Inspection on 25/08/10 for Castle Court Nursing Home

This inspection was carried out on 25th August 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Castle Court Nursing Home 16/06/10

Castle Court Nursing Home 19/11/09

Castle Court Nursing Home 10/12/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Random inspection report Care homes for older people Name: Address: Castle Court Nursing Home Margrove Road Boosbeck Saltburn-by-Sea TS12 3BL one star adequate service 19/11/2009 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: Jacqueline Herring Date: 2 5 0 8 2 0 1 0 Information about the care home Name of care home: Address: Castle Court Nursing Home Margrove Road Boosbeck Saltburn-by-Sea TS12 3BL 01287653990 01287651600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Continuum Healthcare Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 38 Number of places (if applicable): Under 65 Over 65 Conditions of registration: Date of last inspection Brief description of the care home Castle Court Nursing Home is registered to provide personal and nursing care to a maximum number of thirty eight people. The home provides care to both older people and older people with dementia. Castle Court is situated in Boosbeck on the outskirts of Guisborough and Skelton. A bus service is available to transport people locally. The building was formally an old school that has been converted into a care home. The home is divided into two units. The ground floor of the home accommodates twenty eight older people. There is a large lounge, small lounge and dining room. There are twenty eight single bedrooms some of which have ensuite facilities Care Homes for Older People Page 2 of 15 1 9 1 1 2 0 0 9 Brief description of the care home consisting of a toilet and hand wash basin. The first floor of the home accommodates ten older people with dementia. Communal space consists of a lounge, a small kitchen area and a small dining room. There are ten single bedrooms one of which has ensuite facilities. There is a passenger lift. There are panoramic views of the Cleveland hills and surrounding countryside. Care Homes for Older People Page 3 of 15 What we found: This was an unannounced inspection which took place on 26 August 2010. It was completed in one inspection day by a compliance manager and a compliance inspector. The reason for this inspection was as a result of significant concerns being raised at a multi disciplinary meeting. The concerns highlighted issues that potentially impacted upon the safety and wellbeing of people living at Castle Court. CQC needed to be satisfied that Castle Court Nursing Home is a safe place for people to live and that their needs are being met. Two Statutory Requirements Notices and a warning letter had previously been issued to the provider of Castle Court Nursing Home, we did not look at these areas during this inspection or look at other requirements or recommendations from the previous inspection. Health and Personal Care We looked at the care records of three people living at Castle Court. We selected one person with complex general nursing needs, one person with complex EMI needs and one person who had personal care needs. In all three of the care files there was evidence that the assessments and care plans had recently been reviewed and updated. The assessments of need were up to date and were clearly individualised and person centred. In all three of the care records care plans had been developed, which in the main contained good interventions. In two of the care records a range of care plans were in place for areas of identified need. In the third care file, for the person who had complex EMI needs, there was the need to develop some further care plans for additional needs that had been identified. This included a care plan for aggressive behaviour and non compliance with medication. This person also had two core careplans (plans that have been pre written and can be utilised for a number of people). Where these plans are used, there is the need to ensure they contain additional information to ensure they are more specific to the individuals needs. The daily records contained informative information about each individual. People spoken to said they were well cared for by staff who were friendly and helpful. A relative also said they were satisfied with care being provided. Daily Life and Social Activities Lunchtime was observed and people were offered a choice of chicken in a white wine and mushroom sauce or fishcakes. People said they really enjoyed the meals at Castle Court. One person said, I am enjoying my lunch, all of the meals are lovely. One person needed assistance with their meal, they were supported with this in a dignified way by the staff. During lunch people were involved in conversations with each other and the staff and there was a good atmosphere. Later in the afternoon a further visit was made to the dining room, it was clean and well Care Homes for Older People Page 4 of 15 presented. We also observed peopled living at the home and all had clean clothing on with no staining or spillages. People living at Castle Court said they were able to make day to day decisions. They said they decide what time they go to bed and get up, that they have a choice at mealtimes, that friends and family can visit. They said they are treated with courtesy and respect and that staff always knock on their room door before coming in. One person spoken to said there could be more going on in the home in the way of activities and more opportunities to go out. A number of staff also said that activities could be improved. It is noted that a person has recently been employed in the role of activities co-ordinator. Environment We visited the home and looked around during this inspection. We looked at a number of bedrooms, bathrooms and toilets along with the communal areas. All areas looked at were clean and odour free. In some of the bedrooms it was identified that the carpets needed to be replaced and rooms needed to be redecorated due to wall paper being ripped or damaged. The manager said that refurbishment of the bedrooms has already started to take place and includes replacing