Inspection on 22/05/07 for Castle Grove Nursing Home

This inspection was carried out on 22nd May 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Castle Grove Nursing Home 30/06/09

Castle Grove Nursing Home 05/01/06

Castle Grove Nursing Home 20/07/05

Castle Grove Nursing Home 27/01/05

Castle Grove Nursing Home 28/09/04

Castle Grove Nursing Home 16/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Castle Grove Nursing Home Castle Street Bampton Tiverton Devon EX16 9NS Lead Inspector Dee McEvoy Unannounced Inspection 22nd May 2007 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 Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle Grove Nursing Home Address Castle Street Bampton Tiverton Devon EX16 9NS 01398 331317 01398 331329 info@castle-grove.co.uk www.castle-grove.co.uk Mr Raymon Francis Kenny Mrs Isabelle Marjorie Kenny Mrs Susan Thomas Care Home 20 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) Category(ies) of Old age, not falling within any other category registration, with number (20) of places Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: Castle Grove Retirement and Nursing Home is registered to provide a home with nursing care for 20 older people. Castle Grove is situated in the small mid Devon town of Bampton, with people able to benefit from its location in this rural community. It is a mainly Georgian building, although some parts date back to Elizabethan times. There are two double and sixteen single bedrooms, although all rooms are used as single rooms, unless occupied by married couples or others wishing to share. All bedrooms have en-suite facilities. There is a pleasant lounge/reading room and separate dining room. There are four acres of beautiful gardens, which are accessible to residents and visitors. There is ample parking to the front of the property. There are five independent sheltered housing units within the grounds, which have been sensitively converted from barns and other outbuildings. Residents from the sheltered housing are invited to participate with various activities and can choose to use the dining room and laundry facilities at the home. Major building work is underway to provide a further 6 bedrooms and improve the general facilities by installing a new passenger lift and two new platform lifts in the existing building. The cost of care ranges from £520 to £800 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody, hairdressing, personal items such as toiletries, newspapers, magazines and trips. Current information about the service, including CSCI reports, is available to prospective residents, relatives and others who may have an interest such as care managers. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took just over nine hours to complete and we looked at key National Minimum Standards. There were 18 people living at the home at the time with no vacancies. In order to understand the experiences of people using the service, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of the day and seven people were spoken with in depth to hear about their experience of living at the home. Six other people contributed to a lively group discussion at lunchtime. Time was also spent observing the care and attention given to people by staff. During the inspection, time was spent talking with staff about the support and training available to them. Two relatives were also spoken with during the day. Prior to the inspection surveys were sent to people living at the home to obtain their views of the service provided; 7 were returned. Staff were also sent surveys, and 12 were returned. One health professional completed a CSCI survey expressing their views and experience of the home. A tour of the premises was made, including the kitchen and laundry, and we inspected a number of records including residents’ assessments and care plans and records relating to medication, recruitment and health and safety. The manager had completed a pre-inspection questionnaire prior to the inspection, which provides general information about the home. What the service does well: We asked people living at the home what it does well. Comments included, “It provides me with a home, someone who cares about me and a routine that is not too demanding”, “They can cater for all your needs”, “It’s a jolly place to be” and “It provides a nice place to live”. Other people described a friendly happy atmosphere at the home. Good information is available to people to help them decide if the home will suit their needs. Admissions to the home are well managed, ensuring that people’s needs are assessed and that people are made to feel welcome during the settling in period. All people spoken with or contacted were satisfied with the care provided at the home, many were “more than satisfied”. Comprehensive care plans ensure that people’s health and personal care needs are well met. The home works well with other health professionals to ensure people have access to good Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 6 health services. People told us that their dignity and privacy was respected and that they were supported to be as independent as possible. Most people enjoy a varied and fulfilling social life at the home. Where possible people are supported to continue with past hobbies and interests. Families and friends are encouraged to visit regularly and some take an active part in the home. People told us how much they enjoyed the food, comments included, “It’s excellent”, “The food is always good” and “I really enjoy the home made soups”. The home aims to provide hotel or restaurant style dining, which people obviously enjoyed. All