Care Home: Charlton

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What the care home does well A strength of the home is the effort made to provide a service which is centered on the individual and care plans reflected this person centered approach. People we spoke with said how they felt "staff really know us what we like and don`t like", "staff really get to know us and thats important, they know how I like things". There was a strong sense that staff have a real commitment to making Charlton somewhere that "individuals see as their home" and one person told us "its near home as home can be". The environment is well maintained and and again a real effort is made to make Charlton a welcoming and friendly home. The home offers a good range of activities and importantly staff have time to "just sit" with individuals who live in the home. The manager and staff provide an environment where individuals who live in the home have every opportunity to express their views about the service they receive and make suggestion about the daily live of the home. Some of the comments reflect the good level of service provided: "Staff were extremely helpful and very considerate.... nothing is too much trouble" (from a relative) " wonderful care and support" "impressed with the way all staff treat my mother" "staff are angels" "You delivered a high standard of care" Staff told us of the high morale in the home and the supportive approach of management. Comments received in the homes quality assurance from staff reflect this strength of the home: "Charlton has a lovely atmosphere, it has a homely and happy environment. Residents welfare is always our priority. Staff are well trained and professional." " Have always found Charlton a happy place to work". What has improved since the last inspection? At the last inspection we made two requirement these have both been met resulting in improvements in risk assessment and improved access to the garden area. What the care home could do better: We have made one requirement from this inspection this related to records made when changes take place to individuals medication. Key inspection report Care homes for older people Name: Address: Charlton Station Road Filton South Glos BS34 7BX     The quality rating for this care home is:   two star good 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: John Clarke     Date: 2 7 0 5 2 0 0 9 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 21 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 21 Information about the care home Name of care home: Address: Charlton Station Road Filton South Glos BS34 7BX 01454866142 01454866848 rachel.brain@southglos.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: South Gloucestershire Council care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate up to 32 persons aged 65 years and over requiring personal care Date of last inspection Brief description of the care home Charlton was purpose built in 1974. It is a two-storey home providing care and accommodation for thirty two older people. Day care facilities are also provided for one person each day. The home is one of eight that operate as part of South Gloucestershire Councils Community Care Department. The home is located in an established residential area of Filton approximately four miles north of Bristol city centre. It is close to the Avon Ring Road and within easy reach of the motorway system. There are a range of shops, pubs and a church nearby in addition to a variety of shopping complexes including the Mall at Cribbs Causeway and the adjacent leisure complex. Accommodation is provided on both floors in single rooms. There is a passenger lift. Each bedroom has a wash hand basin. The home has a variety of communal areas and activity rooms. There are gardens to the rear of the home. 0 Over 65 32 Care Homes for Older People Page 4 of 21 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: two star good 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: We made an unannounced visit to the home as part of our inspection. We looked at a number of records relating to admission, care plans, medication arrangements. We also looked at documents relating to staffing the home, recruitment and training. There was an opportunity during our visit to talk with a number of individuals who live in the home and staff members. the manager completed a Annual Quality Assurance Assessment this provided us with information about the service and improvements they have made over the past year. We have used this information to help us make a judgment about the quality of the service providing by the home. Care Homes for Older People Page 5 of 21 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 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 6 of 21 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 7 of 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes through and comprehensive assessments of individuals who are potentially moving to the home so that an informed decision can be made about the ability of the home to meet health and social care needs. Evidence: We looked at two pre-admission assessments and they provided good information about the individuals health and social care needs. Individuals are also assessed by the local authority and a copy of their assessment and care plan forms part of the admission information. Care Homes for Older People Page 8 of 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning and arrangements for meeting health care are good providing staff with the necessary information so that the health and social care needs of residents are met. There is a person centered approach to the providing of care so that individuals particular needs and wishes can be met in their daily lives. Arrangements for managing residents medication make sure that residents health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. Evidence: We looked at a number of care plans and they provided clear and detailed information about the care tasks. Risk assessments had been completed in one instance this had identified risk of skin breakdown and had been reviewed monthly, in another this identified the risks associated with an individual purchasing non-prescribed medication. Moving and Handling profiles had been completed. Care plans had been signed by the individual or their