Inspection on 12/06/08 for Castle House Nursing Home & Residential Home

This inspection was carried out on 12th June 2008.

CSCI found this care home to be providing an Good service.

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

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Castle House Nursing Home & Residential Home Castle Street Torrington Devon EX38 8EZ Lead Inspector Dee McEvoy Unannounced Inspection 09:00 12th June 2008 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 House Nursing Home & Residential Home DS0000070924.V363010.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 House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle House Nursing Home & Residential Home Address Castle Street Torrington Devon EX38 8EZ 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) 01805 622233 Cherry Garden Properties Ltd Mrs Carole Ann Bright Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 33. 23rd July 2007 Date of last inspection Brief Description of the Service: Castle House is situated in a quiet residential part of Torrington; it is close to the countryside yet only 5 minutes walk to the centre of this small rural town. Castle House was originally a ‘gentleman’s residence’ which has been adapted for use as a residential and nursing home. Nursing care is provided for up to 33 residents. The rooms are divided over two floors, with the upstairs rooms being accessed by stairs, lift and a stair lift. Currently only one room has en-suite facilities. The home has a large communal sitting room and a separate dining room. There is a reasonable size garden to the front of the property, which residents can use during the good weather. The average cost of care is £300.00 to £600.00 per week depending on whether the residents require nursing care. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports, is available to prospective residents. Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Since the last inspection there has been a change of ownership of the home. This is the first inspection since the registration of the new owners, Cherry Garden Properties Ltd. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home, their relatives, staff and outside professionals, prior to our unannounced site visit. Completed surveys were received from 3 people living at the home; 2 relatives, 2 staff and 3 health care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. We spent just over 9 hours at the service. To help us understand the experiences of people at this home, we looked closely at the care planned and delivered to three people. Where possible we spoke with these people in depth. We also spoke with staff about their knowledge and understanding of people’s needs. Most people living at the home were seen or spoken with during the course of our visit and five people were spoken with in depth to hear about their experience of living at the home. Time was also spent observing the care and attention given to people by staff. We also spoke with one relative, seven staff members and the manager. A tour of the building was made and a sample of records was looked at, including medication records, care plans and assessments, staff files and fire safety records. What the service does well: People had some very positive things to say about life at Castle House, one person told us, “Been very happily satisfied so far with my stay”, another said, “Personally I am happy with everything!” Other comments included, “The whole place is lovely”, “It’s easy going here” and “I have nothing to complain about”. Two people were particularly happy with the setting of the home, looking over the countryside. Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 6 Relatives were happy with the overall care provided, one told us, “I can’t speak highly enough of Castle House”, another wrote, “They look after mother in a caring way. Overall health professionals were happy with the care provided. One health professional told us, “They provide a comfortable and friendly environment for people to live. They communicate well with the district nurses”, another said, “There is a sense of empathy and caring from the staff and in particular the nursing sisters with whom I liaise”. Good information is available to people to help make a decision about whether this home would suit their needs. A good admissions process ensures that the home can meet people’s needs. Care is generally well planned and delivered in that a way meets people’s needs and preferences. People’s health needs are monitored and the home works closely with health professionals to ensure people get the medical and nursing attention they need. People told us that staff were respectful and that their privacy and dignity was maintained. People told that the daily routines were flexible and that they could make choices in their daily lives. Most people enjoy the social life and activities at the home, which provides some daily variation and stimulation. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. Several people described the atmosphere at the home as warm, friendly and welcoming. People were very happy with the food served at the home. People told us the food was “excellent”, “very good” and “really delicious…” People feel confident that their complaints or concerns will be addressed. Staff have a good knowledge about how to safeguard adults from abuse. There are systems in place to ensure that people’s money and valuables are protected. The home was clean and free from unpleasant smells, and private bedrooms were homely and personalise. There are enough staff on duty to make sure people’s needs are met. People spoke highly of the staff team, people told us, “The staff are lovely. I get along with all of them”, “Staff are excellent – very caring” and “All very helpful”. Staff morale is high and several staff told us how much they enjoy their work. Staff feel well supported and have access to variety of training to ensure they can do their job well. People benefit from living in a well managed home that encourages them to share their views and opinions about the service provided. Overall, health and safety is well managed and people are safeguarded from harm. What has improved since the last inspection? Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 7 Aspects of the management of medication has improved, records showed that people receive their medication at the time prescribed. Improvements have been made to the general environment; new carpets have been laid throughout the corridors. Access to bathing facilities has been improved and now offers more people a choice about how they would like to receive their personal care. A new pathway and sheltered seating area are being completed in the garden, to enable people to use the garden more frequently. 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 House Nursing Home & Residential Home DS0000070924.V363010.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 House Nursing Home & Residential Home DS0000070924.V363010.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is available to people about this service so that they know what to expect and overall people benefit from a good assessment process, which ensures that the home can meet their needs. EVIDENCE: Surveys showed that people are given enough information about the services offered at Castle House to help them decide if it will meet their needs. One person told us, “It was good information that I received about the home before I moved in”, another person wrote, “It was close to family and it is the right place”. There is a guide to the home, the Statement of Purpose, which gives people an idea of what to expect of the home. An information booklet about the home is also available, and contains lots of photographs of the home and additional information about the facilities. Where possible, people are encouraged to visit the home before making a decisions to enable them to get an idea of what it is like and to help them decide if it will suit their needs. One Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 10 relative told us, “They were helpful from the beginning, when we first approached the home about Mum moving in”. Another wrote, “Very helpful and obliging giving out information and responding to questions”. Most people told us they had received a contract, informing them of their rights and responsibilities. We saw that contacts contained information relevant to people’s stay and that that the individual or their relative had signed contracts, accepting the terms and conditions. We discussed the admissions process with the manager. The manager will visit people who are considering a move to the home to get to know them, to provide information about the home, to answer any questions, and to carry out an assessment. Admissions are not made to the home until a full needs assessment has been undertaken. We looked at the assessment of need for 3 people during this inspection. Care files showed that lots of information is gathered before people decide to move in, including assessments carried out by health and social care professionals in some cases. This ensures that the home can meet people’s individual needs. Two people spoke to us about their move to the home; one told us, “I felt very welcome when I arrived”, and another said, “It was the right decision for me to come here.” Castle House does not provide intermediate care. Castle House Nursing Home & Residential Home DS0000070924.V363010.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 good. This judgement has been made using available evidence including a visit to this service. A good care planning system provides the staff team with the information needed to enable them to support people in a way they prefer. People’s health needs are met and the management of medication is generally satisfactory. People feel they are treated with respect and that caring staff promote their privacy. EVIDENCE: People living at the home told us they “always” or “usually” receive the care they need. Comments included, “It’s very good here I think”, “Personally I am very happy with everything” and “I am happy here – they are ever so good”. Relatives contacted were happy with the overall standard of care provided at the home; one wrote, “They look after mother in a caring way”, another told us, “I have peace of mind that Mum is being looked after and cared for”. Each person has a plan of care, which details his or her individual care needs, wishes and preferences. Care files we looked at contained important information about people’s past life and occupation, providing staff with an Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 12 understanding of the individual. There were good details about peoples’ likes and dislikes - for example, what time they liked to get up or go to bed, and what their favourite foods are. We saw that some people or their relative had signed care plans to indicate they had been involved in the process. Staff told us they were “always” given up to date information about people’s care needs, one told us, “We let the nurses know when people’s needs have changed and the care plans are reviewed”, another said, “Care plans have the information we need”. Staff spoken with were aware of people’s needs and could describe the care delivered, which reflected what was written in individual care plans. Risk assessments were in place and generally reflected situations or behaviour, which may cause harm to people, for example, poor mobility, falls, aggression and the