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Inspection on 01/02/06 for Castlebar Nursing Home

Also see our care home review for Castlebar Nursing Home for more information

This inspection was carried out on 1st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents indicated that staff treated them with respect and offered a service that enabled them to maintain personal dignity. Residents and staff considered that healthcare needs were met effectively, either by staff at the home or by bringing in external professionals. Residents were satisfied with the quality and quantity of food provided. The menus showed that there was a variety of foods and diets on offer at the home, including an African Caribbean and a vegetarian option. The home was committed to provide food that would reflect individual preferences and cultures. Residents and their relatives knew whom to complain to and were confident that appropriate action would be taken if they raised an issue. The home was in the final stages of an extensive decoration programme. Residents were pleased with the improved environment. Staff said that residents and relatives had expressed much satisfaction with the changing of double rooms into single occupancy. Sharing of bedrooms would only happen if it was the expressed preference of both sharers. There was a large and well-kept garden. So as to better meet the needs of residents, the organisation had supported staff to achieve a care national vocational qualification; about 80% of care staff had achieved this already.A manager, who had the professional qualifications and relevant experience for the post, had run the home, supported by the operational director. (However both the manager and the director had resigned and were going to leave in February 2006). Staff were proud of the improvements made so far and declared their commitment to continue improving.

What has improved since the last inspection?

There continued to be significant improvements in many areas within this home. Management and staff were working to make things better for the people living at Castlebar. Work had continued to progress care planning and reviews. The aim was to clearly reflect the person`s aspirations, goals and preferences, as well as their physical care needs, (which were the previous focus of the plans). To this end the home was working with other agencies and particularly with Lewisham social services and the `care home support team`, (which was a team of health and social care professionals). Training sessions by the manager for staff were held on care planning. The home was introducing regular discussion about diversity and equality and residents` rights, as part of staff meetings and group supervision. The induction programme had been reviewed and, as from April 2006, all staff induction would incorporate the areas identified as essential by the training council. Existing staff would also be re-inducted. Staffing levels on the elderly mentally infirm unit had been increased. Consultation with residents and their relatives was planned, to make sure that their views would influence the development of the home. Decorations and refurbishments had been carried out in many areas of the home.

What the care home could do better:

Although progress had been made, the home still needed to ensure that individual residents` care plans gave emphasis to the whole person, as opposed to, mainly, personal and health care needs. Also that residents would be offered their choice of individual lifestyle and of activities programme. The above had implications both for staff training and for staffing levels. Individual staff training plans were to be drawn up. A previous recommendation about external training on promoting residents` rights had not yet been followed up. However, the manager recognised that this was important and that the sessions by the manager (mentioned above), although helpful, were not a satisfactory substitute.The home needed to ensure that equalities would become integral to any consideration of the service provided to individual residents and to the conduct of the service generally. Staff at this home have repeatedly pointed out that they lacked the time to consistently exercise all expectations of their role and to support emotional and social aspects of the care plans. (A recent increase of staffing on one unit, although an improvement, was still too recent to assure that it was sufficient). The provider needed to implement an effective quality assurance system, to ensure that the conduct of the home was in the best interest of residents. Although steps had been taken to make staff recruitment more robust, to better protect residents, there was not yet enough information available for inspection to assess whether all previous weaknesses had been remedied.

