CARE HOMES FOR OLDER PEOPLE
Castle Mount Bookwell Egremont Cumbria CA22 2JP Lead Inspector
Nancy Saich Unannounced Inspection 9th January 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 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 Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Castle Mount Address Bookwell Egremont Cumbria CA22 2JP 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) 01946 820454 01946 825513 www.cumbriacare.org.uk Cumbria Care Mrs Margaret Sewell Care Home 34 Category(ies) of Dementia - over 65 years of age (9), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (34) Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. A maximum of thirty-four older people (OP) of whom nine may have dementia (DDE(E)). Two named older people with a mental disorder (2 MD/E) The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults by 1st April 2004. When single rooms of less than 12 sqm usable floor space become available they must not 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. 12th September 2005 Date of last inspection Brief Description of the Service: Castlemount is a purpose built home for older people that was refurbished to a good standard in 1999. Cumbria Care, the in-house Cumbria County Council provider, operates the home. The home has a newly registered manager, Many Taylor. 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. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection started at nine o’clock in the morning. This was an unannounced inspection but the inspector had sent out questionnaires some weeks before the inspection and the responses were used as part of the inspection. The inspector spoke to groups of residents in the lounges and to individual residents in their own rooms. She also spoke to staff and to visitors. She spent some time with the manager and with the operations manager for Cumbria Care but spent most of her time out on the different units talking to people, observing what went on and reading documents that backed up what people said or did. What the service does well:
Castlemount is good at only admitting new residents if the staff know they can care for the new person properly and that they will fit in with the existing residents. Residents felt that staff were very kind and caring and gave them polite, dignified and respectful care. One resident also said that the team were “All very dedicated and caring…. even the younger members of staff have a nice approach and are very understanding…” The home is good at giving the residents a choice of nutritious and wellprepared foods. Castlemount provides a comfortable home for the residents in four distinct areas in the home. Each area has a lounge/ diner area with small, individual bedrooms. Residents live in small groups within these different areas. One of these is especially designed for people with dementia. This area is secure and has access to a safe garden. The home was warm, clean, tidy and comfortable on the day. The furniture and fittings were of a good standard and everything was kept in a good state of repair. The residents said that their home was looked after properly and that they were very comfortable at Castlemount. The home has enough staff on duty to make sure residents get proper care and treatment. The home has good systems in place that make sure the home runs smoothly and that residents can live without worrying about how things are managed in the home. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 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 the following standard(s): 3 This home is good at making sure that new residents can be cared for properly and will fit in with other residents. EVIDENCE: The inspector spoke to a new resident who explained how he had been visited before he came to the home and how the staff found out his needs when he came into the home. His file showed that this had been done and that the information was there for staff to read. A member of staff said that the manager or a senior person in the home always visited new residents and they were invited to come to the home. She also said that people with dementia were checked by a psychiatrist or a psychiatric nurse as being suited to the special unit. Residents’ files backed this up. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The home is good at delivering personal and health care in a dignified manner so that residents are as well and happy as possible. EVIDENCE: The inspector spoke to a number of residents either in groups or individually. They were all very happy with the way the staff cared for them. They thought they were treated well and had their wishes and needs met. Each person in the home has a written plan that shows staff what needs to be done for the person and what they can do for themselves. The inspector had asked the manager to review the system for this. She could see that this was well under way and that some of these ‘care plans’ had been made more detailed and specific. Residents were aware of these plans and said they had been asked about their likes and dislikes. The inspector felt that the home could keep on improving this and getting at least some of the residents much more involved in these plans. She also felt that some plans still needed a few more details. She did see evidence that showed that staff understood how important these plans were and were keen to make them better. She considered that the
Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 10 manager and her team were committed to improving these and looks forward to seeing this at the next visit. The manager had improved the efficiency and speed of the way staff reported and took action on any health care needs. Residents said that as soon as they said they were unwell the supervisor or the manager got the doctor or the nurse. One person said that all the staff were really understanding about their health needs. The inspector spoke to a health care professional who was full of praise for the manager and staff and said that the treatment of the residents was “excellent”. The pharmacy inspector had visited the home before Christmas and had found that the way medicines were being handled was generally very good. She made two requirements and some recommendations. The inspector judged that the manager had dealt with these issues. A copy of the pharmacists report can be seen, on request, from the Penrith Office. The inspector saw staff speaking politely and respectfully to all the residents. She felt that staff were very discreet when they helped people and were quick to reassure people when they did things with them. Residents said that the staff treated them with respected and kept them dignified even when they had to help with very intimate tasks. Visitors said there was a “good atmosphere” in the home and the inspector thought it was a relaxed and friendly place where residents were treated properly. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Residents were content with their lifestyle and felt it matched their needs. EVIDENCE: Residents said that they were happy that there were no rigid rules or regulations. They said that they could spend their time where and how they wanted. They spoke about entertainments and activities over Christmas and how they had enjoyed the different things on offer. The manager said she wanted to improve and expand on activities for all the residents. The residents said they had been asked what kind of things they like. This will be looked at again at the next inspection. The manager also wants to develop the way that people with dementia are cared for and the kind of activities and approaches that would be best for them. She had already started to do some work on this but wanted to research some of these activities a little more before she introduced them to the home. The residents were very happy with the meals they were provided with and had a lot of praise for the two people who were responsible for cooking in the home. The inspector sat with residents during lunch. The tables were nicely set and the food was well prepared and well presented. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Any complaints are managed in an open way and dealt with quickly. EVIDENCE: Residents had no complaints during the visit and there had been no formal complaints to the manager or to the inspector. Residents said they knew how they would complain but that they were asked regularly about how they felt and how things were. This meant that any problems did not grow into major complaints. Cumbria Care has its own complaint procedure that the manager would follow if necessary. This policy was available around the home and staff were aware of how to help a resident follow this through. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Castlemount is a comfortable home where residents live comfortably in small relaxed groups. EVIDENCE: The home was warm, clean and tidy right from the start of the inspection. All areas of the home were nicely decorated and had comfortable furniture. The inspector walked around the home and saw all areas apart from the kitchen and the laundry. The inspector saw records and heard staff and residents talk about how things were looked after and repaired whenever there was a problem. Residents were happy with their own rooms and the lounges. They thought the staff kept the home clean and tidy and were good at caring for their laundry. Toilets and bathrooms were clean and had good systems in place to stop infection spreading. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 This home has enough staff to make sure residents needs are met. EVIDENCE: Residents said there were enough staff in the building to help and support them. They thought that there were a few more staff than there had been. The weekly rotas showed that there had been some new staff taken on. The inspector judged that levels of staffing were good enough to make sure that the home ran smoothly. The manager was aware of the need to keep an eye on this depending on changes in residents needs. She said she had rewritten the staff rotas to make sure that the same members of staff worked in teams in the different areas of the home. Staff said this made things much better and residents felt it made for a more settled life and was nice to know that the same team of staff would care for them. The rotas showed that experience and trained staff worked with less experienced people. A new member of staff showed herself to be very knowledgeable but was quick to say that she felt she could always ask a more experienced person. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 The home is managed by a person who has the wellbeing of the residents at heart. EVIDENCE: The manager, Mandy Taylor has been in charge of the home for about four months. She has a background in caring for older people and shows by the things she says and does that she both respects them and has the right kind of skills to care for them. There was evidence to show that she can manage her staff team and has brought in some changes that will make sure that the staff team work as well as possible together. She has plans for how she will make sure that the home follows all the policies and procedures of Cumbria Care but also has ideas about how she will make sure the residents play a big part in home the home develops.
Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 16 She is in the process of applying to the Commission for Social Care Inspection to be the registered manager. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 18 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. 2. Refer to Standard OP7 OP12 Good Practice Recommendations It is recommended that care plans become more detailed and that individual residents are more involved with devising the plans. It is recommended that the manager update her knowledge of social care and activities for people with dementia. Castle Mount DS0000036522.V271297.R01.S.doc Version 5.1 Page 19 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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