Inspection on 29/07/08 for Castle-Ford

This inspection was carried out on 29th July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Castle-Ford 30/01/08

Castle-Ford 07/11/06

Castle-Ford 30/11/05

Castle-Ford 09/06/05

Castle-Ford 07/12/04

Castle-Ford 06/07/04

Castle-Ford 22/01/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

CARE HOME ADULTS 18-65 Castle-Ford 46-48 Princes Avenue Withernsea East Riding Of Yorks HU19 2JA Lead Inspector Janet Lamb Key Unannounced Inspection 29th July & 7th August 2008 09:40 Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle-Ford Address 46-48 Princes Avenue Withernsea East Riding Of Yorks HU19 2JA 01964 613164 01964 612412 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) Mr John Frederick Wright Christine Wright, Mr Mark Anthony Wright, Duncan Joseph Wright Mr Mark Anthony Wright Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 2008 Brief Description of the Service: Castle-Ford is a privately owned registered home catering for the needs of 18 people who have a learning disability. It is located in the seaside town of Withernsea and is within walking distance of the local shops and public transport. The home consists of three terraced properties converted into one building. There is a reasonably private garden and adjacent car parking. Accommodation consists of several lounges, an activities area, a sensory room, 4 double rooms and 10 single rooms none of which have en-suite facilities. There is no stair lift or hoist in the home, people who have mobility problems are situated on the ground floor and have access to bathroom and toilet facilities on the ground floor also. The home does not provide nursing care. The fees charged are £299.00 per week, following a withdrawal of Quality Development Scheme funding from East Riding of Yorkshire and Hull City Councils. An additional charge is made for newspapers/magazines, hairdressing, chiropody, and sweets. Information on the service is made available to people via the statement of purpose, service user guide and inspection report. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1-star. This means the people who use this service experience adequate quality outcomes. The Key Inspection of Castleford has taken place over a period of time. It involved electronically sending an ‘annual quality assurance assessment’ (AQAA) document to the home June 2008 requesting information about people and their family members, and the health care professionals that attend them. It also asked for numerical data held in the home. We received the requested information on 23 July 2008 but survey questionnaires were not issued on this occasion, as there was insufficient time to do so and they had been requested at the last key inspection carried out in January 2008. On the 29th July and 7th August 2008 Janet Lamb, visiting Inspector, carried out a site visit, to check out all of the information the Commission has received since the last key inspection. On the 29th July Steven Robinson, an Expert by Experience was also present to determine his view of what living in the home must be like. All of the information received has been from the provider, people living in the home, East Riding of Yorkshire Council (ERYC) and Hull City Council (HCC) staff and officers, physiotherapists, occupational therapists, and also from information already determined at the last key inspection. Information obtained during observation and interview held on the day of the site visits has also been used to inform this report. Several people living in the home, the manager, staff and visitors were spoken to over the two days and some interaction between people and between people and staff was observed. The communal parts of the home were inspected, and everyone’s bedrooms were viewed with their permission. Care plans and all other documents relating to people, risk assessment documents and some records, etc. were read and staff files and training records were seen. All personal and private documents were only seen with the permission of the people they belong to. Safety maintenance certificates and records were also viewed. What the service does well: Most of the people have lived in the home for a number of years and have been cared for by some of the same staff. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 6 People are satisfactorily assessed according to a specific assessment tool and their needs are well recorded in a person centred plan of care, which reflects those assessed needs. There are satisfactory contracts of residence in place. People are encouraged to maintain appropriate relationships with relatives, friends, acquaintances, staff and each other. People say they receive the support and care how they want to receive it. Medication administration systems are satisfactory and follow a robust trail. The quality assurance system is used well to seek peoples’ views via surveys. The health, safety and welfare of people and staff is satisfactorily promoted and protected. What has improved since the last inspection? The service is now reviewing peoples’ care plans six monthly, though the placing local authorities are not involved in this at the moment. ERYC and HCC are providing support in compiling new care plan and health action plans and expect these, once in full operation, to be the plans that undergo regular review. There are now new risk assessment documents in place for individual people that require them and for areas where several people may be at risk. The service is now maintaining records and documentation more securely and in line with the Data Protection Act 1998. Peoples’ religious and cultural needs are now identified in the new personcentred plans in place. Menus and meal provision has improved since the last inspection, with the employing of a cook and implementation of new menus. There is a new a six-monthly maintenance check contract in place for the lifting equipment. The service now has written protocols in place for people that take medication as required, and not according to prescribed times. There is a new medication administration policy, which contains selfmedication and homely remedies. It has been endorsed by the local pharmacist and is soon to be implemented. There is a new written/pictorial complaint procedure and booklet available, and this is soon to be implemented. