Inspection on 30/08/06 for Castel Froma

This inspection was carried out on 30th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Castel Froma 13/02/09

Castel Froma 24/03/06

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 Jackie Howe Unannounced Inspection 30 August 2006 13:30 th Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 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.V301810.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 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.V301810.R01.S.doc Version 5.2 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.V301810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th March 2006 Brief Description of the Service: Castel Froma is a 57-bedded care home providing 24-hour nursing care for predominantly younger adults, with a severe physical disability deriving from head injury or neurological disease, such as Multiple Sclerosis. The home provides a mixture of single and shared accommodation, with seven rooms having en-suite facilities. The home is set in extensive grounds, which are laid to lawn with flowerbeds, and patio areas. The home has a hydrotherapy pool, which is also available for National Health Service patients not resident at the home. The home employs occupational therapists, physiotherapists and a speech and language therapist to offer a full range of services. There are vehicles at the home to transport the residents on trips and for appointments. Information about the home is given to prospective residents and their families via the ‘Statement of Purpose’ information brochures and a video. The home is situated on a major road approximately I mile from Leamington Spa town centre and all its amenities including a bus services, a variety of shops, pubs and places of worship. Range of fees: Basic rate £969 per week. Additional charges are made for hairdressing, toiletries and sundries such as newspapers. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the inspection year 2006/07 and was unannounced. It was undertaken over a period of two days. The inspection focused on the outcome for residents of life in the home. The finance and facilities manager was present through out both the days, as the registered manager was on holiday. The inspector was able to tour the home, and spend time speaking with a number of residents, visitors to the home and staff. Some comments from people who use the home had been received prior to the inspection, and the manager supplied a completed ‘Provider Information Questionnaire’ (PIQ.) Information from these has been included in the report. The inspector ate lunch with the residents and was able to observe care practices, and how staff interacted with residents in the home. During the inspection the care of three residents in particular were examined, including reading their care plans and documentation, observing care offered to them and that staff have the necessary skills to care for them. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. Records including staff files, policies and procedures, health and safety / environmental checks and risk assessments were also read. What the service does well: The home is a very impressive building set in grounds that are very well maintained with hanging baskets and pots of flowers. The inspection took place in mid summer and residents and visitors were seen to make good use of the grounds, or spoke about enjoying the views from the large picture windows. Some of the residents in the home are in need of very intensive physical nursing care and this is provided by a team of professional staff who provide a good level of nursing, and other health care needs such as physiotherapy and occupational therapy. Refurbishment of the communal and entrance areas of the home has recently been done, and this has had a positive impact on the home making it bright and cheerful. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 6 There are exhibits of resident’s artwork displayed on the walls, and some residents spoke positively of the activities they were able to take part in and were proud of their achievements. Some of the bedrooms are very personal in style and design. A number of rooms have been decorated in a theme chosen by residents, and there is good use of colour, items of interest and placing of objects so that they can be clearly visible even if it is necessary to remain in a fixed often bed bound position all day. Residents and family members spoken with were very complimentary about the staff, their attitude and the level of care provided. ‘You would have to go a long way to find a home like this one’. Staff are offered a good level of training and encouraged to develop new skills and build on expertise. What has improved since the last inspection? What they could do better: Staff receive supervision from senior staff, but this does not meet the required standard in regard to frequency and does not provide a platform for individual members of staff to receive regular feedback on their performance and clearly identify individual development needs. An organised programme of supervision would allow staff members to know that they have an opportunity to discuss their performance on a regular basis, and identify their personal development needs as well as skills based on the needs of the residents in the home. Records held of complaints made do not fully reflect all complaints received, and do not currently demonstrate the outcome of the complaint, if the person making the complaint was satisfied with the outcome, or if the complaint was upheld. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 7 Results of quality assurance surveys undertaken are not feadback to those who have contributed. The home’s management staff need to ensure that an action plan is produced in response to the audit, and that residents and their representatives are informed of the results of the audit, how the home is actioning any improvements if required, and how this will be monitored in the future. 