representative. Included in the care plans were Dietary Likes and Dislikes, Daily Living Action Plan. Reviews of care plans had taken place regularly. Care Homes for Older People Page 9 of 21 Evidence: Of note was the person centered nature of the care plans in that there was good information about the individuals past history and pen pictures. Also included was Important People In My Life and Whats Important to Me, Social and leisure Interests. Individuals have also identified What Id Really Like to Do In 2009 and these included going out for walks to having tea with Prince Charles. In discussion with individuals and staff they spoke of how they had attempted to make these wishes happen for individuals (though the Prince Charles wish may be challenging). For one individuals whose first language is not english the home has arranged independant advocate.This role is being developed with the individual and staff in clarifing the wishes and assisting staff in establishing relationship in terms of greater understanding of the individuals culture and language. Records showed that individuals have access to community health services such as chiropody and dentist. Where individuals need care of a nursing nature such as for ulcers a community nurse visits the home. One individual told us that you just have to ask and a doctor will come. We looked at the arrangements for the management of medication in the home. The home has new treatment room and improved storage of medication. There is good management of stock medication with secure controlled drug storage and separate fridge. Currently no individual are being given controlled drugs. Administering records for a period of 3 weeks were looked at and there were no gaps in recording. It was noted that for three individuals there had been changes to their medication handwritten on the administering records however these had not been signed by staff member. Where individual had eye drops the date of opening was recorded on container so that used within time period. We spoke with a number of individuals about the approach of staff and they told us that staff were all good couldnt better the staff very nice carers. We asked whether they felt staff treated individuals with respect always they listen to what we have to say. During our visit to the home we were able to observe staff and the were always sensitive in their manner this was particularly evident when they were assisting individuals. Care Homes for Older People Page 10 of 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. the arrangements for meeting the social and recreational needs of individuals who live in the home are good with opportunities too maintain links with family, friends and the local community. The homes practice and routines are flexible so that individuals are able to exercise achoice and control over their daily lives. The home provides meals which are balanced and meet the dietary needs of people that live in the home. Evidence: The home has an activities organiser who works three days a week. Individuals we spoke with were very satisified with the activities arranged in the home. On the day of our visit a small group of individuals were taking part in a quizz. Other activities included watching films, bingo, dominoes, outside entertainers and trips out. One individual we spoke with told about how the home has started an arrangement where individuals can invite friends or relatives for lunch. Another told us how much she enjoyed the trips arranged by the home and use of the community bus. Individuals also have travel cards which allows service users and carers to get about free of Care Homes for Older People Page 11 of 21 Evidence: charge. Staff told us that a strenght of the home is that they have time to sit with individuals and take part in activities. Individuals we spoke with told us how they felt their visitors were always made to feel welcome and another said that the home is so friendly theres no restrictions on my family coming to see me. We asked individuals about the food provided in the home and they told us always plenty to eat and a choice, food is excellant, good food. Menu showed a wide variety of meals and any specific needs such as diabetics are catered for. The home has recently been awarded 5 stars kitchen hygeine award by environmental health. Care Homes for Older People Page 12 of 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has procedures and policy in place so that individuals can make a complaint and voice their views about the service and any dissatisfaction they may and feel confident that they will be listened to and action taken where necessary. The home makes sure that as far as possible individuals are protected from harm by having policy and procedure about Safeguarding Adults and providing training to staff. Evidence: We looked at the homes complaint log which showed that the home has received one complaint since our last inspection this is still being investigated. However in discussion with the manager we were able to establish that changes have been made to the homes practice following this complaint. These related to improving communication, record keeping and infection control practice. We spoke with a number of individuals about what they would do if they were unhappy about the service they were receiving or had concerns they all told us they would speak to the manager or a member of staff. One individual told us they knew they could make a complaint if I wanted too. Another said that they would sort it out for me. One individual told us that staff are always approachable. The home has a specific policy about responding to any allegations of abuse and staff receive training in Safeguarding Adults. Care Homes for Older People Page 13 of 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and hygienic environment for the people that live and work in the home. Evidence: A number of improvements have been made to the environment of the home since our last inspection these have included improved access to the garden from the dining room with automatic door with ramp access, loop system installed in dining room, two lounges updated, bedrooms re-decorated, corridors and dining area redecorated. Planned improvement include updating call bell system , installation of Better Caring Radio, new assisted bath and replacement of windows. It