Inspection on 26/01/06 for Castle Grange

This inspection was carried out on 26th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 01/09/05

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 Merseyside L12 7JG Lead Inspector Pat Kearney Unannounced Inspection 26th January 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Castle Grange Address 9 Haymans Green West Derby Village Liverpool Merseyside L12 7JG 0151 226 5676 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) Southern Cross Operations Limited Mrs Jenny May Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 41 Nursing and 8 Personal Care in an overall total of 41 One named person under 65 years of age may be accommodated. Date of last inspection 1st September 2005 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 have 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 DS0000025093.V280480.R01.S.doc Version 5.1 Page 5 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. Southern Cross Healthcare Ltd are in consultation with the Provider Relationship Manager for the Commission for Social Care Inspection and is currently reviewing all documentation and policy and procedures a number of key documents were not available for inspection. This unannounced inspection commenced at 10 00 hours on 26January 2005, Registered Nurse Pinule Mthethwa was on duty. A full tour of the premises took place; the home was clean and tidy but a number of the bedrooms smelt strongly of urine despite bedroom windows being open. Staff 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. Concern was expressed about the lack of a permanent manager being in post. Both service users and visitors were unaware who owned the home and commented” that they had not been informed of any changes of ownership at the home “ All relevant documentation currently available for service users and staff were reviewed, documentation is currently being reviewed by Southern Cross Healthcare Ltd. Therefore there is a mix of Highfield and Southern Cross documentation in use. 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 pre assessment, risk assessment and care planning care is comprehensive up to date and reviewed on a regular basis by the acting manager in the home. Activities are held regularly and service users commented that “they had enjoyed the Christmas festivities” Relatives said the home had been nicely decorated. Preparations were being made to celebrate Chinese New Year. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 6 Chinese lanterns were being hung and the chef was going to serve a Chinese meal to service users. What has improved since the last inspection? What they could do better: Castle Grange has been without a permanent Registered Manager for a period of two and half years. The Responsible person needs to appoint a Registered Manager who will provide leadership in the home and improve the quality of care provided at all times and proactively manage the transitional phase and merger with Southern Cross Healthcare. The Statement of Purpose and Service Users Guide are currently being reviewed and must be introduced as soon as possible so that potential and current service users are informed of the service the care home will provide. All the policies and procedures required by the Care Homes Act 2000 are currently being reviewed and updated these need to be implemented as soon as possible to ensure that staff have direction and understanding how they are to work. Southern Cross should implement a complaints procedure so that service users and/or their relatives know how to raise any issues of concern and will feel confident that those concerns will be addressed. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 7 Staff need to answer the service users bedroom call system when it is used as a matter of priority and not leave service users waiting for care and attention. Greater attention to detail is required to ensure that all the assessed needs of service users are consistently met. These include dental hygiene, putting hearing aids in place. Making sure the service users who are nursed in bed are comfortable and well cared for. Assistance should be provided to service users nursed in bed and records kept of their fluid and dietary intake. The cleaning programme needs to be reviewed and a programme implemented to ensure that the smell of urine evident in service users bedrooms is eliminated. No service users personal finance should be used to meet the expenditure of another service user. Staff members must not receive cheques from service users bank accounts or use their personal banks cards to finance a service users expenditure this practice must stop immediately as discussed with the Regional Manager on the day of this inspection Care staff need to have induction and foundation training that meets the Care Homes Act 2000. Mandatory and specialist training needs to be ongoing and updated to ensure that service users are cared for by staff who are skilled and qualified so that the health safety and welfare of service users and staff is maintained at all times. The meals provided need to be improved and a choice made available at every mealtime. Soft diets need to be prepared and presented in a way that is appetising and appealing to service users. A detailed written menu showing alternatives available at mealtimes which reflect the service users personal choices and preferences must be produced and displayed daily. A staff rota needs to be in place so that all staff on duty do not take their breaks at the same time leaving service users nursed in bed call systems unanswered. Systems should be introduced that take into account service users views that measure the quality of service provided by the home. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 8 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 DS0000025093.V280480.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3.4.5.N/A. 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 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 corporate Statement of Purpose and Service User Guide has been approved by the Provider Relationship Manager for the Commission for Social Care Inspection (C.S.C.I.), however on the day of this inspection no current up to date Statement of Purpose or Service user Guide was available at the inspection. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 11 Service Users personnel files examined as part of the inspection process did not contain revised contracts of terms and conditions from Southern Cross Healthcare. A revised and updated pre admission assessment document has been developed and implemented the document is comprehensive and detailed. No intermediate care is provided at the home. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10.N/A. Care plans, risk assessments, daily health records for each service user are up to date and checked monthly by the acting manger at the home. This ensures that the care needs of the service users are identified, however the care needs of the service users are not always fully met due to poor care practice. 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, there continued to be issues raised about the individual care needs of service users being overlooked by staff this included dental hygiene and spectacle cleaning. 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 DS0000025093.V280480.R01.S.doc Version 5.1 Page 13 During the inspection the inspector observed that there were a number of female service users whose” hold up” stocking were below the hem of their dresses no attempt was made to adjust the stockings this compromises the service users dignity and reflects poor care practice. Another service user was distressed and upset despite their being a number of care staff being nearby none of them attempted to comfort the service user or enquire what was upsetting them until the Registered Nurse intervened. A number of areas of concern were observed regarding a service users who was frail and in bed. The bedroom was extremely cold and the window was still left open, bed rails were in place with no bed rail protector in place. The bed rail protector was folded and stored under the bed making the protector an infection risk. Bed linen was thrown untidily over the service users chair. A drink left for the service user was not within the reach of the service user. When the Registered Nurse who accompanied the inspector around the home rang the service users call system no member of staff answered the call. The call system was working and had been checked by the maintenance team two days prior to this inspection. Another service user who was in bed had no cover on their duvet. A tray had been delivered with the service users lunch on it. The inspector visited the room approximately one and hours following lunchtime the food and cup of tea was cold and the service user had not made any effort to eat the meal. On checking the care plan no records were being kept of the service users weight or fluid and food intake. Another service user had washed gloves and left them to dry on the radiator in the assisted bathroom. 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” “ Attention to detail is lacking and staff don’t look after little things that make a big difference “ was the comment from another relative. 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 Registered 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 DS0000025093.V280480.R01.S.doc Version 5.1 Page 14 Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15. 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. The provision of meals has deteriorated; with no menu planning or choice being available this raises concerns about service users health and nutritional well-being. 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 10 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 the activity programme is displayed on the notice board. On the day of this inspection preparations were in place to mark and celebrate Chinese New Year. Traditional Chinese lanterns were being hung and the inspector was told that a traditional Chinese meal would be served as part of the celebrations. The activities organiser said that she was also making plans to celebrate St. David’s Day. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 16 Service users and relatives said that they had enjoyed a number of social events over the Christmas period and that the home was bright and festively decorated. On the day of the inspection lunch was observed being served the tables were nicely laid with laundered cloths and crockery and cutlery. The meal served to the majority of service users was well presented and looked appetising however there was no choice of meal readily available as an alternative the cook confirmed that” they would always make something available as an alternative if asked” there was no written menu available providing a choice. Those service users who require a “soft diet” were given a meal that was over processed and looked sloppy and unappetising. The cook is newly appointed and said “that they were using up the freezer stock and stores and finding out what the service users individual needs were prior to developing a menu” Direction is needed to ensure that service users whatever their dietary needs are always provided with a nutritious, well balanced diet which is well presented and with a choice prepared and available at all mealtimes. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18. Southern Cross Healthcare need to implement their corporate complaints policy so that both service users and staff have clear direction and understanding how to raise issues of concern ensuring that the interests of service users are safeguarded. Not all staff have sufficient knowledge of Adult Protection issues and how this impacts on their practice which puts the service users at risk of potential abuse EVIDENCE: The home has a complaints policy and procedure which was implemented by the former company who owned the care home. Southern Cross is currently reviewing all policies and procedures since purchasing Castle Grange from Highfield in July 2005. Priority needs to be given to implementing the revised complaints policy and communicating this to service users their relatives and staff so that both service users/ relatives and staff have clear direction and understanding of Southern Cross procedures and how they can raise any issues of concern which will ensure that the interests of service users are safeguarded. There has been one formal complaint which was investigated by Liverpool City Council, the complaint was partially upheld and the service user was transferred to another establishment. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 18 There was evidence on the staff personnel files that P.O.V.A training had been delivered by the regional manager for Southern Cross. The majority of staff interviewed on the day of the inspection demonstrated a knowledge of P.O.V.A. issues and its application for their practice. However the inspector observed a member of staff booking a hotel room with their own personal credit card and had received a cheque from the service users relative taken from the service users bank account to reimburse the staff member for the transaction. The inspector informed the staff member and registered nurse accompanying the inspector that this practice must stop immediately. Southern Cross must ensure that all staff have access to updated P.O.V.A. training. The practice of using one service users money to pay for another service users expenditure is occurring again this is unacceptable and must be stopped. The personnel files of new staff recruited to the home did not clearly show that issues of P.O.V.A had been addressed as part of the induction training. All new recruits must have training on P.O.V.A. issues as part of the induction process. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20.21.22.23.24.25.26. 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 service users however there was a malodour present in some of the service users bedrooms which is unpleasant and unhygienic. EVIDENCE: There is a programme of ongoing maintenance at the home which the handy man undertakes. The lounges were warm, comfortable and clean. The dining room tables were set with fresh laundered tablecloths and crockery and cutlery. During the tour of the building, some of the bedrooms smelt strongly of urine and the majority of the bathrooms and toilets had neither liquid or block soap Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 20 available for hand washing this lack of soap is unacceptable and will lead to unhygienic practices and cross infection. In one bathroom there was a dirty commode pan left in the assisted bath this will contribute to cross infection. A service user was being nursed in bed and bed rails were seen in use without any bed rail protector in place. The bedrail protectors were folded and stored under the bed at risk of being infected. Minimal infection control policies and procedures were in place; and training for the staff regarding infection control, specifically MRSA was not evident. A review of current practice needs to be completed, an action plan developed to address the risk of cross infection at the home. Staff need to have training on issues of infection control and how to minimize the risk and spread of infection at the home. 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 DS0000025093.V280480.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30. The policy and procedures for recruitment of staff are not robust and do not provide the safeguards to offer protection to service users living in the home. There continues to be a level of instability amongst the staff group, which is resulting in inconsistency in the care delivered to service users. 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: There have been a number of new staff recruited since the last inspection a selection of personnel files were reviewed as part of the inspection process. There was evidence that references were being obtained from a member of the new recruits family this practice is not acceptable. Over the past two years there has been a high staff turnover particularly amongst the care staff. Currently only three care staff hold a N.V.Q. Level 2 award which is a very low percentage. 8 Care staff have recently commenced the N.V.Q. Level 2 Award. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 22 Care staff spoken to during the inspection showed some understanding of the service users care needs and how those needs should be met however there are practices occurring in the home as mentioned in this report which are unacceptable and needs to be addressed. #Service users and relatives spoken to said that on occasions some aspects of care needs are not always met these included 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. The level of potential cross infection evident during this inspection needs to be addressed through changes in practice and training for all staff in infection control. Personnel files viewed as part of the inspection process did not always demonstrate that staff have completed their mandatory training or what if any specialist training had been completed. The induction of new staff appeared to be brief and personnel files did not always have evidence that induction took place. There was evidence that induction at the home did not address the specific issues outlined in the T.O.PPS induction programme 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 DS0000025093.V280480.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.32.33.34.35.36.37.38. The acting manager supported by qualified nurses is currently providing the management at the home. The home has gone through a period of considerably instability and has no registered manager in post. The home requires clear leadership so that the care home is managed effectively and efficiently benefiting the service uses who live there at all times. Policies and procedures are being revised and updated by Southern Cross the new owner. This results in some practices that do not promote the health, safety and welfare of the people using the service. The systems for service user consultation are poor with little evidence that service users views are sought or acted upon. EVIDENCE: Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 24 The acting manager has been in post for the two years initially due to the longterm sickness absence of the former Registered Manager. The acting manager has withdrawn her application to become the Registered Manager. Since the last inspection a new manager was recruited who only worked at the home for a two-week period. 