carpets. We saw evidence of this during the inspection. The carpet to the entrance of the home and corridors have been replaced and there is now non slip laminate flooring in place. A number of corridors and the entrance have also been redecorated. The lighting in the corridor to the right of the entrance area was noted to be somewhat dim, energy saving bulbs are currently used. It was recommended that this be looked at with a view to improving the lighting. The two sluice rooms were open and accessible to people. It was agreed that these areas should be kept locked when not in use. The manager confirmed that they would have keypads fitted to these doors. In the upstairs unit, the door to the bathroom did not shut properly and both the bathroom and shower room door need to be painted or varnished and the manager also needed to check that these doors were appropriate for use as it was unclear if they were fire doors. Staffing We looked at the duty rota and discussed the staffing arrangements with the manager. The manager said that there is always a qualified nurse on duty and on day duty they are supported by a senior care assistant and three care assistants. Night duty is covered with one qualified nurse and two to three care assistants. The qualified nurse cover is a combination of qualified general nurses or qualified psychiatric nurses. The duty rota is not wholly accurate as it showed there were some duties still to cover, the manager confirmed that these duties had been covered but the rota had not been updated to reflect this. Care Homes for Older People Page 5 of 15 Discussion took place with a number of staff about the sufficiency of staff on duty. Whilst the actual number of staff on duty seems adequate the actual staff in terms of skill mix and knowledge of peoples needs did raise some concern. The reason for this was on the day of the inspection, the qualified nurse was new and it was their first day, there was one senior carer who had worked at the home for a number of years, one carer who had worked at the home for eight weeks, one carer who had worked at the home for two weeks and a further senior carer who was providing cover from another home. This was discussed with the manager who said they are trying their best in regard to staffing, that they have been recruiting and do ensure that there is always a more experienced member of staff on duty who knows the home well. The new staff who were spoken to confirmed they had completed an induction which had included fire, moving and handling, emergency aid, safeguarding and infection control. They said they had a portfolio and that this was ongoing. Staff spoken to said there had been a recent staff meeting and that there is lots of training being planned. Staff also said the staff team worked well together. Management and Administration A sample of maintenance and servicing records were looked at. Weekly fire tests are being carried out and there was fire training on 22 July 2010 and an evacuation on 29 July 2010. The actual fire alarm system was service in February 2010. The passenger lift was serviced April 2010, bath lift May 2010 and three moving and handling hoists March 2010. There was no certificate in place for the servicing of the fire extinguishers, however six were looked at and had service records to show that had been serviced in July 2010. A copy of the five year electrical installation report was made available, this was dated June 2009. It detailed that the home fails to meet the 2008 regulations and fully details this. The manager confirmed that this is now being actioned. There were no records available to show that the emergency lighting had been serviced. What the care home does well: What they could do better: The two Statutory Requirement Notices and warning letter were not looked at. Two compliance visits are scheduled, when these will be looked at. Care Homes for Older People Page 6 of 15 The work that has commenced on reviewing and updating peoples assessments and care plans needs to continue and all areas of identified risk or need should have a plan of care in place. Activities should continue to be developed increasing opportunities for people living at Castle Court. The doors to the sluice rooms should be locked when not in use. Staffing levels and skill mix should remain under review to ensure that peoples needs can be met and there is continuity of care. There needs to be up to date records to show that the emergency lighting has been tested and serviced. Action needs to be taken in respect of the five year electrical installation report. A system should be developed to show when the maintenance and servicing of equipment is next due. 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 15 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 Comprehensive assesments 30/07/2010 of needs including nutrition, moving and handling, pressure area and falls must be carried out for people that use the service. To ensure the health safety and wellbeing of the person. 2 7 15 Care plans must be 30/07/2010 developed for each assessed need/problem and be specific to the person. Care plans must set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the person are met. To ensure the health safety and wellbeing of the person. 3 7 15 Care plans must be reviewed 30/07/2010 at least once a month, updated to reflect changing needs and current objectives for health and personal care. Monthly reviews/evaluations need to contain any deteriorations or improvements made. This will ensure that needs of the person using the service Care Homes for Older People Page 8 of 15 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 are met. 4 7 15 Care plans for those people 30/07/2010 with dementia must include the level of the dementia or impact of the dementia on life. Care plans for those people with aggression/challenging behaviour must detail in what way the person is aggressive/challenging, the triggers to the aggression and measures/action to take to manage the problem. To ensure the health safety and wellbeing of the person 5 9 13 Medication Must be given as prescribed and a record made at the time it is given. This will ensure that people receive their medication correctly and treatment to their medical condition is not affected. REPEAT REQUIREMENT PREVIOUS TIMESCALE FOR ACTION NOT MET WE ARE CONSIDERING THE ACTION THAT WE ARE TO TAKE. 6 9 13 Medication must be given as prescribed and a record made at the time that it is given. This will ensure that people receive their medication correctly and the treatment to their medical condition is not affected. Care Homes for Older People Page 9 of 15 19/11/2009 19/11/2009 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 7 19 23 Continue with the plan of 30/09/2010 action to refurbish bathrooms and toilets on the ground and first floor and bedoroms on the first floor of the home. This will enhance the environment for people that use the service. 