CARE HOMES FOR OLDER PEOPLE
Castle Dene Throop Road Bournemouth Dorset BH8 0DB Lead Inspector
Trevor Julian Unannounced 16 May 2005 11:00 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 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 Older People. 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. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Castle Dene Address Throop Road, Bournemouth, Dorset, BH8 0DB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 397929 01202 646540 castledene@dorsettrust.co.uk Care South Janice Turner CRH 50 Category(ies) of DE(E) - 10 registration, with number OP - 40 of places MD(E) - 10 Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 50 in the category OP (Old Age) including up to 10 in the categories DE(E) and/or MD(E). The home may accommodate three named service users under the age of 65, one of whom is in the category of PD. Date of last inspection 03 November 2004 Brief Description of the Service: Castle Dene is a care home providing personal care and accommodation for 50 older people of whom up to 10 may have dementia (DE (E)) or mental health (MD (E)) needs. It is operated by Care South, a not for profit organization. The home is located in a residential area of Bournemouth within easy reach of the A338 and the Travel Interchange. The home was first registered in 1991 and consists of a two–storey building. All accommodation is provided in single bedrooms. There is a passenger lift to all floors making access possible for all service users. Visitors are always welcome. Pleasant gardens surround the building, providing safe and easily accessible recreational areas. All meals are prepared in the home. The home has a small shop. There is a programme of activities for service users to participate in and monthly outings are arranged. Castle Dene has suitable aids and adaptations to offer a safe, comfortable and stimulating environment for services users with a variety of needs and abilities. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Monday 16th May 2005 between 11:00 – 18:00; the total inspection time of 16 hours included preparation, inspection and report writing. The visit was the first of two statutory visits carried out in the inspection year. It was the inspector’s first visit to the home and the manager’s first inspection since transferring from another of the group’s homes. Information was gathered through discussion with 7 residents, 4 members of staff and the manager, examination of records and policies and a tour of the premises. For the purposes of this report the term service user and resident are interchangeable. What the service does well:
The home had produced information for prospective residents and their carers allowing people to make informed decisions about the suitability of the placement. Copies of these documents were available in the main entrance to the home. All people considering the home were assessed to ensure that the identified needs could be met at Castle Dene. Records confirmed that these assessments had considered all the relevant topics. Following the admission assessment care plans were in place to ensure that staff could address those needs. The records showed regular reviews and changes were made as needs altered. Residents confirmed that they were aware of the care plans but none had asked to see their own files. Records confirmed that medical issues were monitored and referred to the appropriate agency. Residents said the staff contacted their own GPs as needed. Castle Dene had a comfortable dining room. Residents commented that the variety and standard of food was very good, they were able to take their meals in dining room or their own rooms if preferred. The organisation had a complaints procedure; details were contained in the information provided for potential residents and their carers. Several residents said they would take concerns to the senior staff but none had needed to do so. In the general election several residents had opted for postal votes no one had visited the polling station.
Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 6 The premises offer a safe and comfortable environment. All bedrooms were for single occupancy. There were adaptations in place including specialist baths hand and grab rails etc. in order to promote independence. There were suitable and sufficient communal toilet and washing facilities allowing hygiene standards to be maintained. Residents said that their rooms were comfortable, clean and the home had been kept warm over the winter period. The rooms seen had been personalised by the use of pictures, ornaments and some furniture. An inventory of items brought into the home was maintained. Staff recruitment procedures were followed to select suitable staff. Records confirmed that the staff were started once the required clearances and references had been obtained. The home holds personal allowances for most of the residents. A sample of records and receipts was checked and found to be in order. Records showed that the organisation protects the residents and staff through appropriate health and safety systems and training. Staff confirmed that they received regular fire safety training updates and manual handling training. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3. Standard 6 Intermediate care is not offered at Castle Dene and therefore is not applicable. The organisation provides prospective residents and their carers with information about the home to assist in making informed choices about the suitability of the placement. All new admissions were made once assessments had been completed to ensure that all identified needs could be met. EVIDENCE: The home’s guide was on display in the entrance lobby along with the previous inspection report. Residents spoken with were not able to recall the information provided prior to admission and most said their families had been fully involved in the process. Some had previously visited the home for respite care so already knew of the services provided. Four files were examined each contained pre-admission assessments which identified the care needs of the individual. One file showed that the assessment had taken place at Castle Dene when the prospective resident had
Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 9 visited to have a look around the premises. Staff said that the assessment was used to develop an initial care plan which was updated as changes were observed. New admissions were welcomed into the home by the senior carer. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 Care plans informed the care staff of the individual’s needs and how they would be met. Not all plans showed residents’ involvement in the review. Healthcare needs were monitored and referred to the appropriate agency. EVIDENCE: The care plans showed the good levels of recording. The files followed a standard format allowing easy access to relevant information. As changes occurred staff completed a short term care plan to address those needs. The files were accessible to all care staff. The files examined did not show that all residents or their representatives’ were involved in the review process. The residents spoken with were unable to recall involvement with the care planning but were aware that the staff maintain some records. Some of the files held photographs of the individuals but the manager was working to ensure that a copy was on each file. The records showed contact with GP and other community healthcare services. The residents said that the staff call for GP visits as required. The daily records were used to monitor any specific needs and the home had a process of conveying changing care needs at shift changeover.
Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 To encourage good nutritional intake the home offered a varied diet with good levels of choice and served in comfortable surroundings. EVIDENCE: Residents all said the standard of food was very good with at least two choices for each meal with other alternatives also available. The choice was posted in the dining room. The breakfast meal was served to suit individual preferences; some people had breakfast in their own rooms. Most people went to the dining room for lunch and teatime. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 17 For the protection of residents the organisation has a complaints procedure allowing concerns to be raised without the risk of recrimination. Residents were able to exercise their legal rights enabling them to participate in the democratic process. EVIDENCE: The organisation’s complaint procedure was on display in the entrance lobby. The home had a complaint file but there were no recent investigations. Residents said they felt they could raise concerns with the senior staff although none had recalled any occasion where it had been necessary. The chef spoke with residents each day about the food provided and took notice of the comments he received. The home held details about independent advocacy services. None of the residents said they needed such a service. All residents were added to the electoral register. At previous elections some people had visited local polling station in the last election several had selected the postal voting option. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 23 &26 The premises provide a safe and comfortable environment; adaptations were in place to promote independence. There were suitable and sufficient toilet and washing facilities allowing hygiene standards to be maintained. EVIDENCE: The premises were purpose built and all bedrooms offered for single occupancy. The home was well maintained and had an ongoing maintenance programme. The home had sufficient communal space on the ground floor comprising two lounges, a dining room and a conservatory. Several of the residents were using the dining room as a quiet area during the afternoon. The dining room lead out to the conservatory which was also well used. The areas were comfortably furnished. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 14 The bedrooms were of a variety of sizes and this was considered during the The bedrooms seen assessment to ensure any mobility needs could be met. had been personalised by the individual occupants by the use of furniture pictures and ornaments. The home had two assisted baths on the ground floor and a further four on the first floor. These allow for the safe moving and handling of residents. A record of bath temperatures was maintained and the hot water temperature was regulated. The home was warm and clean with no unpleasant odours. Residents said the staff tried to ensure that their laundry was correctly returned sometimes errors occurred but these were normally rectified promptly. The home had separate laundry facilities away from food storage and processing areas. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 The organisation has robust recruitment practices to ensure that the residents are protected from unsuitable appointments. EVIDENCE: The home had recently recruited several staff the organisation had a recruitment procedure which the staff followed. Each person had a confirmation of Criminal Records Bureau and Protection of Vulnerable Adults clearances and there were two references along with evidence documents used for identity checks. One new member of staff said that the application process and subsequent induction training was thorough. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 38 Procedures were in place to safeguard residents from financial abuse within the home. The organisation protects the residents and staff through appropriate health and safety systems and training. EVIDENCE: Standard 33 was not assessed on this occasion. The organisation had commissioned an independent quality exercise and the results were awaited. The previous requirement is carried over for consideration at the next inspection. The residents spoken with said that their families managed their finances; although the home did hold personal allowances for most people. A sample showed the balances held matched the transaction records. Expenditure
Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 17 included hairdressing, chiropody and toiletries. Receipts were retained for inspection. Fire safety records contained a risk assessment and evidence of system checks, maintenance and training. All were up to date. Accident and incidents were correctly logged and analysis carried out to monitor for trends. All care staff receive safe moving and handling training Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 3 x 3 x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x x 2 x 3 x x 3 Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 19 YES 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. 1. Standard OP33 Regulation 24 Requirement It is required that effective quality assurance and quality monitoring systems, based on seeing the views of service users, are put into place to measure successin meeting the aims, objectivesand statement of purpose of the home. Action had been taken to address this requirment which will be monitored on the next inspection. Timescale for action 31/10/05 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. Refer to Standard OP7 Good Practice Recommendations Care planning and reviews should show evidence of resident involvement. Castle Dene D55 S3901 Castle Dene V220845 160505 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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