Care Home: Charlton Court

What the care home does well People living in the home are provided with up to date information about the services they receive in the home. People were dressed in a dignified way. They looked clean and tidy, their hair was neat and all had some form of footwear. We observed staff being caring and respectful to people when carrying out their basic care needs. The medication administration and recording systems help ensure people are properly protected. All care staff are now employed following a robust recruitment process. What has improved since the last inspection? There has been a complete redecoration programme completed on the ground floor of the home. Deep cleaning has taken place in the kitchen and good cleaning programme is in place. What the care home could do better: More evidence is needed in the care planning and risk assessments to show people or their representatives are involved with consenting to their care. Care plans and risk assessments must reflect the up to date needs of people living in the home. People must be assessed as to whether they are able to self medicate or not when they are admitted to the home. Appropriate measures must be in place to support self medication if a person wishes to follow this pathway. A more structured programme of activity should be implemented throughout all the units of the home. This will improve the wellbeing of people who live there. Key inspection report Care homes for older people Name: Address: Charlton Court 477-479 Bradford Road Pudsey Leeds West Yorkshire LS28 8ED     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: Sean Cassidy     Date: 3 0 0 1 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: Charlton Court 477-479 Bradford Road Pudsey Leeds West Yorkshire LS28 8ED 01274661242 01274656799 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Charlton Care Homes Limited care home 71 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability old age, not falling within any other category physical disability Additional conditions: One specific service user under the age of 65, named on variation dated 20th December 2006, may reside at the home. The maximum number of service users who can be accommodated is: 71 The place for Learning disability under 65 is for the service user specified in the NCSC Notice dated 2 October 2003 The places for Physical Disability under 65 are for the named service users only The registered person may provide the following catgory 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; Learning disability - Code LD; Physical disability - Code PD Date of last inspection Care Homes for Older People Page 4 of 25 Over 65 0 71 0 1 0 2 Brief description of the care home Charlton Court is a large, purpose built care home, which provides care, with nursing, for up to 71 service users. It is located in a residential area of the Leeds suburbs and is very close to the boundary with Bradford. It provides accommodation on two floors, mainly in single rooms, some with en-suite facilities and has three communal sitting rooms and a dining room. There are wide corridors in the home and a passenger lift. There are facilities for laundering all communal linen and personal clothing and a central kitchen that provides all meals there is, in addition, a kitchenette on the upper floor where drinks and snacks can be prepared. There is a large car park for staff and visitors. There are grounds to the rear and an outside area where residents can sit comfortably and safely. There are local facilities nearby - shops, pubs etc.- and it is well placed for access to public transport. Information about services provided by the home is available in the homes combined Statement of Purpose and Service User Guide. Copies are kept in the reception area and can be taken by relatives or visitors. At the time of the inspection, 19 February 2009, the weekly fees were from GBP538 to GBP575 per week and are subject to review. These charges do not include hairdressing or chiropody and a separate list of charges for these and other services is available from the provider. 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: The quality rating for this service is One Star Adequate Service. This means the people who use this service experience adequate quality outcomes. The accumulated evidence in this report has included: A review of the information held on the homes file since the last inspection. Information obtained from people who use the service, relatives, staff and other health care professionals. One Inspector conducted an unannounced visit to the home and it lasted one day. The majority of time was spent speaking to people who live in the home, management, staff and relatives. Care Homes for Older People Page 6 of 25 A number of documents were looked at and some areas of the home used by the people living there were randomly inspected. The information required from the service in the form of the Annual Quality Assurance Assessment (AQAA) was obtained before this report was written. Feedback was provided at the end of the inspection to the homes manager. Care Homes for Older People Page 7 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 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures people are assessed before they are offered a place. Evidence: The home has an admission process that involves the pre assessment of all prospective people wishing to use the service. We found evidence that the home adheres to this policy. We looked at the documentation of a person who was recently admitted and this contained a full pre assessment of the individual. This is good practice as it provides evidence that the home ensures that it is able to meet the needs of the individual before a place is offered. Intermediate care is not offered at this service. 