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.V301810.R01.S.doc Version 5.2 Page 8 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.V301810.R01.S.doc Version 5.2 Page 9 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): 1, and 2 Quality in this outcome group is good. The judgement has been made using available evidence including a visit to the home. Prospective residents and their families are provided with detailed information in an appropriate format, and are assessed by a multi disciplinary team of trained staff. EVIDENCE: The home has a range of information booklets, videos and brochures available to inform prospective residents and their families about the service. The home also has a ‘Statement of Purpose’, which provides additional information about the contract between the home and its residents, and of the fees payable. Whilst supplementary information available is in a number of formats including a web site, which offers choices, the ‘Statement of Purpose’ is presented in very small print and is not up to date with current information. This document is currently under review and the draft of the replacement document is under consultation. It is hoped that this will be available in the near future. The relative of a resident recently admitted to the home, confirmed that she had received information about the home, and found it to be very useful. She said that the home had been recommended to her and the facilities explained Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 10 by the local rehabilitation unit, and she found their word of mouth recommendation to be reassuring. She said she was assisted in looking round the home prior to the admission. Assessment documents seen show that residents are assessed by a multi disciplinary team of health care professionals, and that the home is able to make an informed decision on if it can meet the needs of each individual. Family members if appropriate, are asked to support the assessment process by completing a personal history form, which allows the home to assess the social and psychological needs of residents, asking information about personal choices and lifestyle. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 11 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, 7 and 9 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. Assessed and changing needs are recorded in care planning documents which reflect personal choices and identify where there maybe risks to health and welfare. EVIDENCE: Some residents in the home are aware of their care plan and where possible are involved in its review. Due to the condition of a number of the residents in the home the type of care they receive is intensive and medical, and for some decisions about how their care is assessed and changed is not something that they are able to contribute to. Relatives where possible are used in the review process and were positive when spoken to about this involvement. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 12 Other residents spoke positively about having an input into their care. ‘Living here is quite pleasant actually, you get 24hour cover which makes you feel safe and looked after, and although I am in pain the doctor comes whenever I need him’. Residents confirmed that they have choice over their life style. One resident confirmed that he can get up in the morning at whatever time he chose to do so. Another said that she did not like to have her clothes marked with her name as it made her feel like a school child. Whilst she takes a risk that clothing may get displaced, she said the staff know her clothes and make sure she gets the right things back. Residents spoke about attending a regular committee meeting where they are given an opportunity to voice opinions and are informed about developments. Generally, the rights of residents to undertake an element of positive risk taking, is acknowledged and residents where able, are encouraged to be as independent as possible. Living in close proximity to a number of other people can mean that taking risks which may have an impact on the welfare of others, are restricted, particularly with smoking. One resident said that whilst he acknowledged the importance of health and safety, he felt frustrated that he was not able to take responsibility for his cigarette lighter as it had been deemed ‘unsafe’. He said this made him smoke more as he got more in when given the opportunity, and made him feel ‘childlike’ and he would prefer to have his own independence. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 13 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, 16 and 17 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. The home provides facilities for residents where able, to join in leisure and social activities. Personal and family relationships are supported. Meals provided are varied, nutritious and support a healthy lifestyle. EVIDENCE: The majority of activities available to residents in the home are organised by the occupational therapy department, although some of the larger group exercises and some art sessions, are conducted by outside facilitators. On the day of the inspection, a physical exercise programme was taking place and about twenty residents were taking part. A weekly programme of activities is on display, and residents are given an opportunity to take part in the varied events for example: art, yoga, cooking, current affairs discussion groups and some outings when transport is available. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 14 One resident commented that she could not read the weekly programme, as the font size was too small, so she did not know what was going on. Entertainers come to the home on a regular basis. One in particular is thought highly of, ‘my favourite come three times a year he is a brilliant and gets people involved’. Examples of residents art work is displayed on the walls around the home and in the occupational therapy department, and it is clear from comments made that residents who join in this activity are proud of their achievements, and enjoy taking part. The occupational therapy department is restricted in space meaning that only a few people can undertake an activity at a time. Staff in the department said that the opportunity to join in was shared equally between those interested. Some residents also attend college and other activities outside the home, and have been offered opportunities and supported to develop further education. A number of residents choose not to join in organised activity and prefer to organise their own day, with a significant number of people having computers and, televisions and music systems in their personal rooms. A number of residents are able to take advantage of the transport arrangements provided by the home, although it is recognised by the managers of the home that the minibus available, is used primarily by residents attending hospital and other appointments. The home is currently looking at ways the minibus can be used more efficiently to allow more availability for social usage. One resident spoken with was looking forward to being given the opportunity to go and visit his mother at home; another said that it would be beneficial to her if the mini bus could be made available on a Saturday, and to be able to attend more outings such as to the theatre. Residents’ attendance at activities is recorded in the care plan, although separate records are still written within the department, and fed back via a regular report. Lunchtime at the home was observed with the inspector eating lunch with some of the residents. The meal served was hot and tasty, and there was plenty of choice available. A number of residents require assistance with eating their meals, and lunchtime therefore is a very busy time for staff. Residents who do not require as much assistance and enjoy conversation over a meal tend to sit together. Feedback on the meals from residents was generally positive and one resident who is diabetic and eats a limited food selection, said that if there was nothing on the menu she could eat, that the cook would always supply something different. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 15 One resident said that whilst the food was ‘enjoyable’, some foods could be made tastier by ‘adding flavourings to the cauliflower cheese and mint in the new potatoes’. The cook said that she made as much time as possible to speak with the residents in the home to ensure that their personal tastes and choices are included in the menu. These comments are not recorded by the cook, so that currently there is little evidence to show that residents are consulted within either menu planning or that their thoughts on food provision is taken seriously. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 16 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): 18, 19 and 20 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. Personal support is offered to residents wherever possible in a way that is preferred and staff ensure that health needs are met. Medication management, although monitored, is not always accurate which could result in a risk to residents’ health. EVIDENCE: Residents on admission are asked to complete, with assistance from relatives if required, a personal history form, aimed at finding out as much as possible how each individual prefers to spend their day, and receive their care. The ‘You as a Person’ form asks about personal achievements, education and employment, importance of things such as appearance, colours and food, and also how residents prefer to spend a typical day such as time to get up and go to bed. This information is to assist staff in providing care to residents in a way that they prefer, and that suits their lifestyle. Residents spoken with said that they Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 17 did feel that they were offered care in way that they preferred, and relatives were happy that they were allowed to be involved in the care. ‘They allow me to be a mother, and I am involved in some tasks like washing his hair’. There was some evidence that what is identified on the personal history form is not always put in to practice. One care plan read identified a preferred bedtime as 9pm, but daily records show that the resident is regularly assisted to bed at 8pm. Residents’ care plans read show that the health care needs of the residents in this home are clearly assessed, documented and met. There is a multi disciplinary team of nurses and therapists involved in providing care, and comments received from residents, relatives and outside professionals confirm that standards are good. One resident who has developed a serious health care problem on top of her existing condition, has had her needs efficiently and sensitively addressed, and has received support from specialist nurses. Risk assessments identify areas of potential risk, and the measures to be taken by staff to minimise that risk. Since the last inspection, the manager has introduced a staff auditing process to identify where errors have been made in medication administration. A number of errors have been recently identified and have been reported to the commission. Some errors included residents not receiving their medication, which could put them at risk. A nurse spoken with confirmed that there continues to be on going problems with medication administration, and that herself and the manager were continuing to undertake the audits. A possible reason for the omissions is the way that individual drug items are identified on the Medication Administration Record (MAR) chart, and a meeting has been arranged with the dispensing chemist to try to improve this. On the day of the inspection, no omissions were noted. Other records and systems for storage and ordering of medication, including those for controlled drugs, were found to be correct. A number of residents receive their medication via their stomach, using a tube known as a PEG (a percutaneous endoscopic gastrostomy). Nurses spoken with were knowledgeable about this and the correct methods of administration. The home does not currently have any residents who choose to administer and control their medication, and therefore do not have a policy or procedure to Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 18 support this. The home manager should produce a policy and an associated risk assessment to demonstrate how residents who may choose to control their medication are supported to do so safely. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 19 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 and 23 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Procedures are in place to respond to complaints and to protect residents from abuse, and training for staff has taken place. Records kept of complaints, do not accurately reflect all complaints made, outcomes for those making a complaint nor if a complaint has been upheld. EVIDENCE: The home has a policy and procedure to assist residents and others using the service, to make a complaint. The manager keeps a complaints record log, and the records of two complaints made were read. The records seen did not show the outcome for the person making the complaint, nor if the complaint was upheld. During the inspection residents spoke about complaints that they had made recently to the manager and of the outcome of these complaints. No records were found of these complaints mentioned, but residents spoken with said that they felt satisfied with the outcome. Comments received show that residents feel comfortable in making complaints, and feel confident that they will be listened to and resolved. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 20 The home has a policy for The Protection of Vulnerable Adults (POVA) and there is evidence to show that staff have received adequate training in this area. Staff spoken with were able to demonstrate a good level of knowledge, and one staff member was aware of the ‘whistle blowing’ policy. Staff were unaware if the home had a copy of the Warwickshire multi agency policy for responding to abuse, or a copy of the Department of health ‘No Secrets’ document. There have been a number of incidents recently when money has gone missing from the home. These have been responded to appropriately and have been reported to the commission. New security measures for visitors coming into the home have been put in place, and the management team are in discussions with the local police. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 21 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, 25, 28 and 30 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. The home although large, provides a clean and safe environment, which is well maintained and has been improved by recent refurbishment. Hygiene standards in the home are good. EVIDENCE: A tour of the home was undertaken as part of the inspection process and all areas were found to be clean and tidy with little evidence of bad odours. Some refurbishment has taken place in the entrance and communal areas of the home, which are now bright and cheerful. Residents were positive about the changes made, they had been involved in the colour or fabric choices, and said that they thought it had improved the home. ‘Its spiced it up a bit!’ Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 22 The large windows allow the light to come into the home and offer from the communal rooms and some of the bedrooms, views over the gardens, which are beautifully maintained and have received a gold award in the ‘Britain in Bloom’ competition. There are a number of large communal rooms to supplement personal bedrooms. The dining room is very large, and doubles up as an area to hold group exercises and entertainment. Another smaller sitting room houses a large widescreen TV, DVD and video system that is also linked to receive Sky channels. The bedrooms in the newer part of the home are sufficiently spacious to allow free movement of wheel chairs and equipment. A number have been decorated to personal style, and a number of residents have had them personally fitted to suit their needs. Some of the bedrooms in the older part of the home are a little dated and in need of some redecoration. A number of residents share a room with another person. Screens are provided to promote privacy, and the rooms are large enough for each resident to have some individual space. One resident spoken with who shares a room, said that he did not find it to be an intrusion on his privacy. Residents spoken with found the lack of storage to be a problem and in many rooms clothes were seen hung over the TV wall brackets. One resident said that the cupboards and wardrobe were not designed for independent use, which she found frustrating. Laundry and kitchen areas were found to be tidy and hygienically clean. Good systems for cleaning and storage of foods were found in the kitchen. Evidence seen around the home, and written policies and training records for staff, show that infection control is taken seriously. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 23 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, 34, 35 and 36 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. Staff in this home are well qualified and competent and recruitment procedures are thorough. Records seen do not demonstrate that all staff receive sufficient supervision to guide and support them in their roles. EVIDENCE: The home employs a large number of staff to work in different roles to support the residents in the home. Generally staffing levels are sufficient to allow staff to offer a good level of care to residents. Staff spoken with said that they found staffing levels to be ‘ok’ although at peak holiday times there was sometimes a reduction in staffing. Comments from residents and relatives about the staff were positive. ‘The ‘The ‘I’ve with staff are great’. staff are very good I couldn’t ask for better’. only got to mention something I am concerned about, and they get on it’. DS0000059286.V301810.R01.S.doc Version 5.2 Page 24 Castel Froma One resident said that there were not enough staff at times and that they appeared ‘ rushed off their feet’. There were also some comments made about the way staff move around the home to work in different areas of the home. This is a deliberate management decision to ensure that all the staff get to know all the residents. One resident said how she felt unhappy with this constant movement, and would prefer to have more continuity and a regular staff team. She said that she rarely got to see her ‘named nurse’ and therefore could not see the reason for having her name on her door! Training of the staff is given a high level of importance, and staff training records seen show that