Inspection on 04/08/06 for Castle View

This inspection was carried out on 4th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Castle View 20/02/07

Castle View 21/03/06

Castle View 12/10/05

Castle View 21/02/05

Castle View 25/08/04

Castle View 19/01/04

Castle View 30/10/03

Castle View 20/01/03

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

CARE HOMES FOR OLDER PEOPLE Castle View Bridport Road Dorchester DT1 2NH Lead Inspector Amanda Porter Key Unannounced Inspection 09:00 4 , 9 & 31st August 2006 th th 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 View DS0000028257.V306554.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 View DS0000028257.V306554.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle View Address Bridport Road Dorchester DT1 2NH 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) 01305 756476 01305 756479 castleview@coltencare.co.uk www.coltencare.co.uk Colten Care Limited Mrs Lucy Jane Bradley Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (57) of places Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate a maximum of 36 service users who require nursing care. A recommendation is made that Mrs Bradley completes an external course in adult protection issues and management within six months and provides evidence of completion to the CSCI. 21st March 2006 Date of last inspection Brief Description of the Service: Castle View is a purpose built care home located on the outskirts of the county town of Dorchester in Dorset. There are several local and national bus, coach and rail links within the town itself and the home also has car parking space for visitors. The home is registered to accommodate a maximum of 57 older people in 53 single and 4 suites (bedroom and sitting room) arranged over 4 floors; all are accessible by the use of passenger lifts. All rooms have en-suite toilet facilities and there are 3 lounges and a separate dining room plus activities rooms. The home may accommodate a maximum of 36 people requiring nursing care. There are also attractive outside patio and garden areas for residents and visitors use. The home employs a full time activities coordinator and offers a wide range of activities and has regular mini bus outings to places that residents have shown an interest in. Colten Care Limited owns the home, a company who have a number of care homes in Dorset and adjoining counties, and is managed on a day to basis by the registered manager, Mrs Lucy Bradley. Colten Care Limited aims to provide its residents with a secure, relaxed and homely environment in which their care, well-being and comfort are of prime importance. Weekly fees range from £658 for residential care and £794 for nursing care. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the three days of the 4th, 9th and 31st August 2006. The inspection was undertaken jointly with two officers from the joint Primary Care Trust and Contracts monitoring team and took a total of eighteen hours. The purpose of the inspection was to review the requirement and recommendations made in the last report, to assess all the key standards. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the registered manager. • 23 comment cards completed by residents; relatives/visitors; GPs; health and social care professionals and care managers. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents, visitors and staff. Comments about the home included: “I have been very happy.” “Excellent care and support from all the staff.” “I am happy, apart from the food which could be improved.” “We are blessed with an energetic and imaginative Activities Organiser.” “Housekeeping staff are conscientious and take a pride in maintaining a very clean and hygienic home.” All the staff and residents were welcoming and helpful. What the service does well: Residents at Castle View are cared for by staff who treat them with respect and uphold their right to privacy. Medication is well handled at the home to promote the health and well being of residents. The activities arranged within the home meet the expectations of the residents living there. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents are helped to exercise choice and control over their lives as far as possible. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 6 The house and gardens are well maintained which provides residents with a comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Financial procedures within the home also ensure that residents’ interests are protected. What has improved since the last inspection? What they could do better: As a result of this inspection a total of twenty requirements and one recommendation have been made. All residents must have their health and social care needs assessed fully prior to admission to the home. Trained nurses must have the skills to promote safe practice at all times, including good record keeping, leadership skills, communication, assessment and monitoring ensuring that residents’ needs are fully met. This must include a sound knowledge of current best practice in care for people with high nursing needs in relation to diabetes mellitus, palliative care, psoriasis and Parkinson’s disease. The records available demonstrate some health related assessments that have been undertaken are incomplete and therefore the appropriate information has not been gained or included in the care plans. Where assessments identify a need for specialist equipment this must be provided without delay. Care plans need to be drawn up and reviewed with the involvement of the resident and/or their chosen representative so that their views can be included. Care plans must give a clear and accurate picture to staff reading them as to how the needs of the resident are to be met. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 7 An effective method of nutritional screening needs to be put in place and followed through to ensure each resident’s dietary requirements are met appropriately, particularly for residents with palliative care needs. During the inspection it was found that not all complaints were recorded appropriately, which meant if anyone wanted to make a complaint they could not be sure it would be acted upon. Arrangements for protecting residents from abuse are not satisfactory, placing them at possible risk of harm. Castle View’s policy for the protection of vulnerable adults needs to be reviewed so that it is in line with the Department of Health guidance “No Secrets”. Recruitment records were seen to be incomplete, resulting in the management not being able to guarantee that staff were being employed appropriately. Although committed to training the home needs to continue to develop a training programme to ensure that all staff receive mandatory training and that care staff receive NVQ training. This will equip staff with the ability to meet the assessed needs of the residents effectively at all times. At the time of inspection the registered manager did not hold a management qualification to equip her with the skills to manage the home effectively. She is due to commence this in September. The responsible individual must ensure that the home regularly seeks the views of people living at and visiting the home. From feedback and the results of audits an annual development plan must be produced, which supports continuous improvement, ensuring that the service is run in the best interests of residents. The staff supervision records did not demonstrate that individual members of staff had a clear idea about how well they were performing, nor did they identify learning needs. This lack of direction could cause a delay in training issues being addressed efficiently. Records must be kept up to date so that the home has sufficient information to ensure residents are well cared for. Accidents to residents were not always reported appropriately. Some staff had not had sufficient training in manual handling, fire safety and general health and safety issues to protect residents from risk of harm. 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 View DS0000028257.V306554.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. Standard 6 is not applicable to this service. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The assessment process, prior to admission, is insufficient and does not enable the home to thoroughly assess a persons needs or establish whether those needs can be met. The home cannot guarantee that residents needs will be met because some staff do not have the skills and experience to deliver the services and care, which the home offers to provide; some policies within Castle View are not based on current good practice and at times there is a delay in obtaining specialist equipment. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 10 EVIDENCE: Six care files were reviewed and each contained a pre-admission assessment. However the questions asked in the assessment only required a yes/no answer and, in most cases, did not expand to include a full picture of the individual’s needs, particularly around issues of pain and mobility. The proforma used did not include a section on the assistance the resident required to wash. There was not indication who had been involved in giving the information or where the assessment took place. Colten Care have reviewed their corporate policies and procedures in April 2006. These were seen at inspection and some of them did not reflect current good practice. Training records showed that some staff did not have the skills and experience to deliver care to meet the needs of some individual residents. One pressure risk assessment undertaken highlighted the fact the resident concerned required a pressure relieving mattress but this was not provided. Castle View DS0000028257.V306554.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning system in place does not adequately provide staff with the information they need to satisfactorily meet residents’ needs. The inaccurate/incomplete health needs assessments may result in residents receiving inappropriate care. Systems for the receipt, storage and administration are in place and well managed, which ensures safety to residents. Residents are treated with respect and their privacy and dignity is promoted at all times. Residents with palliative care needs cannot be sure that the home can meet their specific requirements. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 12 EVIDENCE: Six care files were seen and each contained a variety of information including assessments undertaken following admission; • Nutrition • Mobility • Falls • Pressure sore risk • Communication • Personal care Some of this documentation was left incomplete and therefore the information required to formulate a care plan was not available. Some residents who were readmitted for further periods of respite care were not reassessed at the time of readmission. There was no risk assessment or care plan for a resident who had a history of falls. Nutritional assessments are further commented on under standard 15. Some of the information in the care plans was not specific and had no clear goals to give accurate information to staff as to how care needs were to be met, for example: • Care plans for residents with psoriasis stated that creams should be applied as prescribed to the affected areas. This was not useful information for the health care assistants who would be expected to carry out the care, as they would not have easy access to medication administration charts. Nor did it give a benchmark of what the affected areas were or how extensive so that carers could identify whether they were improving or not. One plan for the care of a resident with a leg ulcer said, “To dress and treat wound as per wound care plan.” There were no further instructions in a wound care plan. One care plan seen for the management of diabetes gave instruction that blood glucose should be monitored twice a day but gave no indication what the acceptable blood glucose level should be or what to do if measurements were seen to be outside these levels. • • The care plan for one resident with significant palliative care needs was reviewed. Care documentation indicated there was insufficient care in place to meet the needs of this resident, specifically with regard to pain control, nutrition and symptom control as the resident’s condition deteriorated. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 13 Medicines were stored securely. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Residents spoken with during the inspection said that staff were kind and caring. Staff were seen to be going about their duties in a calm, cheerful and professional manner. Fifteen residents responded to the question “Do you receive the care and support you need?” 10 said “Always”; 3 said “Usually”; and 2 said “Sometimes”. These residents also responded to the question “Do the staff listen and act on what you say?” 12 said “Yes”. The other responses were “Usually”; “Sometimes they do if they have time”; “Some do.” Castle View DS0000028257.V306554.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an adequate range of social opportunities available in the home, which reflects residents’ interests and preferences. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are generally well catered for with a balanced and varied selection of food available that meets their tastes and choices. There is a lack of support for those residents with palliative care needs where their ability to eat is compromised. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 15 EVIDENCE: There was a programme of activities drawn up by the activities organiser these included: • Trips out in the minibus. • Quizzes. • Reminiscence. • Musical entertainment These activities are based on the assessed needs of the residents. The activities coordinator has a written record of each residents preferred activities. 18 residents responded to the question “Are there activities arranged by the home that you can take part in?” 9 said “Always”, 3 said “Usually” and 3 said “Sometimes.” One resident said “Due to the varying abilities of residents activities have to be tailored accordingly. I participate in those that appeal to me. Trips most weeks in the minibus are always enjoyed. We are blessed with an energetic and imaginative Activities Organiser.” Residents confirmed that their visitors were always made welcome at the home and they could have visits in private. Menus reflect a varied and appealing diet, catering for a wide range of tastes and preferences. Residents were able to choose where they took their meals, either in their own rooms or in the dining room. Residents spoken with at the time of inspection said that they generally enjoyed the food provided. 15 residents responded to the question “Do you like the meals at the home?” 4 said “Always”, 4 said “Usually” and 7 said “Sometimes”. Comments about meals included: “Not as good as they should be. Meals are poor.” “Catering for a large number of elderly persons it is inevitable the menu is not always to everyone’s liking. I have always found Chef most obliging with alternatives.” The quality of nutritional assessment and screening was seen to be poor particularly in relation to the nutritional requirements of those residents with palliative care needs. The registered nurses did not ensure that adequate nutritional support was given as the needs of the resident changed. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 16 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 & 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a complaints system with evidence that residents feel that their views are listened to and acted upon. However not all complaints are recorded properly therefore it was not always possible for the resident concerned to know what the outcome was. Staff members are trained in adult protection. The home’s abuse policy does not currently reflect local adult protection guidelines, protection of residents from abuse is therefore not fully supported and guidance for staff on the correct process to follow is not in place. EVIDENCE: The home’s complaint log contained details of the seven complaints the home has received in the last year. Four of these complaints were substantiated and the remaining three were partially substantiated. However, through reviewing care documentation it was evident that some complaints made to the manager had not been recorded in the complaints log and therefore were not highlighted to the senior management team of Colten Care. The complaints procedure detailed within the service user guide does not provide the information of Dorset County Council or South West Dorset Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 17 Primary Care Trust’s complaints departments and this information must be included. Training records showed that some staff had received training in the protection of vulnerable adults. However the home’s abuse policy does not currently reflect local adult protection guidelines, supporting the protection of residents from abuse. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 18 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Castle View is good providing residents with an attractive, homely and safe place to live. The home provides a clean, pleasant and hygienic environment for the residents to live in. EVIDENCE: The home has a programme of routine maintenance and the home provides an extremely comfortable environment in which to live. Records show that a variety of outside agencies have attended the home to undertake the routine maintenance of: • Fire safety equipment. • Gas installation. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 19 • • Lift. Hoists. The grounds are safe and attractive and accessible by residents. A call bell system is available in every room. The home was clean and free from any unpleasant odours. The laundry was well managed and adequate supplies of clean linen were seen throughout the home. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 20 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, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed and deployed to meet the care needs of residents. Shortfalls in the process of recruitment of staff do not protect residents from risk. The shortfalls in training results in some staff not being fully competent to do their jobs properly. Residents would benefit from more staff having NVQ level 2 in care. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. 15 residents responded to the question “Are staff available when you need them?” 7 said “Always”; 7 said “Usually” and 1 said “Sometimes”. However visitors’ comments included: “It would be lovely if they had the time to spend time (5 minutes even) just for chatting to the ‘room bound’ patients. Visitors can’t be there every day.” “Weekends are awful, never enough staff, residents are mostly left to sort themselves.” Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 21 The home has an ongoing training programme, which includes NVQ level 2 in care. At the time of inspection approximately 9 of care staff held this award, which is below the 50 recommended. Six staff files were reviewed and gaps in the recruitment procedure were identified. One gave a brief work history but no dates of previous employment were included. Gaps in employment history were not explained. Where a member of staff was employed and whose first language was not English it was not evident that their level of spoken and written English had been assessed. One file contained only one reference. One member of staff commenced employment before a POVA first check had been sought. Training files demonstrated that healthcare assistants were receiving some induction training and staff spoken with at the time of inspection confirmed this. Records showed that not all staff had received all the mandatory training such as manual handling, food safety, first aid, health and safety and fire safety training. Through discussion with the registered manager, the reviewing of care files and comments from residents it was evident that staff needed further training in certain aspects of nursing care so that the assessed needs of residents could be met effectively. This included palliative care, diabetes and Parkinson’s disease. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 22 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, 33, 35, 36, 37 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered manager has experience with working with the elderly. However, she has no management qualifications as yet. There are currently occasions when lines of communication and responsibility in the home, do not clearly protect and promote the welfare of people living at the service. The home reviews aspects of its performance but this does not include seeking the views of residents and relatives on a regular basis. Therefore they cannot be fully assured Castle View is run in their best interests. Residents are assured of sound management of their financial interests. Although there is a system of supervision in place it does not clearly demonstrate that each member of staff’s learning needs are fully explored or addressed. If these needs are left unaddressed this may result in residents receiving inadequate care. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 23 Residents’ best interests are not safeguarded due to poor record keeping. Staff have insufficient training in manual handling and fire safety to ensure that residents will be safe at all times. EVIDENCE: Mrs Bradley has managed Castle View on a day-to-day basis since March 2004. She is a qualified nurse with some experience in working with the elderly. She is supported in her post by the senior management team of Colten Care and is visited weekly by an Assistant Operations Manager. Support and supervision is given at this time although detailed notes are not taken during these sessions to outline any aims and objectives set. Mrs Bradley has not yet commenced the Registered Manager’s Award, which would give her the underpinning knowledge she needs to manage this large home and ensure the National Minimum Standards are met. As a result of this inspection twenty requirements and one recommendation have been made and issues highlighted within the report show there are currently problems within the home with regard to ensuring effective management and monitoring. For example there were shortfalls in care planning, recording complaints and training. The operations manager and registered manager confirmed that internal auditing includes: • Accidents • The call bell system • Care plans • Medication • Housekeeping The auditing tools used were not always robust. For example the care planning audit had not highlighted the shortcomings of the care plans seen at this inspection. The quality assurance and quality monitoring system does not include seeking feedback from residents, relatives, friends or stakeholders in the community such as GPs, district nurses on a regular basis. There was also no annual development plan available to those using the service. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home holds small amounts of money at the request of individual residents. All monetary transactions were recorded and seen to be accurate. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 24 Staff supervision records were reviewed. They did not clearly identify achievements or shortfalls in performance. To be effective they must clearly show the person being supervised how well they are doing their job and if improvements need to be made how this will be achieved. A variety of records were reviewed during the course of the inspection. Care plans were seen to be inaccurate; assessments were left incomplete or not done at all; staff recruitment files were incomplete; reports about the service made by the provider were not detailed enough to show a true picture of what was happening in the home. Records showed that not all staff had received recent training in fire safety, health and safety and manual handling. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. The accident book was reviewed and this was confusing because two books were being used at once, which meant they were not recorded sequentially. In care documentation reviewed it was evident that one resident had sustained two falls but they were not recorded in the accident book. This resident did not have a risk falls assessment undertaken or a care plan in place to guide staff as to how to manage the risk of falls. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 25 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 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 2 2 Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14 Requirement The registered manager must ensure that a full and detailed care assessment has been undertaken before the resident is admitted to the home. Where a need for specialist equipment is identified the home must ensure it is put in place. Trained nurses must have the skills to promote safe practice at all times, including good record keeping, assessment and leadership skills, communication and monitoring, ensuring that residents’ needs are fully met. The registered manager must ensure that care plans set out in detail the action which need to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. The registered manager must ensure that care plans are drawn up with the involvement of the resident, recorded in a style accessible to the resident; agreed and signed by the resident whenever capable and/or representative (if any). DS0000028257.V306554.R01.S.doc Timescale for action 30/11/06 2. 3. OP4 OP4 12 12 & 18 30/11/06 30/11/06 4. OP7 15(1) 30/11/06 5. OP7 15(1) & (2) 30/11/06 Castle View Version 5.2 Page 27 6. OP8 14 The registered manager must ensure that all assessments made prior to drawing up the resident’s care plan are completed correctly. Nursing and care staff must receive appropriate palliative care training. The registered manager must ensure that any resident with palliative care needs receives appropriate attention and pain relief. Registered nurses must be aware of the nutritional requirements for residents with palliative care needs and ensure that appropriate nutritional support is given. The registered manager must ensure that all complaints are logged and investigated fully. The complaints policy and procedure must be improved to include contact details of the Dorset Care & Health and the local Primary Care Trust. The home must develop, implement and thereafter properly adhere to effective and appropriate Adult Protection procedures. 30/11/06 7. OP11 18 30/11/06 8. OP11 12 30/11/06 9. OP15 16(2)(i) 30/11/06 10. 11. OP16 OP16 22 22 30/09/06 30/09/06 12. OP18 13 30/09/06 13. OP29 19 & schedule 2 The registered manager must 30/09/06 ensure that, prior to a member of staff commencing employment she must obtain POVA first checks; two written references; full employment history with any gaps fully explained; where English is not the candidates first language evidence that a suitable level of spoken and written English is established and recorded. DS0000028257.V306554.R01.S.doc Version 5.2 Page 28 Castle View 14. OP30 18(1)(c) 15. OP30 18(1) (c) 16. 17. OP31 OP33 9 33 Staff must undertake all the mandatory training such as manual handling, food safety, first aid, health and safety and fire safety. Registered nurses employed at the home must have the training and skills to be able to meet the needs of residents with high nursing needs. This includes knowledge of nursing people, with diabetes mellitus, psoriasis and Parkinson’s disease The registered manager must obtain a suitable management qualification. The responsible individual must ensure that the home regularly seeks the views of people living in the home and visiting the home. From feedback and the results of audits an annual development plan must be produced, which supports continuous improvement, ensuring that the service is run in the best interests of residents. The home must ensure that all staff receive effective formal supervision at least 6 times a year, which details how each member of staff is performing and where shortfalls are noted action is taken. Records and policies within the home must be kept up to date and current. This must include training records, policies and procedures, care plans, recruitment records and reports made to the Commission for Social Care Inspection. All accidents must be recorded in the accident book. 30/11/06 30/11/06 01/08/07 30/11/06 18. OP36 18(2) 30/11/06 19. OP37 17 30/11/06 20. OP38 17 30/11/06 Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 29 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 OP28 Good Practice Recommendations The home should continue to work towards at least 50 of staff achieving a minimum of an NVQ 2 award. Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Castle View DS0000028257.V306554.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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