Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Castle Hill House Limited Castle Street Bodmin Cornwall PL31 2DY The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Tworkowski
Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home
Name of care home: Address: Castle Hill House Limited Castle Street Bodmin Cornwall PL31 2DY 0120873802 0120875836 manager@castlehillhouse.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Castle Hill House Limited Name of registered manager (if applicable) Mrs Carol Ann Edwards Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 43. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following catergories: Old age, not falling within any other category (Code OP) - maximum of 43 places Physical disability (Code PD) maximum of 10 places Dementia (Code DE) - maximum of 4 places Mental disorder, excluding learning disability or dementia (Code MD) - maximum of 4 places Date of last inspection 4 4 0 10 Over 65 0 0 43 0 care home 43 Care Homes for Older People Page 4 of 28 Brief description of the care home Castle Hill House is a care home registered to provide nursing care for forty three people over the age of sixty-five. 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 a grand 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 views over the surrounding countryside. The home has been significantly extended and now offers a number of rooms which have en-suite toilet facilities. These rooms are spacious and particularly suited to people who have mobility difficulties. Bedrooms are situated on the ground and first floor; there are two shaft lifts that can take a wheelchair. There is also a garden and a patio area, and ample parking. Information about the home (Service User Guide and Statement of Purpose) is available from the office. A copy of the Service User Guide is available in each bedroom. Prices in the home vary from pounds 525 to pounds 850, this does not include personal items such as hairdressing, chiropody, clothes or toiletries. Care Homes for Older People Page 5 of 28 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection included an unannounced visit to Castle Hill House on 9th February 09 between 8.50 am and 6.35 pm. This inspection was conducted by one inspector, though for the purposes of this report the term we is used, as the inspection was carried out on behalf of the Commission. The Manager and Mr and Mrs Wielkopolska (directors of Castle Hill House Ltd), were present throughout the inspection. As part of the visit we looked around the home and saw almost every room in the house, we looked at the care that was provided to four of the people, (including their records), we looked at the medication system, at the way staff are recruited, trained and managed, and at the way the home is managed overall. Care Homes for Older People
Page 6 of 28 As part of this visit we spent one hour observing the way staff and the people at Castle Hill House interacted, this was during a meal time. In addition we spoke with two of the people who live in the home, one of the care staff, and with a visiting social services care manager and a community psychiatric nurse. In addition we also sent surveys to some of the people who live in the home, nine were returned. We also received information back from the previous Registered Manager in the form of a quality assurance questionnaire. What the care home does well: What has improved since the last inspection? What they could do better: We found that whilst meals were well cooked they were not well presented, tables were not laid and dirty dishes were not collected for some hours after the meal. We found that whilst the care plans, documents that tell staff about the needs people have, were clear they did not reflect the individual choices and preferences that people have. We found that medication was generally well managed, however their was no record of creams or nutritional supplements being administered. Such items are prescribed and their use needs to be recorded. We found that bed or cot sides were used to keep people safe, however there were no risk assessments to ensure that these sides did not pose a risk in their own right. We found that people had received training in relation to keeping people safe, and protecting them from abuse, however the policy did not take into account the role social services play in dealing with any allegations. Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Castle Hill House can be confident that their needs will be known about prior to a move to the home. Evidence: Castle Hill House has recently had a major extension built, and as part of this process was required to provide new documents, a Statement of Purpose and Service User Guide. These documents provide information for people who live at or are thinking about moving to Castle Hill House about what the home provides. When we looked around the home we saw that there were copies of the Service User Guide in rooms. Six of the people who responded to the survey thought that they had had enough information about the home before they had moved, three thought that they had not. We looked at what the staff knew about one person who had recently move to the home. We found that there were records to show that information had been received
Care Homes for Older People Page 11 of 28 Evidence: from other professionals, and a brief assessment completed. We discussed with the Manager ensuring that where information from other documents or assessments is used as part of the homes assessment that this is clearly identified in the homes assessment. This would help ensure that no information is missing by anyone reading the homes assessment. During this visit to the home we were aware that the Manager was making appointments to visit and meet people who were thinking about staying at the home. The Manager said that as part of the assessment process she would be going to meet the individuals concerned. Information supplied by the previous Registered Manager confirmed that the pre-admission assessment covered all aspects of the individuals well being. Care Homes for Older People Page 12 of 28 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Castle Hill House generally feel well cared for. Medication is being safely administered however improvements are needed in recording of the administration of creams and nutritional supplements. Evidence: In the survey we sent to some of the people at Castle Hill House, we asked if they received the care and support that they needed. Five of the nine people said that they always did, three of the nine people said that they usually did and one person said that they sometimes did. We asked if people received the medical support needed, four people said that they always received this support, whilst four said that they usually received this support. We talked with one care manager and with one Community Psychiatric Nurse who was visiting the home, both said they were satisfied with the standard of care. We looked at the way the home provides care to four people in the home. We found that there were up to date care plans that had been regularly reviewed. These
