Care Home: Charlton Kings Care Home

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What the care home does well What has improved since the last inspection? Most of the requirements from the last inspection have been met in full including improvements with recruitment procedures. The major building project is nearing completion and the home appears to be in good decorative order and well maintained. What the care home could do better: Although assessments and care plans are completed well there are one or two omissions identified in the report that are important to include in order to reflect all the needs of each resident. Staff supervision has been delayed because of the lack of senior care staff but this has now been addressed and the programme must proceed immediately. Staff receive training in moving and handling and have the equipment to use but there are no specific risk assessments to guide staff in how moving and handling of individuals should be carried out. Working conditions could improve with a larger commercially fitted kitchen, a staff room and improved staff/relatives toilet and better ventilation in some of the assisted bathrooms. CARE HOMES FOR OLDER PEOPLE Charlton Kings Care Home Moorend Road Charlton Kings Cheltenham Glos GL53 9AX Lead Inspector Mrs Janet Griffiths Key Unannounced Inspection 10:00 19 & 20th November 2007 th 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 Charlton Kings Care Home DS0000042519.V350134.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. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charlton Kings Care Home Address Moorend Road Charlton Kings Cheltenham Glos GL53 9AX 01242 521812 01242 517773 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) Charlton Care Ltd Mr Richard David Royle Care Home 34 Category(ies) of Learning disability over 65 years of age (3), Old registration, with number age, not falling within any other category (34) of places Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd January 2007 Brief Description of the Service: Charlton Kings Care Home is a large detached Edwardian family house that has been adapted and extended to provide personal care to thirty-four elderly people since a major extension was recently completed. This building work has considerably enhanced the facilities offered at the home. The property is situated in Charlton Kings, on the outskirts of Cheltenham, within easy reach of local amenities. Bedrooms are located on the ground and first floor, with access by stairs, a stair lift or a shaft lift. All bedrooms are currently single occupancy although couples may be accommodated if requested; the rooms have either en suite facilities or a hand washbasin. The communal space consists of three lounges and a dining room with patio doors leading into the garden and a conservatory that is accessed through one of the lounges. The provider supplies information about the home, including the most recent CSCI report in a readily accessible folder in the front hall of the home. Current fees range from £600 to £670. Hairdressing, chiropody and any personal items are charged extra. Costs are available on request. People funded through the Local Authority have a financial assessment carried out in accordance with fair access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms can be accessed from the Office of fair trading web site at www.oft.govuk http:/www.oft.gov.uk Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced key inspection site visit took place over eleven hours and thirty minutes on two days in November 2007. During this time the inspector spoke to a number of residents, two relatives, staff working in the home, the manager and deputy manager and the proprietor of the home. A tour of the premises was carried out as this was the inspector’s first visit to the home. Five residents’ files were examined in detail to include their medication records. Other records examined included staff recruitment and training records, accident, complaints and compliments records and maintenance/servicing records. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was completed and its contents used as part of the inspection process and report writing, as was the collation of survey results from service users, relatives and staff. What the service does well: The home has a warm and friendly atmosphere and is very welcoming to visitors. The staff team is very committed to the home and appears to have an obvious rapport with residents and visitors alike. Residents and their families all confirm that they are very happy with the standards of care received and the facilities offered in the home. When asked what the home does well, these are some of the comments received: • ‘Everyone is very kind to me, I can’t get used to having my ‘jobs’ done for me, but it is good to have help. I get very lonely and the carers are patient and loving which is a comfort’. • ‘Makes relatives feel welcome at all times and really takes care of the residents, talking to them etc’. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 6 • • • ‘ The care home is very well managed and there appears to be very good relationship with staff members’. ‘All of the staff are so polite and courteous towards all of the clients and their families. Nothing is ever too much trouble. There seems to be a good rapport amongst the staff and this is reflected in the happy yet relaxed atmosphere of the home. The home employs permanent staff rather than using agency and this gives greater continuity, care and reassurance to everyone. For me, as a relative, this is really important’. ‘I think they treat each person as an individual and as a friend’. What has improved since the last inspection? What they could do better: 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. Charlton Kings Care Home DS0000042519.V350134.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 Charlton Kings Care Home DS0000042519.V350134.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): 1,2 and 3. Standard 6 not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families have all the information they need to make an informed choice regarding placement at the home, and pre-admission visits take place to carry out an assessment and ensure that needs can be met. Residents normally move in on a long-term basis therefore Std. 6 was not assessed. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 9 EVIDENCE: There had been a number of new admissions since the last key inspection in January. Some of these residents were spoken with and their records examined. A copy of the Statement of Purpose and Service Users Guide was available in the front hall together with the last inspection report, and letters were seen to confirm that each new service user/their family had been sent a copy of the service users guide prior to admission. The Annual Quality Assurance Assessment (AQAA) states that ‘the home now offers prospective residents to come and visit the home and stay for a few hours to get a feel for the home’. Surveys received and people spoken with confirmed that they had received enough information about the home prior to admission, with one relative stating: • ‘The staff were very helpful when first my mother, then father (after he came out of hospital) were at the home. They gave my mother great confidence when they came to their home before my father went into hospital’. Service users also made the following comments: • • • ‘Yes, but it’s a leap in the dark of course, never having experienced residential care before’. ‘Arranged by my family after they had looked at a number of homes’. ‘Family member had been resident’. All of the records seen had pre-admission assessments completed. The information gathered varied according to what was provided at the time but should be built on after inspection and should include information on risks of pressure sores, catheters where present and moving and handling requirements. Contracts for residents who were both Social Services and self-funded were also seen and included specific information about the fees charged and additional costs. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is good. These judgements have been made using available evidence including a visit to this service by the key inspector. People who live in this home have their health care needs met through individually planned care. This clearly sets out needs and how they are met, to include healthcare referrals and interventions where required. They are also protected by the medication administration procedures that the home has in place and are treated with respect; their privacy and dignity are protected. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 11 EVIDENCE: A total of five care files to include some of those most recently admitted service users were examined and a number of residents and two relatives were spoken with. All had assessments completed. The amount of information included varied from quite brief to very informative dependent on the amount of information provided by the residents or their family. It was noted that risks of pressure sores/skin integrity and pressure relieving aids in use, were not included in the assessment; other omissions being mention of a catheter where relevant and moving and handling information. This is all to be addressed. Care plans were in place in all of the files seen and these were detailed, reflected most of the current needs and were reviewed monthly; they were also signed in the main by the resident or their next of kin where appropriate. Again there were a few omissions as mentioned above. The home has an excellent relationship with the district nursing service. Nurses from one practice visit any resident in the home requiring their attention and appear to be at the home on a regular basis at present with one resident requiring daily insulin and blood glucose readings and others requiring wound care attention. Nurses were visiting on both days of the inspection and both confirmed that they were very satisfied with the care provided by the home and the responses they receive from the staff, which are always positive and helpful. Records seen also confirmed visits from doctors, physiotherapist, community psychiatric nurses and the chiropodist among others. Wherever possible residents are taken out to attend appointments with dentist, optician etc and two attended the audiologist in the hospital on the second day of the inspection. One resident has become very frail and is now being nursed mainly in bed, on a pressure relieving mattress and other residents were observed with various other pressure relieving aids. Several portable hoists were also observed around the home to be used for any moving and handling procedures. All of the medication records were examined during the inspection and were well maintained. The manager audits these on a regular basis and also checks all new supplies of medication into the home; records of receipt and disposal were seen. The dispensing pharmacist also carries out regular audits. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 12 Only one gap was noted on this occasion; variable doses are being recorded and any handwritten entries are checked and countersigned by two staff. Wherever possible the prescribing doctor signs all new medication orders. There was just one issue staff were asked to address, as they were dispensing medication that had been secondary dispensed by a relative into a medi-dose box, which could be unsafe. This was addressed immediately and will not occur in the future. Two staff currently self- administer their medication and have signed selfmedication agreements and lockable facilities are available in each resident’s room. Procedures in place include assessment and review to ensure residents remain safe to self-medicate. All staff administering medicines have completed medication training which was confirmed by the staff and by the training records seen. When asked whether they felt their needs were met all of those residents who completed surveys said that they always/usually had their needs met. Relatives surveys received gave the following comments: • • • ‘Staff are incredibly passionate about their work and those they care for’. ‘The care home meets all their needs plus more, the staff were excellent in looking after them’. ‘The individual carers make a great effort to help my mother and get to know her. Knowing her as an individual helps them to understand her and therefore her needs. The ethos of the home seems to be to do just this and I feel all staff try very hard to achieve this’. Residents also confirmed that their privacy and dignity is respected and staff were observed knocking or doors and addressing residents by their preferred name. Everyone has a single room with the majority having en suite facilities, but with the new build two double rooms have been created for couples or friends who would like to share. