Inspection on 13/04/07 for Castle Rise Nursing Home

This inspection was carried out on 13th April 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 Rise Nursing Home 31/01/06

Castle Rise Nursing Home 31/08/05

Castle Rise Nursing Home 11/01/05

Castle Rise Nursing Home 02/09/04

Castle Rise Nursing Home 05/02/04

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 Rise Nursing Home Wawne Road Sutton On Hull E Yorkshire HU7 4YU Lead Inspector Eileen Engelmann Key Unannounced Inspection 13th April 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 Rise Nursing Home DS0000000928.V335940.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 Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle Rise Nursing Home Address Wawne Road Sutton On Hull E Yorkshire HU7 4YU 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 839115 01482 821666 tina.morrow@barchester.com www.barchester.com Barchester Healthcare Plc Position Vacant Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40), Physical disability (40), of places Physical disability over 65 years of age (40) Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To admit one service user under 65 years in nursing category. To include 4 service users in the younger physically disabled category. Date of last inspection 31st January 2006 Brief Description of the Service: Castle Rise is a Care Home with nursing that provides a service for service users who meet the following criteria of need: - Dementia, Old age, Physical disability and Terminal illness for those over the age of 65 and four placements for service user’s who have a physical disability and are under the age of 65. The home is situated close to the village of Sutton and enables easy access to the local shops and North Point Shopping Centre. Accommodation consists of forty placements within single (and one double) rooms on two floors with lift access. Service users have the choice of three lounges and two dining rooms in which they can relax and enjoy the company of others, although the staff do recognise that individuals need time to themselves. The home provides a specified lounge for those service users who smoke. An activities organiser is employed, who will see each individual to discuss their interests and hobbies and arrange outings on the home’s minibus. Service users also have access to the grounds of 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 on 15/02/07 within the Pre-Inspection Questionnaire indicates the home charges fees from £460.50 to £595.71 per week depending on the type of room required and the nursing input needed. 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 Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last visit in January 2006 the registered manager for the home has left and Tina Morrow has been appointed to the post. Tina is not registered with the Commission For Social Care Inspection, but in this report is referred to as the manager. This unannounced visit was carried out with the manager, staff and residents of Castle Rise. 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. There have been no complaints or concerns raised with the Commission since the last visit. One allegation of abuse was reported by the home to the Social Services Team. This was investigated and no further action was necessary. The manager and staff at Castle Rise have worked hard to maintain high standards at the home and have exceeded the minimum standards in 12 of the 24 standards assessed in this report. There is a need for the management team to focus more 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 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 Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 6 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: 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 Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 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 Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 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. 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. Information from the surveys shows that the majority of residents received sufficient information to make an informed choice about the service before Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 9 accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. One individual said ‘my son arranged everything for me and I am very satisfied with the home’. Four residents care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the resident or their representative. These documents give clear information about fees and extra charges, which are reviewed and kept up to date. Each resident has their own individual file and four of those looked had a need assessment completed by the funding authority and the home also completes its own needs assessment 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 she is starting to implement a formal, written process of offering placements to prospective residents. Those residents at the home 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 that 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. This will help the manager to assess if the home and staff are achieving the aims and objectives for the service. Residents and relatives are very pleased with the care and support given by the staff, they said ‘both the nursing staff and carers are highly professional. They know the residents well and act in their best interests’. The home employs two staff from Poland and everyone else is from Britain. Discussion with the staff indicates they work well together as a team and are committed to providing a high standard of care. Residents are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has one 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 Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 10 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 deputy manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. 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 medication at the home is well managed promoting good health. EVIDENCE: Since the last visit in January 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 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 Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 12 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. Four residents said that they 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. Relatives commented that ‘the staff look after and care for the residents, any complaints are dealt with quickly. The care staff gives individual attention to the residents, they are extremely busy but will always stop for a quick chat to update you on anything that has happened between visits’. 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. Areas of good practice noted during this visit are •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. The April 07 report highlighted three individuals and two of these were referred to a dietician. •The nutritional audit for February 07 completed by the manager, highlighted the need for new hoist scales (these are now on order) and for training from the dietician in nutritional assessments (completed March 07). The nurses within the home carry out specialist tasks such as PEG tubes/feeding regimes and wound dressings. 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 four residents who came in with pressure sores, their wounds are documented in their care plans and wound care is given as appropriate. Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 13 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. Relatives commented that they are kept informed of their relative’s wellbeing by the staff; they are regularly consulted (where appropriate) on their care and feel involved in their lives. Overall there is a good level of satisfaction with the care being given to the residents. At this visit it was observed that the medication records are up to date and accurate, including those for controlled drugs and refrigerated items. Residents are able to self-medicate at the home if they are well enough to take on the responsibility; one resident, whose care was followed by the inspector during this visit, has been assessed and now self-medicates his/her own pain relief. The staff monitors this process carefully but individuals are able to express independence and control over their lives within a risk assessed framework. 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. The majority of the residents in Castle Rise are extremely dependent on the staff for all care, and individuals thinking about coming into the home should take this into consideration. One resident said ‘ the home has moved to very intensive nursing care and residents are limited in mobility and speech. This makes my life very lonely at times’. One individual spoken to is new into the home, they said ‘the staff have been extremely good at helping me settle into my room and are friendly, kind and take the time to talk to me every day’. Discussion with the manager and staff indicated the home continues to follow the Liverpool Pathway of Care for the Dying. This process has been in place for some time and focuses on the needs of the individual person and ensures they are able to die with dignity, with their wishes and choices being respected at all times. The manager said that she is also interested in achieving the Gold Standard Award and staff training with the McMillan Nurses is due to start at the end of April 2007. Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 14 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: The Activity Co-ordinator for the home works twenty hours a week and is available within the home Monday through to Friday. As many of the residents are quite poorly and spend much of their time in bed, the activities taking place within the home focus on 1-1 time with the residents. This includes doing passive exercises, reading books, writing letters to families, discussing the local news and sports and listening to individual’s problems. Residents comments in the surveys reflects this as 60 said they always had some activities they could take part in, whilst others were not interested or felt limited in their abilities to join in. Trips out in the mini-bus are available every Friday for interested individuals, and friendly rivalry is apparent in those who take part in the regular quiz questions and answer sessions. Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 15 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. Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or friends. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to the inspector showed a high level of satisfaction. Individuals said that the home helped their relatives/friends stay in touch with them. One person said’ the staff look after the residents well, and where applicable they try to encourage social activities. There is a relaxed and friendly atmosphere in the home and we are made very welcome’. 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. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. There are three-monthly resident meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. 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 Rise. Since the last visit in January 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 mixed 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 ‘ I always receive what I ask for and the food is tasty and looks nice’. A few individuals miss the old style cooking, one person said ‘I feel the menu is not appropriate for the residents tastes, it is too exotic’. Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 16 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 Rise Nursing Home DS0000000928.V335940.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 excellent 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 robust complaints system with some evidence that residents’ views are listened to and acted upon. Visitors and residents are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: 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. Seven out of the ten resident survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those residents spoken to said ‘the manager comes round every day to see us and will discuss any problems at this time. Seven out of the eight relatives who completed a survey said that they felt the home responded appropriately if they raised a concern and minor issues were dealt with quickly. One relative said ‘the staff are very approachable, and try to deal with issues before they become a problem’. The home has received three complaints since the last visit in January 2007; one was around noise from a resident and two related to food. All have been investigated and resolved. Castle Rise Nursing Home DS0000000928.V335940.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. There has been one allegation of abuse referred to the Social Service Team since the last visit (January 2006). This was investigated and no further action was required as the person withdrew their allegation and no evidence was found to suggest any wrongdoing. Castle Rise Nursing Home DS0000000928.V335940.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, 22, 24 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: There is an ongoing programme of refurbishment and renewal at the home. Since the last visit in January 2006 the home has redecorated a number of areas including bedrooms and the stairwells leading up to the first floor accommodation. The manager said that she plans to paint the upstairs corridors and lounge by August 2007. Residents were seen to be using the lounges upstairs and down during this visit and observation of the communal areas found these to be warm, bright and odour free. The residents have use of two lounges and two dining areas downstairs and outside of the home is a spacious garden with lawns and paved areas. Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 20 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 built on two floors with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Access to the upper floor is by use of staircases or the passenger lift. 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. Four residents spoken to were very pleased with their individual rooms and said that they had ‘brought in a number of personal possessions to make them feel more at home’. The rooms are decorated to a high standard and supplied with sufficient furnishings to meet the needs of the residents. All bedrooms are supplied with door locks and lockable storage space to ensure resident’s valuables are kept safe. Staff have a master key, which can be used to gain access in an emergency. 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 residents/relatives said that there is a problem with clothing going missing, or someone else’s clothing being put into their room. 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 Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 21 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: Comments from the residents, relatives and staff are on the whole very positive about the staffing levels within the home, and individuals feel that there is a high standard of care being given to the people living in the home. Survey responses said ‘the staff are kind, friendly and interact well with the residents’, ‘there is a caring environment, which involves residents families in the resident’s care and the staff are extremely professional and good at their jobs’. Some individuals feel that staffing could be better in a morning and two relatives commented that ‘we find it difficult to find staff on an evening’. Inspection of the duty rota and discussion with the manager indicated that due to reduced numbers of residents the staffing levels have been lowered accordingly. At present there are 28 residents living in the home and staffing is provided as follows From 8am to 2pm there are 2 nurses and four care staff on duty, 2pm to 8pm there are 1 nurse and four care staff, and from 8pm to 8am there are 1 nurse and 2 care staff. Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 22 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 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 10/18 care staff employed at the home (55 ) 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 customer care, visiting mum, literacy level 1 and 2, numeracy level 1 and 2, non-violent crisis intervention, dementia awareness, equality and diversity, 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 Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 23 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: Since the last visit in January 2006 the registered manager has left the home and Tina Morrow has been appointed in her place. Tina is a qualified nurse and has extensive experience in Neurological Nursing and care of nursing home residents. Tina receives regular support when needed from the management team at the Castle Care complex and is in the process of applying to do her Registered Managers Award qualification. Tina has submitted her application Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 24 to register as the manager of Castle Rise with the Commission for Social Care Inspection and this is being processed. 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. 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. 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 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. Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 25 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 Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 4 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 4 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 Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The home should consider producing the statement of purpose and service user guide in more appropriate formats, that 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. 2. OP3 3. 4. OP7 OP7 Castle Rise Nursing Home DS0000000928.V335940.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hessle Area Office First Floor 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. 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