Care Homes for Older People Page 13 of 28 Evidence: document should describe how care is to be provided, this should be insufficient detail so that it reflect the individuals preferences and such that a carer would know precisely how to help. We found that the care plans were written in general terms. For example one plan said Ensure regular toileting plan is adhered to, however there was no such plan. Some plans said tasks were to be done regularly, but did not say how often this was. We found that care plans did not particularly reflect the individual concerned. There were some risk assessments on file, and consideration had been given to concerns around diet and risk of pressure sores. There were no individual risk assessments in relation to bedsides, even though these were in use for a number of people. Bed (or cot) sides can stop people falling out of bed, however they can also cause injury. We looked at the records of the support people received. Daily notes are kept of care given. We discussed with the Manager improving the recording so that care staff who provide care, record what they have done, as well as the nursing staff. We were shown the medication system by one of the nursing staff who has responsibility for administration. A recommendation had been made at the last inspection that two staff check and sign information that is transcribed, we found that this had happened. The medication system was in good order, including controlled drugs. We did find that medication such as creams and nutritional supplements was not being signed for. We were told that this was because in some cases it was being administered by carers and in other cases because it was not needed on a a regular basis. A record must be kept of all prescription medication, who administers it, and if it is not administered a reason must be given. We also discussed ensuring that there is a record of parts of tablets not administered that are destroyed. Care Homes for Older People Page 14 of 28 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Castle Hill House are provided with the opportunity to take part in a range of activities. Meals are well cooked however the way in which they are presented is poor. Evidence: We asked people in a survey if the home arranges activities they are able to take part in. Four people said that this was the case always or usually, five people said this was rarely or never the case. However a number of these people told us that they did not wish to join in because they were independent, did not like to mix with other people or were unable to do so because of poor health. One person said I have always been asked to their activities but not always felt well enough to join in. We saw that there was information on the notice board about activities that were planned, and observed one of these sessions taking place. Activities planned included: bingo, quizzes, line dancing, and cooking. As part of the survey we were told that six of the people always or usually enjoyed the meals, the seventh person who responded to this question said that sometimes
Care Homes for Older People Page 15 of 28 Evidence: enjoyed meals. As part of this visit we sat and observed what happened for four people over a lunch time. We observed that where people needed help the staff were considerate and spoke to people in a very positive and respectful manner. However, from what we observed we felt that the meal time was not well managed. We sat in a dining room with four people, two of whom needed help to eat. The tables were not laid, the main course and hot pudding were brought and set in front of the individual at the same time. So that by the time the person came to eat the pudding it was cold. Cutlery was brought with the meal, however there were no condiments (salt and pepper) on each of the tables. There was no water or other drinks to have with the meal. The people clearly enjoyed the food they were given however the way the mealtime was managed detracted from the food. It is important that meals are not only well cooked and tasty, but they are well presented. Meals can provide an enjoyable social occasion, this is particularly important for people who have a poor appetite. We spoke with one person who was unable to leave her room. We found that she still had her dinner and pudding plate in front of her at 3.30pm, when the meal had been served at around 12.30pm. We asked the person if this is what happened every day, she said that this was usually the case. We were concerned that during this period no one had been to check on this individual to see if she had enjoyed her meal, remove her dishes or to make her comfortable. Care Homes for Older People Page 16 of 28 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Castle Hill House can be confident that their views will be listened to and appropriate action taken. Evidence: Eight out of nine people told us in a survey that they knew how to make a complaint and that they knew who to speak to if they were not happy. We saw that the complaints procedure was in the information given to people when they move to the home, and also displayed on notice boards. We were shown the complaints file, and the records of complaints received since the last inspection. There were good records to show that complaints had been dealt with and issues followed up. We were told, in the information supplied by the Registered Manager on 16/12/08 that all of these staff receive Safeguarding training in house, and that the majority of staff have also attended training provided by Cornwall County Council. At the last inspection a recommendation had been made that the there to be a clear procedure for the Protection of Vulnerable Adults to enable staff to know the action that they must take. We looked at this policy and found that it was clear, however it did not include any reference to Social Services, who have a central role in co-ordinating investigations and in safeguarding people. Any procedure should give clear directions to staff as to how to contact Social Services. Care Homes for Older People Page 17 of 28 Care Homes for Older People Page 18 of 28 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Castle Hill House provides clean and comfortable accommodation. The new extension is light, spacious,and well adapted to the needs of people who may have difficulties moving around. Evidence: As part of this inspection we were shown around the home by the new Manager. The new extension is light and airy. The bedrooms in this part of the house all have ensuite toilets. There is overhead tracking for hoists so that if people need to be move this can take place with the minimum of disruption. All of these rooms have electric beds which are able to be controlled by the person occupying the bed. We saw a large first floor lounge that was well used and offered a variety of seating. We were told that more people were using this lounge as the lounges in the older part of the house were being redecorated. There are two dining rooms in the newer part of the home, these are clear and tidy, though seemed rather bare in comparison to other areas of the home. The older part of the home was quite different in character to the new extension. We found that some of the bedrooms were well decorated and comfortable, however some had worn carpets and were not well decorated. We were told that these rooms are gradually being renovated as they become empty and funds become available. We
