Inspection on 03/05/07 for Castle Keep Nursing Home

This inspection was carried out on 3rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Castle Keep Nursing Home 24/02/10

Castle Keep Nursing Home 07/02/06

Castle Keep Nursing Home 22/09/05

Castle Keep Nursing Home 08/03/05

Castle Keep Nursing Home 31/08/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Castle Keep Nursing Home Noddle Hill Way Sutton On Hull East Yorkshire HU7 4FG Lead Inspector Eileen Engelmann Key Unannounced Inspection 3rd May 2007 09:30 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 Keep Nursing Home DS0000000925.V339047.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 Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle Keep Nursing Home Address Noddle Hill Way Sutton On Hull East Yorkshire HU7 4FG 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) 01482 879334 01482 835651 castlecare@barchester.com www.barchester.com Barchester Healthcare Plc Mrs Janet Cooper Care Home 58 Category(ies) of Dementia - over 65 years of age (58), Old age, registration, with number not falling within any other category (58), of places Physical disability (8), Physical disability over 65 years of age (58) Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Castle Keep is a purpose built, single storey building providing nursing and personal care for male and female residents over the age of 65. The home is also registered to take up to six people under the age of 65. The home has up to fifty-eight placements within single and double room accommodation. Residents have the choice of two lounge/dining rooms in which they can relax and enjoy the company of others. The home provides an additional lounge for activities. An activities organiser is employed, who will see each individual to discuss their interests and hobbies and arrange outings on the homes minibus. Residents also have access to the spacious grounds at the home, which are designed to be accessible to those in wheelchairs and with mobility problems. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are given to every new resident. The latest inspection report for the home is on display in the entrance hall and copies are available from the manager on request. Information given by the manager within the Pre-Inspection Questionnaire indicates the home charges fees from £484.50 per week. Residents will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available in the service user guide, contract or from the manager. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Carol Sarel is the person in charge of Castle Keep on a day-to-day basis. She is not the registered manager, but for the purposes of this report is referred to as the manager within it. This unannounced visit was carried out with the manager, staff and residents of Castle Keep. The visit took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. Informal chats took place with some of the staff on duty and a number of the residents and relatives; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of staff, relatives and residents and their written response to these was poor. The inspector received 6 back from relatives (29 ), 5 from staff (25 ) and 2 from residents (10 ). The manager completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. Since the last visit in February 2006 the Social Service Department has received two concerns and one formal complaint from relatives about care within the home. These have been investigated and no further action was required. The Commission for Social Care Inspection has also received one formal complaint around staff training and resident care. This complaint was passed to the owner of the home to investigate and this was done thoroughly and no further action was needed. The manager and staff at Castle Keep have worked hard to maintain high standards at the home and have exceeded the minimum standards in a number of areas assessed in this report. The management team need to focus on developing resident information into different formats so individuals understand what is written, and develop innovative ways that help residents to take part in the decision making processes within the home. What the service does well: The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. All of the people spoken to are positive about the home and like living there. Three individuals said they love living at the home and the care is very good. People living in the home and relatives expressed their satisfaction during this Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 6 visit regarding the care given, service received and the living environment of the home. Staff are hard working and do their best to meet the needs of those living in the home People being cared for have good access to professional medical staff and are able to access external services such as dentists and opticians. People in the home are provided with a warm, safe and comfortable environment that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. People said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. The person in charge of the home is very good at taking on new staff and making sure they are the right people with the right skills to look after the individuals living in the home. People working at the home are able to talk to the person in charge and are told if their work is okay or if they need to do different things. What has improved since the last inspection? What they could do better: The people working in the home need to make sure that they write the information for the people living in the home in a way that they can understand. This might mean using pictures, symbols, different languages or photographs, but it will help the people living in the home take part in deciding how their care is to be given and when. People living in the home will be able to look at the information and be involved in their care and have a say in what happens. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 7 have been a valuable source of information, which has helped create this report. 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 Keep Nursing Home DS0000000925.V339047.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 Keep Nursing Home DS0000000925.V339047.