Inspection on 05/11/09 for Castle Dene

This is the latest available inspection report for this service, carried out on 5th November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Castle Dene 05/10/07

Castle Dene 13/02/07

Castle Dene 19/01/06

Castle Dene 16/09/05

Castle Dene 23/02/05

Castle Dene 07/09/04

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Little Sisters Of The Poor

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Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Castle Dene Wilton Village, Redcar TS10 4QY     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: Valerie Daly     Date: 0 5 1 1 2 0 0 9 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 24 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) 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 Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Castle Dene Wilton Village, Redcar TS10 4QY 01642454556 01642430686 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Steven Hudson care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 33 Date of last inspection Brief description of the care home Castle Dene is a care home for older people and is registered under the Care Standards Act 2000 to provide accommodation and care for up to 27 elderly people. The home is situated in a village location. It is on the edge of the village, surrounded by a large grassy area and woodland and provides a minibus service to facilitate outings. The home offers a choice of lounge and dining areas and residents can choose to eat their meals in a dining room or their own rooms. Menus cater for the likes and dislikes of individual residents. Residents are able to personalise their own rooms and relatives and friends are welcome to visit at any reasonable time. Woodside is a care home adjacent to Castle Dene. It is registered under the Care Standards Act 2000 to provide accommodation and care for up to 6 elderly people. At the time of the Care Homes for Older People Page 4 of 24 Over 65 33 0 2 0 1 0 2 0 0 8 Brief description of the care home inspection Woodside was not being used. The provider is looking to change the registration category. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means people who use this service experience adequate quality outcomes. This Key Inspection was to check that the home meets the standards that the Care Quality Commission say are the most important for the people who use the service, and that it does what the Care Standards regulations say it must. The inspection was conducted by a regulatory inspector in one inspection day. During the inspection a number of records were looked at, including records of people who use the service, along with staff recruitment and training records and maintenance. There was also discussion with the manager and care staff who work at Castle Dene. Care Homes for Older People Page 6 of 24 The manager had completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting the standards. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed prior to admission, ensuring their needs can be met. Evidence: The care files of four people who use the service were examined, two of which were for the people most recently admitted to the home. In each file there was a copy of the assessment carried out by the home, which was completed prior to people being admitted to the home. There was sufficient information to determine if peoples needs were able to be met by the home. there was also a copy of the local authority/care managers assessment, which detailed care needs. People spoken to confirmed that they or their families had visited prior to moving into Castle Dene. Care Homes for Older People Page 10 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are care plans in place, however they need to be current and show the identified need and the interventions needed. Risk assessments need to be evaluated regularly. Medication systems are robust. Evidence: Four care files of people living at Castle Dene were examined and there were a range of assessment information and plans of care in place. It was identified however, that in all of the care files looked at each person had the same sixteen care plans, all of which detailed the same areas of need despite people not being assessed as having this care need or needing support in these particular areas. A number of the care plans read as an assessment of need rather than a specific area of need for which there was a goal and a range of interventions. For one person assessments such as Braden Score, a skin integrity assessment, had been done weekly until 08/10/09 but not since and there was no explaination as to why this had stopped and there was no body or weight chart in place. Care Homes for Older People Page 11 of 24 Evidence: It was indentified through looking the daily records that one person was using support stocking, however this had not been detailed within their assesssment or within their care plan for personal care. Also in the daily notes it detailed that a request had been made for a referral to a Dietician due to poor appetite and weight loss. There were no records of weight loss evidenced and it had not been recorded in the evaluation of the Nutritional Screening Tool. For another person there were entries in the daily report regarding them becoming intoxicated on a regular basis. However there was no care plan or management strategies in place detailing how to deal with this and what action is be taken. This person also required oxygen and whilst there was a care plan in place with interventions it related to the management of oxygen supply rather than the persons breathlessness. There was evidence in the files to show that people using the service have access to health care services. District Nurses and General Practitioners