CARE HOMES FOR OLDER PEOPLE
Castle Mount Bookwell Egremont Cumbria CA22 2JP Lead Inspector
Nancy Saich Unannounced 12th September 2005 09:00 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 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 Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Castle Mount Address Bookwell Egremont Cumbria CA22 2JP 01946 820454 01946 825513 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cumbria Care Margaret Sewell Care Home 34 Category(ies) of 34 OP - Old Age registration, with number 9 DE(E) - Dementia, over 65 of places 2 MD(E) - Mental Disorder, over 65 Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 2. A maximum of thirty four older people (OP) of whom nine may have dementia (DDE(E)). 3. Two named older people with a mental disorder (2 MD/E) 4. The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults by 1st April 2004. 5. When single rooms of less than 12 sqm usable floor space become available they must nto be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available.. Date of last inspection 17 November 2004 Brief Description of the Service: Castlemount is a purpose built home for older people that was refurbished to a good standard in 1999. The home is operated by Cumbria Care, the in-house Cumbria County Council provider. The registered manager has recently left the service and the new manager Mandy Taylor is awaiting registration with the Commission for Social Care Inspection. The home caters for older people within the limits of the registered categories listed above. The home is divided into group-living areas and one of these is especially for people with dementia and this part of the home also has a secure garden.i Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted by Nancy Saich. It started just after nine in the morning and lasted for more than seven hours. The inspector met with the new manager, the staff on duty, all of the residents and people visiting the home. She also looked at documents that backed up her observations and the things that people told her about. What the service does well: What has improved since the last inspection?
The content of the written planning for care has been updated and provides plenty of detail that should help staff to give consistent and well thought out care to residents.
Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 6 Steps have been taken to lessen the incidents of errors when staff give out medicines to residents. The home has improved arrangements for residents to have their personal laundry done properly and to make sure that items don’t get lost. Improvements have been made in the way staff attitude and approach is monitored and developed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The home is good at ensuring that they only admit residents who will fit in with the existing group and who they can care for properly. EVIDENCE: The inspector spoke to people who had only been in the home for a short period of time and they were able to talk about how they were helped in a positive way to make the decision to move into the home. Relatives also said that they were shown around the home and could ask staff about all the things they were unsure of. There was evidence in residents’ files that showed that residents needs had been identified by social workers or health care professionals before the staff at the home went out to see if they could meet the needs of prospective new residents. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Health and personal care are managed fairly well but there was some problems seen that showed that staff need to be much more alert to the less obvious needs and preferences of residents. EVIDENCE: The inspector read a selection of the written plans that set out what residents want and need. She read specific plans in depth after talking to individual residents. Very few residents were aware of these written plans and only one person could remember seeing them. They did say that staff asked them what they wanted but they weren’t sure that these things were written down. One person had a number of things that she needed help with but these needs (and how to resolve them) were not written into her plan. Some of the plans written for people with dementia did not give enough strategies for staff. This might mean that staff are unsure about the right way to work with individuals who can be disorientated. Some plans were very detailed and gave lots of directions that staff said were easy to follow. Some of the plans were very good and did match what residents wanted.
Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 10 Residents said they saw the doctor or nurse when they needed to and there were good arrangements in place for monitoring health needs. There was however one occasion seen in a resident’s notes when symptoms of a chronic condition had not been dealt with after the care staff had reported them. The home needs to take action to prevent this happening again. Castle Mount has had some problems related to how medication has been managed on behalf of residents. The manager has kept the inspector informed of these problems and senior management have dealt with this properly. On the day of the inspection medication was being dealt with properly. The residents and visitors were very complimentary about the staff and they felt that they behaved in a way that allowed even the frailest of the residents to be given as much independence and dignity as possible. The inspector spent some time just sitting in the different lounges. She saw staff interacting in a pleasant and patient way with residents. They took time to explain things to residents and had an easy yet polite manner. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Arrangements for daily life and social activities were being maintained in an acceptable way. EVIDENCE: Residents said they were relaxed and content in the home. They said could spend their time much as they chose and that there were no rules or regulations. Visitors said they were made welcome and there was some evidence of community groups visiting the home. Residents said they had control over their lives but one or two people said they wanted a little more control. The inspector judged that this might be improved through some changes to how care is planned and this is discussed earlier in the report. One or two people wanted to go out more or have more meaningful activities and they said that they were looking forward to the activities organiser coming back to work. There was no evidence of therapeutic activities happening in the specialist unit that might help some people who were disorientated because of this disorder. The manager was fully aware of these needs and agreed to formalise her plans and send an action plan to the inspector that would detail the developments she has in mind. Residents enjoyed their meal at lunchtime and said the cooking was very good in the home and that there was plenty of choice. One person wanted lunch
Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 12 later and another wanted something not on the menu. These requests were dealt with without any fuss and residents said this was always the case. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Residents can make their concerns known and are suitably protected by the arrangements in the home. EVIDENCE: Residents said they were able to talk to staff if they had a concern and everyone was confident that the new manager would listen and take action if they had a serious concern. Residents also said that they would talk to the representative of Cumbria Care who came regularly to the home. Residents said that the new manager was very approachable and they were confident that she could deal with any serious complaints. Cumbria Care had dealt with issues relating to medication before they had become of concern to residents or relatives. Residents felt that staff were very protective of them and that there was nothing untoward happening in the home. Staff had received training on understanding the nature of abuse. Cumbria Care has suitable policies and procedures in place that ensure residents are protected from harm and abuse. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 Castle Mount provides a clean, safe and comfortable environment where residents felt safe and at home. EVIDENCE: The inspector went to all areas of the building and found it to be clean, well decorated and suitable furnished. The home was bright and comfortable and residents were relaxed in their home. The home is set out in separate groups and residents live together in small groups. There are four lounge/dining areas where the residents can spend time in small groups and the residents said they liked this arrangement, as it was more homely than having a large dining room and sitting room. One of these areas is specially designed for people with dementia and this area has special arrangements in place to make sure that residents can move around their home safely. The residents said their rooms were kept clean and that the communal areas were comfortable and well set out. The residents said that there had been an improvement in the way their personal laundry was done and they were happy with how things were now.
Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 15 There was evidence around the building to show that good hygiene standards were being met. Staff had received training in how to prevent cross infection. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 There were enough staff on duty to give good levels of care to residents and these staff are trained in the core skills that are needed to do this. EVIDENCE: The residents said that there were enough staff on duty to care for them properly. The manager said that there had been some staffing difficulties but that the team had managed to cover vacancies. The four-week rota for August was seen and the inspector judged that staffing levels were good. Staff talked with some enthusiasm about core training and they could explain how they put what they learnt into practice. The manager had set up a training plan and was aware that some staff were due updates in certain areas. She realised that there was some training and development needs in relation to dementia care and agreed that this would be part of her future planning. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37,38 The management arrangements are in transition in this home but there was evidence to show that the new manager is aware of problems and has already started to make positive changes for the good of the residents. EVIDENCE: The registered manager has moved from the home and a new manager is in post. The inspector was impressed with her ability and enthusiasm. She is being well supported in her new role and is in the process of applying for registration. Residents and staff spoke about her warmly and one person said “I am optimistic about our future with Mandy in charge”. Lots of people spoken to said they could trust her to do her best for residents. There was evidence to show that she had as a resident said, “started to make her mark…”. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 18 The manager was eager to look at quality standards and said she would be looking ways to improve how residents were consulted and in consolidating the management systems in the home. She had also started to focus on arrangements for staff to have formal one to one meetings where they could have time to discuss how they delivered care to the residents. There was evidence to show that this was already beginning to have an effect on how staff did their jobs. There were some problems in how needs and actions were being recorded in residents’ notes and this meant that sometimes problems were not acted upon. There were also some other records relating to the operation of the home that had not always been making communication easy. Staff were aware of health and safety responsibilities. There were some issues that Cumbria Care was dealing with that would lessen risks even further. The fire officer had visited the home the week before and his recommendations were already being addressed. The new manager had introduced some new arrangements for preventing infection and was making arrangements for updates to things like manual handling competences. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 2 3 Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 13 Requirement The registered person must ensure that residents health care needs are acted on promptly and appropriately The registered person must review recording systems in the home with a focus on residents daily records Timescale for action 31st October 2005 31st October 2005 2. 37 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 7 12 Good Practice Recommendations It is recommended that the care planning system is reviewed so that residents feel they have more ownership of their own plans. It is recommended that the manager review the way the special unit for people with dementia is operating. Castle Mount F58 F10 s36522 castle mount v243539 120905 ui stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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