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 7 Three of the staff has received external safeguarding adults training with ERYC safeguarding adults’ board and more are planned to complete it. Staff training has been identified and those without induction and mandatory training courses are steadily working through both. There are dates planned for almost all of the training identified. Recruitment practices have improved, though measures have been put into place for the event of a staff member being employed on only an initial security check, which is only to be used in absolute emergencies. Areas related to the promotion and protection of people and staff’s health, safety and welfare, have been improved. What they could do better: The service could ensure that peoples complex health needs are met by the provision of health screening, health action plans and access to health professionals, so people are confident their health care needs are properly met. It could ensure that all staff that need it have received training in the management of medication and that they are assessed as competent, so people are confident they are safe from harm. The service could ensure that all staff receives training in safeguarding adults, as mandatory training, so people are protected from harm, abuse or neglect. It could ensure that the home has an effective staff team with sufficient numbers and skills to support peoples assessed needs at all times. Staffing levels must be regularly reviewed to reflect changing needs. The service could ensure that all incidents that affect the health, safety and wellbeing of the people that live in the home under regulation 37 are notified to the CSCI, so people are confident their health, safety and welfare is being monitored. It could undertake regular visits to the care home and prepare a written report, which is sent to CSCI to ensure that the owners are monitoring the standard of care and quality of service being provided, so people are confident the quality of their care is assured. The service could make sure when assessed needs are confirmed in writing they can be met, that they are met at all times. Having sufficient staff to meet people’s needs is the only way this can be achieved. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 8 It could enable people to make decisions about their care and take into account their wishes and feelings, so they know their decisions are respected. The service could after consulting people about their social interests, enable them to participate in local social and community activities by ensuring there are enough staff to support them, so people know their individual needs are met. It could maintain the home in a good state of repair: refurbish the toilet and bathroom on the upper floor so people are able to use it again, eradicate the damp odour from the double ground floor room, redecorate bedrooms as identified and replace carpets where identified, and make sure the room without curtains is made private, that it is redecorated and a new carpet is fitted, so people have privacy and a pleasant environment to live in. The service could make sure recruitment procedures are properly followed and only begin staff once their CRB check has been requested and a POVA first has been received. It could make sure staff complete the planned training, so people know competent staff are supporting them. The service could make sure all staff receives two fire safety training drill instructions in every twelve month period and that they sign on completion as evidence they have done the training, so people know competent staff are supporting and protecting them from the risk of harm from fire. It could make sure the statement of purpose is up to date in respect of the procedure for making representations/complaints and who to make them to, so people are confident they will be listened to. It could improve the opportunities for people to lead more independent lifestyles, taking risks if necessary and within risk management systems, so people are confident their individual needs are met. It could make sure new menus in place support and satisfy people’s dietary needs over a period of time by using the quality assurance systems, so people are confident their needs are met. It could fully implement the new complaint procedure by making sure people understand their rights to complain and exactly how they can complain, so people are confident they will be listened to. It could update the home’s maintenance and renewal programme and implement it as required, so people know the home is well maintained. It could make sure the garden is maintained and the fencing and gate is repaired, so people are able to use it safely. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 9 It could continue to provide staff with mandatory and other related training to skill and equip them to care for people with complex learning disabilities and associated conditions, so people know their needs are met. It could make sure the manager achieves the recommended qualifications. It could use the homes quality auditing system more effectively to highlight areas for improvement so people know the service is being properly monitored and assured. 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. The summary of this inspection report can be made available in other formats on request. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People have reasonable information about the home, so they or their relative are able to make an informed decision about whether the service is right for them. The use of needs assessments means that potentially people’s diverse needs can be identified and planned for before they move to the home, so they are fairly confident their needs will be met, but staffing levels do not enable needs to be met fully. The contract of residence provides people with some protection that the service on offer meets their needs. EVIDENCE: There is a statement of purpose and a service user guide in place, but these were not inspected or assessed. It was noticed that the details for making representations or complaints needs to be up dated. The provider has the responsibility to make sure they meet the requirements of regulations 4 and 5 and schedule 1 and it is understood they do. Assessment documents required by standard 2 are available in the home’s format for all people and some were seen in files. There are still no copies of the placing local authority assessments carried out, as at the last inspection, Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 12 but new assessments to be carried out have not yet been completed. One old document was viewed for one person and was dated Nov 1998. The homes assessment contains fifty areas of need from mobility, dressing self, can change own clothes, continence etc. to diet, concentration level, handle finances, sporting ability, religious belief, social interaction, behaviour, motivation, family contact etc. and has a simple tick box scoring of 