CARE HOMES FOR OLDER PEOPLE
Castle Dene Throop Road Bournemouth Dorset BH8 0DB Lead Inspector
Trevor Julian Unannounced Inspection 18th November 2005 09:00 X10015.doc Version 1.40 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 Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 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 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 DS0000003901.V267558.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Castle Dene Address Throop Road Bournemouth Dorset BH8 0DB 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) 01202 397929 01202 726608 Care South Mrs Janice Marjorie Turner Care Home 50 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (40) Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 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. 16th May 2005 Date of last inspection 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 providing care services across the South West. 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 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 DS0000003901.V267558.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 18th November 2005 between 09:00 and 17:00. A regulation manager from the commission, also attended to assess the inspector as part of the Regulation of Care Standards Award. The time taken for preparation, travelling, inspection and report writing totalled 24 hours. The home’s manager had previously agreed to allow the assessment to take place although no date was given for the inspection. Before the visit comment cards had been received from residents, relatives and friends, GP, and care managers giving their views of the home. The responses showed high levels of satisfaction but issues were raised regarding hand nail care and activities provided by the home. These topics were considered during the inspection and the findings are included in this report. During the visit information was obtained from the manager, residents, staff and visitors. Further evidence was found through the inspection of the premises and records. This was the second of two statutory visits carried out during the inspection year. For information on key standards not covered in this report please refer to the previous inspection report. For the purpose of this report the terms resident and service user are interchangeable. What the service does well:
The home’s admission process considers the home’s ability to meet the identified needs of prospective residents. Prospective residents and their families were given good levels information about the services offered in the home. Records showed that there were appropriate referrals for community healthcare support. The records were clear and provided information to the carers about how identified needs were to be addressed. The records were securely held but accessible for reference by the care staff. Residents said they were referred to their GP’s as needed and they had been offered influenza injections by visiting community nurses. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 6 Residents felt their medication was well managed by the staff and none could recall any errors. Medication was safely stored; it was only administered by senior staff who had received appropriate training. Residents felt the staff treated them respectfully and this was also observed during the visit. Residents said they were able to express a preference for male or female carers providing personal care. They also confirmed that they were asked for their preferred term of address. They said that the call alarm system was answered promptly. Church visitors hold services in the home every fortnight and there were hopes that other churches may become involved. Residents said there was a good choice and variety of meals offered. The meal seen was well presented. Two people who had decided they didn’t want their meal were asked if they would like an alternative. The home was well presented and there was redecoration being carried out to maintain the good standard. The rooms seen were comfortable and had been personalised by the occupants. Specialist equipment was seen around the home, these included pressure relieving equipment, hoists, specialist baths, mobility aids, etc. The staff have access to a good training programme. NVQ training continued in order to meet the recommended level. All senior staff had the opportunity to attend Dementia care training and the carers were also trained in Dementia awareness. The manager and senior staff were clear in their plans for the home. They were aware of shortcomings and were actively addressing those issues. Residents and the staff found the management team approachable and welcomed their ideas and suggestions. The manager had monthly budgeting information and performance was discussed during supervision meetings. What has improved since the last inspection?
The home had recruited a new activity organiser and all the residents seen were very pleased with the range of activities offered. During the summer there had been trips organised and plans were taking place for trips to see the Christmas lights and boat trips during next summer. The home had been successful in recruiting permanent staff to reduce reliance on agency carers. The senior team had one vacancy but this was due to be filled shortly. There had been changes to the way nights were organised which were now covered by three wakeful staff.
Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 7 The organisation had completed a quality assurance survey of the home and a report had been provided to the Commission and the home’s manager. 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.
Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 3. An assessment of need for prospective residents is carried out. This is used to determine if the home can meet those identified needs in order to reduce the risk of incorrect placement. Intermediate care, Standard 6, is not offered in Castle Dene and was therefore not assessed. EVIDENCE: A sample of 5 files confirmed that pre-admission assessments were carried out and the recommended topics were considered. The manager confirmed that once the assessment had been completed a letter was sent confirming that the home could meet the needs. None of the residents spoken with recalled the admission process but one visitor confirmed that an assessment had been completed before admission; he had also been given an information pack about the home. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 10 The manager provided an information pack prior to admission. The document provided information on services offered at the home and contact details of the Commission. There was a leaflet on local advocacy services as well as information about the organisation. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 7, 8, 9, 10. Care records were in place to inform the staff how care needs were to be addressed. The home worked with community healthcare professionals in order to meet the health needs of the residents. In order for medication to be safely administered senior staff were trained in the management of medication. Staff treat the residents in a dignified manner in order to respect their basic rights. EVIDENCE: The care records sampled were clear and comprehensive. They showed good contact with healthcare professionals including community nurses and occupational therapists. However, none of the files showed the resident’s, or their representative’s, agreement with the care plan. The home had a system
Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 12 for managing and recording short-term changes in care need. Staff said that any changes were considered at shift changeover. One resident said that the staff arranged for GP’s to call as needed, she added that community nurses had given influenza vaccinations to those residents who had requested them. Senior staff managed medication. The records contained photographs to help ensure that the medication was administered to the correct person. The items were safely stored and no administration errors were seen on the records viewed. There was evidence to show that some handwritten amendments had been verified by a second person, however this was not always the case. The records supplied from the chemist did show residents’ allergies however it is good practice to record “none known” where that is the case. The manager was going to discuss this with the supplying chemist. Three of the residents said the staff managed their medication and there had been no problems. Staff training included principles of the fundamental right to choice, dignity, privacy independence, rights, fulfilment and respect. During the visit staff were observed talking and supporting residents in a dignified manner. Residents said the staff knocked on their doors before entering. They were also asked for their preferred term of address all those seen had opted to be known by their first names. One person said her preference was for a female carer to carry out personal care tasks and the carers respected this. Several people said the call bells were promptly answered. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 12, 13, 14, 15 Activities in the home were developed to meet the needs of the individual in order to provide mental and physical stimulation. The home encouraged contact with the community, family and friends to help the individuals not to feel isolated. Residents were encouraged to exercise as much choice as their circumstances allow, to help them feel valued. The presentation and choice meals in the home encouraged a good nutritional intake. EVIDENCE: The home had appointed an activity organiser. Following completion of her induction programme she was part way through Dementia awareness training. She had organised 4 trips out during the warmer weather and was hoping to arrange transport to see the Christmas lights. During the mornings group activities were arranged including quizzes, many of the residents enjoyed indoor bowls which was the activity on the morning of the visit. During the afternoons she spent time on one to one activities including hand care. At the
Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 14 time of the visit plans were being made to help with residents’ Christmas cards. Reminiscence therapy was used in the home but the activity organiser was aware of the risks associated with evoking some memories. The home has also employed a person who visits the home fortnightly to offer the residents in some gentle therapeutic exercise. Residents said there was a variety of activities for them; all residents seen said that hand-care was one of the one to one activities. The residents seen were well presented and one person said that she appreciated the help that the staff gave to maintain her pride in her appearance. The home has visits from local churches and it was hoped that these visits were to be extended. The home had an amenity fund used to cover the costs of birthday and Christmas presents, entertainment and other social costs. The home benefits from having a range of lounge space around the building including a smoking room. All bedrooms are for single occupancy allowing residents to receive their visitors privately if needed. One of the visitors seen said there were no restriction regarding visiting times but tended to avoid mealtimes. None of the residents spoken to had their finances managed by the staff instead they had help from their families. Information about independent advocacy was provided in the home’s information pack. Care records were safely stored but they were accessible to the care staff. Residents were very positive about the food provided at the home. During the visit two people had declined the midday meal and staff were observed checking if they wished for alternatives. The meals seen were of a good standard and well presented. It was noted, that being a Friday, of the three items offered for the main meal, two were fish. This reduced the level of choice offered on this occasion. Residents said they normally had a good level of choice and their were always alternatives available on request. One person said that sandwiches were available at supper time, 19:30, on request but didn’t feel the need. She added that fresh fruit was available. During the visit residents were regularly offered drinks. Food budgets were discussed, the home was working within the organisation’s budget. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 18 The organisation had procedures for managing adult protection matters in order to protect the residents. However, not all staff were aware of the process which could lead to errors. EVIDENCE: The organisation had a procedure for responding to allegations of abuse. The system was discussed with two new recruits. Both were aware of the definitions of abuse and the topic was covered in their induction training, however, it was clear that they were not familiar with the procedure to follow. This could result in problems with any subsequent investigation. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 19, 24, 25 The home was well maintained and generally provides a safe environment for the residents and staff. However, there remains a risk of burns from hot water pipes and radiators in residents’ bedrooms. The bedrooms provided a good standard of accommodation giving the residents’ comfortable surroundings. EVIDENCE: The main corridors and staircases were being redecorated to providing a suitable environment for the residents. Several rooms were visited during the inspection; all were in good condition. Window restrictors were in place on the first floor rooms and they worked correctly. The rooms had been personalised by the occupants using pictures and photographs, one person said she had been able to bring in some of her own furniture. Most rooms were carpeted but some carpets had been replaced by a vinyl flooring to aid cleaning.
Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 17 Hot water pipes feed the radiators heating the bedrooms. The manager said that there had been risk assessments for individual residents, these were not examined during this inspection, however, the risk assessment did not consider the topics as identified by the Health and Safety Executive. A cleaner said the home had specialist carpet cleaning equipment which was used to maintain the carpets in very good order. The cleaners worked to a roster to ensure weekends were covered. The residents spoken with said that the home was maintained at a comfortable temperature night and day. They found their beds comfortable. One person said it was a quiet place during the night. Pressure relieving mattresses, hoists, specialist baths, bed levers were seen in place during the tour of the premises. The lifting equipment had evidence of testing and servicing carried out by approved contractors. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 18 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30 Proposed increases in staffing levels will bring the levels in line with recommended levels for the size of home. The care staff were receiving appropriate training in order to provide care and support for the residents. EVIDENCE: Since the last inspection the manager had arranged for increasing staffing levels, as there had been a steady rise in occupancy levels. At the time of the visit negotiations were underway to try to employ staff for the equivalent of an extra 1.5 care shifts. Rosters showed that staffing levels were varied during the day to match the needs of the residents. There had been success in a recent recruitment drive. Vacancies were covered by staff working extra hours, the remainder by bank and agency staff. The home tried to use the same agency staff in order to help with continuity of care. Over a two week period the home had 17 of care hours provided by agency staff. This was expected to fall as the new staff were able to work unsupervised. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 19 The senior staff team had one vacancy which was due to be filled shortly after the visit. As a new management team they were settling into their roles well and were clear about their responsibilities. In discussion with one new Care Team Manager it was clear that she was able to offer ideas and suggestions. A new post of Night shift leader had been introduced increasing the number of waking carers on duty at night. This improvement had been welcomed by the care team managers and was commented on by the residents. As the home had recruited a number of new care staff since the last visit, there were less than 50 of care staff with NVQ level 2 but there were plans to address the matter. At the time of the visit there were 7 that had achieved the qualification, 4 were part way through and another was nominated. New staff were being nominated once their trial period had been completed. The senior staff and activity organiser had access to specialist Dementia training; the carers were given Dementia awareness training. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 20 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34. The home is well managed; the senior team had identified and were working on areas for improvement. Residents and others involved in the home were consulted on the running of the home in order to ensure the home was run in the residents’ best interest. EVIDENCE: The manager had experience from managing another care home before moving to Castle Dene. She had completed suitable qualifications to manage the home. The manager had introduced improvements into the home and there had been an increase in occupancy levels as a result. Staff seen during the visit said they had confidence in the senior staffing team who were always on hand when needed. Residents said they were able to go to the manager if they had any concerns.
Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 21 The manager was supplied with monthly financial reports and performance was discussed in her supervision meeting. These reports were seen and showed the home was generally working within the organisation’s budget. The organisation had a system of monthly visits from head office staff to monitor standards. A copy of their report is forwarded to the Commission and the home’s manager. The manager is required to inform the Commission of any significant events in the home that affects the residents, these notices had been regularly provided, but in recent weeks there were delays in providing them. Advice was given and alternatives were suggested. It was noted during the visit that fire extinguishers were overdue for their annual service. The matter was in hand as the contractor had also overlooked other homes. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 22 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. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X 3 2 X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 3 X X X X Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 23 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 OP38 Regulation 23 (4) c Requirement The organisation must make arrangements for annual checks and servicing of fire fighting equipment. Timescale for action 31/12/05 Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 24 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 4 4 5 6 Refer to Standard OP7 OP9 OP9 OP18 OP25 OP31 OP33 Good Practice Recommendations Care planning and reviews should show evidence of resident involvement. Handwritten amendments to the medication records should be verified by a second person to reduce the risk of transcription errors. Medication records should record any allergies or marked as none known. Staff should be reminded of the adult protection procedure in order to ensure that allegations are responded to in the correct manner. Risk assessments relating to hot surfaces should include the topics identified by the Health and Safety Executive. The manager should ensure that significant events affecting the well being of the residents’ should be notified to the commission within 24 hours. The quality assurance survey report should be used to identify areas to be improved. These improvements should be included in a formal annual development plan. Castle Dene DS0000003901.V267558.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Poole Office 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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