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Inspection on 29/04/10 for Castle Grove Nursing Home

Also see our care home review for Castle Grove Nursing Home for more information

This is the latest available inspection report for this service, carried out on 29th April 2010.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Castle Grove benefits from strong management. There are good internal processes which provide audit trails of evidence when assessing outcomes for people who live at the home. People living at the home value the input of managers and rate care delivered from staff as high. People feel empowered and are enabled to speak up if they are unhappy about something and want things changed. They have confidence that their voice will be heard. Meals are events to look forward to and are social occasions. The environment is pleasing, relaxed and homely.

What the care home could do better:

We have not made any requirements nor recommendations as a result of this visit. We have made some suggestions to the service as part of useful discussions with the management on how to further improve some processes. More detail of this is included in the body of this report.

Random inspection report Care homes for older people Name: Address: Castle Grove Nursing Home Castle Street Bampton Tiverton Devon EX16 9NS three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Judith McGregor-Harper Date: 2 9 0 4 2 0 1 0 Information about the care home Name of care home: Address: Castle Grove Nursing Home Castle Street Bampton Tiverton Devon EX16 9NS 01398331317 01398331329 info@castle-grove.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Thomas Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Isabelle Marjorie Kenny care home 26 Number of places (if applicable): Under 65 Over 65 26 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 26. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Castle Grove Retirement and Nursing Home is registered to provide a home with nursing care for 26 older people. Castle Grove is situated in the small mid Devon town of Bampton, with people able to benefit from its location in this rural community. Care Homes for Older People Page 2 of 10 Brief description of the care home It is a mainly Georgian building, although some parts date back to Elizabethan times. There are two double and sixteen single bedrooms, although all rooms are used as single rooms, unless occupied by married couples or others wishing to share. All bedrooms have en-suite facilities. There is a pleasant lounge/reading room and separate dining room. There are four acres of beautiful gardens, which are accessible to residents and visitors. There is ample parking to the front of the property. There are five independent sheltered housing units within the grounds, which have been sensitively converted from barns and other outbuildings. Residents from the sheltered housing are invited to participate with various activities and can choose to use the dining room and laundry facilities at the home. The cost of care ranges from 560 to 890 pounds per week depending on individual needs. Additional costs, not covered in the fees, include chiropody, hairdressing, personal items such as toiletries, newspapers, magazines and trips. Current information about the service, including CQC reports, is available to prospective residents, relatives and others who may have an interest such as care managers. Care Homes for Older People Page 3 of 10 What we found: This was an unannounced routine inspection. We focused on requirements and recommendations made at the last key inspection in 2007 and some records in relation to assessment and admission, on-going and changing care needs, risk assessment of the individual, medication management, staff recruitment, the homes environment, meals and health and safety measures. Choice of home. We spoke to some people who live at Castle Grove. In addition we had received 11 survey returns from people who live at the home. In person and by survey people told us that they had received information about the service to assist in decision making about moving into the home. People also told us that they had opportunity to talk with senior staff or managers about their care needs before moving into Castle Grove. Before the inspection visit we also received survey returns from 3 community based health and social care professionals who visit the home. They all indicated, in their opinion, that Castle Grove arrange for accurate assessments of peoples needs in order for the right service to be planned for people living at the home. Castle Grove has an informative brochure and website. In the survey returns from people living at the home 2 people told us that they could not remember if they had a contract with the home. We told the home this information and we were told that all people living at the home do have a contract and people would be asked if they knew where their contract was. Health and personal care. We looked briefly at care records for two people; one person had been recently admitted. We saw that care records reflected changing needs and detailed descriptions of care was recorded. We discussed with the nurse manager bed rail risk assessments and suggested that it would be beneficial to develop a pro forma risk assessment for the use of bed rails rather than the present process of including a brief assessment for bed rails in the main body of the care plan. We saw in care records that peoples nutritional needs were regularly assessed and action plans put into place to help people maintain a healthy weight. We saw that the service has worked well in providing care for and support to frail underweight people in order to help them return to a healthy weight for their height and frame size. All survey returns from people living at the service confirmed that people believe they receive the care and support they need at the home and that staff are available when they need them. We looked at the management of medicines at the home. This was managed well. People are encouraged to self-medicate to their level of ability to do so. There are homely Care Homes for Older People Page 4 of 10 remedies arrangements in place agreed with the local GP practice. We suggested that the acceptable range of plus two to plus eight degrees Celsius be included on