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, 4 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All residents undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: The statement of purpose and service user guide is given out to new residents on admission and copies are available from the manager. Each of the packs is produced in a clear print version, and these are very in-depth and informative. Given the wealth of information in the documents the inspector queried how many of the residents are able to take in and use the information provided. It is recommended that the home consider producing more appropriate formats that use innovative methods to make the information they give meaningful and interesting, for example using photographs, leaflets, visual or audio versions. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 10 The majority of residents received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. One individual said ‘ I was brought here by my family to see the home and talk to the staff before I made the decision to stay’. Each resident has their own individual file and four of those looked had a need assessment completed by the funding authority or the home before a placement is offered to the resident. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the resident and family. Discussion with the manager indicated there is no formal, written process of offering placements to prospective residents and it is recommended that this is implemented. Residents who receive nursing care have undergone an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. It is recommended the manager makes sure that the admission process is looked at as part of the quality assurance audits to determine the level of resident satisfaction with their experiences of these processes within the home. This will help the manager to assess if the home and staff are achieving the aims and objectives for the service. The home employs eight staff from overseas; these individuals are welcomed as members of the staff team and give staff and residents valuable insight into the customs and beliefs of other cultures through participation in themed social events. The most recent was an African party night with dancing and celebrating going on until late. Residents can make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has two male care staff as well as the female members. The manager said that she would discuss this with prospective residents during the assessment process. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of the residents. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of the residents. Information from the Pre-Inspection Questionnaire and discussion with the residents indicates that all of the residents are of white/British nationality. The home does accept residents with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 11 indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Residents and relatives are satisfied with the care being given, they feel the staff have the right skills and experience to look after people living in the home and they meet the needs and expectations of those receiving care. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 12 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 and 10. People who use the 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 health, personal and social care needs of the residents are clearly documented and are being met by the service and staff. The Memory Lane approach is improving dementia care and promoting person centred activities of daily living. EVIDENCE: Since the last visit in February 2006 the home has changed the format of its care plans, all documents have been up dated and reviewed and information transferred onto the new paperwork. The care plans are very detailed and contain a lot of nursing information. This could make them difficult for the residents to read and understand without staff support and guidance. The manager should look at how the plans can become more ‘resident friendly’. Individual care plans are in place for all residents and the four examined set out the health, personal and social care needs identified for each person. The Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 13 plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Risk assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are included within the individuals care plan. The funding authorities are carrying out yearly reviews of the care plans and the minutes of these meetings show that residents have input to this process (where possible), and family/representatives are also invited to the reviews with the resident’s permission. Residents or their representative have signed the care plans at the point of their being written to show they agree with the content, however there is little evidence that residents are consulted on a regular basis about their care, especially when staff are completing the monthly evaluations. This was discussed with the manager and she said she would look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. Residents who have dementia will eventually have specific information in their care plans linked to their conditions, this paperwork is part of the ‘Memory Lane’ concept that is being used within the home. Families are able to input information into this part of the plan and give staff detailed information about the life, likes and dislikes of an individual. This is only useful if the paperwork is filled in correctly: as the one example seen was incomplete. Residents have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that the residents and relatives are satisfied with the level of medical support given to the people living at the home. Entries in the care plan specify where individuals have dietary needs, including peg feeds, supplement drinks and pureed diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. One area of good practice noted during this visit was the monthly nutritional reports for the manager detailing which residents have lost or gained weight, their risk assessment outcomes and any input from outside professionals. One individual whose care was checked by the inspector has progressed from having a peg tube in place to having this removed and eating a soft diet. Pressure areas are monitored carefully and proactive measures include risk assessments and specialist beds, mattresses and seat cushions. Information from the pre-inspection questionnaire and discussion with the manager indicates that currently there are eight residents who have pressure sores, Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 14 their wounds are documented in their care plans and wound care is given as appropriate. Checks of the wound care records showed these were detailed around the type of dressings used and the progress of the wound. The staff ask the tissue viability nurse for advice, where required, and documented any changes as necessary. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. All of the residents spoken to prefer to have staff administer their medication. Checks of the medication records showed that overall these are well maintained and kept up to date, however there were two missing signatures for medication administered and one member of staff needs refresher training in signing in medication received from the pharmacy. Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. Resident and relative comments show they are very satisfied with the care and support offered by the staff. Chats with the residents revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. One person said ‘the staff are very supportive and helpful, they make sure we are okay and check on us regularly’. Relatives commented that ‘the staff always speak to the residents when they pass by, they give them a hug and speak to them if they think they are distressed and offer support in a friendly and professional way’. The home is introducing the Memory Lane concept of care into the home for those people with dementia. It follows a less structured care pathway that focuses on an individual’s abilities and needs rather than daily routines. Staff have received training in this approach to care and are able to choose if they wish to work on the dementia unit in the care home or with those whose needs are relating to old age and general nursing. Castle Keep Nursing Home DS0000000925.V339047.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 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: Discussion with the activities co-ordinator indicated she has twenty hours a week (flexible) to carry out social activities with the residents. Every week there is a minibus trip from the home to the local community to go shopping, visit the marina or have a meal out. The home is changing the focus of activities and developing more for the dementia residents. Nightingale unit is following the Memory Lane care pathway and on the day of the visit the activity co-ordinator was working with a group of residents doing craft work and pictures. A small kitchenette has been provided for residents to make drinks and re-learn life skills. Discussion with the manager indicated that the home is trying to recruit a parttime activity person to work on Rainbow unit with the residents who do not Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 16 have dementia. These individuals have missed the daily activities and their comments were past on to the manager. Each resident receives a card and cake from the home for their birthday and staff do their best to help residents celebrate all major Christian events throughout the year, such as Christmas and Easter. There are no in-house church services, but access to home visits or local services can be arranged on request. Resident/relative meetings are held every 2-3 months; these are used as an opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Good records are kept of all the social interactions going on in the home. Relatives said that they enjoyed visiting the home as ‘the open visiting hours give you the freedom to come and go as you need’. Individuals felt that staff kept them up to date with any important changes affecting the well being of their friend or relative and said ‘ the staff ring you or get in touch immediately’. Residents spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. Information about advocacy services is on display in the home and includes leaflets made available to the residents and relatives from the manager. Discussion with the manager indicated that no one at the home is currently using an advocacy service, although these have been accessed in the past. The service continues to attain the local Council’s Heartbeat Award for kitchens serving healthy and well balanced diets, and the company has produced a cookery book that includes favourite recipes from a number of residents within different homes, including Castle Keep. Since the last visit in February 2006 the Company has employed a highly skilled and qualified chef who has totally revamped the daily menus and is committed to providing restaurant quality meals. Comments from the residents and relatives indicate a positive reaction to these changes. The majority of the residents enjoy their food and are very satisfied with the choices and range of food on offer. One resident commented that ‘the meals are wonderful, with lots of different things to eat’. Observation of the midday meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft/pureed diets in an attractive way. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to residents who need help with eating and drinking. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the 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 home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. Staff and residents are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: Since the last visit in February 2006 the home has dealt with eight formal complaints relating to food, laundry, care and staff training. These are well documented and include the investigation notes, outcomes and actions taken. Residents and relatives are very satisfied with the way that the home deals with complaints and individuals said that the manager listens and acts quickly to resolve any problems. The home has a complaints policy and procedure that is included in the statement of purpose and service user guide. It is also on display within the home and can be found in every bedroom. It was recommended that the manager consider providing a simplified format for the complaints procedure as the one available is in clear print, and this is not appropriate for everyone in the home to understand. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 18 The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Information in the staff training files showed that they all have received Safeguarding of Adults training and also have the opportunity to attend training around challenging behaviour and breakaway techniques. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 and 26. People who use the 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 standard of the environment within this home is very good, providing residents with a comfortable and homely place to live. EVIDENCE: Re-furbishing and re-decorating has been ongoing at the home since the last visit in February 2006. All areas seen by the inspector were in a good state of repair/decoration, clean and tidy. Nightingale wing The home has created a dementia unit in this area; the fire doors in the main corridor have been fitted with keypad locks to provide security and safety for the residents on this unit. The nurses have a new office, which provides a lockable room for documents and records and residents have use of a small kitchenette that leads off from the dining room. The lounge area is being Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 20 redecorated to fit in with the Memory Lane approach to care, with new carpets and curtains being fitted this month. Corridors have been repainted in bright colours and have new carpets. The bedroom doors are painted in different colours, chosen by the resident or their relative. The home has created an enclosed garden area that can be enjoyed by all the residents. The flat walkways and decking areas provide good access to seats and tables, where residents can sit and enjoy the better weather. The gardeners have planted colourful boarders and lawns around the garden and the manager has plans to turn one corner into a seaside scene. Rainbow Wing Corridors have been painted in bright colours and residents have access to a large lounge and dining room. The carpet in the corridor has been damaged by a water leak (now repaired) and is due to be replaced. There are a number of windows around the home, which have ‘blown’ double glazing units. The manager should make sure these are replaced. Some bedroom carpets are in need of replacement as they are stained or have moved and present a trip hazard to residents and visitors. The manager said that these are done on a monthly rolling programme. Residents who wish to smoke in the home do so in their own bedrooms under staff supervision, this is risk assessed and monitored closely. Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious and have enough room for people in wheelchairs or with walking frames to pass by comfortably. The home is a single storey with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home. This includes mobile hoists, stand aids and handrails. Specialist nursing beds are provided throughout the home to aid staff in caring for the residents and make life more comfortable for individuals who spend a lot of time in bed. Changes to Nightingale unit and the outside garden have made the home safe for those individuals with dementia and have reduced the chances of residents wandering outside of the home. The environment is clean, warm and comfortable and no malodours were present. Comments from the surveys indicate that the residents find the home to be spotlessly clean and the majority of people are satisfied with the laundry service provided by the home. Two relatives said that there is a problem with clothing going missing. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 21 The laundry service for the home is sited in the grounds of the Castle Care Complex, it deals with the laundry for four homes and has a twenty-four hour turnaround on clothes and linen sent in daily. Each home has its own colour co-ordinated bags and there is a housekeeper on site who oversees the laundry work and care of the washing within the homes. Observation of the laundry operation shows that the system is efficient and effective, but the problems occur when the laundry goes back to the home. The manager said that she would deal with any concerns on an individual basis and try to resolve the problems. Castle Keep Nursing Home DS0000000925.V339047.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 and 30. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of recruitment, induction and training of staff are very good with appropriate checks being carried out and staff demonstrating a clear understanding of their roles, ensuring that residents are protected from risk and looked after by motivated and knowledgeable people. EVIDENCE: The home has separate staff teams who work on the two units within the home. At this visit there were some bed vacancies at the home and the staffing has been adjusted accordingly. The staffing rotas show that there is some flexibility in the system, but on average each unit has one nurse and four care assistants on duty from 07.00 to 20.00 and at night the home is run as one unit with two nurses and four care assistants from 20.00 to 07.00. Residents and relatives are very happy with the amount of staff on duty and one individual said ‘I would like to praise the staff for the good job they do, they work as a team and there is a very friendly atmosphere in the home’. Observation of the staff showed that the home is busy, but well organised. Information from the pre-inspection questionnaire about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the residents, was used with the Residential Staffing Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 23 Forum Guidance and showed that the home is meeting the recommended guidelines. The company has achieved City and Guild training status and staff members are undertaking their NVQ 2/3 with the homes training officer. At the moment 11/33 care staff employed at the home (43 ) have achieved an NVQ 2 or 3. The home has access to a separate recruitment department on the Castle Care site, which organises and monitors the recruitment/employment procedures as