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 13 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are supported to realise their own preferences and expectations, both in the home and in the community and are able to maintain contact with friends and family. They also receive a wholesome, appealing and balanced diet in pleasant and comfortable surroundings. EVIDENCE: The home employs an activities co-ordinator who works five afternoons a week and aims to provide some form of activity/social interaction for every resident should they wish to participate. The AQAA states that ‘all residents have a choice of how much or how little they partake in’. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 14 A weekly activities programme is displayed on the notice board and residents are also informed individually of special events that occur. The Christmas programme was also on display during this inspection and includes a table sale on 3rd December, Carols on 12th, a pantomime on 14th and a Party on 17th. The weeks’ activities programme included an entertainer twice during the week, arts and crafts sessions and outings. A trip out is organised every week but a number of the residents also go out individually with the activities co-ordinator or other staff to the shops or for a walk locally. A number spoke of their enjoyment just sitting in, or walking around the garden and a number of rooms have access from their rooms to individual patios where some have a seat and plants/bird tables or feeders. New garden furniture has recently been purchased. A picture board was also on display illustrating a number of outings/social events that had taken place and an activities record is kept. An annual boat trip with Willow Trust now also takes place. Spiritual needs are also met, either through the communion service held monthly at the home or by enabling residents to attend their own churches if they wish. When asked about activities most said that they usually or sometimes participated in the organised activities but the following responses were received: • • • • ‘I don’t want to participate’. ‘ Prefer to stay in own room’. ‘I am quite deaf and I miss out on events if they are just announcedit would be helpful if they could also be written on a white board/notice board as well’. ‘ More would be welcome’. The following comments were received from relatives regarding activities: • • ‘To have more activities available, in particualr for those clients who are more physically able. To have quiet familiar music playing in the background or a designated room’. ‘Possibly more hobbies/entertainment’ These comments were all fed-back to the manager. Visitors are made welcome at any time of the day or evening and residents have access to privacy when having visitors. Both of the visitors spoken with were with their relative in their own rooms. Both were happy with the care provided and one spoke of his grandmother being given a choice of the new rooms once completed and how she chose one with a lovely outlook into the garden, because of her love of gardens. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 15 The cook seen during inspection stated that a copy of the weeks’ menus is usually available and the days’ lunch is also usually displayed in the dining room, but on both days of the inspection this did not occur. Reasons for this were given. There is just one main course choice each day but individual preferences are well known, alternatives are always available and special dietary needs are catered for. The home currently provides meals for a vegetarian, diabetics and soft diets for those who require assistance. Food and fluid charts were noted in one resident’s room. Surveys received stated that they usually liked the meals provided and the following comments were made: • ‘I am a vegetarian and my diet is well catered for’. • ‘ A lot of the time I wouldn’t choose them’. • ‘ My taste buds are not like they used to be but old fashioned puddings are nice’. One of the people spoken with during the inspection stated that as a man, with a healthy appetite, initially he felt the portions were too small, but once he had mentioned it this improved. He also said that having made suggestions of what he would like at the residents meetings, such as smoked fish, this is now on the menu. It appears that the catering and care staff do all they can to accommodate differing tastes in food. However, one other spoken with, together with a relative, felt that they should be told what is on the menu each day in good time to ask for an alternative if they did not like what was being offered that day. The kitchen seen both days of the inspection is quite small for the size of the home now, and is still fitted with domestic appliances. The owner when spoken with stated that an enlargement of the kitchen is something that may be considered in the future, but not immediately and there are plans to redecorate in the New Year. Comments from two relatives/visitors surveys refer to this saying: • • ‘The kitchen seems rather small for the enlarged home. Nevertheless meals appear to be very good’. ‘ I think, perhaps, conditions for the staff could be improved by having eye level ovens fitted and more work top areas in the kitchen. They currently prepare and cook good meals for 34 people in a kitchen the size of which is usually found in an average family home’. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home are protected by the systems in place. EVIDENCE: The home has a clear complaints procedure, which is on display in the home and also included in the service users guide provided to each service user. Residents spoken with and surveys received confirmed from both residents and their relatives that they are fully aware of how to complain, adding the following comments: ‘But I did not need to do so’. ‘Information was placed by the book to sign when you go in, if you had a problem’ ‘I have never had to raise any concerns about the care of my mother’. ‘We had no problems so I cannot comment’. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 17 The home keeps a record of any complaints received but they have not received any since the last inspection. However, there was some correspondence on file from earlier in the year, from the relative of one service user who had felt they had problems mainly regarding the management of the home not dealing with issues raised by him on behalf of his mother. It appeared that these issues have since been resolved. This resident was spoken with during the inspection and she was on the whole satisfied with her care in the home, but did make some comments, which were fed-back to the manager. The home has policies on adult protection and on suspicions of abuse/neglect Staff also receive training on Protection of Vulnerable Adults, confirmed by the training matrix provided and further training is planned. The AQAA states that they plan ongoing reviews of the homes policies and procedures to ensure that they are up to date with current legislation. All of the policies and procedures were reviewed earlier this year according to the information provided in the AQAA. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 18 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): 19,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, clean and hygienic throughout. Equipment is provided to aid mobility and promote independence. Individual bedrooms are decorated and equipped to meet the needs of their occupants. EVIDENCE: The major building works are now completed and the residents are living in greatly improved, pleasantly decorated and appropriately furnished accommodation. They also enjoy the benefits of the new spacious internal communal facilities. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 19 During a walk around the building the inspector visited at least ten of the residents in their own bedrooms. All of the rooms seen were clean and in good decorative order, with evidence that each person had had the opportunity to personalise their rooms with photographs, small items of their own furniture and other treasured possessions. Since the last inspection, most rooms now appear to have additional seating provided for visitors although there were still one or two rooms where the inspector had to sit on the bed, which as pointed out before could be an infection control risk. Communal areas were also clean, in good decorative order and comfortably furnished. One lounge (used as the television lounge) was currently being redecorated but as this is one of three, residents were comfortably seated elsewhere around the home with no mention of any inconvenience to them. One resident who was at the home for respite care did comment on her bin not being emptied and lack of a bath towel, but this was immediately addressed when fed-back to the housekeeper. Considering the home has managed with only one cleaner for some time (a new cleaner had just commenced the previous week and was being inducted to the work) she is to be commended for the high standards of cleanliness around the home. Comments received from residents and visitors to the home included the following: All said that the home was always or usually fresh and clean, with one saying that the home provided clean, attractive accommodation, but one did say that they had had to complain about the cleanliness of their room often lots of dust on pictures etc and felt that they needed more cleaners, believing they only have one for the whole home. Another stated: ‘ One cleaning lady works very hard to keep lounges. dining room, 34 bedrooms, toilets and bathrooms clean- she needs help surely?’ It is hoped that with an additonal member of the cleaning staff the above will improve. There was one corridor wall and one en suite on the first floor that still require attention to complete the recent work, but otherwise most areas appeared to be well maintained. One comment from a relative/visit survey when asked ‘ what the home could do to improve’ did state the following: ‘ It would be nice to see a staff room for the staff so that they can take a break properly. The visitors toilet is not very appealing and needs updating’ Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 20 A schedule of work was displayed on the notice board up to March 2008, indicating that the kitchen and staff/visitors toilet are being redecorated in February 2008 and the outside for redecoration in March. The question of a staff room was raised in the last inspection report and was discussed with the proprietor at this inspection. There are currently no plans or space to provide a staff room, but it was generally felt that with the number of communal areas within the home, there was adequate space for staff to take their breaks within these areas Work undertaken in the past 12 months centred mainly round the major refurbishment which added nine more rooms, two of which are doubles which may be used by couples who wish to share. A larger dining room has been created with the conservatory being added to the dining room and an additional assisted bathroom has been built. There is an ongoing programme of redecoration, more furniture has been replaced and new garden furniture purchased and the car park resurfaced. Two existing bathrooms did appear hot and airless and some staff reported that it could become very uncomfortable working in this atmosphere. However, the proprietor did explain that each bathroom does have an extractor fan but because residents need a warmer/constant temperature these often get turned off. The laundry room seen briefly, was tidy and well organised. There is no longer a dedicated member of staff to take responsibility for laundry duties; the former laundry assistant now works on a voluntary basis only, so in her absence care staff carry out laundry duties. The manager must ensure that non-care tasks do not compromise care hours when arranging staffing rotas. However, there are plans to appoint a laundry assistant as soon as possible. It was noted that good infection control procedures are being maintained in the home with staff wearing colour coded –white aprons and gloves for personal care and blue for food handling. Staff spoken with were fully aware of the infection control procedures within the home and the training matrix provided confirmed that most staff had received infection control training recently. One explained that aprons and gloves were changed between residents. However, staff must be reminded to dispose of gloves immediately after personal care tasks performed and not to continue to wear them around the home. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 21 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, & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their needs met by sufficient skilled staff who are able to meet the needs of the current number of people living at the home. They are also protected by the homes recruitment system. Staff are supported to undertake regular and relevant training. EVIDENCE: Staffing levels during the inspection appeared to be adequate to meet the current needs of the residents but this is under constant review when planning rotas in accordance with dependency levels. On the first morning of the inspection, in addition to the manager and six care staff there was the home co-ordinator, two housekeeping staff, a cook and kitchen assistant and the property manager (maintenance). Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 22 The proprietor was also in the building on both days of the inspection. The activities co-ordinator was on during the afternoons. All of the residents spoken with were very happy with the care provided and no one gave any indication that they felt the home was short-staffed, or that they had been kept waiting for attention at any time. No call bells were heard constantly ringing. All those who completed surveys stated that the staff are always/usually available when needed and get the care and support they need, and all but one said staff always listen and act on what they say The following comments were received from the surveys: ‘Staff always cheerful and helpful’. ‘ But I do need to remind them about some requests, sometimes more than once’. ‘Staff are incredibly passionate about their work and those they care for’. ‘ The care home meets all their needs plus more, the staff were excellent in looking after them’. ‘ The individual carers make a great effort to help my mother and get to know her. Knowing her as an individual helps them to understand her and therefore her needs. The ethos of the home seems to be to do just this and I feel all staff try very hard to achieve this’. When staff were asked if there is enough staff to meet residents needs, all but one said usually. The one exception staing: ‘Weekends are vulnerable-very due to staffing levels; no cover when someone goes sick; residents needs don’t change at weekends; they still require care whatever day it is’. It was also felt by this same member of staff that more staff were required at vulnerable times such as weekends, evenings and night times and not enough staff were around to ‘keep an eye on vulnerable residents at break times’. This was fed-back to the manager. Three staff files were examined on this occasion, of staff newly appointed since the last inspection. All the required paperwork and checks were in place with the exception of a photograph and in one instance a Criminal Records Bureau (CRB) check was still outstanding but the member of staff, the new domestic, had a Protection of Vulnerable Adults (POVA First) check and was working under supervision. In accordance with the Data Protection Act 1998 the home was advised not to keep photocopies of any CRB’s and that once checked by the inspector they should be shredded. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 23 From the training matrix provided and information in the AQAA, eight care staff have NVQ 2 or above (over 50 of the staff) with another four currently working towards this qualification. From the surveys received and staff spoken with it was confirmed that they all receive regular training and that they have the right support, knowledge and experience to meet differing needs. Most also felt that they had training relevant to their role and to keep up to date with one stating: ‘We have ongoing training which covers all aspects of care; and moving and handling- first aid and fire are done on a very regular basis’. Most also felt that their recruitment and induction was carried out thoroughly. Evidence was seen within the staff files of an induction programme being completed and staff spoken with confirmed this, adding that they shadow experienced members of staff until competent to work alone. It was discussed that there should be some record of an assessment of competency signed by carers who provide the induction/shadowing in the workplace. There was also evidence in the files seen of certificates to confirm recent training undertaken. In addition to NVQ’s recent training includes medications, moving and handling, first aid, infection control, dementia, POVA and fire training. All of the mandatory training is ongoing with food hygiene organised for the beginning of January and further medication training planned. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 24 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): 31,32, 33,35, 36, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their best interests met by the manager and staff who are committed to their responsibilities. They and the staff are generally protected by the health and safety systems in place in the home. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager of the home has good experience in the care of elderly people. He has completed the Registered Manager’s Award and has been awarded a National Vocational Qualification, Level 4 in care. He also attends regular training workshops to assist him to undertake his duties and to keep up to date. The deputy manager and the home’s coordinator support him in his role. The management approach of the home does create an open, positive and inclusive atmosphere, which was clearly observed during the two days of inspection. From relatives surveys received all felt that they are kept well informed about important issues with the following comments being made: ‘I can relax knowing that I will be informed immediately if necessary’. ‘My relatives were very happy and when I arrived I was kept up to date about them’. In response to the question ‘what does the home do well?’ they included the following responses: • • • • • ‘ Wonderful caring, friendly atmosphere-good food-clean attractive accomodation’. ‘The home takes care of all my mothers needs and she is very happy living there’. ‘Care for the needs and welfare of my Aunt’. ‘ All its staff are very caring and friendly. Run in a well organised way. Always available to listen to any concern that we may have for our father. Happy for us to pop in at any time’. ‘Creates a friendly safe atmosphere. the carers are kind, patient and loving which is perhaps as good as practical help’. The home has a quality assurance programme in place and to ensure that residents are involved in the running of the home, regular residents meetings are held, the last being on 6th November with 22 residents in attendance. Minutes were seen of this meeting. A yearly satisfaction survey is also handed out to residents/their families, the results of the last seen at the last inspection. A further survey will be due to go out in the New Year. Any complaints, accidents or adverse incidents are monitored closely. A suggestion box is also available but rarely used and a file of thank you letters and cards is also on display within the front hall. The last staff meeting was held in June 2007 and again minutes were seen of this. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 26 The proprietor has been completing monthly Regulation 26 audits as required and sending a report to the Commission. He also carries out spot-checks during the night on a regular basis. The home provides a safe place for residents to store their valuables and money and a record is kept of them (holding large sums of money in the home is discouraged). The home does not act as appointee for any resident but does hold small amounts of money for a few on request and a record of any financial transaction undertaken on their behalf is kept and was seen. The manager admitted that being without a deputy manager for some time this year he has been unable to complete the staff appraisal and supervision programme but this is now underway and will be checked at the next inspection. However, staff spoken with and surveys completed confirmed that most staff feel very well supported by the manager, with one person saying, ‘he always thanks us for what we do, which is very important’ and one survey saying: ‘We have a great deal of support from our manager. He encourages us in all areas and helps us with difficulties’. Records were provided to show that statutory maintenance/servicing of equipment is arranged in a timely fashion. A recent Environmental Health inspection was undertaken and issues highlighted for improvement are being corrected. With the completion of the extension much of the dried food storage is now being brought into the home, whereas it was stored in a garden shed previously. Fire prevention processes are in place confirmed by training records and records of fire alarm and emergency lighting checks. There was just one area of concern noted with regard to the number of accidents recorded for one of the staff (a total of eleven in the last year). Whilst none of these were serious injuries this needs to be explored with regards to the environment and the methods of working for this member of staff. A risk assessment was completed on everyone, related to falls and other identified risks in the home but there did not appear to be a moving and handling risk assessment completed on anyone; one service user requires a hoist for mobility and another, nursed in bed, had obvious moving and handling requirements. This must be addressed. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 27 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 1 X 2 Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 (1) and (2) Requirement Care plans must be provided to address residents’ care needs, particularly in relation to pressure relief, catheter care and moving and handling requirements. Timescale of 28/02/07 not met in full with relation to pressure relief. Timescale for action 31/12/07 2. 3. 4. OP29 OP36 OP38 19 Schedule 2 18(2) 13(5) Ensure that proof of each new 31/12/07 employee’s identity, includes a recent photograph. Ensure that all persons working 31/12/07 at the home are appropriately supervised. Make suitable arrangements to 31/12/07 provide a safe system for moving and handling residents in the form of a risk assessment to ensure staff are given clear instructions. Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 29 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 OP15 Good Practice Recommendations Ensure that there is a menu (changed regularly) offering a choice of meals in written or other formats to suit the capacities of all residents, which is given, read or explained to them. The home should consider providing a dedicated staff room where employees might take a break from their duties. Provide comfortable seating for two in all resident’s rooms unless they state otherwise. Keep some record of an assessment of competency signed by carers who provide the induction/shadowing in the workplace. All care staff should receive formal supervision at least 6 times a year. In accordance with data protection act 1998 shred all CRB disclosures once seen by inspector and do not keep photocopies. Ensure that gloves are disposed of promptly after use. 2. OP19 3. 4. OP24 OP30 5. 6. 7. OP36 OP37 OP38 Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Charlton Kings Care Home DS0000042519.V350134.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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