the sheet to capture evidence of daily medicine fridge records. This is because we saw that, on occasions, the temperature had fallen too low for the safe storage of insulin. The range prompt would help nurses to report or take action to correct the temperature within the fridge. We saw that everyone living at the home who takes medicine to regulate their pulse has their pulse recorded daily. We do not question the medical logic of this but we saw no reference to this in care plans of people who take such medication, which suggests that daily pulse readings are a nursing routine task. We discussed with the home management the best practice ethos of person centred care and that the pulse readings assumed and relied on nurse knowledge of an individuals normal range for their pulse. A person centred care plan would explain why medication is required to regulate a pulse, how often the pulse should be recorded, what a named individuals normal range is and what to do if the pulse reading was outside of the normal range. Daily life and Social Activities. We spoke with some people preparing for a reading group held at the home. This is an activity suggested by, formed by and facilitated by people who live at the home or whom have resided at the home. It is clearly a group that people value and enjoy. Survey returns from people living at the home indicated that there are always or usually planned activities at the service which they want to participate in. During the inspection people were moving freely about the home, conversing with one another and staff or receiving visitors. We stayed and observed lunch. We met the chef and saw the kitchen and storeroom facilities. Castle Grove has an established record of providing excellence in eating and dining, detailed in previous inspection reports. Survey returns from people told us that they either always or usually enjoy meals. Menus are varied and take account of peoples food likes and dislikes. We saw that people ate in one of two dining locations or in their own room if this was their preference. Lunch was a social occasion and dining areas were pleasantly presented. People who needed assistance with meals were attended to by staff who gave assistance at the person needing helps pace. Soft diets were presented in a manner that was appealing to the eye to stimulate a persons appetite. We saw that portion sizes were good and that the meal was received well by people. Complaints and Protection. The AQAA submitted to the Commission prior to the inspection informed us that the service has not received any complaints in the last 12 months. There have also been no safeguarding referrals. We have received no complaints directly about the service. Survey returns from people who live at the service told us that they felt able to raise concerns directly within the home, if they had any. Care Homes for Older People Page 5 of 10 Environment. We conducted a tour of the home and saw communal areas and staff areas. The environment is pleasant, clean and homely. These findings were echoed in survey returns from people living at the service and their relatives. Staffing. We looked at the recruitment records of 3 staff employed since the last key inspection visit. All files were complete and recruitment was robust in order to protect against potentially unsuitable candidates from gaining employment in a home that cares for vulnerable older people. The home is able to provide placement for nursing students. We met a student on placement, who was enjoying the experience of working at the home. Staff we questioned during the inspection were able to give us credible accounts of safeguarding processes and Whistle Blowing awareness. Survey returns from people who live at the home indicated that staff either always or usually listen and act on what people living at the home say. Comments about the staff in surveys from people living at the home included. Very good care and attention and willingness to discuss any questions I may wish to ask. Castle Grove gives me security and contentment. The staff work as a team that interacts well, and all staff treat residents with respect and understanding. It is informal and friendly. The caring and nursing staff are efficient, very kind and fun. Management and Administration. The service completed an AQAA for us prior to the inspection. It is clear that the home knows where its strengths lie. The AQAA did not provide us with much information to where further improvements could be made. In survey returns from 3 visiting health and social care professionals all respondents indicated that they consider the service always responds to their diverse needs of individual people (such as considering disability, gender, race, age, ethnicity, faith and sexual orientation). The professional survey respondents also told us that they consider the managers and staff as having the right skills and experience to support peoples social and health care needs. We spoke with the manager about feedback in staff surveys and we talked about matching the frequency of supervisions to that desired by individual staff, such as increasing the frequency for some staff if they want more supervision from that as normally scheduled, if staff feel this would make them feel more supported. We found the home management open and receptive to adjusting staff supervision frequencies. Since the last inspection upgrades to radiator covers have been fitted where assessed as posing a risk of heat transfer burns to people living at the home. Care Homes for Older People Page 6 of 10 The home has a fire risk assessment, audited externally on an annual basis and an individual fire evacuation plan for people who live at the home. We have been informed of events at the home via the required reporting process. The home works well with us and has established a history of providing an excellent quality service. We spent approximately 5 hours on the inspection visit and reviewed other records outside of this time. Castle Grove continues to provide excellent outcomes for people living at the home. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, 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 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 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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