Care Home: Charterhouse Residential Care Home

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What the care home does well Care management needs assessments and care plans are requested and recieved for people who are placed at the home by Social Services or Care Trusts. The care and ancilliary staff interact well with the people who use the service. During the inspection considerable happiness and laughter was observed between the residents and staff. The home liases well with the health care services to ensure that people have access to the professional health care services as and when needed. Regular in house activities are provided for the residents. This encourages people to socialise with each other and with the staff. Care has been taken to give the communal areas of the home including the dining room, lounge and conservatory a pleasant and homely appearance. New staff are recruited safely. This means that people who may not be suitable to work with the vulnerable that live in the home will not be employed. What has improved since the last inspection? Assessments of residents needs and the planning of care has improved to an adequate standard. Improvements have been made to various other documents including the Statement of Purpose, the Service Users Guide, and safeguarding policy. Some staff training has been achieved and some plans have been made for further training. Medication administration is safe and adequately managed. Following consultation and agreement with the fire authority appropriate improvements are being made to the Fire protection system. What the care home could do better: The Statement of Purpose and the Service Users Guide have been combined into one document by the home. Although this document has been redrafted since the last Key Inspection it does not contain many of the elements required by Care Home Regulations 4 and 5 and the accompanying Schedule 1. At present all of the hotwater outlets available to the residents are not adapted to limit the hot water temperature at the point of use. Also there are a number of window openings above ground floor level which are unrestricted. The home must adequately risk assess each of these taps and windows to ensure that residents are not being placed at unreasonable risk. The home must improve the quality assurance system and ensure that feedback from residents, relatives and professionals is obtained in a planned and regular manner and that this feedback is then responded to, to ensure that all stakeholders in the service are satisfied that their views are being heard and responded to. Within the investment plan of the home consideration should be given to covering the remaining uncovered radiators in the home, adapting the hotwater outlets and restricting the openings of windows above ground floor. The regime of staff training should be improved to ensure that all staff have up to date basic training, and additional training as necessary to meet the needs of the client group, to ensure that the staff can meet peoples needs as effectively as possible. Considering the client group that lives at the home these training areas should include dementia care, medication administration and safeguarding training. The home should support residents to access more external activities of a type, and in a manner, that will be accepted by the residents. Key inspection report Care homes for older people Name: Address: Charterhouse Residential Care Home Second Drive Dawlish Road Teignmouth Devon TQ14 8TL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Brendan Hannon     Date: 2 1 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Charterhouse Residential Care Home Second Drive Dawlish Road Teignmouth Devon TQ14 8TL 01626774481 01626774481 margaretbrett@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Stephan Barry William Brett,Margaret Louise Brett Name of registered manager (if applicable) Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Charterhouse provides accommodation and care for a maximum of twenty people in the registration categories of old age, dementia, physical disabilities and mental illness. The home does not provide nursing care. A partnership of Mr Stephan Brett and Mrs Margaret Brett are registered as the service Care Homes for Older People Page 4 of 32 Over 65 20 20 20 20 0 0 0 0 1 4 0 5 2 0 1 0 Brief description of the care home providers. A manager has been appointed to manage the home on a day to day basis but the Care Quality Commission has not received a completed application to register this person. Charterhouse is a large detached period property set in landscaped gardens. It is less than a mile from the town, which has a good beach, railway station and frequent bus services. The fees range from £330 to £468 a week. Extra costs include private hairdressing, private chiropody and items of a personal nature. Information about the home including a copy of the last inspection report can be obtained on request from the Home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Since the last key inspection on 11th February 2010 there has been an additional random inspection on the 14th May 2010. This report is available upon request from the Commission. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for residents and measures the quality of the service under for general headings. These are: -- excellent, good, adequate and poor. Each outcome group is given a rating and the ratings are then collated to give an overall rating for the service. The quality rating for this service is one star. This means that the people who use this service experience adequate quality outcomes. This unannounced Key inspection was undertaken on 21st June 2010 by the link inspector who spent 8 hours in the home from 9.00am till 5.00pm. There were 13 people resident in the home at the time of the inspection. During this time he observed the activity in the home, toured the building, inspecting relevant documents and Care Homes for Older People Page 6 of 32 discussed the care provided in the home with staff and with Mrs Brett, the registered provider. Three peoples care plans and service delivery records were examined in detail and also case tracked during the inspection. These documents included the assessments of each persons needs, their care plans and risk assessments, and their daily records. Some of the other systems that were inspected included medication adminstration, accident reporting, staff recruitment and the management of health and safety. The views of residents, relatives and social and health care professionals have been taken into account within the compilation of this report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and the Service Users Guide have been combined into one document by the home. Although this document has been redrafted since the last Key Inspection it does not contain many of the elements required by Care Home Regulations 4 and 5 and the accompanying Schedule 1. At present all of the hotwater outlets available to the residents are not adapted to limit the hot water temperature at the point of use. Also there are a number of window openings above ground floor level which are unrestricted. The home must adequately risk assess each of these taps and windows to ensure that residents are not being placed at unreasonable risk. The home must improve the quality assurance system and ensure that feedback from residents, relatives and professionals is obtained in a planned and regular manner and that this feedback is then responded to, to ensure that all stakeholders in the service are satisfied that their views are being heard and responded to. Within the investment plan of the home consideration should be given to covering the remaining uncovered radiators in the home, adapting the hotwater outlets and restricting the openings of windows above ground floor. The regime of staff training should be improved to ensure that all staff have up to date basic training, and additional training as necessary to meet the needs of the client group, to ensure that the staff can meet peoples needs as effectively as possible. Considering the client group that lives at the home these training areas should include dementia care, medication administration and safeguarding training. Care Homes for Older People Page 8 of 32 The home should support residents to access more external activities of a type, and in a manner, that will be accepted by the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home makes available some written information but most information about the service is given verbally to prospective residents and their relatives. The registered providers and staff have the skills and experience to deliver the service offered to residents. Evidence: The home has produced a new joint statement of purpose and service user guide document that is available for prospective residents and their families to view. There are specific items as listed in the Regulation which must be covered within a Statement of Purpose. This document did not contain a statement of the facilities available in the home. There are specific items as listed in Schedule 1 of the Regulations.This document does not include the age range and gender of the client group, the range of potential needs that can be met by the home, the homes policy on emergency admission, the homes system for quality assurance, and the homes fire precautions and procedures. Care Homes for Older People Page 11 of 32 Evidence: There are specific items as listed in the Regulation which must be covered within a Service User Guide.This document did not include, a brief description of the services provided,the Terms and Conditions of residence, the scale of fees and any other additional charges, a copy of the standard contract of residence, and a copy of the most recent report. However the document does contain the majority of the required content for these documents, including the complaints process, the staffing regime, contact information and the Aims and Objectives of the service. The Registered Provider was advised to print copies of the combined Service User Guide and Statement of Purpose document to give to prospective residents and their relatives so that people can take information away from the home to consider. Two of the three people whose care was case tracked had pre admission assessment documentation in place. However the most recently admitted third person whose care was being purchased privately did not have a written assessment of need prepared by the home before they were admitted. We recommended that an assessment of needs is completed before admission for every person entering the home. This will help the service identify that the service provided by Charter House can meet the persons needs at the time that they are admitted and will assist in planning the persons care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are very caring. The documentary plans of care and the staff knowledge of residents needs and how to meet them are adequate to meet peoples individual needs. Evidence: Many of the people that live at the home have some form of dementia. Throughout the inspection the majority of residents were in or near the main lounge. Despite the significant psychological needs of many of the people that use the service we heard and observed