0 – 5 (0 being totally dependent/incompetent and 5 being independent/healthy/strength). The home also uses a checklist that contains 27 activities from watching television, doing craft work, receiving visitors, attending day centres, etc. to visiting museums and social clubs, going to parties, shopping, playing cards and board games, etc. Neither form provides opportunity for prose information. The home now provides written documentation that people’s assessed needs can be met by the competence and skills of the staff group, as required of regulation 14(1)(d). However, staffing levels do not enable needs to be met fully. In the circumstances the home has achieved what it is able to in terms of acquiring any statutory assessment document completed for people. Contracts seen in files x 2 were both dated 30/08/05 and were signed by people living in the home. There are two files for each person – a working care plan file and an archived file. Some contracts and assessment documents were also seen in the archived files for other people. Standards 1, 2, 3 and 5 are adequately met. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Peoples who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People enjoy making some of their own decisions in life, with risk assessments being put into place where necessary that enables them to lead lives of reduced risk. Care plans are now improved for everyone to reflect needs better and these are reviewed as requested, necessary or in line with the requirements of the providing authority. EVIDENCE: Evidence of new person centre planning care plans is now in place for everyone and their needs have been reviewed without the involvement of placing local authorities as they are not attending reviews in the home because of dissatisfaction with the service and with the progress being made. Requirements made at the last key inspection were very much in relation to setting up of care plans that reflect the diverse needs of people and especially Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 14 their particular conditions, as well as showing how risks are managed. Support and information has been supplied by the contracting local authorities over the last six months to enable the home to set up new person centred care plans, based on reassessment of needs. At the time of this key inspection we were told that all peoples’ case files have been set up anew and include the new person centred care plans. Four of these were seen and inspected. New care plans follow the format of admission details, professional health contacts and details, a personal history, personal care needs (nine areas), daily routines and social activities, health care needs (seven areas), communication, a bereavement plan, behaviour, religious and cultural needs, safety issues, finances and relationships. There are also risk assessment documents that include personal and generic areas of risk. Care plans also contain some records for such as monitoring of health professional visits or appointments, a person’s weight, activities and outings undertaken, personal bodily functions, and checks on their individual equipment. There are satisfactory risk assessment documents in case files and all of the ones seen in one file were dated either April 2007 or Dec 2007 and were reviewed April 2008. There is evidence within diary notes of people taking risks – some go out alone, others manage their personal care themselves, etc. Those with less ability though need to be encouraged more to be independent and to risks if they choose. A generic risk assessment file, seen for the house, contains documents on Fire Safety and Health and Safety, as well as others on such as working in the kitchen etc. There are still no health authority ‘continuing nursing’ care plans in place, as peoples’ health care needs are still being assessed anew. See standard 19 below in the section on ‘personal care.’ There are no specialist care plans in place for any particular medical condition or learning disability people may have, but the person centred care plans are a good start. People now have management programmes in their case files, for such as health issues, behaviour patterns etc. compiled by the home, but the actual implementation of these needs to be sensitively and accurately facilitated to ensure people are making informed decisions for themselves on a wider scale and on a daily basis. People were observed making decisions about going out, taking a bath, what to eat, what to do and who to interact with etc. The home needs to make sure it records the decisions people make on a daily basis and also when they are assisted in decision making by external professionals, bodies or agencies. The comments received from the visiting Expert by Experience are as follows: Individual choice: Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 15 “People could go to bed when they wanted to (I saw one go to bed in the afternoon) and they could lock their doors if they wanted to which is good. There were two sets of people who shared a bedroom, two to a room. I was told that two of the people who shared had asked to be together, but I do not think the other two had a choice. Those who were more independent could do what they wanted, as far as I could tell from what I saw and what I was told, but people who needed support to do what they wanted did not seem to get it because there were not enough staff. I think they need more staff.” Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People enjoy some level of satisfaction in their lifestyles that are partly of their choosing, with support from staff where necessary. So they are relatively confident their needs are met. EVIDENCE: Discussion with people, the manager, provider and staff and viewing of case files and documents reveals people try to live the lifestyle of their choosing. Staff sometimes guide them in this. Care plans and case files now include information on peoples’ religious and cultural needs, so the requirement to make sure these are identified and met made at the last key inspection has itself been met. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 17 People in the home have a mixture of abilities and some engage in community activities or learning etc. E.G. people attend the ‘Red Disco’ at Hull University every month and Mensoc at Withernsea High School. Some people go out in small groups to such as to Hornsea, take outings with relatives, or attend Victoria Day Centre as two people did on one of the days the home was visited. There are also some in-house pastimes – dominoes observed being played, watching television, listening to music on the radio, and a weekly Tuesday group of bible reading, held by local Jehovah’s Witnesses because one person in the home is a witness by religion. One or two people go out to the local Christian church. Everyone goes to the local shops, chemist or supermarket to help staff or the providers if they want to – individually or in twos and threes. People interact differently and at different levels. Some converse well and enjoy full sharing of time and activities, others do not speak or communicate well except to indicate their needs to staff that have learned to understand the signals. Most people have good links and relationships with family members. People stay over at weekends with family or take day trips out with them. Diary notes show all of this activity and people are happy to talk about their pastimes and outings. Peoples’ freedom of choice in their daily routines is sometimes limited and staffing levels being as they are (see the section on ‘staffing’) often means there are times when people must be up and ready for the day if they are to take part in activities, attend centres or classes etc. Sometimes people have to fit their individual requests around the group’s needs, or they do not have their requests met at all, as with one person who expressed a need to go out more but the support is not available. Staff in their present numbers cannot support people if they are to get through the volume of tasks that present on a daily basis. This restricts the scope for individuals to lead flexible and wholly individual lifestyles. The low levels of staffing are greatly responsible for this. The fact that new care plans have been set up enables staff to think more widely about helping people to identify new interests or ones that have been lost. Unfortunately they cannot always be realised. Over the last few years there has been no cook employed so meals have been processed foods heated when needed by staff. One of the care staff has recently taken over the role of cook, however. New menus are in place and shopping is now done locally to involve people more in the process and the routines of the home. Meals are regular and informal, and always take only as long as the people in the home need them to take. Generally people do not complain about food provision and seem to be Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 18 accepting of what is on offer. However, this is an area where staff could assist people to exercise more choice and be recorded in their health action plans. There is a small kitchen off the dining room that has fitted units of domestic style and is equipped with the necessary domestic electrical items and tools. There is a door from the kitchen to the outside of the property, and a small pantry containing freezer and dry stores. People living in the home tend to assist with pot washing and laying of the tables etc., but they do not help prepare meals. There are some opportunities to bake or cook as an activity though. Satisfactory hygiene practices are encouraged amongst the people living in Castleford and staff have completed food hygiene certificates, via the Mulberry House package in April 2008, and done infection control training. The comments received from the visiting Expert by Experience are as follows: Food, drink, shopping and housework: “I did not see the residents eating, but staff told me everyone chooses what they want to eat, on the night before, but usually change their minds on the day, and they still get what they want. A member of staff told us that certain people always went shopping. Staff said that people chose whether or not to do their own washing, or to have it done for them.” Activities: “People were quite independent, and went out to different activities in the day, but others could not go on their own, and there were not enough staff for them to be able to do what they wanted. I think they need to get more staff so that people will get support to do the things they want to do. I was told that they no longer had their own bus because they could not get anyone to drive it. I think that the home needs to have its own transport. The staff told us that they have a lot of parties, and that they all loved parties. There was one being planned at the moment, to take place in the pub.” Socialising: “The manager said that the people who lived in the home could not have visitors staying overnight. I think this is wrong, as they should be able to have visitors staying overnight. Some of the residents did not seem to know this, and one of the staff said that she did not know if they could or not, because no one had ever asked when she was there. I saw one visitor, who came from the other home, which was run by the same people. I heard about another visitor, because one of the residents said that her boyfriend came for dinner every Sunday, and he lived in the other home. She said he was her only visitor. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 19 I heard they had a lot of parties, and were planning one at the moment in the pub.” Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People now enjoy an improved and adequate level of support and protection with their health care and personal care, and with administration of their medicines, so they know their care and health care needs are met, but there is still room for improvement in this area to ensure needs are thoroughly and well met and practice is safe. EVIDENCE: Discussion with people, the manager, provider and staff and viewing of case files and documents reveals people now receive a more satisfactory level of support to maintain their personal and health care. Most people in the home require more support with their personal and health care than actual assistance with it. There are one or two others that do need hands-on physical assistance and help to maintain personal and health care. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 21 Those that are self-caring may only require prompting and guidance on how well they should be carrying out a task. They speak of receiving satisfactory support to maintain a healthy wellbeing. One said, “I look after myself with washing, shaving. I have to be careful with my hip though.” Another said she was quite satisfied with the assistance she receives to bathe and didn’t mind which gender of staff. This is an area where the staff can improve the dignity of people though if they make more effort to provide personal intimate care from people of the same gender. There is now more information held in people’s care plans that show their preferences on getting up/going to bed, bath times, meal likes/choices and activities, what specialist equipment they require if any etc. Any specialist nursing intervention is provided by the District Nursing services, following referral from a GP. The home has been provided with support from the Community Team for Learning Disability and has improved and increased the level of activity in respect of meeting people’s physical and health care needs. Some of the people spoken to are aware of their documentation and remember the processes they have gone through in respect of having assessments and care plans put into place. Health action plans have still to be completed fully, but these are being worked through with support from an East Riding of Yorkshire Council Community Team for Learning Disability Nurse. Also ‘best interest’ meetings are being held for some people, though these are taking time to arrange and hold. Not everyone has a health action plan yet, but two staff have now received the training in compiling them and others are soon to be instructed. People in the home are also taking part in putting these together. One went through her health action plan with us. There are records that show visits from GPs and District Nurses, to the local surgery, to dentists and chiropodists, and hospital appointments though. People speak of seeing the optician, the dentist and chiropodist and express satisfaction with new equipment and even the attention involved in the process of obtaining new glasses or false teeth, etc. Much more is now happening for people in respect of health needs and diary notes show this. There is a medication administration policy and procedure for staff to follow, but it has been rewritten to include self–administration of medicines, and has been submitted to the local supplying pharmacist for validation. People in the home say they prefer staff to be in control of medicines and to give support in taking them, so self-administration does not take place. Storage is satisfactory for the moment, as the pharmacist has checked temperatures generated by the kitchen, (medicines are in the pantry within the kitchen). Staff still check them and record their findings. Storage may Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 22 only need changing to a designated medication fridge if drugs requiring much cooler storage are used. At the moment there are no such medicines held and eye drops and topical cream prescribed is held in a plastic tub in the main fridge. Medication administration practices are satisfactory – sample signatures are held, pictures of people are available with administration record sheets, there is a control drug register, returns are recorded and signed for, stock controls are maintained and start of drugs is the same for each month, and the number to be taken is highlighted. Two signatures are made for administering one particular drug that is not a control drug but still a potent one. There is a protocol in place for as required medicines for one person. One person takes the administering card with them when they go out with family or stay over etc., as they are the only person on lunchtime medicines, and the administration record sheet shows this happens. A photocopy of the record sheet is sent with him for family to complete. All staff that administers drugs have received medication administration training via the Mulberry training manual and they are designated to administer drugs. There is still no evidence they have been competence assessed though. However, the manager has been offered access to the Hull City Council Training Diary courses, of which medication administration will be taken up for all staff that give out medicines, once the course has been booked. This will ensure staff are competence assessed. Meanwhile the manager has been given funding to have staff complete a management and safe handling of medicines course at level 2 with Leeds College, where competence assessment is external. Either or both of these training options are suitable. There are no controlled drugs in the home at the moment, but if there were it is expected they and all other medication be handled in line with the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the Misuse of Drugs Act 1971. A controlled drugs register requested at the last key inspection has now been acquired in the event they are prescribed. Controlled drug storage is not necessary unless controlled drugs are prescribed and then the home has approximately three months to obtain a suitable metal cabinet. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People and their relatives have access to satisfactory complaint and protection systems within the home, which have been improved. They are fairly confident their concerns are dealt with appropriately and that they are protected from harm or neglect. EVIDENCE: A new complaint booklet has been devised since the last key inspection in picture and written format and this is to be discussed and read through with each person in the home, to ensure they understand how they can complain. The booklet is yet to be published so people have not had a chance to read/look through it yet. This process must be completed. People spoke freely about talking to the staff or the manager if they are unhappy about anything and everyone was observed to be cheerful and generally quite satisfied with their routines and activities. There is a complaint book in place, but we are told there has been no complaint made for some years, so it is empty. There is also a safeguarding adults’ policy and procedure in the home that staff are aware of and would follow. There is a Hull and East Riding Safeguarding Adults’ Board procedure in place. Discussion with staff reveals they are fairly well aware of their responsibilities and why and when to pass on any Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 24 information to the appropriate safeguarding adults’ team. They have a whistle blowing policy and say they would use it to protect people. Up to now safeguarding adults’ training has been via the Mulberry Care booklets and question sheets, but this ought to be supplemented by an external source where possible and annually. The manager and three staff have done the Safeguarding Adults’ Board training – 22/11/07 and 14/05/08. Though staff demonstrate a good understanding of their responsibilities and the procedures more of them still require a more thorough training course on an annual basis. There have been no safeguarding adults referrals since the last inspection. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People live in a satisfactorily furnished and equipped home, that is clean, safe and comfortable, though it could be made better if the upper floor bathroom facilities were refurbished, some carpets were replaced and the dining room were redecorated. The home offers sufficient space, but not facilities so people are only potentially able to lead independent lives. EVIDENCE: People spoken to are satisfied with their rooms, those that share are very used to sharing, and are very accepting of what they have. They speak of their possessions freely and take pride in what they have. Rooms seen are generally clean and comfortable and colour coordinated. One room seen had no curtains at the window, as the person in here prefers this. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 26 We discussed need to have some alternative privacy for the person – film fixed on the glass to allow light in and the view out to be seen. The film needs to reflect from the outside so no one can look in, especially at night. This room also needs a new carpet and redecoration. Requirements are made. There is malodour in one single room on the ground floor, and very bad malodour in one double room on the ground floor. A humidifier has been put into use for much of the time and a damp course has been done, but still the room has a very damp odour present. A requirement is made to take some alternative action to rectify it. One double room used by two females on first floor also needs a new carpet. The bathroom and a single toilet on the first floor also need some major refurbishment and redecoration, as toilet is kept locked and bathroom is out of use, because equipment in them is not useable. Pipes need boxing in, floor surfaces and ‘bathroom furniture’ need replacing etc. Requirements are made. The manager says there is a renewal programme but it needs updating. A recommendation is made to make sure it is updated and followed. The dining room is now desperate for some redecoration. A requirement is made. Generally the house is clean and comfortable, with the exception of the dining room and some carpets in bedrooms. The comments received from the visiting Expert by Experience are as follows: Environment: “I did not like the way the house was. It had a lot of stairs and little passages and funny places, and it felt a little bit creepy. Some of the rooms smelled of different things, including a bedroom, but they said they had called in people to stop it being damp, and the people had said they could not do anything about the smell. The carpets were too old, and I think they should get new ones. Everywhere was tidy. Some people chose their own decorations in their rooms, which is good, but some had the decorations chosen for them. However I was told that the staff chose things that were the sort of things that they knew the people liked. The garden needed an awful lot of work doing. The manager said it was going to be done, but she did not say when. There were holes in the gates, I think they were made by local kids, this would make me feel very unsafe if I lived there (but I was told they would be fixed soon).” Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 27 Recommendations to repair the fencing and gates, and to improve the garden facilities are made. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. People who use the service experience poor quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People are not cared for by staff in sufficient numbers to meet their needs. Staff are now recruited better and training opportunities are improved though and staff are adequately supervised to do the job. Overall people cannot be fully confident they are safely cared for. EVIDENCE: It was expected that improvements since the last inspection would be great in this area. However, no increase in staffing levels has taken place at all despite staffing in the sister home being closely monitored, and the provider/manager stating that Castleford is undergoing the same changes as the sister home in all areas identified for improvement. Staff qualifications were discussed with the staff and the manager and staff are keen to do training and learn new skills, and they say opportunities have been good since the last inspection. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 29 All of the Mulberry Care training packages have been worked through since then and some new skills courses are being accessed from Hull City Council’s training diary. Some training has already been done and other training is planned for the coming months. Leeds College is offering medication administration training, while BILD is being accessed for crisis prevention and intervention training. Autism and communication are to be done with Hull City Council. There has been a slight improvement in skills development and staff feel positive about what they have done and are to do. Mandatory training is usually completed through the Mulberry House courses. Training completed so far includes - manager plus 3 staff have done safeguarding adults 22/11/07 and 14/05/08, five staff have done autism 30/07/08, four staff have done fire safety 01/07/08 and one on 01/08/08. The manager and seven staff have done the Mental Capacity Act residential training set April 2008, five staff have done epilepsy awareness 25/06/08. The home holds other details on health action planning and training the trainer on moving and handling. Training yet to be done includes the manager and six staff doing Certificate in Management of Medicines, (this started 03/07/07 and runs for 3 months), and eight staff to do first aid in Aug 08. One staff is currently doing the Learning Disability Qualification. Staffing levels were discussed with staff and the manager, and staff say more on shift would be better, as at the moment only basics get done. They say there is good staff morale now though considering the happenings of the past few months. The provider/manager says there has been no increase in staffing levels because of implicated costs and reductions in placing authority fees paid at the present time. The provider/manager has only recently been looking at employing agency staff and recruiting new staff. This is not good enough, as the provider/manager should have been keeping abreast with the sister home, where staffing levels and other areas for improvement are concerned. The fact that people spoken to say they are not supported to go out enough, that only two staff were on duty the day of the first site visit, and that people had no supervision while staff were bathing or preparing the mid day meal etc. is evidence there is insufficient staffing hours provided each day. Two staff for 18 people with differing degrees of learning disability and a wide range of levels of need, is not enough to meet people’s needs properly. Recruitment of new staff has been poor in past and evidence seen for this inspection indicates