use of equipment. Where people’s behaviour may challenge the service care plans described events or circumstances, which may affect that individual. There are good instructions for staff to follow when dealing with difficult situations, which helps to provide a consistent approach. Moving and handling, skin care, nutrition and continence assessments and plans were in place and generally provided staff with the instructions needed to deliver care. Staff were observed to assist people with manual handling needs in a competent and sensitive manner, using the correct equipment and giving gentle instructions and reassurance to people as needed. Currently the home is not developing specific care plans for people with diabetes, which would be good practice. Although some staff demonstrated a good understanding of diabetes, there are no clear guidelines to ensure an agreed range of acceptable results for blood sugars to ensure all staff know what to do should levels fall outside of the range. People living at the home felt they “always” or “usually” received the medical care they needed. Health professionals told us people’s health care needs were “always” or “usually” met by the service, they told us the home sought advice and “usually” acted on advice given. One GP told us, “I think this service tries to help individuals within the bounds of possibility of course, given that many of the individuals are very frail”, and “The nurses in charge are experienced, empathic and helpful”. Another health professional told us, “Generally Castle House staff very good and communicate with us if they have concerns with residential clients. We have a good relationship”. A third visiting health professional was concerned that some staff did not fully understand the importance of compression hosiery. We spoke with several staff about this. Some staff had an understanding of how to use hosiery safely, although they had not received specific training on the subject, which would be useful to ensure all staff were aware of the importance of fitting this hosiery Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 13 properly. None of the people currently living at the home require this care at present. There are good preventative measures in place for people at risk of developing pressure sores. The home has the necessary equipment in place and care plans provide detailed information about the care to be delivered to reduce the risks. Wound care plans are detailed and show the progress of wounds and the current treatment being used. Records show that people have access to a variety of health professionals including GP, district nurses, optician and other specialists and out patient clinics. We looked at the way the home stores and administers medicines. Medicines are stored and disposed of safely. The storage and management of controlled drugs is satisfactory and medicines needing refrigeration are kept at the appropriate temperatures. However, there is no record of the range of maximum and minimum temperatures of the fridge, which is good practice. The home ensures they receive written confirmation from GPs when changes are made to people’s medicines, and on the whole two staff sign handwritten entries on the Medication Administration Record (MAR) to verify accuracy, although there were a number of entries not signed by two staff. Where medication is prescribed as “when needed”, accurate records were available to show what does was given and why. Medication with a limited ‘shelf life’ once open had been dated to ensure they were used within the timescale suggested by the manufacturer. People spoken with told us staff were respectful, kind and caring. Comments included, “Very friendly and pleasant helpers”, “Staff are excellent, caring and always respectful” and “We can have a laugh but they (staff) are respectful and kind”. During our visited we saw that staff had a considerate and friendly approach when delivering care or chatting with people. Staff use privacy signs on bedroom doors when delivering care to ensure that people are not disturbed and privacy is promoted. People’s personal care is well attended to, which promotes their dignity and improves their feeling of self worth. People were well dressed and groomed, and attention to their personal care was good. The hairdresser visits weekly and several people enjoyed having their hair done during our visit. One relative told us, “People here are always well turned out and clean, never scruffy”. There are three shared rooms at the home. People are consulted with before they are expected to share a room. There are fitted privacy curtains in each shared room, which provide a private space for people, and the rooms are spacious enough to allow people to receive personal care. We spoke with two people sharing a room, both were happy with the arrangements. One person Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 14 told us, “I am busy during the day and tired at night. I don’t spend a lot of time in the room”. Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. Routines are flexible and people are supported to exercise control over their daily lives. Social activities meet most peoples’ expectations and preferences and people benefit from contact with their family and friends, which is encouraged by the home. Meals at the home are enjoyed and provide a nutritious variety. EVIDENCE: We spoke with people about the routines at the home. People told us the routine was fairly flexible, one person told us, “I am not restricted here. We can do as we like really”, another person told us, “It’s easy going. I can get up when I want to, sit where I want to”. In surveys people said there are “usually” activities available that they can take part in. One person wrote, “I feel that there could be more outings throughout the year”. We spoke with several people during our visit about activities, most were satisfied. Their comments included, “There is always something going on…”, “There is lots to do if you want to” and “There is usually enough but I dare say there could be more”. One person told us, “There is not enough to keep me busy. I would like to get more often”. This Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 16 person said they would enjoy a visit to the pub but they couldn’t go alone. Other people told us they had been out and about, visiting the town for coffee and shopping. People can access the garden and a number of people told us how much they enjoyed this. One relative told us, “They try to involve Mum with other people. Put on plenty of activities to try to break up the time. The staff have the time to be individually involved with people – to talk to them and do individual things”. Another relative told us that enjoy taking part in some activities at the home, such as coffee mornings. The home has a monthly programme of activities for people to enjoy if they choose. These include visits into town for coffee and shopping, weekly coffee mornings, visiting musical entertainers and local library, pets as therapy visits and games. One member of staff is allocated two and a half hours three times a week to provide additional support for activities. The home has established “The friends of Castle House” who visit weekly to organise games such as bingo. One person told us they really enjoyed the skittle games. Several people have enjoyed planting seeds and watching them grow in the front porch. A reminiscence table has been set up in the foyer of the home to engage people with themes associated with past times, special occasions, such as weddings and holidays, and other special days and celebrations. The current theme was pets. The manager had arranged for various pets to visit the home daily, including two sets of puppies and a hamster. It was clear that people really enjoyed the visits from the puppies. Most people had an opportunity to hold the puppies, which gave much pleasure and stimulated memories of their own pets. This was a focus of conversation for some time. We saw that staff had time to spend with people individually. Some people enjoyed a manicure, whilst other people enjoyed a chat with staff. Staff were seen to read the local paper to one person and chat about local happenings. One person told us they particular liked the regular service at the home provided by a local church. People also talked about the friendships they had developed at the home, one person told us, “I have made friends here…I have good company”. Visitors to the home say they are always made very welcome, offered refreshments and they can choose to have a meal with the person they are visiting. One relative told us, “We are offered tea and biscuits and made to feel most welcome”. Relatives said the home kept in touch with them and informed them of any changes or events affecting their relative. Relatives are encouraged to be involved at the home and are invited to meetings, coffee mornings and other events. One relative told us, “Always obliging if we mention something regarding mother that we think should be done”. The home provides a relaxing, comfortable and supportive environment for people to live in. People responding with surveys felt that staff “always” Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 17 listened and acted on what they said, ensuring that they have the opportunity to exercise some choice and control in their daily lives. Relatives and health professionals told us people were “always” supported to live the life they choose. People told us they make daily choices, such as what to eat and the clothes they wear. Care plans include a record of people’s preferred daily routine and people told us they get up and go to bed when they want to. People told us they liked the food served at the home, comments included, “Excellent food”, “The food is beautiful and more than enough”, “The food is very good indeed” and “The cook is good, the best we’ve had…” Several people told us they had enjoyed a cooked breakfast on the day of our visit. People are involved in menu planning and asked to give their ideas and suggestions to the cook. People told us they could have an alternative to the main meal if they wanted and there is always a vegetarian option on the menu. The cook is experienced and is well informed about people’s dietary needs and likes and dislikes. The kitchen is well stocked with fresh fruit and vegetables and a good supply of dried goods. The cook told us that all food was of a “good quality” and supplied locally. A visit recently by the Environmental Health Officer found good standards within the kitchen. The dining room was pleasantly laid for mealtimes, with nice attention to detail, for example flowers and condiments were on the tables, and vegetables and gravy were served in individually dishes to enable people to help themselves. Staff were on hand to assist people individually where needed. Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 18 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. People can be confident that their complaints will be listened to and staff understand the principles of adult protection, which helps to protect people from abuse. EVIDENCE: A copy of the complaints procedure is given to people when they first move in, a copy is also in the Service Users Guide found in each bedroom and in the foyer of the home. Most people know how to make a complaint and who to speak with should they have any concerns. One person told us, “I would speak with the manager, she always listens”. Another wrote, “Speak to carers when unhappy or if anything is troubling me”. One person responding with a survey told us they “sometimes” knew who to speak with. Relatives contacted were aware of the complaints procedure and said they knew who to speak with if they had any problems. Records at the home show that one complaint has been received since the last inspection. This was dealt with and responded to promptly. No complaints or concerns have been raised with the Commission about this service. Staff spoken with confirmed that they received adult protection training to ensure they are aware of the action to be taken should they have any concerns about peoples’ wellbeing or safety. Staff demonstrated a clear understanding of the various forms of abuse and were aware of their responsibilities to report Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 19 any concerns. Staff told us they had seen the home’s policy for dealing with allegations and knew to whom to contact outside of the home to report concerns, although this information is not in the home’s policy. People living at Castle House told us they felt well cared for and that staff treated they with respect and kindness. Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 20 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, 22, 25, & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made and are being made to ensure that people enjoy a good standard of accommodation that is attractive, clean, homely and well maintained. EVIDENCE: The general environment at Castle House is improving. The new providers have invested by replacing carpets throughout the home, developing areas of the garden and improving access to bathing facilities. The home employs a maintenance person, which helps to ensure that repairs and maintenance are promptly dealt with. One health professional commented, “The decorative state of the building is being improved”. An Arbour and pathway is being built in the garden to enable better access for people and provide a sheltered seating area. This is a direct response to Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 21 people’s request and is to be commended. There are pleasant and comfortable communal areas for people to enjoy, and the bedrooms we visited were comfortable and personalised. People told us they liked their private bedrooms and had been able to bring items of furniture and mementos from home. One relative told, “We brought Mum’s things in to make it more like home”. Since the last inspection the assisted bath on the first floor has been adapted to enable the use of a hoist. This has improved people’s choice, as the bath is now accessible to most people. The home has the necessary equipment to assist people; Aids, hoists, specialist beds and assisted shower and bath are able to meet people’s individual needs. Staff told us they generally had the equipment they needed to ensure that care was provided safely. Two told us they would like more reliable hoists as they found the batteries did not hold their charge for long. This was discussed with the manager who told us hoists are serviced regularly and all were in good working order. Information in the AQAA confirms this. Concerns were raised about a ramp used to access some bedrooms on the ground floor. One professional felt that the arrangements for using the ramp could put people at risk. Most staff said the ramp was rarely used at present but also said that it could be “awkward” to put in place when needed. This was discussed with the manager who said that the ramp had been used for years and that no accidents or injuries had occurred. The home is generally safe for people; radiators are covered to reduce the risk of burning to people. Windows on the upper floors are restricted to prevent accidents from falls, and records show that water temperatures are regulated to prevent harm from scalding. The home was clean and free from offensive odours throughout. People responding with surveys said the home was “always” clean and fresh. Some staff are in need of infection control training to ensure that good standards are maintained. Three infection control training days covering various topics relating infection control, including managing MRSA, are planned for July and August. Staff have the necessary protective equipment, such as gloves and aprons. There is liquid soap and disposable towels in most toilets and bathrooms to promote good standards. However one small on the first floor does not have a sink or gel for people to use. Castle House Nursing Home & Residential Home DS0000070924.V363010.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 good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to ensure that peoples’ needs are met in a timely way and experienced and friendly staff support people well. People are protected by the robust recruitment practice followed at the home. EVIDENCE: People told us staff were “always” or “usually” available when needed, and staff told us there were “usually” enough staff on duty to meet people’s needs. Duty rotas show that there are usually 5 care staff and one registered nurse on duty, with the manager working Monday to Friday. Additional staff such as cooks and domestics are also on duty each day. During this inspection we saw staff responding to peoples’ bells swiftly and attending to people’s needs and requests promptly. Staff had time to spend individually with people, chatting or reading. Mealtimes were unrushed and people were given the attention they needed. The manager and staff told us they felt the staffing levels were currently meeting people’s needs. People living at the home spoke highly of the staff, comments included, “Carers are very keen to help”, “Staff are excellent”, “Staff are lovely – very kind people…” and “…We all get on very well”. Staff morale is good and several members of staff told us how much they enjoyed their work. Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 23 Three staff recruitment files were looked at to ensure that the home operates a robust procedure, which protects people. Two files contained the necessary checks to ensure people are safeguarded from unsuitable staff, such as Criminal Record Bureau (CRB) check and references. A third person working in the kitchen did not have a CRB. The manager showed us a risk assessment, and job description that showed that this person had no contact with people living at the home and was never left unsupervised. We saw that the CRB had been applied for but not returned. References had been obtained. Staff returning surveys told us that employment checks such (CRB) check and references had been undertaken. The AQAA shows that 75 of care staff hold a nationally recognised qualification in care, helping to ensure that good standards of care can be achieved and maintained. Relatives and visiting professionals told us that staff “always” or “usually” have the skills and experience to meet people needs. All staff responding with surveys said they had received induction training, which covered everything they needed “very well”. We looked at two records, which showed that staff have a structured induction to help them understand how the home works and how to care for people safely. Nurses are encouraged and supported to attend training to keep their skills up to date and enable them to deliver the care people need, such as palliative care. Castle House Nursing Home & Residential Home DS0000070924.V363010.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 good. 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. People’s health and safety is generally managed well at this home. EVIDENCE: The manager is both qualified and experienced. She is a registered nurse; She has obtained the Registered Manager’s Award and she has several years of experience of managing a care home. The manager works hard to ensure people living and working at Castle House are happy and safe. People living at the home and their relatives described the home as a “friendly” place and staff spoken with said there was a good atmosphere with everyone Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 25 working together. All spoken with had confidence in the manager and felt that she was approachable and ready to listen. People are asked for their views on the service they receive. Regular questionnaires are given to people living at the home, their family/friends, outside professionals and staff. The results are audited by the manager, and a report is completed and made available to people. Action is taken where issues arise, for example people have been reminded about the complaints procedure, and changes have been planned to activities as a result of feedback from people. Residents’ and staff meetings are held, both providing an opportunity for the manager to give and receive information about the home. A representative of the company visits the home monthly to undertake a review of the service. We saw that written reports were available of the outcome of these visits and action taken as a result to improve the service. The home does not deal with any financial affairs of the people living there other than to hold, if required, small sums for personal items. Records are maintained of money held and safeguards are in place to ensure balances are checked. The accounts for three people were checked and found to be in good order. Health and safety at the home is generally well managed. During our tour of the building no immediate hazards were identified. Staff receive mandatory training such as manual handling, infection control, fire safety and where appropriate food hygiene. The AQAA shows that all catering staff and 90 of care staff have undertaken food hygiene training to ensure that standards in this area remain high. However the manager told us and records show that some staff are over due fire safety training. The manager explained that some training was not completed during the sale of the home but that the training programme was now back on track. Fire training sessions were booked for early in July. The fire log showed that many staff had attended fire drills in between fire training. The AQAA showed that maintenance of equipment and systems, such as water, gas and electrical systems, and equipment such as the passenger lift, chair lift and hoists were up-to-date. Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 X X 2 X X 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Castle House Nursing Home & Residential Home DS0000070924.V363010.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP8 Good Practice Recommendations It is recommended that an agreed range of acceptable levels for blood sugars be recorded in care plans to ensure that staff are aware of the appropriate action to take should levels fall outside agreed levels. It is recommended that handwritten MAR entries be signed by two competent people to ensure accuracy. In order to store medicines correctly, you should ensure that maximum and minimum temperatures the fridge are accurately recorded. In order to ensure people’s safety, it is recommended that a full risk assessment be completed for the use of the portable ramp, to ensure that risks are identified and reduced where possible. To promote good infection control, it is recommended that hand gel is provided in the toilet without a hand sink on the first floor. DS0000070924.V363010.R01.S.doc Version 5.2 Page 28 2. OP9 3. OP22 4. OP26 Castle House Nursing Home & Residential Home Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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