considerable positive interaction between staff and residents throughout the whole of the day. There was considerable chatting and laughter between the residents and staff and there was a happy postive atmosphere in the home. We found that the staff interaction with the residents was good and included bending to speak to people and hand touching to get a persons attention. People were asked if they wanted tea or coffee and a biscuit. People were offerred both hot and cold drinks frequently and these were left with them to drink as and when they chose. During lunch staff encouraged and supported people as necessary to eat their meals or eat more of their meals. Care Homes for Older People Page 13 of 32 Evidence: During the inspection people were seen to be assisted out of the lounge to the toilet discretely and with sensitivity. One person needed the toilet door held open with her walking frame, but staff assisted her so that her privacy was maintained at all times and other peoples dignity was respected. In general incontinence issues were being well managed.There was only one bedroom within the home where there was a significant incontinence odour and the staff were seeking to remedy this. There was discussion with a senior staff member about storing peoples incontinence aids out of view to support peoples dignity. One of those people whose care was tracked required the support of 2 carers to stand. Her care planning documented this need and the plan in place to assist her to be moved safely. Care staff were aware of how to move this person in accordance with her care plan. It was noted that since the Key Inspection in 2009 the bath in the ground floor bathroom has been removed. This makes access to this toilet easier and safer for people who use wheelchairs and walking frames and for the staff assisting them. Arrangements are made for people to receive help when they need it from the professional health care services. The District Nurse visited during the morning to treat a number of residents and she told us that she was satisfied with the care provided by the service and that the support the service gave the residents with their physical health was of good quality. The residents care planning documents are kept securely in locked filing cabinets in the administrative area in the front hallway. The care planning documents of three people were selected at the beginning of the inspection to support the tracking of their care. These documents were basic but adequate to describe the needs of each person and how their needs were to be met by the service. In addition there was an individual assessment of risks relating to each person. A number of people that use the home have dementia and these needs were also described and how this impacted on the persons daily life. However it was evident from discussion with staff and management that further training and knowledge related to the delivery of dementia care would improve the experience of many people with dementia care needs that live at the home. One of the senior care staff provided information about delivery of care througout the inspection and it was evident that she possessed considerable indepth knowledge of the needs of each person that lived at the home. During the day she was seen supporting and directing the other staff in the delivery of care and the staff were seen to be patient and sensitive. The knowledge of the care staff was evident and this overcame the basic standard of the documentary care planning and it is hoped that in the future documentary care planning will become more detailed to reflect the depth of care provided by the service. Care Homes for Older People Page 14 of 32 Evidence: Peoples individual risk assessments did assess that any uncovered radiator in a persons bedroom was safe with respect to that persons abilities. However these risk assessments had not considered risks from the hot water that is available to residents or the risks from unrestricted window openings above the ground floor. These risks will be greater at Charter House due to the needs of many of the people that live at the home. The medication trolley was chained securely to the wall to the rear of the administration area in the entrance hall. We were told that the trolley is not moved from this location and this was observed to be the case. All the medication administered by the home was securely stored in this medication trolley. The contents of the trolley were ordered and tidy and the senior member of staff that administered medication throughout the day was able to easily locate and identify each medication. The home has a lockable medication fridge and a Controlled Drugs cupboard. Neither were in use at the time of the inspection. The absence of controlled drugs was evidenced from the controlled drugs record. As far as possible the home uses the Lloyds pharmacy monitored dosage system to order, administer and dispose of unused medicines. We looked at the medication administration record sheets and it was possible to follow the prescription and administration arrangements. We saw that codes had been used to identify a reason why a medication had not been administered as prescribed and medicines that had been given were signed for. There were occassional missed signings in the Medication Administration Record but the senior member of staff was able to evidence that the medication concerned had been given and was able to explain the audit system that was used to capture such occurences and challenge any staff member concerned. We were told that Lloyds pharmacy was in the process of supplying more detailed information on each medication in use to support the home to expand the information held in each persons medication profile. It was evident that the home had an effective relationship with their supplying pharmacy. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to engage in activities within their home. Little support is available to enable people to go out into the community and use facilities there. Peoples dietary needs are met and as people are given support as necessary to eat their meals. Evidence: Activities are facilitated by the staff in the lounge every day. These include skittles, bingo, quizzes and painting as well as passive activities, such as watching television and listening to music. A quiz was observed being played during the afternoon of our visit and this activity promoted alot of laughter amongst the staff and residents. Activites are now coming into the home and records were seen of monthly visits by an music and movement facilitator and on the 17th June the Donkey Sanctuary brought a donkey into the building for the residents to interact with. During our visit Mrs Brett, the owner of the service, brought her two puppies in to visit the residents and people again enjoyed this interaction. There are plenty of books around for people to read if they wish to do so and a piano and games for people to play. Photographs and pictures of things which would have been familiar to people in their younger days were displayed in the communal rooms, which helped to give the room a homely feel. No restrictions are placed on visitors by Care Homes for Older People Page 16 of 32 Evidence: the home and during the inspection we saw that visitors were made to feel welcome by the staff and residents alike. A Church leader has been visiting on a regular basis for seven years to lead short services at the home. Group outings have been arranged in the past but these have not taken place for some time. Generally people are not able to participate in activities outside their home unless they have friends or families to escort them. The service should particularly consider those people that have not got family available to support them to go out and should develop external activities that suit peoples individual abilities and interests. There is an enclosed terrace area to the front of the building which is accessed by a ramp through the French doors from the annex to the side of the main communal lounge. This can be used safely by all the residents without need for staff supervision. This area was used occassionally in this way by residents during the day of our visit. The larger grassed garden area below the house is not secure and so most of the residents would need supervision to use this area. The inner front door of the home has a key pad lock to prevent residents that cannot use it from leaving the home without an escort and thus putting themselves at high risk. The use of this lock is appropriate to manage risk for some people that live at he home. However we did not see documented evidence of assessment of each persons abilities when outside the building with or without support. Such a risk assessment would have demonstrated that no one was being inappropriately restricted by the use of this lock from leaving the building when they chose. Food is adequately managed in the home. The dish of the day had been written up on a notice board in the dining room and we were told of a an alternative that to this that one person was having. People are not rotinely offered a choice of the main meals, although alternatives are provided where specifically requested or when the meal does not suit a persons food preferences. Greater basic choice of main meal should be offerred. During lunch there were two staff in the dining room serving the meals. They were attentive and helped people with cutting their food and gave encouragement where help was needed. Food storage, its preparation and the food preparation areas were seen to be managed appropriately. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is aware of protection of vulnerable adults but awareness of what is abuse and how to address it is needs further development. Evidence: The Complaints procedure was displayed in the entrance hall and the registered provider told us that any complaints will be acted upon within twenty-eight days. There was a policy and procedure on safeguarding vulnerable adults but this needed further development and demonstrated that a greater understanding of safeguarding and how to manage a safeguarding alert was needed. The 2 most senior members of care staff have recieved awareness of abuse training but none of the other staff have yet recieved such training. Since the inspection we have seen evidence that Devon County Council has been approached by the Registered Provider to obtain safeguarding training for the staff team. Throughout the inspection the staff were seen to be considerate and caring towards the residents and we saw no evidence that would lead us to believe that the residents are being put at risk of abuse. Care Homes for Older People Page 18 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and homely including the communal rooms and bedrooms. Further maintenance and development should take place to help the environment within the home meet peoples care needs and ensure their safety. Evidence: During the inspection we spent time undertaking a full tour of the building and the outside areas of the home. We found the home to be clean and fresh throughout, with the exception of one bedroom which had some incontenence odour. The large entrance hall has seating in it and some of the residents choose to spend considerable time seated in this area. If people want