8 20 13 Window restricors must be 30/07/2010 fitted to the first floor kitchen window. To ensure the safety of people that use the service. 9 20 13 The kettle that is in the 30/07/2010 kitchen on the dementia unit must be emptied and locked away after use. Consideration must be given to fitting a key pad locking system to the kitchen door because of the hazards within. To ensure the safety of people that use the service. 10 20 13 A risk assessment must be 30/07/2010 carried out to determine if there is a need to fit a key pad locking system to the door in the activities lounge that leads to the staircase to the dementia unit. Consultation with the fire Authority must take place prior to the fitting of any lock. To ensure the safety of Care Homes for Older People Page 10 of 15 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 people that use the service. 11 24 23 The offensive odour in the bedroom on the first floor must be eliminated and the vanity unit around the sink replaced. To enhance the environment 12 26 23 The registered person must ensure that appropriate sluicing facilities are provided. This will help to prevent the spread of infection. 13 26 23 Appropriate sluicing facilities 28/02/2010 must be provided. This will help to prevent the spread of infection. REPEAT REQUIREMENT PREVIOUS TIMESCALE FOR ACTION NOT MET WE ARE CONSIDERING THE ACTION THAT WE ARE TO TAKE. 14 27 18 The Registered person must 30/07/2010 carry out a dependency assessment of people that use the service and make sure that there are sufficient, suitably qualified, competent and experienced staff on duty at all times. To ensure the health safety and welfare of people that use the service. 15 29 19 Any new staff member employed at the home that starts work on an ISA Adult 29/06/2010 28/02/2010 13/08/2010 Care Homes for Older People Page 11 of 15 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 First must be supervised by a suitably qualified person until receipt of a satisfactory Criminal Record Bureau Check. To ensure the protection of people that use the service 16 30 18 Staff must receive mandatory training and training appropriate to the work they perform. In particular staff must receive training in first aid, food hygiene, health and safety, fire, infection control, dementia awareness and challenging behaviour. This will make sure that staff have the correct knowledge and skills to care for people that use the service. PREVIOUS TIMESCALE FOR ACTION OF 31/01/2010 NOT MET 17 30 13 The registered person must 31/01/2010 ensure that mandatory training is up to date and that certificates are on file to confirm that training has taken place. This will help to ensure that staff are trained and competent to do their job. 10/09/2010 Care Homes for Older People Page 12 of 15 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 1 23 13 The doors to the sluice rooms must be kept locked when not in use. This will ensure that people living at the home cant access these areas and are kept safe from any areas of risk. 30/09/2010 2 38 13 The emergency lighting must 30/09/2010 be serviced and records must be in place to show this has taken place. Action must be taken in respect of the five year electrical installation report. This will ensure that the systems are fully operational and provides safety to the environment. Care Homes for Older People Page 13 of 15 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 7 Where core care plans are used, these should be amended to include specific details about the individual needs and interventions. The bed rail risk assessment needs to be updated to include best practice safety measures that need to take place prior to using the bed rails and safety checks that need to take place on a regular basis whilst the bed rails are in use. The use of bed rails should be discussed with a multidisciplinary team to confirm that they are the safest option for the person. Evidence of discussion should be available within the bed rail risk assessment. Medication competency assessments should be carried out at regular intervals and dated. More activities should be available for people on the dementia unit so that people are given appropriate social and leisure opportunities. The Complaints procedure should be updated to advise people that they can contact the Primary Care Trust (funding authority) should they with to make a complaint. The adult protection procedure should be updated to link to No Secrets, Teeswide inter-agency policy/procedure andpractice guidance. Consideration should be given to improving the lighting to one of the ground floor corridors. The needs and dependency of people on the dementia unit should be reviewed to determine if there are sufficient staff on duty. Additional staffing should be considered so that a staff member is present at all times in the lounge area. This would enable more social activity to take place. Staffing levels and skill mix of staff should be reviewed to ensure they are sufficient to meet the needs of people living at the home and provide continuity of care. A system should be in place to show when the maintenance and servicing of equipment is next due. 2 8 3 8 4 5 9 12 6 16 7 18 8 9 23 27 10 27 11 38 Care Homes for Older People Page 14 of 15 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. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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