CARE HOMES FOR OLDER PEOPLE
Castle Hill House Limited Castle Hill House Castle Hill Bodmin Cornwall PL31 2DY Lead Inspector
Philippa Cutting Unannounced Inspection 12th October 2005 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 Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 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 Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Castle Hill House Limited Address Castle Hill House Castle Hill Bodmin Cornwall PL31 2DY 01208 73802 01208 75836 castlehillhouse@hotmail.com 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) Castle Hill House Limited Mrs Judith Ann Adams Care Home 20 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (20), Physical disability (20), Terminally ill (20) Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. Service users to include up to 20 adults of old age (OP) Service users to include up to 20 adults aged over 65 with a terminal illness (TI{E}) Service users to include up to 20 adults aged over 65 with a physical disability (PD{E}) Service users to include up to 4 adults, aged over 65 with dementia (DE{E}) Service users to include up to 4 adults aged over 65 with a mental illness (MD{E}) Total number of service users not to exceed a maximum of 20 Date of last inspection 23rd March 2005 Brief Description of the Service: Castle Hill House is a privately owned care home registered to provide nursing care for up to twenty older service users. Four of the beds in the home are registered for service users with a dementia DE(E) and four beds are registered for service users who have a mental disorder MD(E). The home is registered to take service users who require terminal care, TI or have a physical disability PD(E). One of the Registered Providers manages the home on a day-to-day basis. The home is an older style residence set in its own grounds in a quiet residential area on the outskirts of Bodmin. The home is in an elevated position, providing super views over the surrounding countryside. There is a car park to the front and side of the home. Bedrooms are situated on the ground and first floor. They are not en suite. The floors are linked by stairs and a shaft lift that can take a wheelchair. The communal space comprises a double lounge and dining room on the ground floor. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out between 10.00am & 4.45pm. The inspector spoke to service users, staff and relatives. The premises were toured and records inspected. The inspector had not visited the home before. The registered provider commented that service user were becoming increasingly frail and she was particularly frustrated that, due lack of funding for placements, people wanting and needing care from Castle Hill House were not able to benefit from it as she felt they should. What the service does well: 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 Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 6 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 Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 7 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): 2,3,4,5, Service users are provided with the opportunity and information needed to make an informed choice about residence at Castle Hill House. EVIDENCE: The service users guide provides details of the services and amenities offered by the home. The terms and conditions pertinent to the home are recorded in the contract provided for service users. Prospective service users are visited and assessed to ascertain that the home can meet their needs. The deputy manager commented that for people who are in hospital awaiting assistance with the funding of their fees, the delay can now be so long that assessments may no longer be accurate by the time funding is agreed. Records showed that advice is sought from other agencies where a need is identified and that within the home’s staff group, the trained staff and carers have the skills needed to care for service users.
Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 8 Service users can visit the home before deciding whether or not to seek permanent admission either by means of respite care or a visit. In reality most potential service users are too frail to visit in advance so the choice of accommodation is made by relatives on their behalf. The first four weeks of any stay is on a trial basis. The home does not provide a rehabilitation service at Castle Hill House although the registered provider said that there are staff who have completed a rehabilitation course but they work in the community. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 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): 7,8,9,10,11 Service users’ health care needs are properly addressed. EVIDENCE: Care plans are available for each service users. These are provided by a computer-generated system. The headings include all aspects of care. It would be better if a comment such as ‘no problems identified’ or ‘not relevant’ were to be inserted rather than leave fields blank. This would show that the topic has been considered rather than ignored. There is also scope to put more information in certain fields, especially personal care. Stating what a person can do is as important as what needs to be done. All service users are registered with local GPs and have access to Consultants and specialist nurses, such as continence or tissue viability advisors. The home has a supply of equipment which is used to promote skin care and healing if necessary. Other professions ancillary to medicine are used as needed. Mobility is encouraged where ever possible but staff said that at present an increasing number of service users needed to be moved with a hoist or other
Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 10 device for their own and the staff’s safety. Hoists must be used correctly at all times. Medication is stored in a locked trolley that is secured to the wall when not in use. The home has documented procedures for all aspects of medication and a signed ’returned medication’ book was seen to be completed. The home prefers, with the GPs help, to keep medication to a minimum. Syrups or soluble tablets were noted for people who have difficulty in swallowing. Only trained staff administer medication; the medication administration record sheets were fully completed. There are no controlled drugs in current use. There are no rooms in use as a double at present but a lack of curtaining or screening around the wash basin was noted in one ‘double’. The registered provider commented that very few service users can now sit at a wash basin to wash themselves so the staff used the basin to collect water to wash people either in bed or at their bedside. ‘Thank you’ letters and cards sent to the home are evidence of the care provided to people. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 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): 12,13,14,15 Service users are encouraged to retain their independence as much as they are able. EVIDENCE: Most of the service users are very frail and limited in their ability to participate in many activities. The home does never the less, organise regular activities with the service users, encouraging them to either participate actively or watch. Routines appeared to be flexible and designed to meet peoples’ needs. Examples of service users who choose to lead slightly idiosyncratic lives were noted. Visitors are able to visit freely and were seen to do so during the inspection. The opportunities for choice have become limited for some but staff said they tried to provide these when ever possible, albeit in a limited way. Currently there are a number of service users who have communication problems so there are potential difficulties when decisions have to be taken. However the registered provider said that these people all have interested and involved families who would be consulted. If the home encountered a problem
Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 12 with a service user who lacked support, Age Concern or a similar organizations would be approached for help. Service users with whom the inspector spoke said the food was good. Those who are able, eat in the dining room where tables were nicely presented. People who needed help with their food were helped in a quiet environment where they were undisturbed. Care staff sat with them whilst they had their meals. The wish to remain in one’s room for meals was also respected. A choice is offered for all meals. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 13 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 The home is aware of its responsibilities with regard to protecting vulnerable adults. EVIDENCE: The home’s complaint policy is outlined in the service users guide. It includes information regarding the Commission for Social Care Inspection. A book in which compliments, comments and concerns were listed has lapsed. It would be a good idea to restart this, not only as a record of any complaints that the home has to address but also as a measure of people’s satisfaction. The registered provider is aware of the issues surrounding the protection of vulnerable adults (PoVA) & has attended a seminar regarding this. It is planned that more staff should attend similar sessions. The home was advised that should they accommodate anyone funded by another county, they should seek the PoVA procedures for that area and not presume that everyone ascribes to the local Cornish model. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 14 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, The home was clean and provided service users with the equipment they needed for their care. EVIDENCE: The reception and hallway have been redecorated and present a good first impression. Service users’ rooms showed individual taste and choice with regard to ornaments and personal items. Variable height beds are provided for all with furniture and furnishings of a satisfactory nature. A variety of chairs are provided in the sitting rooms to enable people to sit in comfort. Externally the grounds are largely laid to lawn and kept tidy. The laundry was not inspected on this occasion. The registered provider said the home had had a recent visit from the Environmental Health Officer (Food Hygiene). The home is participating in the ‘Working in Harmony’ scheme with the Environmental Health Officer.
Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 15 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): 27,28,329,30 Staff in the home appeared to be attentive & caring to service users. EVIDENCE: The home is staffed by trained staff supported by carers, who are encouraged to undertake National Vocational Qualifications. Seven staff have NVQs at level ll with some going on to level lll. Written references were seen for staff but the home is reminded that PoVA checks must be obtained for staff before they start work. This was an issue in one case; all other staff had Criminal Records Bureau clearance. The deputy manager said that she was undertaking appraisals and supervision with staff. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 16 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): 31,32,33,35,36,37 The registered providers exercise their duties and responsibilities in the home in the service users’ best interests. EVIDENCE: The registered manager is a registered nurse and holds management qualifications. She is innovative in ideas for the home but is currently frustrated by a lack of funding from agencies for service users that prevents her from instigating them. Quality assurance questionnaires have been distributed to service users but the registered provider commented that most are too frail to complete these. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 17 The home prefers not handle money for service users. Relatives would be approached if something was needed or an item would be billed, as appropriate. The registered providers were expecting an appointment with their consultant about employment issues relating to staff. They are also investigating various distant learning opportunities for staff to supplement the existing induction and further training opportunities. Records for accidents accord with the Data Protection Act 1998. The fire log and testing is current. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 18 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X X X X STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 X Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 19 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 OP29 Regulation 19 Schedule 2 Requirement PoVA checks must be obtained on all staff before they start work Timescale for action 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP16 OP18 Good Practice Recommendations All sections of care plans should be completed to show that they have been considered. The home’s comments, compliments and concerns book should be re-started or alternatively a log book for any complaints must be set up. The preferred PoVA procedures should be obtained from the funding authority where a service user comes from outside Cornwall. Castle Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Hill House Limited DS0000054294.V257556.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!