to use the telephone privately, a cordless phone is available to enable them to do so from their bedrooms. The communal lounge is off the entrance hall and was seen to be very domestic and comfortable. The provision of a well stocked fish tank, budgies, books, games and bric a brac items helped to create a pleasant sense of homeliness. The dining room has a homely feel and provides a pleasant room for people to eat their meals in. There is a conservatory annex that can be accessed from the lounge or the dining room. This room is spacious, homely and comfortably furnished. Little consideration had yet been given to the environment of the building with regard to peoples dementia care needs. Signage could be used more to help people navigate Care Homes for Older People Page 19 of 32 Evidence: their way around the building and identify facilities such as toilets. The carpets in the communal areas are very heavily patterned and consideration could be given to replacing these with plain carpets, which would make it easier for people with dementia to interpret the surface they are walking on. A greater understanding of the support that can be provided for people with dementia in their environment would help to identify potential investments in this area within the homes annual development plan. Since 2009 the bath, which was making it very difficult for people who use walking frames to access the only communal toilet on the ground floor, has been removed and this has solved the problem of accessibility to this communal toilet. However, this does mean that there is now only one communal bathroom in the home, which can accommodate up to twenty people. This bathroom is on the first floor and is accessible to people who can bear their own weight due to the availability of both a shaft lift and stair lift on the main stairwell from the ground floor to the first floor. However the homes bathing facilities would be unsuitable for a person that was unable to bear their own weight to mobilise and transfer. The bathroom on the first floor has a fixed hoist to enable the staff to assist people in and out of the bath safely. The communal bathroom and toilet had a bolt lock that could not be overidden from the outside. This lock was potentially putting some people at risk as assistance could not easily reach them inside the bathroom if the door was locked from the inside. The bath side was broken and the room was carpeted and therefore surfaces in the room were not easily cleanable. We obtained a general measurement of the water temperature coming from the hot tap in the bathroom using the homes bath thermometer. This gave a reading of approximately 50 degrees centigrade, as the hot tap at the bath had not been fitted with a water temperature restrictor. This temperature is appropriate for the water in the pipe system to prevent Legionella but must be assessed for risk, particularly with consideration to the dementia care needs of many of the people that live in the home, and the need for the toilet in this bathroom to be freely accessible. There was no documented risk assessment in place to demonstrate that this hotwater outlet had been considered for risk. We were told that there were no restrictors on any of the hot water outlets available to the residents throughout the home. There were no risk assessments in place to show that these outlets were safe. We spoke to the Registered Provider about this issue and they confirmed that the unrestricted hotwater outlets had not been risk assessed. We spoke to the Registered Provider about the window openings above ground floor level that have a significant drop outside the building. We were told that only the ground floor window openings had been physically restricted for security purposes but that none of the windows above the ground floor had been physically restricted. The Regisered Provider also confirmed that there were no documented risk assessments to Care Homes for Older People Page 20 of 32 Evidence: show that these unrestricted window openings were safe particularly with consideration of the dementia care needs of many of the people that use this service. Communal toilet facilities are available on both the ground and first floor. All of the bedrooms were adequately furnished and decorated and most of them had been personalised by the people who use the rooms. In two of the bedrooms a pressure mat has been fitted into the call bell system. The pressure mats are necessary to maintain the safety of the people who use these bedrooms particularly at night. However this means that these rooms do not presently have call bells fitted. The home should have a call bell available in every bedroom that is in use. During our tour of the premises we noted that several radiators in peoples bedrooms had not yet been covered. The Registered Provider confirmed that it is their intention to cover all of the radiators in the home to remove any potential risk. Documented risk assessments were seen within peoples care planning identifying the acceptable risk posed by these uncovered radiators. The kitchen is spacious and well equipped to cater for the needs of the home. The laundry facilities are in the basement and approached via steep steps which make it inaccessible to the residents. The washing machines have a sluicing facility and are capable of reaching temperatures high enough to kill bacteria. Since the last inspection the carpet tiles in the laundry have been removed and the concrete floor has been painted to give an easily cleanable surface. The service uses disposable bags to manage faecally soiled laundry and the service was advised to maintain this system to avoid the need to open sluice such laundry. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The present staffing levels are adequate to meet the needs of the residents. Care staff have the basic skills to meet the needs of the residents. The care staff have not yet been provided with all the necessary and appropriate training. Evidence: There were 13 people living in the home at the time of our visit and only one person needed the assistance of 2 staff to help them to stand and transfer. We inspected the staff rota record and sampled the 18th June 2010. This record showed that there were 3 care staff on duty, including a senior staff member on duty from 8.00am till 2.00pm, 2 care staff on duty from 2.00pm till 5.00pm, 3 care staff on duty from 5.00pm till 8.00pm and a waking staff and a sleeping in staff on duty from 8.00pm till 8.00am. In addition to this a cook was employed from 8.00am till 2.00pm and a housekeeper is employed for 6 hours a day from Monday to Friday. The Registered Provider is now managing the home. On the day of our visit we met both the cook and the housekeeper. Considering the present level of dependancy of the people using the service, both individually and as a group, and that only 12 people are presently living at the home we do not consider that it is necessary for the Registered Provider to review the staffing level being provided at this time. We inspected both the staff recruitment records and the staff training records.There were 10 care staff employed by the care home at the time of the inspection. Four staff files were sampled to inspect the recruitment procedure including the most recently Care Homes for Older People Page 22 of 32 Evidence: recruited staff. These recruitment practices were in general satisfactory. However the 2 most recently recruited foreign national workers had not had their ISA 1st checks returned until approximately 2 weeks after they started work at the home. However all the other elements of the recruitment procedure was in order, including reference checks and an additional police declaration from their country of origin. Therefore the recruitment practices undetaken by the home are considered to be adequate. There are 10 care staff employed at the home. At present 6 of these staff have a National Vocation Qualification (NVQ) level 2 or above in the provision of care. This is above the minimum proportion of the care staff team that should be trained to this level of qualification. The home has introduced a new central record of training to help establish a system for training and to ensure that appropriate levels of training are maintained for the staff team. We were assured by the Registered Provider that supplying the staff team with training would be a priority for the home. We saw evidence that Devon County Counil has been approached to supply safeguarding training to all the staff. There should be an adequate induction programme for new members of staff to ensure that these persons have an adequate level of skill at the end of their first 6 weeks of employment. The present tick list form in use does not meet this specification. However we observed that new staff did possess the basic skills necessary to deliver care safely. The home should develop or obtain a new system of induction and implement this with each new care staff that begins employment at the home. The necessary regime of basic training on safe working practices has not been maintained. All members of care staff should have in place up to date training in Moving and Handling, fire safety, first Aid, food hygiene and infection control. Particular areas of concern were Moving and Handling training where the number of existing staff trained, has deteriorated to a low level, and Health and Safety, where again the number of staff trained is too low. However we did not observe that the staff did not possess basic skills in care delivery. Other relevant training that should also be obtained for all the care staff at this service would include dementia care training, only 3 staff have recieved appropriate training in this area, Safeguarding training which has yet to be implemented, and medication administration training where presently half of the staff team have recieved this training. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration arrangements at Charterhouse are adequate. Evidence: The registered persons in ownership of the home are Mr Stephan Brett and Mrs Margaret Brett. Mrs Brett has taken over the role of day to day manager of the care home and thus has accepted direct responsibility for the quality of the care supplied by the service. Mrs Brett has made improvements to adminstration of the service since she took over this role. The home has made attempts to introduce a Quality Assurance for the service. Residents have been surveyed and an Annual Development plan has been introduced. However a policy and procedure for the Quality Assurance system is not in place to structure and guide the use of an adequate system. The service should also seek feedback on the service more widely ensuring that as many interested people as possible are asked for feedback on an annual basis. Such people would include relatives and representatives of the residents, and health and social care professionals involved with the home. The quality assurance system should be based on a cycle of, Care Homes for Older People Page 24 of 32 Evidence: feedback gained which then informs plans, followed by actions carried out on the basis of these plans. The people who use the service are encouraged to seek support from their families, friends or legal representatives to handle their personal financial affairs, which is good practice. The home does look after small amounts of personal spending money for some of the residents and records are kept of any money deposited for safekeeping or spent by the individual or on their behalf. As previously mentioned in this report unrestricted window openings above ground floor have not been risk assessed. Similiarly unadpated hot water outlets available to the residents have not been risk assessed. The home should plan to physically adapt these fixtures to comply with the National Minimum Standards. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered persons 10/06/2010 should rewrite the Statement of Purpose and include all of the information that is required by the Care Homes Regulations and recommended in the National Minimum Standards to be included. This is the ensure that people considering using the service and their representatives have the information they need about the home and the service provided. 2 1 5 The registered persons 11/06/2010 should rewrite the Service Users Guide and include all of the information that is required in the Care Homes Regulations and recommended in the National Care Standards in it. This is to provide the people who live at the home with the information they need about what they should expect from the service. 3 33 24 The registered persons must 28/12/2009 establish and maintain a system for reviewing and improving the quality of care provided at the home. This Page 26 of 32 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action should be done by consulting the residents and their representatives and by producing an annual development plan for the home. This is to enable the people using the service and their representatives to influence the way the service develops. Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Registered person 23/11/2010 should amend the Statement of Purpose to include all the information that is required by this regulation and Schedule 1 of the Care Homes Regulations. This to ensure that people considering using the home and their representatives can obtain information about the service before using the home. 2 1 5 The Registered person should amend the Service Users Guide to include all of the information required by this regulation. This is to provide the people who live at the home and their representatives with adequate information about the service. 23/11/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 33 24 The Registered person must implement an effective quality assurance system to regularly seek the views of residents, their relatives and representatives, and professionals, involved with the home. This is to enable the people involved with the service to be consulted and their views taken into account in the delivery of the service. 23/11/2010 4 38 13 The Registered Person must 23/11/2010 document a risk assessment for each hotwater outlet that has not been adapted at the point of use, and each window opening above ground floor level that has not been physically restricted. This is to ensure that the residents are not being put at unreasonable risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 All assessments of need carried out by the home for prospective residents prior to their admission should be documented. Care Homes for Older People Page 29 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 8 The service should obtain greater knowledge and training to consider on how to meet peoples dementia care needs and implement new knowledge throughout the delivery of the service. The service should develop external activities that suit peoples individual abilities and interests. Each persons ability to be unsupervised outside the building should be risk assessed so that it is documented that the front door key pad lock is not unreasonably restricting any persons liberty. An alternative main course should be offerred at every main mealtime to support the availabilty of choice. The safeguarding policy and procedure should be improved and all staff should recieve training in safeguarding vulnerable adults. A call bell should be available in every room that is in use. All hot water outlets available to the residents should be fitted with pre set valves to provide water at close to 43 degrees centigrade. All hot surface radiators and pipework available to the residents should be covered or have guranteed low surface temperatures. The surfaces in the bathroom including the bath side, and the surfaces in the ground floor toilet, should be sealed and impermeable, and a lock that can be overriden from outside should be fitted to the bathroom door. The ISA register should be checked for each new employee and a result obtained before this person come into contact with the vulnerable adults that live in the home. Every potential employee should provide a record of their employment for the 10 years prior to application. All care staff should have up to date all of the basic safe working practice trainings. All the homes staff should have dementia care training and all the care staff should have medication administration training. All new employees should recieve induction and foundation training of an appropriate quality during the first 6 weeks of their employment. 3 4 12 14 5 6 15 18 7 8 22 25 9 25 10 26 11 29 12 30 13 30 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 14 38 All window openings above ground floor level should be physically restricted so that they provide adequate ventillation and cannot be used to exit the building. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - 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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