visited people in the home regularly. There was discussion about the procedure in the event that people need to go to hospital or for appointment. The manager said that they do not provide staff to escort and that relatives are asked to take them. IShe said that if this was not possible then the appointment would be changed to a more convenient date for them. The home has policies and procedures in place for the ordering, administration, storage and disposal of medication. People spoken to during the inspection all said that the staff were caring and would help whenever asked. During the inspection staff were noted to be knocking on bedroom doors before entering. During interviews they were able to describe how they ensured privacy and dignity was maintained when carrying out personal tasks. Care Homes for Older People Page 12 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have choices in their daily lives as much as is possible. Good contact is maintained between the people who live in the home, relatives and friends. A varied diet is provided. Evidence: The home has an activities programme in place and in October people had enjoyed bingo, crafts, pampering sessions including manicures, video afternoons with a glass of wine, a clothes party and being entertained by a Dance Group. Activities and who attended are recorded. The home also have a minibus and the manager said that people are taken on trips out locally in the community twice a week. Since the last inspection the home had purchased a Wii console and games. Two relatives were spoken with during the inspection, they both said they could visit anytime. One of the relatives said that she or another family member visit every day. Staff interviewed said that people go to bed and get up when they like. This was confirmed when speaking to people about their day. People commented about the staff, their friendly and relaxed manner, giving reassurance where needed. Care Homes for Older People Page 13 of 24 Evidence: At the time of the inspection the cook was in the process of changing the menu, offering more choice to the people who use the service. At lunchtime the tables were nicely set in a pleasant environment. The meals were well presented and there was evidence of choice, turkey casserole or sausages. Staff were observed to offer assistance. Some people were having meals in their rooms. All those spoken to said the meals were lovely. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to express their concerns and have access to a robust complaints procedure, are protected from abuse, and have their rights protected. Evidence: The home has a complaints policy and procedure in place. There had not been any complaints recorded since August 2007. There had been some safeguarding issues, which were recorded separately. Two relatives and three people living at the home said they would talk to the manager or another member of staff if they had a concern. The home has a whistle blowing and safeguarding people policy and procedure in place. There was evidence to show that staff had received training in safeguarding people, they had all used the training workbook provided by Redcar and Cleveland Council. During interviews with staff they confirmed they had received training and were able to to discuss the procedure to follow in the case of suspected abuse. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have a well maintained and comfortable environment. Evidence: A number of areas of the home were visited during this inspection. There was evidence that people are able to bring some of their own belongings. Bedrooms contained personal items, some people having brought items of furniture along with photographs, ornaments and pictures. Since the previous inspection a number of bedrooms and some communal areas had been redecorated, including a new shower on the ground floor. A number of carpets had also been replaced in peoples bedrooms. The lounge/dining room on the first floor is pleasantly decorated with lovely views over the grounds. People sitting in the room said they found it comfortable although one person said it felt cold in the evening. It was agreed that the temperature of this room be monitored and if found to be too cold action taken to address it. There were no paper towels in the bathrooms or toilets, which could be a concern for cross infection. On the day of the inspection the home was very clean and odour free. Care Homes for Older People Page 16 of 24 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 level of staff is not based on an asssessment of need or dependency tool. Staff in the home receive regular training. The recruitment and selection procedure is not sufficiently robust to protect the people who use the service. Evidence: The home has a staffing rota in place, however it did not show different grades of staff, or the capacity in which they were employed. From 8am until 3pm, there are three care assistants. From 3pm until 9pm, there are two care assistants and from 9pm until 8am, there are two care assistants. The manager and deputy manager work from 8am until 4pm Monday to Friday. The manager confirmed that she is told by the provider what the staffing levels should be. She confirmed that these levels are not based on any assessment of need or dependency tool. It is therefore unclear how this is being monitored to show that staffing levels are sufficient to meet peoples needs. At the time of the inspection there were three people using the service who required two members of staff to assist. Since the previous inspection staff had undertaken training in, Fire Safety, First Aid, Moving and Handling, Food Hygiene, Health and Safety, Dementia Awareness and Infection Control. Staff interviewed said there was a lot of training and regular Care