the same continues to be the case. One staff’s application is dated 11/03, contract dated 03/04, and their security check is dated 09/04. Another staff’s application is dated 06/03 and their security check is dated 01/04. Staff were in post and working with a contract before their security checks had been received. However this was noted at the last inspection and Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 30 any checks on long standing staff at this inspection will produce the same results. Practice has improved slightly and systems are in place to make sure where emergency recruitment takes place staff are supervised. One new staff taken on since the last inspection had a security check done under Nexus Umbrella body and was working on shift under the initial security check before the main one had been obtained. They were being supervised and never left to work alone, and records of the supervision were made. The management are now more measured about security checks, as when an agency staff arrived for induction they sought advice regarding her clearance. Training and development of staff has been looked at in standard 32 above and is assessed as adequate. The comments received from the visiting Expert by Experience are as follows: Staff and residents: “The staff seemed very nice, very friendly and very helpful. The residents also seemed very nice and very friendly. They seemed to be very happy in the home, they smiled and laughed a lot, and everybody seemed to be getting on together very well while I was there. However, I found the residents very difficult to talk to, I thought they were very shy, and it made me feel a bit shy. I have not found people difficult to talk to like this in any of the other care home inspections I have been on. When I asked questions that could be answered with ‘yes’ or ‘no’, they mostly just said ‘yes’ or ‘no’, and when I asked questions that could not be answered with just ‘yes’ or ‘no’, and they often did not answer, or they would answer with a joke instead of information, and sometimes staff would answer for them. It is clear that they do not meet many people. I think they need another manager to cover when the first manager is off, instead of having to get the manager of the other home, as well as more general staff so that people can get enough support to do the things they want to do.” Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 31 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to this service. People enjoy some benefits of an adequately run home, but this is an area where much improvement can still be made. The quality assurance systems are good for determining the quality of some of the service provided, but fall down in other areas and again more improvement is possible. Peoples’ care needs are only adequately met and so they only lead relatively fulfilling lives. Promoting and protecting of peoples’ health, safety and welfare is adequate, though could be better. EVIDENCE: The manager of the home does not yet hold NVQ level 4 In Care, or Management, and has tried twice to undertake the NVQ level 4 Registered Manager’s Award. He has been the provider/registered manager for some Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 32 years. Efforts are being made to make sure the NVQ level 4 Registered Manager’s Award is signed up for as part of the Commission’s and the two placing and supporting councils recommendation. The provider/manager is doing some of the courses on offer with Hull City Council and has completed safeguarding adults training with Hull & East Riding Safeguarding Adults Board. There is a quality assurance system in operation that involves quarterly audits of all records held and paperwork in use, sending of surveys to people, relatives and staff, and holding of management meetings. Surveys have been sent out monthly for the last ten months and no negative views have been received. The regular and differing surveying of people and relatives has been very good, and positive information obtained via the system has lead the provider to believe everything has been more than satisfactory. It is unfortunate the auditing element of the system has not properly identified any shortfalls and been critical of the service provided, because of the way it audits and the issues it looks at, as it may then have highlighted the areas needed for improvement. The auditing system should be reviewed and used more effectively. This is recommended. Areas looked at under standard 42 are as follows: – There is a new maintenance contract on the lifting equipment with Eden Mobility, equipment last checked 07/07/08. The Portable Appliances Test was done 20/07/08. JLA Ltd serviced the washing machine on 17/07/08, the landlord’s gas safety check was done 06/02/08, the first aid box has been checked every month and restocked as necessary since 2002, and weekly check on the emergency call bell since has been done since 05/08. There is a monthly check on water temperatures from 3 outlets and findings are recorded, and a legionella water storage check was done by Aquacert 24/04/08. Fire safety records are maintained. Richardson’s Electrical Contractors checked fire safety systems and lights on 08/07/08, and the general system and emergency call bell on 02/06/07. An electrical certificate is available to show that the identified remedial work done was checked on 18/07/08. Records show monthly drills are supposed to be held, but actually were only held in Feb and May 08. In 2007 they were done in Jan, Feb, Mar, Apr, May, Aug and Nov, and in 2006 they were done in Oct, Nov and Dec. Holding of safety drills is not monthly as suggested, but is spasmodic and needs to be more consistent. The record must show staff signatures so there is evidence they have completed a drill, and it must also show that all staff completes a minimum of two safety training drills in every twelve-month period. Requirements are made. Evidence of weekly checks made on the system is in the form of records seen showing reverse dates from 05/08/08 to 14/05/07. Evidence is also available Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 33 in records seen for 2004 and before. Extinguishers are showing as last being tested by Pegasus Fire Protection, in July 2008. Finally, regulation 26 reports need reviving monthly and sending to the Commission to show how monitoring of the progress is done and what the findings of outcomes are for people. More importantly, they need to show what action is being taken. This is a recommendation. The comments received from the visiting Expert by Experience are as follows: Conclusion: “I think it is a very good home, because the residents seem very happy there and the staff seem very nice. I would not like to live there myself, because I do not feel I would be able to get on with the people and talk to them and easily, and I did not like the house. They need to get some work done on the house and in the garden. I think they should get more staff, including another manager as well as other staff, because a lot of the people who live there need more support than they can get now, so that they can do what they want to and have choice.” Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 35 No 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 YA3 Regulation 14 (1) Requirement The registered person must make sure when assessed needs are confirmed in writing they can be met, that they are met at all times. Having sufficient staff to meet people’s needs is the only way this can be achieved. The registered person must enable people to make decisions about their care and take into account their wishes and feelings, so they know their decisions are respected. The registered person must, after consulting people about their social interests, enable them to participate in local social and community activities by ensuring there are enough staff to support them, so people know their individual needs are met. The registered person must maintain the home in a good state of repair: refurbish the toilet and bathroom on the upper floor so people are able to use it again. The registered person must eradicate the damp odour from the double ground floor room, so DS0000019657.V370759.R01.S.doc Timescale for action 31/10/08 2 YA7 12 (2)(3) 30/09/08 3 YA12 YA13 YA16 16 (2) (m and n) 30/09/08 4 YA24 23(2)(b) 31/10/08 5 YA24 16 (2)(k) 31/10/08 Castle-Ford Version 5.2 Page 36 6 YA24 23 (2)(d) 7 YA24 23 (2)(d) people have a pleasant environment to live in. The registered person must redecorate bedrooms as identified, redecorate the dining room and replace carpets where identified, so people have a pleasant environment to live in. The registered person must make sure the room without curtains is made private, that it is redecorated and a new carpet is fitted, so the person in that room has a private and pleasant environment to live in. The registered person must ensure that the home has an effective staff team with sufficient numbers and skills to support peoples assessed needs at all times. Staffing levels must be regularly reviewed to reflect changing needs. The registered person must make sure recruitment procedures are properly followed and only begin staff once their CRB check has been requested and a POVA first has been received. The registered person must make sure staff complete the planned training, so people know competent staff are supporting them. The registered person must make sure all staff receive two fire safety training drill instructions in every twelve month period and that they sign on completion as evidence they have done the training, so people know competent staff are supporting and protecting them from the risk of harm from fire. 31/10/08 31/10/08 8 YA33 18 30/09/08 9 YA34 18, 19 30/09/08 10 YA35 18 31/10/08 11 YA42 23(4) 28/02/09 Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 37 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 YA1 Good Practice Recommendations The registered person should make sure the statement of purpose is up to date in respect of the procedure for making representations/complaints and who to make them to, so people are confident they will be listened to. The registered person should improve the opportunities for people to lead more independent lifestyles, taking risks if necessary and within risk management systems, so people are confident their individual needs are met. The registered person should make sure new menus in place support and satisfy people’s dietary needs over a period of time by using the quality assurance systems, so people are confident their needs are met. The registered person should ensure all peoples complex health needs are met by the provision of health screening, health action plans and access to health professionals, so people are confident their health care needs are met. The registered person should ensure that all staff that need it have received updated training in the management of medication and that they are assessed as competent, so people are confident they are safe from harm. The registered person should now fully implement the new complaint procedure by making sure people understand their rights to complain and exactly how they can complain, so people are confident they will be listened to. The registered person should make sure all staff receive training in safeguarding adults, as mandatory training, so people are protected from harm, abuse or neglect. It is acknowledged that three more staff have completed training and others have planned dates to complete it. The registered person should update the home’s maintenance and renewal programme and implement it as required, so people know the home is well maintained. The registered person should make sure the garden is maintained and the fencing and gate is repaired, so people are able to use it safely. The registered person should continue to provide staff with mandatory and other related training to skill and equip them to care for people with complex learning disabilities and associated conditions, so people know their needs are DS0000019657.V370759.R01.S.doc Version 5.2 Page 38 2 YA9 3 YA17 4 YA19 5 YA20 6 YA22 7 YA23 8 9 10 YA24 YA24 YA32 Castle-Ford 11 YA37 12 YA37 13 YA39 14 YA42 met. The registered person should make sure the manager continues to notify the CSCI of all incidents that affect the health, safety and wellbeing of the people that live in the home under regulation 37, so people are confident their health, safety and welfare is being monitored. The registered person should provide confirmation that he has commenced the Registered Manager’s Award and has the intention of commencing a National Vocational Qualification at level 4 in care. This is an outstanding recommendation from previous inspections. The registered person should use the homes quality auditing system more effectively to highlight areas for improvement so people know the service is being properly monitored and assured. The registered person should continue to undertake regular visits to the care home and prepare a written report, which is sent to CSCI to ensure that the owners are monitoring the standard of care and quality of service being provided, so people are confident the quality of their care is assured. Castle-Ford DS0000019657.V370759.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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