Care Home: Charlton Lodge

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What the care home does well Charlton Lodge is well managed and provides a safe, comfortable and homely place in which individuals can live their lives. Everyone looked clean and well cared for. There is a good assessment process that assures people thinking of moving into the home that their needs will be met. Everyone living at the home has a care plan that sets out their needs. Staffing levels are sufficient to meet the needs of people currently living at the home and staff are well trained. People living at the home said that staff were helpful and friendly. One person commented on their survey form that ‘The manager and staff are all very helpful’. Staff generally said that they felt well supported by management and each other. Staff said via survey forms, that ‘the service users’ needs come first at all times’. Another said when asked what the home does well ‘Great menu, friendly staff and relaxed atmosphere`. Another staff commented ‘…(the home) takes into consideration the way they lived at home and try to make the atmosphere as homely as possible`. There was evidence of good multi-disciplinary working with other professionals and all records, including those relating to medication administration were well maintained. A GP commented via their survey form that the home ‘remains very caring in spite of being efficient and professional’. People felt that meals were very good and there was a good variety of food available, also that there was always an alternative if they didn`t want what was on the menu. What has improved since the last inspection? All of the requirements and recommendations made at the last visit have been addressed. People are now given their medication as prescribed and within correct timescales. Care plans set out in detail any action needed to be taken by staff in order to meet people’s needs. Staff ensure people’s privacy and dignity is respected at all times. The home now has regular activities on offer ans records are kept of each activity and who attended it. All staff have received up to date training in Safeguarding Adults issues and moving and handling.Charlton LodgeDS0000039224.V377578.R01.S.docVersion 5.2 What the care home could do better: No major issues were identified at this visit. However, a few recommendations were made and these include, ensuring that all identified risks are properly assessed and any controls measures put into place are clearly shown. All recordings made about people should be objective and non-judgemental. Any complaints that are received should be recorded separately so that people who wish to see information about themselves are not able to see information about other people. Key inspection report CARE HOMES FOR OLDER PEOPLE Charlton Lodge Orchard Way Tiverton Devon EX16 5HB Lead Inspector Sue Dewis Key Unannounced Inspection 7 &10 August 2009 09:45 DS0000039224.V377578.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.2 Page 2 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 Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charlton Lodge Address Orchard Way Tiverton Devon EX16 5HB 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) 01884 253319 01884 253319 http/www.devon.gov.uk Devon County Council Mrs Tina Bartin Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 30. 1st August 2008 Date of last inspection Brief Description of the Service: Charlton Lodge is a care home providing personal care and accommodation for up to 30 people over 65 years of age. The home is a detached purpose built property owned by the local authority, Devon County Council (DCC). It was refurbished in 2004 when many rooms were made bigger and facilities improved. The building is set over two floors, with access to the top floor by shaft lift. All bedrooms are for single occupancy only with shared bathrooms and toilets. The home has three lounge areas and pleasant grounds. It is situated centrally in Tiverton, close to local shops and amenities. Some people at the home stay long term but the home does offer a short stay respite service and an intermediate care service. Up to ten people can be accommodated for intermediate care at any one time with the aim of helping them to regain their independence so that they can return to their own homes. The home also has a flat equipped with kitchen, large bed/sitting room and a bathroom where people can develop their independent living skills with the appropriate support. The home offers easy access for people with mobility problems, the entrance is level with an automatic door, there is a passenger lift to the first floor, and there are plenty of aids and adaptations to assist mobility, such as grab rails. Fees are currently £599.34 per week. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.2 Page 5 Current information about the service, including CSCI reports, The Service Users’ Guide and Statement of Purpose, is available to people thinking of moving into the home and all documents can be found in reception. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced visit took place over 12 hours, 2 days at the beginning of August 2009. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. Although only one inspector undertook this inspection, throughout the report there will be reference to what we found and what we were told. This is because the report is written on behalf of the Care Quality Commission. During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care and wherever possible speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CQC likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to 10 people living at the home, 3 health and social care professionals (including GPs and care managers) and 10 staff. At the time of writing the report, responses had been received from 7 people living at the home (6 of which had been completed with help from staff), 3 health and social care professionals and 8 staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 4 people living at the home were spoken with individually and 5 in group settings. We also spoke with 3 staff and the manager. A full tour of the communal areas of the building was made and a sample of records were looked at, including medications, care plans, the fire log book and staff files. The interaction between the people living at the home and those who care for them was also closely observed. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.2 Page 7 What the service does well: Charlton Lodge is well managed and provides a safe, comfortable and homely place in which individuals can live their lives. Everyone looked clean and well cared for. There is a good assessment process that assures people thinking of moving into the home that their needs will be met. Everyone living at the home has a care plan that sets out their needs. Staffing levels are sufficient to meet the needs of people currently living at the home and staff are well trained. People living at the home said that staff were helpful and friendly. One person commented on their survey form that ‘The manager and staff are all very helpful’. Staff generally said that they felt well supported by management and each other. Staff said via survey forms, that ‘the service users’ needs come first at all times’. Another said when asked what the home does well ‘Great menu, friendly staff and relaxed atmosphere. Another staff commented ‘…(the home) takes into consideration the way they lived at home and try to make the atmosphere as homely as possible. There was evidence of good multi-disciplinary working with other professionals and all records, including those relating to medication administration were well maintained. A GP commented via their survey form that the home ‘remains very caring in spite of being efficient and professional’. People felt that meals were very good and there was a good variety of food available, also that there was always an alternative if they didnt want what was on the menu. What has improved since the last inspection? All of the requirements and recommendations made at the last visit have been addressed. People are now given their medication as prescribed and within correct timescales. Care plans set out in detail any action needed to be taken by staff in order to meet people’s needs. Staff ensure people’s privacy and dignity is respected at all times. The home now has regular activities on offer ans records are kept of each activity and who attended it. All staff have received up to date training in Safeguarding Adults issues and moving and handling. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.2 Page 8 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. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.2 Page 9 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 Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the 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 admission procedure ensures that there is a proper assessment prior to people moving into the home, and that they can be assured that their care needs can be met. People are helped to maximise their independence and enabled to return home. EVIDENCE: There is a Statement of Purpose, Service User Guide and Brochure available to people thinking of moving into the home. These are also available in everyone’s room for reference. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 11 The manager explained the admission process from when she first receives a referral. She said that she will go to see the individual in their own home or hospital and complete an assessment form, she also collects as much other information from as many people as possible. The files for three people were looked at. Their admission records showed evidence of good assessments and risk assessments undertaken prior to the person moving in. However, one assessment was not dated or signed. One person that we spoke with said that they knew the home before they moved in because they had visited a friend there. Survey forms that were returned to us showed that 4 people felt they had received enough information about the home before they moved in, while 3 said they did not. The concept of Intermediate Care was introduced in order to avoid unnecessary hospital admission, facilitate discharge when hospital care is no longer needed, and prevent unnecessary admission to long-term care. It might also be described as intermediary, being somewhere between hospital and home, which is why there are higher levels of therapeutic interventions than usually provided by care homes. The intention is for the active rehabilitative programme to enable someone to return home within 2- 6 weeks. The home has a separate intermediate care unit which is sited on the ground floor, with it’s own facilities, such as dining area, sitting room and bathrooms. People admitted here are supported to regain their independence and confidence by a number of health professionals, such as physiotherapists and occupational therapists. All individuals now have a ‘white board’ in their room that shows their aims and objectives for the next week. Staff have weekly meetings when these aims are reviewed or set. A physiotherapist visits weekly and an occupational therapist visits most week days. The service generally supports people for about 4 weeks at Charlton Lodge then 2 weeks within the community. We spoke with one person on the unit who was very happy with the care they had received there, and told us that they had improved considerably since leaving hospital. There is also now a ‘Rapid response’ service operating from the home, which goes into people’s homes 2 or 3 times daily to try to prevent a hospital admission. Staff from the home’s Intermediate care Unit have been moved over to work for this team which has meant that the numbers of people being supported within the home is limited. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to review the pre-admission procedure. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone who lives at the home has a care plan which provides staff with information to enable them to meet peoples health and social care needs on a day to day basis. The management of medication is good and helps ensure people are protected from the risk of not receiving their prescribed medication. EVIDENCE: We looked at three care plans to help us judge how care is planned and delivered. Since our last visit, the manager and care staff have continued to improve the quality of information in care plans. Care plans provide good information to staff about people’s abilities, and the assistance they need to complete activities of daily living, such as personal Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 13 care. They also describe people’s preferences, including preferred routine, likes and dislikes relating to food and important information about people’s past life and occupation, providing staff with an understanding of the individual. We saw that some people had signed their care plan to indicate they had been involved in the process. Other care plans had not been signed but noted that the person had been made aware of the content of the care plan. We saw that appropriate moving and handling assessments and plans had been completed and we saw staff using appropriate moving and handling techniques when needed. Risk assessments were in place and generally identified areas, which may cause harm to people, for example, poor mobility, falls, aggression and the use of equipment. However, one care plan identified that the person’s ‘ability to swallow had deteriorated’ but there was no risk assessment for choking. Also there were no risk assessments relating to the use of bedrails or why they were being used. Staff told us that they found care plans useful but lengthy and one staff told us that they were having staff meetings to discuss care plans to try to separate out the information needed daily by care staff from the information that could be held in the office. Survey forms that were returned by staff indicated that 3 felt they ‘always’ had enough information to help them care for people, 3 felt they ‘usually’ had enough information and 2 felt they ‘sometimes’ had enough information. Daily recordings are made by all staff and contained some good information that evidenced when care needs were met. However, some of the language used was at times a little judgemental. People told us that their healthcare needs were generally well met, although one person did say that it took sometime to get to see a GP –‘not like in hospital’. The three care plans looked at showed that health care issues were clearly identified and any specific issues were followed up. We saw where one person had complained of cold symptoms, a GP visited and antibiotics were prescribed. Information about visits from and to health care professionals had been recorded in individual care plans, showing clear evidence that people are supported to maintain access to specialist medical services. We received survey forms from a community nurse and a GP, both felt that the home ‘always’ sought advice from them and acted on it in order to improve people’s well being. The manager showed us a new form they were introducing called a ‘Medical Alert Form’. This will be printed on red paper and placed at the front of the individual’s care plan to alert staff when there have been changes to the person’s medication, condition or care needed. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 14 We spent sometime talking to a member of staff who was administering medications. There is a policy and procedure for the administration of medicines and evidence was seen to show that people are supported to look after their own medicines if they wish to. All medicines were seen to be stored correctly and staff were seen administering them appropriately and signing the MAR (Medication Administration Record) as needed. We were told that all staff who administer medication have received appropriate training and that no-one administers medication until they feel confident to do so. On the day of the visit a manager from another DCC home was conducting an audit on the medications at the home. All people we saw during this visit looked well cared for, were treated with respect by the staff and their right to privacy was upheld. Personal care was seen to be offered in a discreet manner. Staff told us how they respect peoples privacy when helping them with personal care and we heard staff speaking with people in a kindly, friendly way. People told us that staff were very good and were always respectful to them. They also said that staff were very caring. There was an obvious affection between staff and the people they care for, with much friendly banter and laughter around the home. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to train 2 senior staff to be key workers in moving and handling, continue to improve on nutrition and diet and to continue to improve care plans and personal profiles. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social interaction and activities are available, and there is good daily variation for people living in the home. EVIDENCE: People’s preferred daily routines are recorded in their care plans to ensure staff are aware of what time they like to get up or go to bed etc. We spoke with several people about the routines at the home, and people told us that the routines were flexible and suited their needs. One person told us that they always stayed in their room and another told us that they are able to help around the home. Although care plans do contain some very useful social history the detail is limited and the manager said she was looking to expand this by sending questionnaires to people’s representatives who may be able to provide extra information. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 16 A regular programme of activities has been established and the weekly programme is displayed in the hallway and on each unit. Activities on offer include bingo and other games, pampering sessions, coffee mornings, skittles and outings. There is now a member of staff who can drive the home’s mini bus, so outings have been increased. We were shown a record of all the activities that have been provided and who has attended them. On one of our visits we saw people being taken out in wheelchairs to feed some ducks and an entertainer visited to provide a sing-a-long for people. We also saw staff playing dominoes with individuals. People told us that they enjoyed reading and watching TV as well as the entertainments provided. People are able to go into the Day Care unit, to attend any activities that are on offer there. There is a religious service held each Sunday by different local parishes. The manager told us that there is limited contact with the community. Although there is a League of Friends for the home and someone from the local school visits to play a musical instrument. People that we spoke with said that they often had visitors and that they were always made welcome by the home. One person told us of how they often went out to spend time with their family. Staff were able to tell us how they offered choices to people