was evident from looking around the home and being able to see individual rooms there is high standard of cleanliness which was confirmed by individuals we spoke with its always lovely and clean here its all kept really nice here. The home has infection control procedure and practice in place which is based on Department of Health guidance. Staff have undertaken infection control training delivered by North Bristol Primary Care Trust. Staff confirmed to us that they have access to protective clothing when ever this is required. Care Homes for Older People Page 14 of 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements in the home are good so that the needs of individuals who live in the home can be met in an efficient way with care being provided by skilled, qualified and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of individuals is protected. Evidence: We were provided with worked staff rotas for a period of 4 weeks. This showed that there is generally 3/4 care staff on duty am (7-2,8-3), 3 pm and two waking night staff. It was also noted that there is 3 domestic staff on duty as well as laundry assistant (3 days) On the day of our visit there were 4 care staff am, 3 pm and 3 domestic. Individuals we spoke with told us we always get help we need give any help I need the staff are always there when we need them. Staff told us one of the good things about the home was that staffing levels good. We looked at the recruitment and selection record for three members of staff. We found that the necessary checks had been undertaken with two references, POVA1st check and Criminal Record Bureau check. Full application forms had been completed by the applicants. We have been told that all permanent day staff have completed NVQ 2 professional qualification and all domestic staff have NVQ 1. In total there are 13 of 17 permanent Care Homes for Older People Page 15 of 21 Evidence: staff who have NVQ. A number of staff are undertaking NVQ 3. Of four duty managers two have NVQ 3 and one recently completed Level 3 Management Award. All of the duty managers are NVQ assessors. Training records showed that staff had completed mandatory training: moving and handling, Safeguarding Adults, Health & Safety, First Aid. Other training completed by staff included Infection Control. Nine members of staff and 3 duty managers are currently undertaking the clinical skills training at North bristol Trust which is a recognised training undertaken by nurses and health care assistants which incorporates basic nursing skills such as taking blood and blood pressure, taking pulses, urines tests and simple dressings. Staff who have completed this training will be working under the supervision and direction of GPs and Community Nurses. A duty manager is also a key mover and has been trained to issue basic occupational therapy equipment. This then allows for the both the needs of the service user and staff to be met more promptly (from AQAA) Care Homes for Older People Page 16 of 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place so that individuals who live in the home can express their views about the quality of the service they receive. The practices of the home help to make sure that the health and safety of individuals who live and work in the home is protected. Evidence: MS Brian has 9 years experience of managing a care home and extensive experience working in a care setting. She has the NVQ 4 Registered Managers Award and is currently working towards a degree in Health And Social Care. She is also an NVQ assessor. Individuals we spoke with were very complimentary about her as manager of the home approachable we can talk to her about anything she listens to what we have to say shes very good. Staff said go to her anytime her door is always open. They also said how they were confident that if they had any concerns or difficulties the manager and senior staff would deal with it. The home provided us with the results of an independent quality assurance survey Care Homes for Older People Page 17 of 21 Evidence: which was completed by 21 individuals who live in the home and 24 staff. The home achieved 97.7 satisfaction and awarded All Star home. Some of the comments made by individuals and staff included: I thoroughly enjoy my meals. food is very good the lunch today was lovely. I enjoyed bingo, watch film shows, also playing cards. Went to Slimbridge last week, enjoyed the day out. Staff: When I enter the building there is a feeling of calmness and a relaxed atmosphere. Line management is very supportive of good working relationships I have an excellent manager, who motivates me and is always willing to listen to my ideas. I have recently started working at Charlton. I find the staff and management teams very professional. The home also uses Listening forms bi-monthly where individuals who live in the home can comment on the care and register any concerns or questions they may have. We looked at some of these for April/May 2009. They included an individual who requested a bigger room and was subsequently offered one, one wanted night checks and this now takes place and another wanted more blood checks and a district nurse was requested to do this. There are also Food Reviews monthly and suggestions regarding the menu and food made by individuals who live in the home and again changed had been made as a result of these reviews. Residents meetings are held monthly where issues relating to the home are discussed such as staffing, trip outs and the menu of menu. We looked at health and safety records relating to fire alarm and frequency of drill and found these regularly take place. Equipment is serviced yearly if not twice yearly. Care Homes for Older People Page 18 of 21 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 19 of 21 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 1 9 13 The registered person shall 19/06/2009 make suitable arrangements for the recording, safe administration of medicines received into the care home. This refers to the need for any changes which are made to individuals medication and handwritten on administering records are signed and witnessed to evidence and be able to audit the change. 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 20 of 21 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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