dietary needs, and individual likes and dislikes are catered for and the kitchen team will ensure that everyone has food they enjoy. People told us they felt confident that they could raise any concerns or complaints with the management and these would be dealt with satisfactorily. No complaints have been received by the home or by the Commission, since the last inspection. The home has been maintained, decorated and furnished to a good standard. People were happy with the general environment, comments included, “It’s all kept very nicely” and “The house and gardens are lovely”. People told us how much they enjoyed the “beautiful” gardens. The standard of cleanliness within the home is good; people told us the home was “always” clean and fresh. The staff team have a good understanding of people’s needs and are well supported by the management team to do their job well. Staff felt training was a particular strength of the home; staff are offered training, which is relevant to their role and ensures that good practice is maintained. There is a strong management team in place to ensure the effective running of the home. People living at the home expressed their total confidence in the manager and the owners. Good systems are in place to ensure that people living at the home “have their say” and can influence the service provided. On the whole the health and safety of people living and working at the home is promoted, with systems in place to ensure good practice. What has improved since the last inspection? No requirements were made at the last inspection; one recommendation issued has been acted upon to improve good practice. A programme of redecoration and refurbishment means that people continue to live in a well maintained and pleasant environment. Since the last inspection six bedrooms have been refurbished and two en-suite showers have been fitted. Improvements planned for other facilities include a new lift and 2 new platform lifts, which will provide better access to all areas of the home for people with limited mobility. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Good information about the home is available, which enables people to make an informed choice before moving into the home. There are good arrangements in place to ensure that people have their needs fully assessed, which means that people can be assured that they will receive the care and support they want and need. EVIDENCE: There is a detailed and clear Statement of Purpose that gives an indication of what to expect at the home. The home also has an excellent website (www.castle-grove.co.uk), which provides good information, links to CSCI reports, pictures and an audio history of the home. All people responding with CSCI surveys said they had been given enough information about this home before moving in, so they could decide if it was the right place for them. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 10 Several people told us that they had heard about the home locally or through friends and that the home “had a good reputation locally”. People and their families are encouraged to visit the home prior to making a decision to move in. One person told us, “This place has very much lived up to my expectations”. Two other people, “I would recommend this place to anyone”. Contracts are issued to people living at the home which helps to make sure people are clear about the terms of their stay, their rights and responsibilities. Three were looked. Two had been signed in 2005 and did not reflect the annual increase in fees, although separate letters were seen about any individual increases. 5 of the 7 people responding with CSCI surveys had received a contract. Two people did not answer this question. Three assessments were looked at, including one for a person who recently moved into the home. All had an appropriate assessment, which reflected people’s physical and mental health needs, and the support required to sustain these needs. People’s social interests and hobbies were less well recorded (Refer to standard 12). The manager will visit people before they move into the home, either in hospital or their own home, in order to talk about their needs and the services offered at the home. One person told us, “I have been made to feel most welcome” and another said, “It’s all very friendly”. Staff surveyed said they had not been asked to care for people outside of their area of expertise, which would suggest the home admits people appropriately. Castle grove does not provide intermediate care. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive care planning system in place, which provides the staff team with the information needed to enable them to support people appropriately. Personal support is offered in such a way as to promote peoples’ privacy, and dignity. Some areas of the management of medication are not satisfactory and could put people at risk. EVIDENCE: Surveys showed that the majority of people “always” received the care and support they needed, one person said they “usually” receive the required support. People spoken with during the inspection told us, “I get whatever help I want here”, “We are well cared for” and “I appreciate the care I get”. Two visitors spoken with were happy with the overall standard of care delivered to their relative, one said, “Couldn’t be better.” Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 12 Staff spoken with were able to describe people’s needs and preferences and how these should be met. This knowledge means that people can be confident that they will get support from people who understand their care needs. Each resident has an individual care plan; three care plans and associated records were looked at to see how care is planned and delivered. Good information about people’s personal care and health needs is available for staff to ensure that individual needs are met. All staff responding with surveys said that the care plan allowed enough time for them to provide the care required. Care plans looked at had been regularly reviewed to reflect any changes. Some people spoken with were aware of their care plans; others said they were not really interested. People feel they can be involved if they want to be. The home has completed relevant risk assessments, including falls, manual handling, mobility and pressure care with risk management strategies developed to address the risks identified. Good consideration has been given to other personal risks, such as behaviour, without infringing on people’s independence and choice. People told us they “always” or “usually” receive the medical support they needed. One G.P said the home “always” sought advice and acted upon it to manage and improve people’s health care needs. The G.P felt that individual health care needs were “always” met by the home. One relative described how the nursing staff had worked hard to improve a long-standing wound. Good nutritional assessments had been completed and where people have been identified as being at risk of weight loss, good measures are in place to monitor and take action to ensure people’s good health is promoted. Comprehensive diabetic care plans were also available to ensure that this condition is monitored and treated in line with good practice. Equipment necessary for the prevention and treatment of pressure sores is provided in order to reduce the risk of people developing problems. Several different aids, such as mattresses and cushions were seen to be in use around the home. There was evidence of good wound care management and the involvement of the nurse specialist. There was multidisciplinary involvement and guidance for staff regarding resuscitation, where people had expressed their wishes about this. Care notes showed that people have access to a range of health professionals, including specialist nurses for wound care and diabetes, chiropody, optician, dentist and other out patient services. Where possible people are supported to manage their own medication, which is to be commended. Agreements have been completed for people wishing to retain their medication. New risk assessments have also been completed for Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 13 some people but one was outstanding. Secure storage is provided in individual rooms but one person had chosen not to use the storage saying, they “didn’t think it was necessary”. This had not been considered in the agreement/risk assessment, but could pose a risk to others. The medication system was inspected. Only registered nurses administer medication within the home. Medicines are stored and disposed of safely. Medication administration record (MAR) charts were generally accurate and completed but showed that two hand written entries had been made; these had not been signed by two responsible people or dated to ensure accuracy and accountability. One medicine had not been given as prescribed but appropriate codes had not be used to indicate why not. Some people are prescribed creams to be applied daily. In some cases records were poorly complete indicating that this may not be happening. This was discussed with the registered nurse in charged, who said that all creams were applied as prescribed but that this was not always recorded accurately. The community pharmacist visits regularly and is available for advice. During the last visit, an “excellent” standard was found for the administration of medicines, and other areas, such as recording, were found to be “of a high standard”. One G.P told us that the home “always” supports people to manage their own medication or manages medication correctly where this is not possible. People told us they felt their privacy was respected and that staff were sensitive when they needed help with personal care. Comments included, “Staff are generally respectful”, “I am treated with great respect”, “Everyone is so kind and caring” and “Staff are polite and respectful”. During the inspection staff were observed to interact with people in a friendly, sensitive and respectful manner. Staff were heard to address people by their preferred name or title. People told us that they could see visitors in private and most had a private telephone line in their own room. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is adequate provision for social fulfilment for some people, but more specific recreational opportunities suited to peoples’ individual needs and capacities would support a better quality of life for all. Overall, people are supported to exercise choice and control over their lives. Meals at the home are enjoyed and cater for the individual likes, and provide a varied wholesome diet. EVIDENCE: Most people described the daily routine at the home as flexible, comments included, “The routine suits me”, “We can please ourselves” and “There are no strict rules, I can do as I please”. Five people responding with CSCI surveys said there are “always” activities arranged by the home that they could take part in; two people felt that activities “sometimes” suit their needs and preferences. Several people at the home enjoy a busy and fulfilling social life, people have been able to continue with past hobbies and interests, such as green bowling. Other people told us that there was usually some kind of activity going on at Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 15 the home, such as a reading session, music and concerts, film afternoons, exercise sessions and occasional outings. A regular communion service is also held at the home. Records show that some people regularly join in with organised activities or have some one to one time with staff to walk in the gardens or visit the village. Two people felt that due to their immobility they were unable to enjoy trips out, one felt that the cost of trips was prohibitive. A third person said they would like to be able to go shopping occasionally but hadn’t had the opportunity. Two people and one relative sited access to appropriate transport as a particular problem for people with mobility difficulties. Two other people said they were not interested in “organised” activity. Individual social interests and hobbies had not been fully explored with people in two of the three care plans looked at. The assessment for a third highlighted the person’s previous interests and hobbies but the care plan did not reflect this and there was little meaningful information for staff to follow to ensure that social needs were met. Two relatives told us that they could visit at anytime and always felt welcome at the home, one said, “You feel like part of the family”. Another relative told us that communication was good and that they were informed of any significant changes or issues. People living at the home said their visitors were always offered refreshments. People valued the fact the home promotes independence and choice, one person told us, “We have freedom but safety at the same time”. Staff were seen to listen and respond to people requests for assistance or information. All people responding with CSCI surveys said that staff listened and acted upon what they said, although one person felt that younger staff could need “more training and compassion”. This was an isolated comment. People were given simple choices by staff throughout the day, for example what they preferred to drink or where they would like to sit or spend the afternoon. The inspector joined people in the dining room for lunch. The dining room was pleasantly laid for mealtimes, with excellent attention to detail, for example linen napkins and condiments were available and people enjoy a silver service at mealtimes. People who may have spent the morning in their room appeared pleased to see each other and there was a buzz of conversation over meals. Staff were on hand to assist where required. Lunchtime was enjoyable and unhurried. People told us they “always” or “usually” enjoyed the food and appreciate the choice of menus. Comments included, “The food is excellent”, “It’s very good and I am happy with all I get”, “Our plates are always clean after meals!” and “The little touches make all the difference”. In generally conversation at the table, people told us that they could “give praise and criticism where needed” Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 16 and that their suggestion were listen to and acted upon. The homemade soup proved very popular at teatime. Special diets are catered for and alternatives offered. The chef was knowledgeable about individual preferences and dietary needs. Menus and other records show that people receive a varied and balanced diet. ‘Theme meals’ are often prepared and offer an opportunity to experience different foods from different cultures. The chefs prepare various traditional meals to celebrate St Georges’, St Andrews’ and St Patrick’s Day; and other dishes are prepared from African countries. We were told that these particular celebrations were well enjoyed. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system and people feel their views are listened to and acted upon. People are protected from abuse by robust policies and procedures and most staff are well-informed, where staff lack information people could be put at risk. EVIDENCE: Everyone at the home contacted by us as part of this inspection knew how to make a complaint or who to speak with should they have any concerns. The pre-inspection questionnaire shows that no complaints have been received by the home since the last inspection. People told us that they could raise any issue with the owners or manager, one person said, “They work very hard to get things right”, another wrote, “Open lines of communication”. Staff surveys showed that most nursing and care staff were aware of adult protection procedures. One member of the care team said they were not aware of the procedures, which could put people at risk. Two other staff members responding with surveys were also unaware of the procedures to follow. Training records show that adult protection is covered during staff induction and pre-inspection material shows that on-going training is available to staff to ensure they are aware of issues and procedures. Three staff spoken with demonstrated a good understanding of adult protection issues and were clear about how to raise any concerns. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 18 All people spoken with on the day said they were well cared for and treated respectfully by staff. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good, providing people with a comfortable, clean and homely place to live. Attention is needed to ensure that a safe environment is maintained for residents. EVIDENCE: The home is very well maintained and decorated throughout. Several improvements have been undertaken or are planned. In order to provide better access to all rooms, new platform lifts are being installed. A new lift is to be installed within the new extension, which will enhance the environment further. Two new showers have been installed in bedrooms to better meet the needs of individual people. Continued redecoration of bedrooms ensures that the home offers a pleasant environment for people and 6 have been refurbished since the last inspection. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 20 The home is situated in 4 acres of gardens. Several people commented on the lovely gardens, which are beautifully kept, and provide people with a much appreciated space. There is a summerhouse and several areas for people to sit and relax. There is a communal sitting room and separate dining room. The sitting room is pleasant and comfortable, and has a log burning stove, wooden flooring, T.V, music centre and books; the dining room is elegant, providing people with a pleasing environment. All rooms are used as single rooms. People told us they were happy with the accommodation provided. All rooms visited had been personalise with pieces of furniture and other personal items such as pictures and photographs. Several rooms have a patio area directly outside giving people a garden area of their own. Work is nearing completion on a new extension to the home, ‘The Orangery’. This will provide six additional bedrooms and increased communal space. People said that the building work had caused minimal disruption and many said that it was good to watch the progress of ‘The Orangery’. All bedrooms have their own WC and bath or shower. Three people told us that they could not use the bathing facilities in their en-suite but used the fully assisted communal bathroom. This did not pose a problem for people, but one person said this was the only area of improvement they could identify. Thermostatic valves regulate the water to ensure that people are safe, but on this occasion the water temperature from one bath was excessively hot at 57oC. This was discussed with the provider, who said they would have a plumber check the thermostatic value and re-adjust it to reduce the risk of scalding. Not all radiators within the home are covered although general risk assessments have been completed to identify the risk of burns. The risk assessments identified the risk but did not always state how the risk should be managed. Some radiators are behind pieces of furniture, which lessens the hazard, but others were next to people’s beds and could present a high risk of harm to people. This was also discussed with the home by a recent visit from Health & Safety officers. The owner told us that newly refurbished rooms have low heat surface radiators. The home was clean throughout, with no offensive odours; people told us it was “always” like this, one person wrote, “cleaning is excellent”. Cleaners are employed to ensure that good standards of cleanliness are maintained. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 21 The laundry room is well equipped and was clean and well organised. Systems were in place to control the spread of infection (protective clothing, bags for soiled laundry, suitable programmes on washing machines, etc.). Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff on duty is sufficient to meet individual needs and preferences, and staff are trained and competent to do their jobs. However, people are not fully protected by the home’s recruitment practice, which is poor in places. EVIDENCE: People told us that staff were “always” or “usually” available when needed, one person said, “They are excellent, always there when you need them”, another said, “Staff come when I need them”. People spoke highly of the staff. Comments included, “The staff are excellent”, “They will do anything for you” and “They are all very nice. I always get the help I need”. One person told us, “The overseas staff work hard and are particularly pleasant”. Three staff recruitment files were looked at to ensure that procedures were robust and protected people living at the home. All contained the necessary information, such as application form, references and Protection of Vulnerable Adult (POVA) checks and Criminal Record Bureau (CRB) checks. However, it was noted that all three staff had started working at the home before POVA or CRB checks had been completed. This practice is potentially unsafe. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 23 The home has achieved the Investors in People award, and their last review highlights many strengths and areas of good practice, including a learning and development plan for staff, which is reviewed annually. The pre-inspection questionnaire shows that 57 of care staff have achieved a nationally recognised care qualification (NVQ 2 or above) to ensure that staff are competent to meet peoples’ general care needs. The home arranges training for staff about health care topics that relate to the health care needs of people living at the home, for example diabetes and wound care. This ensures that good practice is maintained and that people receive a good standard of care. All nursing and care staff responding to CSCI surveys said that they had received an induction period, which helped them to understand how to work safely and respectfully with people. All staff felt that the home provided funding and time for them to receive relevant training. All staff said they had enough support to do their job well. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed, with good systems in place to ensure that people’s views are sought and acted upon. In the main satisfactory systems are in place to promote the safety and welfare of people living and working at the home but additional measures must be taken to fully protect them. EVIDENCE: The management team, including the owners and registered manager, give clear leadership, guidance and support to staff. The manager is a registered nurse and has the necessary experience, skills and qualifications to do her job effectively. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 25 People living at the home spoke very positively about the management team, comments include, “The owners are wonderful, very involved” and “It is splendid here and that starts at the top!” People expressed complete confidence in the management team. One person wrote, “A well run home”. Staff said they had the support they needed and that the manager and owners were approachable and provided a “happy atmosphere” and a “warm and friendly atmosphere”. One staff member wrote, “This is the best nursing home that I have worked in”. The home has a range of methods for seeking people’s views, in order to review the services provided and ensure there is continuous improvement. Questionnaires are sent out and the results from these are collated. Regular meetings are held with residents and staff. Minutes showed that these meetings were well attended and that a variety of issues were discussed, including activities and menus. The management team always take the necessary action within agreed timescales to implement requirements identified in CSCI inspection reports. The pre-inspection questionnaire showed that the home does not manage any finances on behalf of people living at the home. The home prefers not to hold any cash or valuables if at all possible, and in most cases they have a system where the home pays for services and personal items and a bill is presented once a month for these items. Staff spoken with said they had received training and updates on health and safety related topics, including, first aid, manual handling, fire safety and food hygiene. Fire safety equipment, for example fire extinguishers, had been regularly serviced and the fire log showed regular checks and maintenance on emergency lighting and fire alarm. Records show that staff receive regular fire drills and training. The home had not completed a recent fire risk assessment in line with fire regulations. The one on file dates back to 2001. Following the inspection the manager contacted us to say that a new fire risk assessment had been commissioned and was due to be completed by 6/7/07. The pre-inspection questionnaire showed that equipment, such as hoists and the call bell system, had been maintained and checked to ensure safety. Risk assessments have been carried out on the environment and actions to reduce or eliminate the risks had been identified where necessary. The pre-inspection questionnaire showed that gas and electrical equipment is serviced and maintained and certificates were up to date. The kitchen was organised and generally well equipped, the chef said he had the necessary equipment. The home has implemented “Safe food, better Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 26 business”, a nationally recognised benchmark for food hygiene and safety. Fridge and freezer temperatures are recorded regular to ensure that food is stored safely. The fridges in the kitchen were clean and food stored had been labelled and dated. The two freezers in the shed were in need of defrosting and cleaning. The chef agreed and said that it would be done as soon as possible. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 27 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 4 3 4 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 1 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 2 Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP25 Regulation 13 (4)(a) Timescale for action You must ensure that water 17/07/07 temperatures are safe and that radiators are covered or comprehensive risk assessment are in place in order to reduce the risk of harm to people. You must ensure that you 17/07/07 operate a robust recruitment procedure in order to protect people. Staff must not start working at the home until the required information and safety checks are in place You must take adequate 26/06/07 precautions against the risk of fire, this includes ensuring that an up to date risk assessment is completed. Requirement 2. OP29 19 (1) (a)(b) 3. OP38 23 (4) 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 Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 29 1. 2. OP2 OP9 3. 4. 5. OP12 OP18 OP38 In order to fully protect people, it is recommended that contracts of residency are reviewed and re-issued following the annual increase in fees. It is recommended that for all hand written entries on the MAR chart the person signs and dates the entry, and this is then checked and signed by a second person. The application of medicines prescribed for external use must be recorded to ensure that it is possible to audit that these medicines are being used as prescribed. Risk assessments for people choosing to manage their own medicines should consider the risks and management of any risk when a person declines secure storage for medication. It is recommended that particular consideration be given to stimulating and meaningful activities for all residents, which meet with their preferences and capabilities. In order to ensure that all people living at the home are protected fully, it is recommended that all staff be aware of the adult protection procedures. It is recommended that freezers are regularly cleaned and defrosted to ensure that food safety standards are maintained. Castle Grove Nursing Home DS0000026704.V331291.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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