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. There is evidence that peoples healthcare needs are provided for by the staff at the home. However, all care needs must be clearly identified and planned for in a person centred care approach. Evidence: We looked at the care documentation belonging to three people living in the home. Each file contained care plans and risk assessments to assist staff with ensuring personal and nursing care needs were met. The new home manager has performed an audit of the care files and has identified that they are in need of a complete review. One care file that had already been reviewed and changed was inspected. The care files and risk assessments contained within this file were person centred and reviewed monthly. They were detailed, easy to follow and reviewed monthly. The other two care files had not been reviewed and they contained less detailed information and did not have a person centred approach. We identified out of date Care Homes for Older People Page 11 of 25 Evidence: information such as assessment documentation written by a community matron that was two and a half years old. We found evidence that some risk assessments were not representative of the changing needs of the people they had been written for. Foe example, a moving and handling assessment identified that one person was able to mobilise with two but it was evident that this person was nursed in bed. A continence risk assessment for another person identified that she was continent but the daily record sheet showed this was not the case. One person had a Not for Resuscitation care plan in place. This document was signed by a doctor and a nurse but there was no evidence that family or other representatives had been involved with the process. The document had not been signed or dated. There was little evidence in all the care documentation that people had been involved with consenting to their care plans and risk assessments. the manager has identified this also and has commenced work to address these gaps. The care plans seen contained evidence that showed peoples health was well monitored by health professionals such as GPs, district nurses, chiropodists and opticians. Evidence was seen to show people had received recent flu vaccination jabs. Weights were also monitored regularly and we found evidence to show those that were identified as losing weight were referred to a health professional. The home has a medication policy and procedure. We inspected the medication administration charts and these appeared to be in order with no gaps in signatures identified. Two people told me they were never asked if they wished to self medicate when they were admitted. They said that if this was offered when they were admitted they would liked to have tried it, but they didnt want to do it now. The manager was unable to produce a risk assessment tool to assess individuals to self medicate if they wished to do so. It is important that all new people coming into the home are assessed to self medicate and therefore promote independence where possible. People living in the home and their relatives told us that the staff were helpful and respectful when providing the care service. Some comments made were, The staff are very helpful when i need assistance. Staff are always respectful and helpful. Care Homes for Older People Page 12 of 25 Evidence: The staff will go that little extra mile for me. People were dressed in a dignified way. They looked clean and tidy, their hair was neat and all had some form of footwear. We observed staff being caring and respectful to people when carrying out their basic care needs. Care Homes for Older People Page 13 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. People living in the home should be provided with a more structured activities programme that provides them with leisure opportunioties both internally and externally. Improvements are needed with the development of a menu that reflects the chices and tastes of the people who live in the home. Evidence: The care files looked at as part of the inspection contained information about each persons interests and what activities they liked to get involved with. However, there were no care plans written to show how these activity needs were supposed to be met by staff. There were records in place that showed some one to one therapy took place but there gaps of up to two weeks recorded in the care files. We looked at the daily records for three people in the home. These records did not provide us with detailed information as to how each person spent their day. They gave some detail as to what personal care needs were provided. During the morning we observed some people sitting in the lounge area of the home. seven people were sat in chairs around the room. We observed little interaction Care Homes for Older People Page 14 of 25 Evidence: between staff and the people sitting in the room. There were no activities provided only the television which no one appeared to be watching. There was an activity person in the home in the afternoon who provided a game of bingo which some people were actively involved in. People told us that they are able to have visitors when they choose. The visiting times are displayed and highlighted within the Statement of Purpose. The home provides care on two different levels. Three people receive their care in the first floor level. One person was in a large lounge on the top floor and the other two remained in their rooms. Two of these people said they were quite happy to stay up stairs and liked to be left on their own to do their own thing. The person in the lounge was quite dependent on carers to meet personal care needs. She had her call bell close by and said that staff came when she needed them. Due to the large number of empty rooms it was recommended that the home be aware of the implications of social isolation. The care files for this person showed that this was not identified as a possible potential problem. People we spoke to said they wanted more activities both in and outside of the home. they told us: There is very little to do here in relation to activities. I don,t like bingo and that is a popular game. They never provide us with opportunities to leave the home. I want to get out and get some fresh air now and again. They dont seem to have the time to provide interesting activities. Care files showed evidence that peoples weights are regularly checked and that action is taken to ensure appropriate professionals are refereed when a persons weight drops significantly. We spoke to the person cooking