CARE HOMES FOR OLDER PEOPLE
Castle Dene Throop Road Bournemouth Dorset BH8 0DB Lead Inspector
Trevor Julian Unannounced Inspection 29th September 2006 09:45 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.V314016.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 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.V314016.R01.S.doc Version 5.2 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 646540 castledene@care-south.co.uk www.care-south.co.uk 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.V314016.R01.S.doc Version 5.2 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. 18th November 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.V314016.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Friday 29th September 2006 between 09:45 and 17:00. The manager was on the premises throughout the visit. Before the inspection residents and visitors to the home were invited to complete comment cards to give their views of the home. Responses were received from 41 residents, 4 care managers, 2 GP’s and 23 relatives. Their views are included in this report. During the visit, information was obtained through discussion with residents, visitors, staff, the home’s manager, a tour of the premises and a review of records. In September 2006 the fee levels were between £425-£515 per week. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx What the service does well:
The home remains well run and provides a safe and comfortable environment for the residents. The home had a comprehensive pre-admission assessment process to ensure that those needs could be met within the home. The records kept in the home provided clear detail of the tasks undertaken to meet the needs of the individual. Healthcare needs were addressed by referral to the community healthcare teams. Comment cards showed the how maintained good links with the local surgeries and GP’s. Medication was safely stored and administered. Residents were treated with dignity and respect and there was a relaxed atmosphere within the home. The home had an activity programme and outings had been arranged during the summer. There was evidence that the staff were open to ideas from family and friends to ensure there were appropriate activities and pastimes for the individual residents. Food was described as very good with a good variety offered. Fresh fruit was provided and available to the residents. The residents and visitors had access to the complaint procedure although none of the residents spoken to had needed to use the process as they felt their concerns were addressed by raising them directly with the staff. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 6 The staff had been trained in responding to allegations or signs of abuse. The premises were clean and well maintained. The cleaning staff were trained in infection control procedures. Consideration was being given to changing the entry system for the main entrance. The home’s senior team was at full strength following a successful recruitment campaign. Agency and bank staff still covered vacant care and domestic posts. Staffing levels were appropriate to the needs of the residents. Staff said the organisation’s training and induction programme equipped them to meet the needs of the job. The home had a management team with the skills and experience to run a good service. The organisation carried out its own monthly checks at the home to ensure standards were maintained. Annually there was an independent quality audit which sought the views of those involved with the home. The last report showed that the home continued to provide good levels of customer satisfaction. Where needed, there was a system for managing the personal allowances for the residents. There were internal audits to ensure that any errors were quickly addressed. What has improved since the last inspection? What they could do better:
The home’s care plans held good levels of detail and gave clear indication of the tasks required to meet the needs of the individual. However, the files seen did not show the involvement of the individual or their representative. It was also noted that a decision had been made to cease a task without evidence or indication how the decision was arrived at.
Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 7 There had been staff changes in the senior team since the last inspection as a result the recording of monthly fire safety checks and inspections had not been recorded for the previous few months. The home had a number of shifts covered by agency staff, a check of the fire training records showed that an agency member of staff on shift had not had any fire safety training. 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.V314016.R01.S.doc Version 5.2 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.V314016.R01.S.doc Version 5.2 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. The home does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission process helps to ensure that a placement is only offered once the home has confirmed it can meet the assessed care needs. EVIDENCE: The file of a recent admission showed that a pre-admission assessment was completed to verify that the home had the facilities and capacity to meet the needs of the individual. A letter of agreement includes confirmation that the home is able to meet those needs. There were also Social Services care plans where appropriate. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to identify and manage the assessed needs of the residents. The home maintained good links with the community health care teams to help meet the health needs of the individuals. The home’s medication system helps to ensure the medication is correctly and safely administered. The rights of the individual residents were respected and upheld by the staff within the home. EVIDENCE: A sample of four care records was examined. Each contained good levels of information with the care plans including goal setting. They included information on social and spiritual needs. On one of the files there was
Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 11 information about religious preferences although there appeared to be no follow up. The daily reports recorded the care tasks undertaken. There were basic nutritional assessments and where a person was identified as having a poor appetite and low fluid intake nutritional charts were in place as a monitor. However, in one of the files formal nutritional monitoring had been stopped without explanation even though the individuals weight was still below their admission weight. The care records showed input by GP’s and community healthcare teams. The responses from comment cards showed the home had good links with these teams. There was information recorded about falls and incidents involving individuals. None of the care plans seen had been agreed with the resident or their representative. In discussion with senior staff they said that the senior team was now at full strength and that there were plans to address the issues and to ensure that the care plans showed that the resident had been involved. The medication system promoted the safe storage and administration of medication. On the medication records there were photographs of the individual and there were copies on the individuals medication holder this helped to ensure the medication was administered to the correct person. The records were well kept and up to date. Those records seen contained the required information and detail. Temperature sensitive items were stored in a refrigerator and the date opened recorded. Throughout the day, staff were seen interacting with the residents in a relaxed and friendly manner. Residents and visitors said they had found the staff to treat individuals with dignity and respect. There were appropriate locks on the bedroom doors to offer additional privacy. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of activities and pastimes to help promote social and mental stimulation. The home welcomes the involvement of family and friends to reduce the risk of residents feeling isolated. The menu offers a good range and variety of meals. Mealtimes were unrushed and the staff able to offer help and prompting as needed. EVIDENCE: One person had commented, “the employment of a person to organise games/outings etc has made a huge difference to my relatives enjoyment”. During the visit staff had organised a quiz which was enjoyed by several resident. During the summer the garden at the rear of the property was well used by the residents and visitors. One resident who was an avid gardener said that he liked to plant seeds and to help keep the garden tidy; he also gained great enjoyment from tending the bird table. For the most part people felt there were appropriate levels of activity and entertainment within the
Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 13 home many had enjoyed the outings arranged during the summer. The home was trying to re-establish links with local churches to help meet the religious needs of the residents. From discussion with visitors it was apparent that the staff work with families and are open to ideas about the appropriate activities and mental stimulation. Visitors said they were made welcome in the home at any time. Residents said that generally they were encouraged to retain as much control and choice in their daily lives as their circumstances allow. Staff were seen assisting residents with their meals in a discreet and unobtrusive manner, they were chatting and discussing daily life creating a supportive environment. All the residents describe the meals as good with appropriate choice. The daily options were listed on a white board in the dining room. The choices made by the residents were recorded and retained and included a note who had not taken a meal and the reason. One resident said that her appetite varied according to the choices offered. The four-week rota showed a varied diet. The sweet trolley had a range of desserts including fresh fruit. Some people were selecting fruit to eat later. Throughout the day, there was evidence of staff encouraging people to drink regularly and helping those who needed assistance. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 14 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisation’s procedures allowed complaints to be raised without fear of recrimination. Adult protection procedures were in place to help protect the residents from abuse. EVIDENCE: There had been no formal complaints recorded in the past year. No issues or concerns had been reported to the Commission. There was a system for recording complaints and investigation. Residents said the staff were approachable and that any concerns were addressed before they became bigger issues. The organisation had a procedure for responding to allegations or signs of abuse. Staff were aware of their responsibilities and the topic was covered during their initial training and during subsequent supervision meetings. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 15 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a safe, clean and comfortable environment. EVIDENCE: The home is maintained to a good standard. Any major works are included in the annual business plan. Earlier in the year there had been an unplanned situation in the home’s kitchen. There were no other planned alterations although consideration was being given to changing security arrangements on the front door. The situation was well managed and resulted in a major unplanned refurbishment of the whole kitchen area. All areas of the home were clean and in good condition; specialist hoists and lifting equipment in use in the bathrooms had been checked and serviced by approved contractors. The bedrooms visited had been personalised by the occupants using pictures,
Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 16 photographs and items of furniture from their former homes. The home was maintained at a comfortable temperature and the residents said that the home is kept warm over the winter months. The radiators remain uncovered and could present a risk of burns to the residents. Risk assessments had been completed to consider the hazard posed for the individual. Residents felt that the home was a good place to live and many enjoyed the conservatory and garden during the summer months. The residents said that the cleaning staff take a pride in their work and keep the place clean and hygienic. During the visit, one of the cleaners said that she was booked on an infection control course to ensure she and colleagues are kept aware of best practice. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 17 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, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was appropriately staff to meet the needs of the residents. The organisation’s recruitment process helps to ensure that the home employs suitable staff. Staff members undertake appropriate training to ensure that they are competent to carry out their work and residents are in safe hands. EVIDENCE: The home had recruited a full senior team and it was hoped that this would provide increased stability for the whole of the staff group. There were times, especially during weekends, when the home had a high reliance on agency staff but this was seen to be reducing. On the day of the visit there were two agency carers on duty one person was a regular at the home the other was on her first shift. The staffing rosters showed levels were varied during the day to respond to demands. The responses to the survey showed that generally people felt the home was adequately but some felt there were times when staffing levels should be higher. The organisation has a thorough recruitment process to ensure that all references and clearances were in place before new staff start work.
Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 18 New staff complete induction training to ensure they are competent to work in the home. Ten of the care staff had completed NVQ level 2 in care and a further 5 were part way through either level 2 or 3 in care. The staff spoken with said the organisation had a very good training programme which they accessed through the supervision process. The organisation arranged courses and updates for essential training e.g. manual handling, first aid food hygiene etc. as well as more specialist courses e.g. sight loss, dementia awareness, mental health awareness etc. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 19 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, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by a dedicated team helping to ensure that the resident’s best interests are always considered. The organisation’s quality assurance system ensures that the residents and others are able to give their views on the running of the home. Financial procedures help to protect the residents from financial abuse while in the home. The residents and staff are generally provided with a safe environment, however some shortfalls were identified and need to be addressed. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 20 EVIDENCE: The homes manager and senior team have the required skill and experience to ensure the home is well managed. The manager has completed the registered managers award and other training to help keep up to date with current best practice. The organisation has extensive policies and procedures to cover the day-to-day running of the home and there is a monthly visit carried out by head office staff to ensure standards are maintained. The home has an annual quality report completed by an independent person. The views of all involved in the life of the home are invited to comment anonymously if preferred. The findings are then reported back to the home and the organisation. Residents said they could raise concerns with the staff at any time during the year. The last QA report confirmed high levels of satisfaction with the services provided. The home looks after personal allowances for most of the residents this covers expenses e.g. hairdressing, chiropody etc. A small sample showed the cash held matched the transaction records and receipts. There were also regular internal audits carried out to promptly rectify any errors. The organisation’s training programme ensured that staff were trained and updated in health and safety systems and procedures. The home had systems in place for the testing and recording fire safety precautions in the home. Most areas were up to date however there had been no recent reports of monthly checks on the emergency lighting or fire fighting equipment, although the equipment had been checked and serviced by the contractor in the past month. It was also noted that agency staff do not always confirm that they had been trained in fire safety and evacuation procedures. The home had a fire risk assessment and the organisation had commissioned a contractor to carry out a review of the risk assessments on all the homes. Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 21 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 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Castle Dene DS0000003901.V314016.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement The registered person must ensure that fire fighting equipment and emergency lighting checks are completed and recorded monthly. The registered person must ensure that agency staff are given basic fire safety training before commencing work at the home. Timescale for action 30/11/06 1. OP38 23 (4) a 2. OP38 23(4) d 30/11/06 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 DS0000003901.V314016.R01.S.doc Version 5.2 Page 23 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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