throughout the day, including what time they get up, what they wear and where they sit. We were told that people were encouraged to remain independent and that as few restrictions as possible were put on their daily lives. We ate lunch with people in one of the dining rooms. The meal was tasty, well presented and nutritious and people said that they enjoyed it. All of the people we spoke with during the visit were very pleased with the quantity and quality of food provided at the home. They told us that there was always an alternative if they didn’t want something on the menu. However, of the 7 people returning surveys, 5 said they ‘usually’ liked the food, 1 said they ‘always’ liked the food and 1 said they ‘never’ liked the food and wanted more to eat at tea time. We were told that vegetarian and diabetic meals are also available if needed. Catering staff were aware of individual needs, and likes and dislikes. We saw fresh bowls of fruit on each unit for people to help themselves to and people had fresh drinks available throughout the day. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to organise regular outings, trips to the local town and more 1:1 social interaction. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 is a good complaints procedure and people can be confident that their concerns will be listened to. Robust procedures are in place to ensure that people are protected from abuse. EVIDENCE: A new complaints procedure has been introduced by Devon County Council which outlines the action people need to take if they wish to complain. Brochures about this new procedure are displayed around the home. The new procedure also gives information to staff on how to deal with complaints. Some people living at the home who were spoken with during this visit were unsure about the homes formal complaints procedure. However, those who were spoken with were able to tell us who they would speak with if they were unhappy about anything and this was generally the manager. There were mixed responses received via survey forms. Some people knew of the formal complaints procedure, some did not. Some people knew who to speak with if they were unhappy about anything but again some did not. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 18 The AQAA (Annual Quality Assurance Assessment) showed that no complaints have been received by the home since the last visit. We looked at how the home records complaints and the action they take to respond to people’s concerns. Records relating to all complaints have been kept on the same sheet, allowing people wishing to see their own information to see other people’s. This is contrary to the Data protection Act and all complaints should be recorded on separate sheets, showing the investigation and outcomes. The Commission has received no complaints about the home since the last visit. Records show, and staff told us that they had received training in Protection Of Vulnerable Adults (POVA) issues. All staff that we spoke with were able to discuss different forms of abuse and said that they would report any suspicions they had to the manager. They were also able to tell us who they would report any concerns to, outside of the home. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 People using the 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 pleasant, comfortable and safe environment for those living in, working at and visiting the home. EVIDENCE: A full tour of the communal areas of the home was made and some individual bedrooms were looked at. The home was clean, tidy and pleasantly decorated and furnished. There were no unpleasant odours. Peoples bedrooms contained many individual items and reflected the personality of the occupant. People told us that they had been able to bring Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 20 things from their home when they had first moved in, including their own furniture and pictures and photographs. . Charlton Lodge is purpose built and provides a good standard of accommodation for people. There are pleasant communal areas and all bedrooms are for single occupancy only. The home is accessible throughout for people with mobility problems and a lift provides access to all floors. There are well-equipped bathrooms with various aids and adaptations to help people, including hoists and grab rails. People living at the home were happy with the accommodation provided. The home has a neat, accessible garden and two people said they particularly enjoyed visiting the garden, when possible. There are several benches around the garden so that people can enjoy this space in good weather. The home is generally well maintained and has access to maintenance personnel from DCC. A record is kept of any maintenance that is required and the maintenance person visits the home regularly to carry out some safety checks and make minor repairs. A small team of cleaners work hard to ensure the home is clean. People returning surveys to us said the home was ‘always’ clean and fresh. Staff confirmed that disposable gloves and aprons were available to them in order to minimise the risk of cross infection. They also confirmed and records show that they have received training in this area. The laundry is well equipped, clean and well organised and an impervious floor covering is fitted to minimise the risk of cross. A red bag system is used for any soiled laundry ensuring staff are protected. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to introduce a better cleaning rota. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A wide range of training is provided and the numbers and skill mix of staff on duty are sufficient to meet the needs of people currently living at the home. People are protected by robust recruitment procedures that ensure people who may be unsuitable to work with vulnerable people are not employed at the home. EVIDENCE: On the days of the visits there were 6 care staff on duty this being 2 staff for each wing. There was also the manager, assistant manager, 3 kitchen staff, 3 domestics and a laundry assistant on duty. Over night there are 2 waking care staff and a Night Care Officer on duty. People that we spoke with during the visit were very happy with the care they received. They told us that they did not have to wait too long for help and that the staff were ‘very good’. We received mixed responses from people who returned surveys. While 4 people thought there were ‘always’ enough staff available, 2 felt this was only ‘usually’ and 1 person thought that there was Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 22 only enough staff available ‘sometimes’. However, everyone felt that the care they received was good and felt that this was something the home did well. Staff were able to tell us about time they spend with people playing board games and chatting. Staff were also able to tell us about people’s needs and how they are met on a day to day basis. However, several staff commented via survey forms that the home was not always fully staffed, due to sickness and annual leave, and that this led to domestic duties being left and individual’s care being rushed. The manager told us that there had been some problem recruiting staff recently as DCC were not issuing permanent contracts. However, she has still managed to reduce the numbers of agency staff being used. She also told us that all staff will be having development portfolios and as part of this, staff who have worked at the home for some time will be doing the same induction as new staff. Three staff files were looked at. All 3 files contained all the required information, including satisfactory CRB (Criminal Records Bureau) checks, two written references and proof of identity. Training has a high priority at the home. Records show and staff confirmed that they receive a wide variety of training, including Fire procedures, Moving and Handling, Food Hygiene, First Aid and Infection Control. Staff are also encouraged to work for NVQs (National Vocational Qualifications) and the AQAA shows that 18 staff currently have NVQ level 2 or above. All staff have received training in POVA (Protection Of Vulnerable Adults) issues and training for staff working with people with Dementia has also been provided. All new staff receive a full induction in line with Skills for Care recommendations. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to ensure all staff complete the Skills for Care induction. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 People using the 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 is well managed resulting in practices that promote and safeguard the health, safety and welfare of people who live and work in the home. EVIDENCE: The manager, Tina Bartin, is both qualified and experienced. She has obtained the Registered Manager’s Award and she has experience of managing a care home. The manager works hard to ensure people living and working at Charlton Lodge are happy and safe. We saw her communicating with staff and people living at the home in an open and friendly manner. Staff spoke highly of Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 24 her and felt that she would deal with any concerns they may raise. One person commented on their survey form ‘My views are respected and I feel a valued member of staff’. An assistant manager on each shift support the manager, and when we spoke with two of them they said that they felt she also supported them. However, there were mixed responses from staff on their survey forms. While some staff felt that managers gave them the support they needed others felt this was not always available to them. The manager told us that there was no-one living at the home that is subject to a deprivation of liberty authorisation. We saw no evidence to show that anyone living at the home is having their liberty deprived without an authorisation. There is a quality assurance system in place to ensure that people’s views and wishes are sought and listened to. Annual satisfaction questionnaire are sent to people using the service, including those admitted for intermediate care. We saw a development plan for the home that had been produced in 2007, but one has not been produced since. In line with Regulation 26 of The Care Standards Act 2000, the Responsible Individual (the representative of Devon County Council) carries out monthly quality audits covering all aspects of the provision of the service, to ensure that standards are maintained. On the day of the visit a manager from another service was conducting an audit of some aspects of the home. The home assists some people with personal finances. We saw that records clearly account for any purchases made on behalf of a people living at the home and receipts are kept. Transactions are signed by two people to ensure accuracy. However, we found that while transactions are recorded on separate sheets, people’s cash is held in one ‘pool of money’, rather than separately, which would be good practice. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit, provided evidence that Charlton Lodge complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. The record of fire safety training and accident and incident records were found to be accurate and up to date. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 25 risks to people living and working at the home. We saw risk assessments for fire and the building. So that the risk of burning from hot surfaces is minimised, radiators within the home are covered. All windows above ground floor level are fitted with restrictors, in order to minimise the risk of anyone falling from these windows, and so that the risk of burning from hot water is minimised temperature controls are fitted to bath taps. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to continue to update the Quality Assurance system. Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 26 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 X 3 X X 3 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 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations You are recommended to ensure that all identified risks are properly assessed and any controls measures put into place are clearly shown. You are recommended to ensure that all recordings made about people are objective and non-judgemental. You are recommended to ensure that any complaints that are received are recorded separately so that people who wish to see information about themselves are not able to see information about other people. 2. 3. OP7 OP16 Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 28 Charlton Lodge DS0000039224.V377578.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission Southwest Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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