was clear that they were all enthusiastic about her achievements. Going into the various lounges it could be seen that there was a lot of chatting between the service users themselves as well as the staff. Staff were seen encouraging this whenever necessary. The way that the service users reacted to them suggested that this was what they had come to expect. Talking with the service users and the staff it was also clear that relatives and friends are encouraged to visit the home with the visitors’ book confirming this. Copies of the menus were seen in the kitchen. Talking to the service users confirmed that these were accurate and that what was offered was varied and nutritious. When asked about the food the usual reply from the service users was a firm “very nice”. Talking to the cook established that a number of special diets were being catered for, the most common being low sugar for people with diabetes. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents have access to a robust, effective complaints procedure, are protected from abuse and have their legal rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One complaint had been received since the last inspection and this had been appropriately resolved within the homes complaints procedure which in its self contained all of the information required by law. There had been no referrals made through the local Vulnerable Adults procedures since the last inspection. The records showed and a number of the staff confirmed that they receive training about those processes. Talking with a number of the service users confirmed that they feel able to approach any of the management team about any such issues should the need arise. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is in Oakengates and is situated within walking distance to the main shopping parade. It is set in its own grounds with its own private secure garden. The accommodation is arranged over three floors in single bedrooms. It has a passenger lift which enables access to all parts of the home. Cartlidge House comprises of six individual units, each with its own lounge/dining room, bathroom, and small kitchen. One of the lounges is Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 15 considerably larger than the others and was seen being used by all of the residents for religious services and bingo. Two of the six units accommodate people with dementia related illness, and another unit accommodates people for short-term stays in the home, for either respite care or for intermediate rehabilitation. Both the laundry and the main kitchen are situated in an annex to the rear of the main building. The laundry is equipped with a number of washing machines some of which are capable of dealing with heavy soiling. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of residents. However, the recruitment process is unsafe as it does not include the minimum background checks required by law. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As mentioned elsewhere in this report the members of the staff team that were seen during this inspection were observed to not only to be treating the service users with respect and dignity but were also interacting with them in a constructive way. A number of the service users spoken to said that they found the staff very helpful and approachable. Listening to staff talking with the service users showed that they were skilled in communicating with the service users, particularly those with dementia related conditions. Talking to a number of the staff showed that they had received training in dementia care as well as such safety matters as food hygiene, infection control, manual handling and medication. This was confirmed by looking at the home’s training records. The manager also confirmed that the figures relating to National Vocational Qualification training provided by the home prior to the Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 17 inspection were still correct in that approximately 66 of the care staff have achieved National Vocational Qualification level 2 in care. Staffed talked about the staffing rota and said that they found the numbers for each of the units to be appropriate. This was repeated by the manager and borne out by the activity levels in each area of the home. The files of a number of staff who had recently been recruited to the home were looked at. One of these did not contain the written references that are required to be obtained by law. Two documents were found in that file acknowledging that this was accepted practice within the provider’s organisation. Those documents suggested practices that are not considered to be a substitute for those required in the Care Homes Regulations 2001. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. There is a qualified and competent management team within the home, however it has an ineffective quality assurance system and does not maintain the recruitment records required by law on the instructions of senior managers within the provider organisation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Talking with the manager confirmed that she has achieved the Registered Managers Award as well as National Vocational Qualification level 4 in care. These are considered to be the qualifications appropriate for someone who is managing a service of this kind. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 19 The manager explained that a number of service user satisfaction questionnaires had been distributed to the service users recently but it had been found that the layout was too complicated for the residents. These are now being reconsidered. She also explained that the home is visited once a month by representatives of the provider company as required by Regulation 26 of the Care Homes Regulations 2001. Some of these visits had been carried out by managers of other registered homes within the providers organisation. The manager explained that the home holds small amounts of cash for the service users and she and her deputy manager explained the process for recording transactions and how these are monitored. Equality and diversity for the service users were seen to be promoted throughout the home within the assessments, care plans and activities. A number of records were looked at that showed that safety checks are regularly carried out. These included the records of tests on portable electrical equipment, water temperatures in bathrooms, the fire equipment log and the gas safety certificate. The home was also seen to have secure storage for hazardous materials and have developed instructions for their safe use. As mentioned elsewhere the records showed that staff received any required safety training. The records showed that a recently recruited member of staff had only had one professional supervision session with her manager since starting work in the middle of August. However, the provider explained that this was due to the fact that the member of staff was undertaking their induction programme which involves meeting with a mentor every week. The provider will explore ways of evidencing this. Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 20 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x 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 x x x x x x 3 STAFFING Standard No Score 27 4 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 3 2 2 3 Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 21 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 OP29 Regulation 19(1)(b)(i ) Requirement The home must obtain written references about an individual before they start working with service users as part of the process that ensures that they are fit to work with vulnerable people. Timescale for action 19/11/07 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 OP37 Good Practice Recommendations The records that show that appropriate employment checks on new staff have been carried out in order to ensure that the manager has the appropriate information about the person to plan their induction and further training Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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 Cartlidge House DS0000020542.V346412.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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