Inspection on 01/09/05 for Castle Grange

This inspection was carried out on 1st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Castle Grange 16/06/08

Castle Grange 01/05/07

Castle Grange 06/06/06

Castle Grange 26/01/06

Castle Grange 05/01/05

Castle Grange 02/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Castle Grange 9 Haymans Green West Derby Village Liverpool L12 7JG Lead Inspector Pat Kearney Unannounced 1 September 2005 9:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Castle Grange Address 9 Haymans Green West Derby Village Liverpool L12 7JG 0151 226 5676 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Operations Limited Mrs Jenny May CRH N 41 Category(ies) of OP - 41 registration, with number of places Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) 41 Nursing and 8 Personal Care in an overall total of 41 2) One named person under 65 years of age may be accommodated. Date of last inspection 5 January 2005 Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Castle Grange is a large modern purpose built care home with nursing, for 41 Older people. The home is located near to West Derby village close to shops, churches and other amenities with public transport links to the city centre 5 minutes walk from the home. The care home formerly owned and managed by Highfield Care has in July 2005 merged to become part of the Southern Cross Healthcare organisation and the home is currently going through a transitional phase. Accommodation is provided on three floors with lift access to each floor. There is a pleasant garden to the rear of the premises and shrubbery to the front. Car parking facilities are located to the front of the building.All rooms are single except for one double which is used as a single. Six rooms enjoy ensuite facilities and 38 rooms are at least 12 sq metres in size. There are two lounges, one of which is larger and which provides a smoking area and the other lounge which is smaller and used as a quiet lounge. There is a large dining room with patio windows overlooking the rear garden. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Castle Grange has in July 2005 commenced a merger with Southern Cross Healthcare Limited and so the care home is in a transitional phase The unannounced inspection commenced at 10 30 hours on 1st September 2005, the acting manager was on duty. A tour of the premises took place; the home was clean and tidy but a number of the bedrooms and entrance hall smelt of urine. Both staff and service users and their visitors were spoken with about the service. Service users and their visitors were generally happy with the service but all those spoken to said that greater attention to detail was needed in relation to service users care needs being met. All relevant documentation for service users and staff were reviewed, all documentation is being reviewed and a Statement of Purpose and Service Users Guide is currently not available however Southern cross has produced a brochure called “ Southern Cross Healthcare an introduction” What the service does well: The service users documentation relating to care is comprehensive up to date and reviewed on a regular basis by the acting manager in the home. Regular meetings have been held with service users and their visitors to keep them informed about the changes due to the merger with Southern Cross Healthcare Limited. Activities are held regulary and service users commented that “they had enjoyed the outing to the pub by the River Mersey” the day prior to the inspection. Services users and visitors told the inspector that the food at the home” was varied and enjoyable “ Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 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 standard(s) 1.2.3.4.5.6. The homes Statement of Purpose and Service User Guide is inadequate and does not provide sufficient information for prospective service users to be clear about the services the home provides .to meet their needs. The homes new Pre assessment document is comprehensive ensuring that service users needs prior to admission will be fully assessed. EVIDENCE: All the care homes documentation is currently being reviewed since the merger in July 2005 with Southern Cross Healthcare. The Regional Manager said that “the company are in discussions with the Provider Relationship Manager for the Commission for Social Care Inspection to agree all documentation” The Acting Manager confirmed that there had been a number of meetings held to inform the current services users and their relatives about the change of ownership to Southern Cross. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 10 Southern Cross have produced a brochure titled” Southern Cross an Introduction” which details the organisations Core Values of Care, Mission Statement and outlines its philosophy and how the care will be delivered. A further meeting is planned with service users and their relatives when the brochures will be distributed. A letter is also due to be sent out to all relatives which will include a copy of the brochure to ensure all service users and their relatives are kept informed of ongoing changes. The Acting Manager Confirmed that all potential service users will receive a copy of the brochure until the new Statement of Purpose and Service User Guide are produced. The Acting Manager confirmed that all service users will receive new written contracts and statement of terms and conditions from Southern Cross when they are revised. A revised and updated pre admission assessment document has been developed the document is comprehensive and detailed. No intermediate care is provided at the home. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7.8.9.10.11. Care plans, risk assessments, daily health records for each service user are up to date and checked monthly by the acting manger in the home. This ensures that the care needs of the residents are identified, however some of the care needs are not always fully met. EVIDENCE: All service users in the home have an individual care plan, which is formulated on admission to the home, reviewed by the acting manager on a monthly basis. Daily health records are documented daily for each resident, this includes any critical incidences plus any visits from GPs, specialist nurses etc. During the inspection several service users and their relatives were spoken to and all confirmed that the standard of care was good at the home however all but one of those spoken to said that on occasions individual care need were overlooked these included shaving, attention to dental hygiene, spectacle cleaning and making sure hearing aids were put in. This attention to detail in delivering care to older people makes a big difference to the quality of life of service users and ensures that those needs assessed are fully met. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 12 Service users and their relatives said that “most of the time the staff are respectful” and treat them with respect but some staff are on occasions” busy and they rush me” On the day of the inspection, no pressures sores on service users were reported to the inspector, most of the nursing staff have undertaken training on tissue viability. The Primary Care Trust (PCT) tissue viability nurse will visit the home at any time if the need arises. No service user in the home self medicates, all prescribed medicines for service users are administered by the nurses in the home. The protocols for the receipt, storage, disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). All residents in the home can access their NHS entitlements. Resident’s documentation is kept secure in accordance with the Data Protection Act 1998. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12.13.14.15. Service Users have choice and flexibility how they spend their day in the home, and pursue leisure activities according to their choice and preferences. This allows independence and individuality for each resident. EVIDENCE: Service Users confirmed that they are able to choose how they spend their days and said that they were able to “spend time alone in their rooms or in the communal parts of the home” Castle Grange has an Activities Coordinator who works 9 hours per week she coordinates the activities at the home, asks service users about their preferred interests and hobbies and develops an activity programme which includes a range of activities which is displayed on the notice board. Service users confirmed that they had visited a pub overlooking the River Mersey for lunch yesterday. Other service users had “chosen not to go” and said that” their decision was respected “ Visitors are allowed in the home at any reasonable time of the day, service users entertain their visitors, in the communal lounges, or in their own bedroom. Visitors spoken with said that ”they were offered refreshments and could stay for a meal if they wanted to.” Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 14 The residents informed the inspector that they enjoyed the variety of food in the home, and had” enjoyed their lunch especially the lemon sponge “ Therapeutic diets can be catered for in the home for residents with a medical condition. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16.17.18. The home has a satisfactory complaints system with evidence that residents feel their views are being listened to and acted upon. The homes policy and training programmes for POVA, and Whistle blowing, ensure that the homes residents are protected from any abuse. EVIDENCE: There has been 1 internal complaint, which was subject to a formal complaint being made to and investigated by Liverpool City Council at the time of this inspection the investigation was ongoing. The care home has information on the Protection of Vulnerable adults, the acting manager said that this information is communicated to new employees on their induction course. On the day of the inspection there was evidence that many of the staff in the home had recently updated their undertaken training on POVA protocols. Staff interviewed on the day of the inspection demonstrated an knowledge of P.O.V.A. issues and it application for their practice. As part of the transitional review of documents the complaints procedure will be reviewed and updated and then communicated to service users and their families Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19.20.21.22.23.24.25.26.. The standard of decor within this home is acceptable in most areas, with evidence of continuing improvements, through maintenance and planning. The home generally presents as a comfortable environment for the residents. Although some areas of the building smelt of urine. EVIDENCE: Since the last inspection the environment of the home has improved, and carpets have been replaced in some resident’s rooms, and other rooms have been re-decorated. During the tour of the building, some rooms smelt of urine and the entrance hall of the home was very unpleasant. Some carpets have been replaced with vinyl floor covering which still smelt of urine and in need of deep cleaning. The homes manager should consider deep cleaning all smelly carpets and give particular attention to the floor covering and other room furnishings which might require additional cleaning. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 17 Since the last inspection a number of pieces of furniture have been purchased these include new lounge chairs, coffee tables, a new hoist and six profiling beds. The large conifer trees have been pruned in the gardens which has improved the amount of natural light. The laundry at the home was clean and well organised equipment was suitable to manage the large amount of washing and drying incurred each day. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.28 29.30. The recruitment policies and practices of the home are robust, and the appropriate checks on staff are being carried out. This safeguards the service users from risk or harm. After a period of considerable instability at the home there is now a group of staff who are working as part of a team, however some inconsistency in the care delivered to service users was evident. Records of staff training lack detail and do not evidence the competence of staff to do their jobs. The specialist care training needs of staff must be reviewed to ensure the health, safety and well being of all residents. EVIDENCE: Over the past two years there has been a high staff turnover particulary amongst the care staff. Currently only three care staff hold a N.V.Q. Level 2 award which is only 18 of the care staff a very low percentage. The Acting Manager said that 13 care staff have signed up to start the award later in the year. Care staff spoken to during the inspection showed an understanding of the service users care needs and how those needs should be met when questioned they showed a knowledge of adult protection issues and the implications for their practice. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 19 Service users and relatives spoken to said that on occasions some aspects of care needs are not always met these included shaving, dental hygiene, cleaning spectacles and placing hearing aids in position and switching them on. Staff must appreciate how important this attention to detail can make to the quality of life of the service user. Since the last inspection work has been completed on the staff personnel files which now contain all the appropriate information and P.O.V.A. checks. The majority of staff have completed the Protection of Vulnerable Adults training and there was evidence of ongoing training and development. The Registered Nurses have accessed ongoing training which they have accessed through the Primary Care Trust. This has included tissue viability , dementia care , wound care and occupational health. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32.33.34.35.36.37.38. The acting manager supported by qualified nurses is currently providing the leadership at the home. The home has gone through a period of considerably instability and needs to have clear direction and leadership, EVIDENCE: The acting manager has been in post for the past eighteen months due to the long term absence due to sickness of the former Registered Manager. The acting manager has withdrawn her application to become the Registered Manager. It is a matter of urgency that a new manager is appointed to provide effective leadership during the period of major change at the home due to the merger of Highfield Care with Southern Cross Healthcare. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 21 The acting manager is a first level nurse with many years experience working in care homes. The acting manager has with the support of the regional manager introduced a number of initiatives at the home this includes regular service user/relatives meetings. Staff receive regular supervision and ongoing training is in place. Staff meetings are held and records are kept of all meetings. Service Users accounts that are held by the care home were examined. The accounts were individual as required, but are managed via a bank account held in the home’s name. With any interest shared between all service users. All Service users have signed a written statement agreeing to this. As identified in the previous inspection some service users accounts are being used to pay for other service users expenditure. While letters had been sent to relatives of those service users who were in debit to reimburse the money owed it is not acceptable to allow this practice to continue and a more proactive approach must be adopted to ensure that no service users money is used to subsidise another services users expenditure. The £660 in the service users account which was unaccounted for at the previous inspections has now been paid into the service users activities fund to be spent for the benefit of all service users. Southern Cross are currently holding discussing with the Commission for Social Care Inspections Regional Provider Relationship Manager all aspects of the merger of Highfield Care with Southern Cross this included issues relating to financial viability. The homes certificates of insurance and worthiness for machines, electricity, fire equipments, lift, hoists were in date and valid. With the exception of the gas certificate and Portable appliance testing these were tested and proof forwarded to the C.S.C.I .office within 5 days. The Fire Officer visited in June and gave a satisfactory report. The Regional manager visits the home on a monthly basis and completes the Regulation 26 report which is forwarded to the Commission for Social Care Inspection. Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 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 Standard No 16 17 18 Score 3 3 3 2 2 3 3 2 3 3 3 Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard O.P.1-38 O.P.1 Regulation 43 4&5 Requirement There are 5 requirements outstanding from the last indspection. The registered person must keep under review the Statement of Purpose and Service User Guide which must contain all the information as identified in the Care Homes Regulations 2001.A copy of the updated Statement of Purpose and Service User Guide must be forwarded to the C.S.C.I. office. The Registered Person shall prepare a written care plan as to how the service users needs in respect of his health safety and welfare are to be met and take steps to ensure that the needs identified are met at all times. The registered person is required to ensure that all staff receive training to prevent service users being harmed or suffering abuse or being placed at risk of harm Mandatory training as required by the Care Homes Regulations 2001 must be updated.Care staff must have access to N.V.Q. Level 2 training to meet the requirements of the 50 ratio Version 1.30 Timescale for action 1.11.05 1.11.05 3. O.P.8 7 1.11.05 4. O.P.28 18 15.11.05 Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Page 24 by 2005. 5. 6. O.P.31 O.P.35 8 20 The Responsible person must appoint an individual to manage the care home. The registered person shall not pay money belonging to any service user into a bank account unless the account is in the name of the service user to which the money belongs.Money must only be used for service users whose account it is at no time must money be loaned to other service users. The registered person shall ensure that unnecessary risks to the health or safety of service users and staff are identified and so far as possible eliminated.The registered person must take steps to develop a cleaning programme that minimises the smell of urine throughout the home. 1.12.05 1.11.05 7. O.P.38 13 1.11.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Castle Grange F52_F02_s25093_CastleGrange_v236885_010905_Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!