Care Homes for Older People Page 19 of 28 Evidence: discussed the need for one of the carpets to be cleaned immediately as the room had become rather smelly. The bathrooms in the new extension are spacious, bright and clean. One of the bathrooms in the older part of the building had been renovated and this stood in stark contrast to the other toilets and bathrooms which were waiting to be revamped. We saw two large lounges in the older part of the building that are currently being decorated. These rooms are large and airy and are clearly well used, containing lots of personal items which gave the rooms a more homely and domestic feel. With the exception of one room the home was clean and free from unpleasant odours. There were disposable gloves, aprons and soap in all of the places that they were required. We noted that some of the bins did not have bin liners, and were told that this had been over looked as the cleaner was on leave. We tested hot water from taps in showers and bathrooms during the tour of the building and found that the water was not excessively hot. We were told that regular checks are now being done to monitor water temperature and we were shown a chart that was being used for this purpose. Care Homes for Older People Page 20 of 28 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people in Castle Hill House are cared for by competent well trained staff. The recruitment system is robust. Evidence: The people who live at Castle Hill House who responded to our survey when asked if staff were available when needed, two said staff were always available, six said staff were usually available and one person said that they were sometimes available. Eight out of the nine people said that staff listened and acted on what was said. We were told that there was always a nurse on duty at all times, in addition there were five or six carers on during the morning, and three or four carers on in the afternoon and evening. At night there is one carer on in addition to the nurse. We were told that the current shift pattern is being reviewed so that the hours are spread better across the day, and so that staff do not have to work such long shifts. As part of this visit we looked at the recruitment records for two new staff. We saw that there was a system for making the necessary checks to ensure only people who are suited to the work are employed. We discussed with Mrs Wielkopolska, who represented Castle Hill House Ltd, the need to ensure that all gaps in the employment history are accounted for. Also, where an individual has worked in a care home, a
Care Homes for Older People Page 21 of 28 Evidence: reference should be sought from this employer. We saw that checks had been made in relation to criminal records and of lists of people who are not permitted to work with vulnerable people. We were shown induction check lists for the two staff who had recently started in the home. Mrs Wielkopolska told us that staff were given a range of in house training, but were also expected to start their National Vocational Qualifications in Care. When we looked at the information provided as to how many of the care staff had completed a National Vocation Qualification in Care, we found that their were only five out of fourteen. However Mrs Wielkopolska has confirmed that this information was out of date and that over 50 of staff have an NVQ in Care to level 2 or above. We asked about on going training, and were shown a training matrix, which identified courses that staff had completed. We were told that staff have recently received training in relation to continence, medication and in relation to the Mental Capacity Act. We were told that staff receive regular 2 monthly supervision and annual appraisals. Care Homes for Older People Page 22 of 28 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people who live at Castle Hill House are taken into account in running the service. The recent change in managers is an opportunity to improve the day to day management of staff and to improve the quality of service in the home. Evidence: We were told that the Registered Manager had recently left the home, and we met the new manager who had started the week before. The new manager will be required to go through the process of registering with the Commission. It was clear from our discussions with the new Manager she was quickly becoming acquainted with the staff and people in the home. We discussed with the Manager and Mrs Wielkopolska, the view that staff were not being well directed or led in their daily work. This was evidenced by the lack of organisation at meal times and the fact that a person had was regularly being left with their dinner plates in front of them for two and a half hours after they had finished. Care Homes for Older People Page 23 of 28 Evidence: We were given a copy of the homes satisfaction survey that had been completed in October 2008. The results of this survey were seen on a notice board. We looked at the results of this survey and it evident that the the views of the people who live at the home were taken seriously. We asked to see the risk assessments for the home and were shown risk assessments that had been updated and reviewed. We were told in information sent to us that all staff are required to read the Health and Safety handbook as part of their induction. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 15 16 Meal times must be 01/05/2009 managed so that people are able to eat and enjoy their meals in a pleasant environment that encourages social interaction and well being. This means that tables should be well laid, drinks provided, and crockery cleared away when no longer needed. The people who live at Castle Hill House need to be able to enjoy their meals in pleasant surroundings. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 7 Care Plans need to be reviewed so that they are more specific and better reflect the interests and preferences of individuals. The use of bed or cot-side should be risk assessed. 2 8 Care Homes for Older People Page 26 of 28 3 9 Medication must be administered as prescribed and a record kept of this administration, unless there is a reason why it cannot be given. This must include creams and nutritional supplements. Safeguarding or vulnerable adults procedures must include reference to the role of Social Services and give details of the relevant contacts. 4 18 Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!