staff receive training in all the mandatory areas such as Moving and Handling, and Health and Safety, but also in specialist areas to develop expertise. One nurse has recently achieved a degree in Palliative Care and Multiple Sclerosis, to become a specialist practitioner, receiving financial support from the home. She is now hoping to use this knowledge to develop protocols for the home and attain the Gold Standard award in Palliative care. One member of staff spoke positively about attaining her National Vocational Qualification (NVQ) in care, and said that she had found it useful and informative. The home has achieved well over the standard of 50 of its staff attaining an NVQ award at 82.5 , and this is commendable. Staff recruitment records checked show that good procedures are in place, to ensure that all staff employed are suitable to work with vulnerable people. Records seen do not show that staff are receiving adequate supervision in their role. ‘Clinical supervision’ is offered in groups of different grades of staff, and is often in response to an incident such as ‘inadequate communication’. Supervision meetings held are not currently focused on the development of an individual member of staff and do not meet the standards required. Staff spoken with confirmed that they met with a senior member of staff approximately twice a year. Supervision is held in a group of other staff between two and six but are inconsistent depending on who is on duty. Staff grades are mixed, which makes it difficult to address a common area such as medication administration, and there is not normally an agenda. Staff confirmed that they did have an annual appraisal when training objectives are set. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 25 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, 39 and 42 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. The home is well run and the views of people who use the service are listened to. Policies and procedures are in place to ensure that the health and safety of residents and staff is protected. EVIDENCE: The manager was on holiday at the time of the inspection but previous inspections have found that she demonstrates a competent management style. Staff spoken with said that they found her to be ‘excellent’ and approachable. A local GP who visits the home commented that the home was ‘ a well run home dealing with patients with severe long term illness’. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 26 Regular meeting are held for residents and their families to attend and put forward their ideas and suggestions for improvement. Relatives spoken with confirmed that they found these meetings to be useful and that actions agreed were always followed up. At one meeting held recently, it was commented that senior staff were often unavailable to speak with in the evenings and at the weekend when most visitors are around. The home has responded by buying an ‘on call’ mobile phone which relatives can ring if they have a question. Minutes of relatives meeting kept show that the meetings are well attended, and relatives are sent invitations. The home also uses the meeting as an opportunity to inform relatives by inviting speakers. At the last meeting a palliative care nurse gave a talk and there is a speaker on the ‘Mental Capacity Act’, booked for the next meeting. Regular surveys are undertaken and questionnaires are sent to all those using the home. One resident said that whilst she filled it in she never received a response or heard what the results were. The management team should develop the current system, to include a process to demonstrate what actions are being taken as a result of the surveys and what is being done to monitor these actions. Systems to ensure the quality of the housekeeping systems are currently being introduced. Health and Safety in the home is taken seriously, and the home keeps good records and has policies and procedures in place. The home is quick to action requirements made at inspections. A recent fire safety inspection has been undertaken and work is being undertaken to ensure that the home complies with the new regulations. Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 27 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 3 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 3 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 28 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. 1. Standard YA20 Regulation 13(2) Requirement All nursing staff must adhere to the Nursing and Midwifery Council Code of Ethics and published guidelines for administration of medicines. Staff must be regularly assessed and supervised to ensure they reach the required standard. An ongoing training course must be offered to all nursing staff for the administration of medication. Timescale for action 30/11/06 2. YA36 18 The registered manager must ensure that all staff working in the home are appropriately supervised, and that this supervision covers all areas directed in the National Minimum Standards. 31/12/06 Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 29 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. Refer to Standard YA12 YA17 YA20 Good Practice Recommendations Signage in the home should be displayed in formats that are accessible to all. Particular attention should be given to the use of larger font sizes on information posters. The cook should record residents’ involvement in menu planning and feedback on the quality of the food. The manager should introduce a policy and procedure, with an associated risk assessment to demonstrate how residents who may choose to control their own medication, can do so safely. The manager should review the current storage arrangements for residents to provide suitable space to individual requirements and abilities. It is recommended that a training matrix be devised, to ensure ease of identifying what training is required for each individual staff member. 4. 5. YA25 YA35 Castel Froma DS0000059286.V301810.R01.S.doc Version 5.2 Page 30 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.V301810.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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