Homes for Older People Page 17 of 24 Evidence: updates were also received. At the time of the inspection the majority of care staff had achieved NVQ level 2 or above with a couple of people working through the course. This is far above the 50 and commendable. There was a policy and procedure for the recruitment and selection of staff. Three out of four staff files examined showed that the required information, references and Criminal Record Bureau checks were in place prior to staff commencing work in the home. In the fourth staff file looked at there was no application form and only one reference addressed to Whom it May Concern. This is of concern and does not show that good recruitment procedures are in place, which are needed to protect people living at the home. Care Homes for Older People Page 18 of 24 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. Quality in this outcome area is adequate. This judgment has been made from evidence gathered before and during a visit to this service. The quality assurance system needs to be developed further. Evidence: The manager is competent and experienced to run the home. Both the manager and deputy manager have achieved NVQ level 4 in Care and the Registered Managers Award. People spoken to during the inspection, who use the service and two relatives all said the manager and deputy are approachable. Meetings for staff are held six monthly and minutes are kept. The manager said there are meetings held for people who use the service four times a year. People are then given questionnaires to complete asking their opinion regarding food, personal care and support, daily living, the premises and management. The quality assurance system needs to be developed further and questionnaires should be Care Homes for Older People Page 19 of 24 Evidence: sent annually to relatives, District Nurses, and other professional bodies to seek their opinion on how the home is achieving goals for people who use the service. The results should be examined and any comments/suggestions taken on board for improvement of the service. A report should then be available for people who use the service, other people who have contributed, and the Care Quality Commission. The provider completes a regulation 26 visit monthly and the reports were viewed. They need to be developed further to include comments from people and staff interviewed and a record of events and any complaints. There should be a written report on the conduct of the home. A number of health and safety documents were examined at the inspection, including hot water temperatures, fire tests, emergency lighting tests. Hot water temperatures for a number of wash hand basins, showers and baths were found to be too cold. Minimum temperature being 35 degrees Celsius to a maximum of 39 degrees. Checks were carried out monthly. However for health and safety guidance, where people are immersed in water the temperature should be checked and recorded weekly. Records showed that the last fire drill had been carried out on 21/01/09. There were no records to indicate the time this was done or the effectiveness of the drill. The home has a formal supervision system in place and there was evidence to show that staff received supervision. However in the four staff files examined the supervisions were not up to date. A selection of policies and procedures were looked at. They had been reviewed and updated since the previous inspection. Care Homes for Older People Page 20 of 24 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 29 19 Two written references are required for all staff employed in the home. To ensure the protection and welfare of the residents is being met. 30/11/2008 Care Homes for Older People Page 21 of 24 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 29 19 The recruitment procedures needs to be strenghten and fully implemented and must include completed application form and two written references, which must be obtained prior to commencement of employment. This is required to ensure the health, welfare and safety of the people who use the service is being met. 17/01/2010 2 33 26 The regulation 26 reports need to be developed further to include comments from people and staff interviewed and a record of events and any complaints. There should also be a written report on the conduct of the home. 17/01/2010 Care Homes for Older People Page 22 of 24 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 This is required so that the provider can form an opinion of the standard of care provided in the home. 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 2 7 . There should be a care plan in place where a need has been identified through the assessment process. Plans should give the required interventions for staff. The daily report should be cross referenced with the care files to ensure that if a persons needs have changed, then the assessment of need is updated and that there is a care plan in place. 3 27 The staff rota should show the different grades of staff and the capacity to which they are employed. The ratios of care staff to people should be according to the assessed needs of the people who use the service. 4 5 6 7 29 33 38 38 Each person should complete an application form prior to being interviewed for a position in the home. The quality assurance system needs to be developed further. When a filre drill is carried out written records should be taken of the time taken and the effectiveness. Water temperatures for baths, showers and wash hand basins should be close to 43 degrees celsius. Where people are immersed in water the temperature should be taken and recorded weekly. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 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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