necessary. There is a comprehensive recruitment policy and procedure and the recruitment department follows the procedure, and ensures the interview process, police/CRB checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Checks of four staff files showed these are up to date and reviewed regularly. The home offers staff a wide range of training aimed at meeting the needs of the residents, in addition to a comprehensive induction and foundation programme, which meets the Skills for Care training targets. Staff receive in excess of three days paid training per year and the home has individual staff training plans that are discussed through supervision and appraisal. Four staff files were looked at and they contained evidence of a variety of training events attended over the past year, including peg-feeding, dealing with distressed clients, effective communication, Memory Lane, challenging behaviour, Parkinsons Disease, customer care, tissue viability, pain management, dementia awareness, palliative care as well as those pertaining to safe working practices. Staff said that ‘the home offers staff fantastic training opportunities and career structure’. Castle Keep Nursing Home DS0000000925.V339047.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, 36 and 38. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of residents, staff and relatives. EVIDENCE: The registered manager has the qualifications, experience and competencies needed to run the home and meet its stated purpose, aims and objectives. The registered manager for the home manages three units on the same site, and each unit has its own unit manager. The registered manager has held this Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 25 post for a number of years and has an up to date registration with the Nursing and Midwifery Council (NMC). She has also achieved suitable management qualifications. The registered manager undertakes periodic` training and development’ to maintain her knowledge, skills and competence, whilst managing the home. The home has an up to date quality award from Investors in People, the local councils quality award (QDS) parts one and two and the local councils Heartbeat award. Continuous monitoring and assessment of the home and its practice/service by the various authorised bodies is an essential part of the process leading to the awards being reaffirmed year after year. Resident meetings are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. Residents and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the registered individual does spot checks and completes the regulation 26 visits. A copy of the monthly visit is sent to the commission. During this visit the Health and Safety Manager for Barchester Healthcare was on site to do a spot check of the home, look at the audits and staff practices. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. Evidence was seen that the Barchester Company has produced its own crisis plan for the Flu Pandemic that may affect the country in or around 2009, this is detailed and sets out what each home must do to ensure the residents and staff receive the care and support needed in the event of a flu outbreak. Checks of the financial systems found that these are computerised, up to date and maintained on a daily basis by the administrator of the home. All residents have their own personal allowance account, and these are independently audited each year. Where individuals have their families looking after their finances, relatives who are unable to visit very often are asked to send spending money for the residents as and when their personal allowance accounts show their monies are low. These requests from the home are accompanied by a print out of the resident’s account. Additional charges for hairdressing, chiropody, toiletries and newspapers are invoiced to the resident or their representative on a monthly basis. The home only keeps a limited amount of money within the safe, surplus monies are kept in a communal resident account, which does not pay individuals any interest. This information is put into the Service User Guide so Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 26 all those coming into the home are aware of the homes arrangement, and can decide if they wish to make their own. Individuals receive regular supervision, both formal and informal and feel that this aspect of support is useful and offers them an opportunity to discuss their views and get feedback on their performance. Yearly appraisals are completed and staff receive advice and constructive criticism on their work performance. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 3 3 X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 4 4 X 3 Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 OP1 Good Practice Recommendations The home should consider producing the statement of purpose and service user guide in more appropriate formats, which make the information within them meaningful and interesting for the residents. The manager should make sure that the admission process is looked at as part of the quality assurance audits to determine the level of resident satisfaction with their experiences of these processes within the home. The manager should look at how the care plans can become more ‘resident friendly’ and easy for individual to read. The manager should consider how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. The manager should make sure staff understand how the medication system works and receive refresher training on a regular basis. DS0000000925.V339047.R01.S.doc Version 5.2 Page 29 2. OP3 3. 4. 5. OP7 OP7 OP9 Castle Keep Nursing Home 6. OP18 7. OP19 The manager should consider providing a simplified format for the complaints procedure as the one available is in clear print, and this is not appropriate for everyone in the home to understand. The manager should replace the ‘blown’ double glazing units around the home and replace bedroom carpets where these are stained or present a trip hazard to residents. Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI Castle Keep Nursing Home DS0000000925.V339047.R01.S.doc Version 5.2 Page 31 - 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. 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