the food during the site visit. The permanent cook has only been working three days a week in the home as she was asked to provide a cooking service to another company home that had no cook. The person cooking the meal had her food hygiene certificate and showed good awareness of infection control and health and safety. The food served in the home did not match with the planned menu. the menu was Care Homes for Older People Page 15 of 25 Evidence: only seen in the kitchen and was not displayed in any other area of the home. There was little choice provided to people in relation to the food served. people told me that you found out what was being served when you came to the dining room. this is poor practice and does not show that the home promotes choice in relation to food. The tea time menu showed that people were provided with a choice of sandwiches and no hot option. I spoke to one person and her family who said they were not happy with the food provided in the home. this was relayed to the manager to look into as part of the home auditing and quality assurance process. The manager could not provide evidence that the quality of the food provided was consistently audiited and changed when needed. We were able to have an opportunity to sit and have lunch with people in the dining room. people were supported by staff to eat their meals if they needed assistance. people appeared to enjoy their meal that was provided to them. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints and safeguarding procedures implemented by the home help ensure people are properly protected. Evidence: The complaint policy is displayed at the entrance of the home and also in the Service User Guide and the Statement of Purpose. People told us that they were confident that any complaints they made would be properly looked into by the manager of the home. They said they knew how to complain if they needed to. There is a safeguarding procedure in place and staff spoken to were aware of the safeguarding procedure and their role within it. People told me they felt safe living in the home. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment that suits their needs. Evidence: We randomly looked at the environment of the service during our site visit. it appeared clean and tidy. There are housekeepers on duty during the course of the day. people we spoke to said they were happy with the standard of cleanliness of the home. There have been recent changes made to the decor of the home on the ground floor. people we spoke to acknowledged that these have made a significant improvement to the home environment. The manager acknowledged that plans are in place to improve the first floor in the coming months. 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. People receive their care package from a staff group thta is trained and recruited to a good standard. Evidence: We looked at the staff recruitment files for two people and found evidence that showed the home operates a good recruitment process. Staff training files were reviewed and we found staff are provided with training in areas that are relevant to their roles. The manager has developed a training matrix and has identified the need for training in the coming year. People told us that they felt the staffing levels in the home were appropriate for meeting their needs. Evidence was seen that showed the manager is implementing a more structured approach to supervision. Not all staff have received a good standard of supervision but it is clear that there are plans underway to improve this. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some of the management systems and processes are still being reviewed people[s care is managed well, Evidence: The manager has been in post since August. This is her first management position and it is clear that she is enthusiastic about her role and ensuring the quality of care provided improves. The is aware that she has to complete the registered manager award and also apply for registration as manager. She has begun to implement her own quality audits within the home to help improve the quality of care. The organisation also performs its own quality audits which are then made available at the entrance for people to view. The last audit available for people to read was carried out in 2008 and is therefore out of date. The manager provided evidence that showed monthly Regulation 26 visits are performed by a regional manager. these were informative and detailed. However, they Care Homes for Older People Page 20 of 25 Evidence: should be reviewed to ensure they are more robust and identify the areas where the home does not provide good outcomes for people using the service. The health and safety records showed the home monitors the checks of equipment and safety systems on a regular basis. Care Homes for Older People Page 21 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 22 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 1 7 15 people who use the service must be involved with consenting to the care they receive. This will provide evidence that choice is promoted in the home. 30/04/2010 2 8 13 All care plans and risk assessments must contain the up to date information on each individual at all times. This will help ensure each person receives the correct care package at all times. 30/04/2010 3 9 13 People should be assessed in 30/04/2010 relation to self medication at the point of moving into the home. This will show that choice and independence is being promoted. Care Homes for Older People Page 23 of 25 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 4 12 16 the home must provide a 30/04/2010 flexible and structured activity programme tyhat is developed around the identified needs of the people that live in the home. This will help improve the well being of people who live in the home. 5 15 16 The people living in the 30/04/2010 home must be provided with a menu that has been designed around their preferences and tastes. Systems must nbe in place to monitor the quality of food provided within the home. This will promote choice and well being. 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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!