Care Home: The Carlton Nursing Home

What the care home does well When people`s relatives and visitors were asked in the surveys, "What do you feel the care home does well?" People made the following comments: "They look after the patients very well. They give lots of love to them to make them happy. Also keep them clean and tidy. Nothing is too much trouble for them." Another person said, that the staff had a good knowledge of their relative`s personality, reactions, and likes and dislikes. A third person said, "I think the service that they do could not improve. They do a great job." For people`s safety, floor and wall sensors have been fitted in every bedroom to help alert staff if anyone gets up in the night and needs assistance due to the majority of people not being able to use a call system. What has improved since the last inspection? A record is now kept of all money or valuables deposited by people to ensure that there is a clear audit of the finances held on behalf of people. The care documentation in relation to the daily records has improved and now reflects the care given to a person on a daily basis. What the care home could do better: All areas of the home that are showing signs of wear, should be redecorated/ refurbished for the comfort and safety of people living there. The bathroom floor covering should be replaced and sealed to ensure that it can be properly cleaned. All staff should have regular supervision to ensure that they are supported and competent to do their job. There were no requirements made at this inspection. CARE HOMES FOR OLDER PEOPLE The Carlton Nursing Home 25 Greenway Milnsbridge Huddersfield West Yorkshire HD3 4RZ Lead Inspector Karen Summers Key Unannounced Inspection 29th September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Carlton Nursing Home Address 25 Greenway Milnsbridge Huddersfield West Yorkshire HD3 4RZ 01484 655511 01484 655511 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) Carlton Nursing Homes Ltd Care Home 17 Category(ies) of Dementia - over 65 years of age (17) registration, with number of places The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for one named service user under 65 years assessed as requiring EMI nursing care/DE. 2nd October 2007 Date of last inspection Brief Description of the Service: The Carlton provides both personal care and nursing care to people over the age of 65 suffering from dementia. The bedroom accommodation is on the first floor of the home, which is serviced by a passenger lift. The bedrooms are all single rooms, some of which have ensuite facilities. The communal space is on the ground floor and consists of two lounge areas and a separate dining room. The home is within easy reach of Huddersfield. There is limited parking within the grounds of the care home adjacent to The Carlton. There is some on road parking. The Provider informed the Commission for Social Care Inspection on the 29/09/08 that the fees range from £384.55 to £525.00 per week. There are additional charges for hairdressing, newspapers, and magazines. Information about the home and the services provided are available from the home in the statement of purpose and service user’s guide. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This report refers to an inspection, part of which included an unannounced visit on the 29th September 2008, commencing at 9 am, and the length of the inspection was 7.25 hours. There were 17 people living at the home on the day of the visit. As part of the inspection in order to provide information to help us form judgments about how the service is run, the manager was asked to complete an annual quality assessment document. This she did, and the document provided the Commission for Social Care Inspection (CSCI) with a lot of information about the way the home is run, and what they hope to achieve in the future. During the visit we spoke with members of staff and relatives of people who receive care to obtain their views. We also looked at a sample of care records, staff recruitment, and training records, quality assurance audits and looked around the home. To enable people who use the service to comment on the care it provides, we sent surveys to people living at the home, and due to the illness of people none of these were returned. Ten surveys were sent to relatives/advocate/friends, six of which were returned, and five to local doctors and health care workers (social workers, community nurses), one of which was returned at the time of writing this report. The comments in the surveys were positive about the standard of care provided by the staff at the home. Comments from the surveys included: We continue to believe that are relatives needs are well met at The Carlton. In addition, support to ourselves as relatives has also been excellent, particularly when our relative became very ill last year. We also feel well consulted with regard to our relatives Care. Relatives are always included in social events. We would like to thank all the people who gave feedback about this home, and would like to thank the manager and staff for their co-operation throughout the inspection process. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are assessed prior to them moving into the home and are able to visit the home to establish whether or not it is the right place for them. EVIDENCE: The information received from the home prior to inspection said that people are only admitted after a full assessment to ensure that their needs can be met. The care records of three people who use the service were examined, all of which contained a pre-admission assessment carried out by the funding Local Authority. Each assessment contained detailed information about the person’s current needs. In addition to this, there was evidence that the home had also carried out an assessment of the person’s needs. The Manager also said that people are encouraged to visit and look round the home to see if it is the right place for them however, the manager also said that not everyone is able to make an informed choice, on these occasions their The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 9 relatives or advocates usually makes that choice for them. A relative who was visiting the home also confirmed this. Relatives of people living in the home also said that they received enough information about the home before deciding that it was the right place for their relative to live. One person made the comment, We discussed this with the senior practitioner at social work team and also visited and were shown round by a senior member of staff. All our queries were answered and our worries satisfied. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ care plans outline the level of support and care each person requires in ensuring their health and welfare needs will be met. People are treated with respect. The recording and administration of medication is satisfactory. EVIDENCE: The care records of three people were looked at and although the records in some areas need to be more detailed, the manager said that staff are in the process of changing over from one system to another, and that the new way of recording would be more comprehensive. The information in the care records inspected did outline the level of support and care each person requires to ensure that their needs will be met. There was evidence that the care plans are updated monthly or as the needs of the person change. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 11 Evidence was seen of involvement from people’s doctors, and other healthcare professionals where needed. Relatives said that they were kept up to date with important issues affecting their friend/ relative, and that the staff were kind and helpful. Relatives also said that their relative received medical support when needed. One person commented, I have no criticism of the staff at the Carlton at all. All are helpful, supportive and keep us informed. I have no worries about mums care, and never have had since she has been at The Carlton. Another relative said, The staff are brilliant, they are very helpful, answer any questions that I have about my father, and also anything that I ask about him they will sit down and listen. During this visit staff were observed to maintain the privacy and dignity of people, and staff approached and spoke to people in an appropriate manner. A sample of people’s medication was checked, and the storage, administration and recording of the medication were done correctly. There was also evidence that audits are carried out to ensure that the medication is being given correctly. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle at the home appears to satisfy the needs of the people living there, and encourages the involvement of family and friends. EVIDENCE: During the visit individual people were seen to be participating in various activities including listening to music, and visitors were seen to come and go throughout the day. Staff said that they bring newspapers and magazines into the home, but no one at present has a paper delivered. The activities that people are involved were recorded in their care records on a daily basis, and staff confirmed that the types of activities that take place are; dancing to music, tactile therapy, skittles and reminiscence, and taking individual people out to the local garden centre. Relatives said in the surveys that there were usually activities that people could take part in. One person said, that the only criticism that they had was that they would like to be included as a family in more events. Staff were in the process of converting a sitting area, which had recently been decorated, into a reminiscence room. Due to the mental health problems suffered by the people who live at The Carlton, it is very difficult to ascertain their views or how individuals make The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 13 choices. Choices are, however, promoted as to what time people get up, go to bed and what they eat, and evidence was seen of this in the care records examined. The manager also said that although there are no people who are actively practising any religion, this would be pursued should any one express any interest. The menus offered a variety of food, and the food preferences and diets of people were also taken into consideration. The manager said that should someone wish to have a diet specific to his or her culture then one would be provided. At the time of the visit, people were seen having their lunch, and staff assisted those who needed assistance, in a relaxed and dignified manner. Visitors were offered hospitality, and people said that they were always made welcome. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that their complaints will be listened to and taken seriously. People are protected from abuse. EVIDENCE: The complaints procedure is located in the hall and showed the procedure to follow should someone wish to complain. Relatives of people, who use the service, said that they knew how to make a complaint and knew who to speak with if they were not happy. The manager keeps a folder where she would record complaints however, she had not had any complaints since the last inspection and the CSCI had not received any concerns from relatives or visitors about the service. The home has a whistle blowing procedure, and staff that were spoken with were aware of the procedure to follow. Records showed that all staff have had safeguarding (adult protection) training, which provides information on how to protect people from abuse. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home offers people a homely and comfortable environment. EVIDENCE: As part of the inspection a tour of the home was conducted which included the communal areas, and a number of people’s bedrooms. The information received from the home prior to inspection stated that in the last twelve months the home had started a redecoration programme and that this was, Ongoing. Areas around the home had been tastefully redecorated since the last inspection, including the small lounge, a number of bedrooms, and the room that was used as a staff room had also been decorated and is now a treatment room for people living in the home. To assist in the movement and handling of people in the ground floor bathroom, a ceiling hoist has been fitted. Floor and wall sensors have also been fitted in every bedroom to help alert staff if anyone gets up in the night and needs assistance due to the majority of people living in the home not being able to use a call system. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 16 The ground floor bathroom was showing signs of wear and in need of refurbishment and redecoration. Tiles had fallen off and were damaged. The unit below the sink was also damaged and in need of replacement, and the floor covering around the toilet was lifting and could not be properly cleaned. The down stairs main corridor carpet had also faded. One of the people who commented in the survey said that the home was, Always clean, no odours but very Jaded. The information received from the home prior to inspection also stated that what they could do better was, Improve aesthetics of the home environment. Particularly the lobby as this is a visitors first impression. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported by qualified, competent and experienced staff in sufficient numbers and that has had all the necessary checks before working with people so that they are kept safe. EVIDENCE: The information received from the home stated they are staffed to optimum levels with appropriate skill mix. Evidence suggested through speaking with staff and looking at the duty rotas, that there were sufficient numbers of staff and skill mix to meet the needs of people in their care. Relatives of people who use the service also said that there were staff around when they need them and this was evident on the day of inspection. A relative commented, Staff are always present to oversee residents…. Evidence was seen to suggest that care staff are encouraged to have an NVQ level 2 in care, and the manager confirmed that all care staff have the qualification. Staff recruitment files of three members of staff were looked at in detail and they contained the required information and employment checks. These checks are necessary to help protect people from potentially unsuitable staff. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 18 The staff that were spoken with confirmed that they had received induction training when they came to work at the home, which provides them with knowledge and skill to look after people in their care. On the day of the visit a new member of staff was having their induction, and this person was working as an extra member of staff, and along side another staff member to ensure that she was supervised. There was also evidence in staff files that staff had dementia care training, and staff also confirmed this. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from the management approach of the home and the manager ensures so far as is practicable that the health, safety and welfare of people and staff are protected. The home is run in the best interest of people who live there. EVIDENCE: The manager has the Registered Managers Award. She is a long standing member of staff who knows the home and the people who live there. To ensure that the home is run in the best interest of people who live there, satisfaction surveys were sent out in April 2008 however, very few were returned. The ones that were returned said that they were happy with the service and care that their relative receives. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 20 The provider to ensure that the quality of service provided is maintained carries out monthly management visit. The documentation relating to these visits were seen, and the manager also confirmed that the provider visits the home frequently. Visiting relatives confirmed that relatives meeting take place regularly where they can express their views and contribute to improvements to the service for there relative. Minutes of the meeting were seen, and the manager confirmed that the next meeting is due to take place in November 2008. A number of staff said that they had not received supervision for a number of months. Records showed that not all staff had received regular supervision. This was discussed with the manager and she said that she would ensure that all staff have regular supervision to ensure that they are competent to do their work. For those people who wish, small amounts of personal money are held safely at the home and receipts and records were seen. Routine health & safety checks and maintenance checks are carried out and appropriate records were seen of those looked at. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 X 3 X 3 2 X 3 The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 22 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. 2. 3. 4. Refer to Standard OP7 OP19 OP29 OP36 Good Practice Recommendations Staff could more clearly and comprehensively record the identified needs of each person to ensure that their needs are being met. For the comfort and safety of people, areas of the home that are showing signs of wear or are damaged, should be redecorated or refurbished. The area of floor covering around the toilet base should be replaced and sealed to ensure that it can be properly cleaned. All staff should have regular supervision to ensure that they are supported and competent to do their job. The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Carlton Nursing Home DS0000062776.V372569.R01.S.doc Version 5.2 Page 24 - 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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