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 and to improve the quality and consistency of the care provided at the care home. Service users and their relatives expressed concern regarding the lack of permanent leadership at the home and “said it had been a long time and they wondered if the home was closing” Further questioning by the inspector indicated that that relatives were not aware of the merger between Highfield care and Southern Cross and were unsure who owned the home. This needs to be addressed as a matter of priority by post or through a service users and /or relatives meeting. 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. However on the day of this unannounced inspection the quality of care and the management of the home have deteriorated since the last inspection. Staff receive regular supervision there was no evidence of recent ongoing training and staff on duty said that they had not yet registered for the N.V.Q. Level 2 Award. Staff meetings and held records were not available on the day of this inspection. 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. A rota system needs to be introduced so that all staff do not take their lunch or tea breaks at the same time so that the service users call system does not go unanswered and service users waiting for care and attention. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 25 Southern Cross are currently holding discussions with the Commission for Social Care Inspections Regional Provider Relationship Manager about all aspects of the merger of Highfield Care with Southern Cross this included issues relating to financial management of service users personnel accounts. The homes certificates of insurance and worthiness for machines, electricity, fire equipments, lift, hoists were in date and valid. The Fire Officer visited in June2005 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. The inspector was informed that there had been several incidents were the passenger lift had been broken all incidents of this nature that impact on the service users must be reported to C.S.C.I. Via a Regulation 37 form. Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 N/A 18 3 3 3 2 3 3 3 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 2 3 2 2 Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? yes 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 OP1 Regulation 4&5 Requirement Timescale for action 15/03/06 2. OP2 5 3. OP8 7 4. OP15 16 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 is required 15/03/06 to provide for each service user a written contract detailing terms and conditions in respect of accommodation, amount and method of payment of fees services and facilities to be provided by the registered manager and a summary of the Statement of Purpose The Registered Person shall 01/03/06 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 shall 01/03/06 provide adequate quantities, DS0000025093.V280480.R01.S.doc Version 5.1 Castle Grange Page 28 5. OP16 22 6. OP25 23 7 OP26 16 8 OP28OP30 18 suitable wholesome and nutritious food that is varied and properly prepared and available at such time as may reasonably require by service users. Soft diets must be prepared presented and served to service users so that they look appetising The registered person shall establish a complaints procedure for considering complaints made to the registered person by a service user or person acting on the service user’s behalf. The registered person shall not use premises for the purpose of a care home unless ventilation heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. Staff must ensure that service users who are nursed in bed have suitable and adequate heating in their rooms at all times. The registered person shall after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home,so as reduce the risk of infection. Through the implementation of policies and procedures for the control of infection which includes safe handling and disposal of the contents of commodes and any splillages, provision of protective clothing and that soap is available for handwashing at all times. Also That the care home is free from malodour at all times. The registered person shall ensure that all staff receive training to prevent service users DS0000025093.V280480.R01.S.doc 01/03/06 01/03/06 15/03/06 15/04/06 Castle Grange Version 5.1 Page 29 9 OP29 19 10 OP31 8 11 OP33 24 12 OP35 20 13 OP37 17 being placed at risk harmed or suffering abuse. Care staff must have access to N.V.Q. Level 2 training to meet the requirements of the 50 ratio. Induction, mandatory and specialist training must also be updated. The registered person shall not employee a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2 of the Care Standards Act 2000 The Registered Provider shall appoint a person to manage the care home who has the qualifications skills and experience necessary for managing the care home. The Registered Provider shall establish and maintain effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the 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 maintain and update records as specified in Schedule 4 of the Care Standards Act 2000 required by regulation for the protection of service users and for the effective and efficient DS0000025093.V280480.R01.S.doc 01/03/06 15/03/06 15/03/06 01/03/06 15/03/06 Castle Grange Version 5.1 Page 30 14 OP38 13 running of the business are maintained, up to date and accurate. The registered person shall ensure that unnecessary risks to the health safety and welfare of service users and staff are identified and eliminated. The registered person must take steps to develop a cleaning programme that minimizes the malodour in the care home and ensures the development and implementation of policies and procedures for maintaining safe working practices which complies with relevant legislation. Staff have access to induction ongoing mandatory and specialist training which meets T.O.PP.S specification on all working practices. 15/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Castle Grange DS0000025093.V280480.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 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 DS0000025093.V280480.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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