CARE HOMES FOR OLDER PEOPLE
Castle Hill House Bimport Shaftesbury Dorset SP7 8AX Lead Inspector
Gloria Ashwell Unannounced Inspection 10th January 2006 11:15 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 Hill House DS0000026778.V277093.R02.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 Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Castle Hill House Address Bimport Shaftesbury Dorset SP7 8AX 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) 01747 854699 01747 858760 Community Health Association of Shaftesbury Limited Mrs Immacula Ballard Care Home 30 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (13) of places Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of 2 bedrooms, measuring 15.5m sq metres or more, may be used for double occupancy at any one time. 3rd November 2005 Date of last inspection Brief Description of the Service: Castle Hill House is owned by the Community Health Association of Shaftesbury; a charitable company limited by guarantee. The home is managed by Mrs I Ballard and is registered to accommodate up to thirty older people including a maximum of seventeen service users who are mentally frail and suffering from dementia. The home also offers respite care to up to three older persons. Service user accommodation is provided on three floors; there are two double and twenty-six single bedrooms. The home has two passenger lifts; all service user areas are accessible by the lifts and there are no steps or ramps in corridors or bedrooms. The home has a range of baths including one of variable height with a fixed hoist, and another with a fixed hoist only. A visiting activities co-ordinator leads regular activities in the home (at extra charge to service users). Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was one of the two statutory inspections required in accordance with the Care Standards Act 2000. The previous inspection took place during November 2005; since that inspection no complaints against the home have been received or investigated. The inspector spoke to some staff and some residents, and together with registered manager Mrs Ballard considered other evidence relating to the National Minimum Standards, as described in this report. Additional information used to inform the inspection process included the reports periodically sent to the Commission by the provider organisation. In recognition of the circumstances and history of this home, which is known to meet most National Minimum Standards this inspection was relatively brief in duration and focussed on assessment of only the most essential standards. Standards assessed and found met during the previous inspection were not reassessed during this inspection; this report should therefore be read in conjunction with the report of the previous inspection. What the service does well:
Staff treat service users with respect, promoting their dignity and encouraging them to maintain their independence. Service users are able to retain control over their own lives, with guidance and support where needed, and to personalise their bedroom by bringing in additional items. The home offers a weekly programme of activities, providing a stimulating environment for service users. Visitors are always made welcome and the staff encourage friends and relatives of service users to keep in contact. Service users enjoy their meals at Castle Hill and are provided with a nutritious diet. Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 6 The complaints procedure is clearly set out so that service users or their representatives can raise any concerns. There are policies and procedures in place to help protect service users from coming to harm. The home is well maintained and refurbishment is carried out when the need arises. The services and equipment are regularly maintained. The accommodation is comfortably furnished and suitably equipped to enable staff to provide care safely to the service users. The premises are kept in a clean and odour free condition. The laundry arrangements are very good and staff properly care for residents clothes. There are staff on duty in sufficient numbers to meet the needs of the residents. The registered manager is suitably experienced and encourages residents and staff to participate in decision-making. The management organisation promotes and protects the health, safety and welfare of all who live and work at the home by minimising risks and encouraging staff to be observant and careful. 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 Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 7 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 Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 8 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): Standard 3 was assessed and found met at the previous inspection. The home does not provide intermediate care so Standard 6 does not apply. EVIDENCE: Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 9 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 (Standard 3 was assessed and found met at the previous inspection) Staff do not have all written information necessary to ensure the provision of correct care to each resident. Some care plans omit reference to known and significant care needs and records of care events are not reliably accurate and complete. The home does not operate in accordance with a comprehensive set of written policies or procedures for care provision so residents may be at risk of harm. Medicines prescribed by doctors are safely stored and carefully administered to residents by staff, unless the residents have chosen to store and administer their own medicines, in accordance with risk assessment. EVIDENCE: Care plan documentation is well suited to recording changes in condition/ circumstance but aspects of care need have been overlooked. In particular the presence of a urinary catheter of one resident was not referred to in the care plan, and there was insufficient detail regarding a known wound although other
Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 10 records indicated that appropriate attention had been provided to this person during recent health deterioration. It was also noted that for some residents there were insufficient records of ongoing care; e.g. for one resident records had not been kept between mid August 2005 and late October 2005, despite the changing needs and periodic ill health of this person. The home has not developed or implemented a written policy/procedure for the management of urinary catheters, although there are service users using this equipment and staff are involved in associated care provision. Medicines prescribed by doctors are safely stored and carefully administered to residents by staff who have received appropriate training, unless the residents have chosen to store and administer their own medicines. Risk assessment has been recorded for those who self-administer. To ensure accuracy of information and knowledge, the home should keep a record of the reason for prescription of each medicine. Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 11 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): (All these Standards were assessed and found met at the previous inspection) EVIDENCE: Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 12 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): Standards 16 & 18 were assessed and found met at the previous inspection EVIDENCE: Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 13 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): Standards 19 & 26 were assessed and found met at the previous inspection EVIDENCE: Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 14 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):
29 (Standards 27, 28 & 30 were assessed and found met at the previous inspection) Recruitment practices ensure the protection of residents from potentially unsuitable staff. EVIDENCE: The home adheres to robust recruitment procedures implemented by the provider organisation; the records of 2 recently employed staff members were examined and found to contain required information, indicating evidence of personal identification, CRB check and personal health and fitness. Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 15 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):
33 and 35 (31,32,36 & 38 were assessed and found met at the previous inspection) Residents are satisfied with the home and feel staff care for them well and put them at their ease. The home periodically issues ‘user satisfaction’ questionnaires to ensure that residents and their representatives remain satisfied with all aspects of the home. With the exception of the personal allowances of some residents, the home does not manage the finances of residents. EVIDENCE: To ensure that residents and their representatives remain satisfied with all aspects of the home there are monthly Residents Meetings and ‘user
Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 16 satisfaction’ questionnaires are issued each year. The home produces and distributes to each resident a periodic newsletter. With the exception of the personal allowances of some residents (for which all transactions are confirmed by receipt), the home does not manage the finances of residents. Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 18 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 OP7 Regulation 17 Requirement A comprehensive care plan must be recorded for each resident and care records must accurately and adequately describe the condition and care provision for each resident. Timescale for action 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8OP8 OP9OP9 Good Practice Recommendations The home should develop and implement a written policy/procedure for the management of urinary catheters. The home should keep a record of the reason for prescription/administration of each medicine. Castle Hill House DS0000026778.V277093.R02.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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