Inspection on 24/03/06 for Castel Froma

This inspection was carried out on 24th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Castel Froma 13/02/09

Castel Froma 30/08/06

Castel Froma 28/09/05

Castel Froma 24/03/05

Castel Froma 11/10/04

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Castel Froma 93 Lillington Road Leamington Spa Warwickshire CV32 6LL Lead Inspector Justine Poulton Unannounced Inspection 24th March 2006 09:40 Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 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 Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 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 Adults 18-65. 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. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Castel Froma Address 93 Lillington Road Leamington Spa Warwickshire CV32 6LL 01926 427216 01926 885479 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) Castel Froma Charity Trustees Mrs Marilyn Kaliczak Care Home 57 Category(ies) of Physical disability (57), Physical disability over registration, with number 65 years of age (57) of places Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 Brief Description of the Service: Castel Froma is a care home providing 24-hour nursing care for predominantly younger adults with a severe physical disability deriving from a head injury or neurological disease, such as Multiple Sclerosis. Seven rooms have en-suite toilets. There are extensive grounds. There are vehicles at the home to transport the residents. There is an out- patient service of hydrotherapy for National Health Service patients not resident at the home. Occupational Therapists, Physiotherapists and a Speech and Language Therapist are employed at the home. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday and was carried out by two inspectors from 9:40 until 16:00. A pharmacy inspector also participated in the inspection with the sole objective of assessing medication procedures within the home. The manager, residents and staff co-operated fully with the inspection. A total of 16 standards were inspected of which none had shortfalls. The inspection process included talking to nursing and care staff, examination of records such as care plans, talking with those residents who were able to converse and spending time with residents who could not communicate because of a low awareness state. The inspectors would like to thank the residents, manager and staff for their co-operation and hospitality during the inspection process. What the service does well: A multi disciplinary team seeks comprehensive assessment information prior to offering any prospective resident a place in the home, to ensure that a service can be offered that will be able to effectively meet all of the individuals care and support needs. There is strong emphasis on ensuring that relatives and families are also involved this process. Care planning documentation is comprehensive and covers all aspects of a residents life, ranging from the levels of nursing care required right through to social and leisure interests. A dedicated occupational therapy department provides a varied programme of weekly activities that the residents are free to participate in should they choose. The general health of residents is maintained via good access to heath care and relevant specialist professionals. Complaints and protection from abuse policies and procedures are in place. Residents feel able to make complaints and feel satisfied that they will be dealt with effectively. Staff spoken with were knowledgeable about infection control procedures. Areas within the home that may constitute a high risk for cross infection were clean tidy and well organised. Comprehensive training records are available to indicate that staff training is a high priority in the home. All staff across every discipline are offered training pertinent to their role. A large proportion of staff have achieved NVQ qualifications to levels II or III. The home has continued to maintain the Investors In People Award that it gained in 2004. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 6 The home is managed by a qualified, competent manager. The health and safety of residents, staff and visitors is maintained to a high standard. All of the necessary records and checks regarding health and safety were in place. 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. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective residents are assessed prior to their admission which ensures their needs are identified and enables the home to confirm it can meet their needs. EVIDENCE: A multidisciplinary team comprising of a nurse, physiotherapist and occupational therapist visit each resident before their admission to undertake a full assessment of their needs. The care files of five residents were examined and contained detailed reports from this team. Files also contained reports obtained from health and social care professionals in the establishments where residents are currently living. Occasionally, a prospective resident will visit Castle Froma and has the opportunity to view the facilities offered and the assessment is undertaken then. Relatives and families are involved in the process and are asked to complete a form which indicates level of abilities and areas of daily living where the prospective resident requires support. Consideration is given to lifestyle choices and preferences, as well as physical and healthcare needs. The registered manager writes to prospective residents or their families following the assessment to inform them whether or not the home can meet their identified needs. The home was expecting the arrival of a new resident on the day of inspection. Examination of his care file demonstrated that the assessment had taken place Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 9 and the information had been used to ensure all the necessary resources were available and in place before the admission. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Care plan programmes and risk management strategies are in place to meet the assessed and changing needs of residents. EVIDENCE: Key standards 6 and 9 were inspected at the last inspection of this home which took pace on 28 September 2005. From this inspection requirements for information regarding residents activities and leisure pursuits to be included in their care plans and for all generic risks assessments to be reviewed were made. Inspection of a sample of residents care plans confirmed that the information pertaining to activities and leisure pursuits offered to and undertaken by the residents is now included within their files, therefore this standard is now deemed to be met. A look at a sample of the generic risk assessments for the home confirmed that they had been reviewed recently and updated as necessary. This standard is therefore now met. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 Opportunities are in place within the home for residents to participate in age, peer and culturally appropriate activities. Relatives and friends are welcomed into the home without restriction. EVIDENCE: Key standard 12 was inspected at the last inspection of this home which took pace on 28 September 2005. From this inspection a requirement for information regarding residents activities and leisure pursuits to be included in their care plans was made. As recorded previously in this report evidence was available to confirm that this has been actioned. This requirement is therefore deemed to be met. The home is fortunate in that it has a dedicated Occupational Therapy department that provides residents with opportunities to undertake or participate in social, educational or occupational activities. A weekly programme of activities has been devised that is based around what the residents in the home have appeared to enjoy when offered in the past. This programme includes things such as yoga, art, gardening or cooking, quizzes, a film club and outings to various places of interest. External facilitators come Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 12 into the home and run the art and yoga sessions, for which those residents that participate are charged a small percentage of the overall fee. Evidence was available to demonstrate that some residents choose to participate in a number of activities during the week, whilst some join only a few or none at all, however the occupational therapist said hat the activity programme on offer was available to all. The home also has an attached Physiotherapy department which provides a service to those residents assessed as requiring it. This also provides a service to patients referred from external sources. A key part of life within the home for the residents is the opportunity to maintain relationships with their families and friends. In conversation residents spoke about how they enjoy visits from their families, and also about how they like going to visit them when the opportunity arises. Throughout the inspection various relatives of residents were observed to visit. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 Residents’ general health is monitored by the home and they have good access to health care and relevant health professionals ensuring their health needs are fully met. The home demonstrated some good practice for medicine management and the registered manager was keen to improve this further to exceed the national minimum standards. EVIDENCE: It was evident from examination of residents’ files and through discussion with nursing staff, care staff and therapists that the healthcare needs of residents are identified and met. The home uses risk assessment tools to monitor falls, choking, manual handling and potential restraints such as cotsides. The risk of developing pressure sores is assessed and all residents have pressure relieving equipment such as specialist mattresses in use. The home currently has no residents with pressure sores. About half of the residents in the home have their nutritional needs met by being fed through a tube inserted into their stomach (a percutaneous endoscopic gastrostomy, or ‘PEG’). A community dietician visits weekly to Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 14 monitor residents who are nutritionally compromised. The home employs a Speech and Language therapist who is involved in monitoring swallowing problems and their deterioration or improvement. Residents are supported by staff to access hearing and dental services at the local hospital and an optician visits the home to provide optical services. Cervical and breast screening is also accessed by residents. All residents are registered with a GP who visits the home each week. Monthly records are maintained of vital signs such as blood pressure and weight is recorded regularly. There was evidence that residents are involved in making decisions about their health. Nursing staff and therapists described one particular resident who was making a decision about having a PEG inserted with support and information from staff and relatives. Evidence in care files demonstrated that when a new or changed healthcare need is identified, care plans are implemented to meet the need. The systems installed since the last inspection have significantly improved the medicine management in the home. Audits demonstrated that the medicines are administered as prescribed in most instances. The home does not order or see the prescriptions prior to dispensing and do not adequately check the dispensed medicines received into the home. “When required” protocols had been written following the last inspection and this was commended. There was no system to confirm staff competence in medicine administration and recording in the home but the registered manager was keen to implement a staff drug audit system. Nursing staff interviewed had a good understanding of the clinical needs of the service users many of which had complex clinical needs. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Complaints are handled objectively and residents are confident that their concerns will be listened to and acted upon. Policies and procedure are also in place to protect residents from harm EVIDENCE: The home has a complaints policy and associated procedures in place. The manager keeps a log of all complaints received any action taken and the subsequent outcome. Examination of this log confirmed that two complaints have been received by the home since the last inspection. Residents spoken with were quite clear about what they would do and who they would talk to should they have a complaint. A policy on the Protection of Vulnerable Adults from Abuse (POVA) is available in the home. The manager was able to demonstrate a good understanding of the procedures that would be undertaken should a suspicion of or allegation of abuse be made. Staff receive training on abuse from a video supplied by TOPSS. Those staff that have completed or are currently registered on an NVQ award also receive training via this qualification. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 The home provides a clean environment for residents to live in and the practices used to manage the control of infection protect residents from potential harm. EVIDENCE: Key standard 24 was inspected at the last inspection of this home which took pace on 28 September 2005. From this inspection a number of requirements pertaining to the environment were made. Inspection of the relevant areas within the home confirmed that these requirements have been met. The home is generally clean and tidy and there were no unpleasant odours. The inspector toured the laundry with the registered manager and discussed the processes for the management of dirty laundry. The laundry was tidy and well organised with designated areas for storage of clean and dirty laundry. Suitable commercial washing machines with sluice cycles and tumble dryers are installed. Hand washing facilities are available. Residents were observed to be dressed in well laundered clothes. Nursing and care staff spoken to were knowledgeable about measures to reduce the risk of infection and observation of their working practice confirmed that the correct procedures are followed. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 17 Protective clothing such as gloves and aprons were readily available throughout the home. An alcohol based hand gel is available for use of staff and visitors. The home has suitable arrangements in place for the disposal of clinical and household waste. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 Residents are supported by a skilled and knowledgeable staff team who understand their needs and wishes. EVIDENCE: In excess of 150 staff are employed to work at the home in a variety of roles that include qualified nurses, care assistants, lounge assistants, occupational therapists and physiotherapists. Extensive training records were available that covered training that had been completed, training that was booked and training that was available. Examples of subjects covered include all of the mandatory areas as well as more specialist areas such as understanding Parkinson’s Disease, assessment and diagnosis of Multiple Sclerosis and supra pubic catheterisation. Staff training is co-ordinated by a training co–ordinator and overseen by the manager who said that she goes through the training file on a regular basis to ensure that all training for staff is up to date and current. Although all of the information regarding training is contained within two files, it may be useful for the manager to develop a training planner that would identify when refresher training is due for staff ‘at a glance’ to save having to trawl through the files regularly. Evidence was available to demonstrate that 77 of care staff have obtained NVQ level II or III, which is above the national target of 50 . The home was also successful in achieving the Investor in People Award given by the Warwickshire Chamber of Commerce, in 1994. The manager said that this has Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 19 to be reassessed on an annual basis in order for it to remain a current award. At the time of the inspection the assessment for 2006 was due to be undertaken shortly. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42 The leadership, guidance and direction to staff ensures residents receive consistent quality care. The policies and procedures for safe working practice in this home are ensuring that service user health, safety and welfare is being promoted and protected. EVIDENCE: The home is managed efficiently by a registered manager who demonstrates an effective and competent management style. The manager was fully aware of all of the residents needs, and was able to answer all questions asked satisfactorily. The members of the staff team spoken with were very supportive of the manager. Key standard 42 was inspected at the last inspection of this home which took pace on 28 September 2005. From this inspection a number of requirements pertaining to health and safety were made. Evidence was available within the home to confirm that they have all been actioned. In addition all of the health and safety records required to be in place were available for inspection and were accurate and up to date. Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 x 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 x 4 x x x x 3 x Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? 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 Refer to Standard YA20 YA20 Good Practice Recommendations It is recommended that staff drug audits be undertaken before and after a medicine round to confirm nursing staff competence in medicine management The nursing staff are advised to order all the prescriptions that the residents need and install a system to check these and the dispensed medication and MAR charts received into the home. It is recommended that a training plan be devised to ensure ease for identifying 3 YA35 Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 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 Castel Froma DS0000059286.V287925.R01.S.doc Version 5.1 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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