CARE HOMES FOR OLDER PEOPLE Castlebar Nursing Home Castlebar 46 Sydenham Hill Sydenham London SE26 6LU Lead Inspector Rossella Volpi Announced Inspection 1 February 2006 9-45 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 Castlebar Nursing Home DS0000007013.V274998.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. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Castlebar Nursing Home Address Castlebar 46 Sydenham Hill Sydenham London SE26 6LU 020 8299 6384 020 8299 6385 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) Castlebar Healthcare Ltd Ms Jayshree Karikari Care Home 74 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 53 patients, frail, elderly persons aged 60 years and above (female) and 65 years and above (male), and four young disabled persons 21 residents, persons aged 60 years and above, and persons aged 55 years and under 65 years of age suffering from mental disorder 26 October 2005 Date of last inspection Brief Description of the Service: Castlebar is a care home, which provides nursing and residential care for up to sixty-six older people with nursing needs, or support needs due to mental infirmity. The overall stated aim is that of offering care in a home from home setting, meeting individual needs and striving to offer sensitive and conscientious nursing and personal care. The registered provider is Castlebar Healthcare Limited, a company associated to an organisation called ‘Excelcare’, who runs over thirty homes in England. A director, to whom all the staff are ultimately accountable, directs the service. The day-to-day running of the home is delegated to a care manager, who works full time at the home and who leads a team of staff. Accommodation is provided in a large nineteenth century building, which has four floors, divided into two main units: one residential and one nursing unit. The nursing care unit is on the ground and first floors and is staffed by qualified nurses and health care assistants. The residential unit, which provides support for mentally infirm service users, is on the second and third floors and is staffed by care assistants. There is a lift. Bathrooms and toilets are located on each floor. Four of the bedrooms have en-suite facilities. All bedrooms are single rooms. There are shared dining and lounge areas on each of the first three floors. The home has extensive grounds surrounding the property. The front of the premises is paved to allow parking for visitors and staff. The front and back doors are accessible to people in wheelchairs. The home is sited on Sydenham Hill, just off the London south circular road and is accessible by public transport. Local amenities are sited some distance away from the home. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day in February 2006. The emphasis was to follow up the issues raised at previous inspections and particularly to consider what progress had been made towards meeting existing requirements. The inspection findings relied on information gathered through review of the service with the home’s manager, the deputy manager and the regional operations director. The inspection was also informed by comments by residents and relatives, discussion with a group of staff, general observations and inspection of records. This inspection focused on progress and improvements since last inspection and on what still needed to be addressed. What the service does well: Residents indicated that staff treated them with respect and offered a service that enabled them to maintain personal dignity. Residents and staff considered that healthcare needs were met effectively, either by staff at the home or by bringing in external professionals. Residents were satisfied with the quality and quantity of food provided. The menus showed that there was a variety of foods and diets on offer at the home, including an African Caribbean and a vegetarian option. The home was committed to provide food that would reflect individual preferences and cultures. Residents and their relatives knew whom to complain to and were confident that appropriate action would be taken if they raised an issue. The home was in the final stages of an extensive decoration programme. Residents were pleased with the improved environment. Staff said that residents and relatives had expressed much satisfaction with the changing of double rooms into single occupancy. Sharing of bedrooms would only happen if it was the expressed preference of both sharers. There was a large and well-kept garden. So as to better meet the needs of residents, the organisation had supported staff to achieve a care national vocational qualification; about 80 of care staff had achieved this already. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 6 A manager, who had the professional qualifications and relevant experience for the post, had run the home, supported by the operational director. (However both the manager and the director had resigned and were going to leave in February 2006). Staff were proud of the improvements made so far and declared their commitment to continue improving. What has improved since the last inspection? What they could do better: Although progress had been made, the home still needed to ensure that individual residents’ care plans gave emphasis to the whole person, as opposed to, mainly, personal and health care needs. Also that residents would be offered their choice of individual lifestyle and of activities programme. The above had implications both for staff training and for staffing levels. Individual staff training plans were to be drawn up. A previous recommendation about external training on promoting residents’ rights had not yet been followed up. However, the manager recognised that this was important and that the sessions by the manager (mentioned above), although helpful, were not a satisfactory substitute. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 7 The home needed to ensure that equalities would become integral to any consideration of the service provided to individual residents and to the conduct of the service generally. Staff at this home have repeatedly pointed out that they lacked the time to consistently exercise all expectations of their role and to support emotional and social aspects of the care plans. (A recent increase of staffing on one unit, although an improvement, was still too recent to assure that it was sufficient). The provider needed to implement an effective quality assurance system, to ensure that the conduct of the home was in the best interest of residents. Although steps had been taken to make staff recruitment more robust, to better protect residents, there was not yet enough information available for inspection to assess whether all previous weaknesses had been remedied. 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. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 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 Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 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): None This area was not looked at in sufficient detail on this occasion to enable a judgement, but was considered satisfactory at the previous inspection. EVIDENCE: On the previous inspection report the judgement, based on outcomes for standards 1 and 3, was that the information in the statement of purpose and service users guide gave prospective residents and their relatives a good picture of the service that the home provided. A full assessment of needs was undertaken before offering a place. This meant that residents would only be offered a place if the home considered that they could meet their needs and offer effective care and support. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 10 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 has continued taking steps to ensure that in the near future all residents would have in place a holistic care plan identifying all areas of need, expectations and aspirations. Residents’ health needs were met by staff at the home or by bringing in external professionals. EVIDENCE: It was previously considered that the provider needed to audit the way the reviews of care plans were conducted and recorded, to ensure that they would be holistic and consistent with the stated values of the organisation. In particular to ensure that: - Care plans give a picture of the person as a whole, with emphasis also given to cultural and other identity issues. - Guidelines are developed for staff supporting users with maintenance and developmental goals. - Developmental and maintenance objectives are separated from tasks, to enable clearer monitoring, evaluation, review and update of objectives. - Recording includes what is learnt from supporting the service user. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 11 - When there are communication issues, (to help establish how the user can best be supported), information is kept around what the person does, what the staff think it means and when it happens. This was a long term requirement as it was necessary, to fully implement it, to properly re-train staff, to review the ethos underpinning care planning, to consider effective ways to consult residents and their families and to review the role of the care workers. Original time scales set were therefore extended, in discussion with the manager. The last time scale set, of 28 February 2006, had not yet expired. However it was evident, from discussion with the managers, that work had continued to improve the care plans. A new form had been introduced and was being completed, to identify residents’ histories and what they currently liked and disliked. Some files contain care plans that had started to address social and cultural issues. The requirement continues, but the managers were confident that they would be able to meet it in the near future, with the help and support they were also receiving from other professionals, such as the home care support team. At the previous inspection it was found that residents’ files had been reorganised to include information about health needs. (This was the subject of a requirement). On this inspection this was again checked with staff and residents, who considered that healthcare needs were met effectively. There was a previous requirement that the quantities of all prescribed medications, carried forward from the previous month, were to be stated on the medication administration record. The manager confirmed that all medication was now returned to the chemist at the end of the month and staff showed records to indicate that this was done. Additionally, as previously recommended, patient information leaflets were obtained from the pharmacy for the medications dispensed on the elderly mentally infirm unit. The manager also said that the visiting general practitioner had carried out blood monitoring for all residents on those medications where this would be appropriate (This was a recommendation from a previous inspection). At the previous inspection, staff were noted to treat residents with respect and dignity. Observations on this occasion confirmed previous findings. It was also positive that residents’ rights, dignity, privacy, equality had started to be included in team meetings, supervision and would be part of the new induction programme for staff. Comments from residents indicated that they felt that staff treated them with respect. Relatives had previously raised discontent about laundry items being misled, which had also caused, on some occasions, one resident being inappropriately dressed (i.e. wearing somebody else’s clothes). The managers described the steps that had been taken to improve this problem. Two relatives interviewed on the day of inspection, confirmed that the problem had greatly improved. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 12 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, 14, 15 Residents were satisfied with the quality and quantity of food provided. Residents had not been significantly supported to exercise choice, control and achieve an individual lifestyle, which matched their preferences and needs. The home was starting to make some progress towards enabling this. EVIDENCE: As discussed above, the home was reviewing care planning to ensure that they would be holistic. The review involved training, improving consultation with residents and reviewing the role of the care assistants. Integral to this would be to ensure that carers would support the residents with activities reflecting individual preferences and lifestyles. There had been much discussion on this subject at past inspections. Yet, at the previous inspection, it was found that while some individual activities had been identified, the vast majority of activities involved the throwing of balls to residents. This did not reflect an assessment of what each person wanted or of what would stimulate him or her. It was also discussed that activities needed to be integral to the care plans and constantly supported by the carers, (as opposed to being the responsibility of just one co-ordinator for sixty-six residents). However some staff had raised that there had not been enough carers to even manage the basic care. It had been a recurrent concern, from Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 13 observations at different inspections, that some residents, who did not take part in group activities, appeared to receive little stimulation or attention. The previous requirement is repeated, with the time scale changed to coincide with the one set for the requirement on care planning (and which had not yet expired). A separate requirement under standard 14 is not imposed because compliance with the requirements under standard 7, 12 and 33 is likely to address also the shortfall identified under standard 14. The home had acted on previous discontents raised by some residents or relatives about food at the home. All residents had been consulted and their preferences noted and acted upon. For example the amount of petty cash held at the home was increased to enable ad hoc shopping for food, when required; the home had negotiated with the butcher to acquire for them particular meat, regularly, following a request from a resident. The menus showed that there was a variety of foods and diets on offer at the home, including an African Caribbean and a vegetarian option. The manager assured that, from then on, choice of food would be given due emphasis. Also she said that the home would consult residents and relatives to ensure that recipes (for food to reflect cultural preferences) would be authentic and consistent with the range of food the resident was used to before coming to live at the home. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 14 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 Residents and their relatives knew whom to complain to and were confident that appropriate action would be taken if they raised an issue. EVIDENCE: At the previous inspection it was found that overall residents knew how to complain and were protected by the procedures in the home for preventing and addressing potential abuse. It was found that the home had worked to make the complaints’ procedure more effective and to ensure that staff were able to facilitate complaints, as previously required. However, one comprehensive record needed to be maintained of all complaints and concerns, identifying action taken, whether it was successful and whether the complainant was satisfied with the outcome. The manager showed how she had met the requirement. It was not possible to assess whether such new system would be effective, because it had been newly introduced. There was not yet a number of complaints recorded to show how the system would work. The manager and director assured that management would monitor the new system and take steps to amend it if necessary. The complaints’ procedure (and guidelines in the service users’ guide) did not yet include the up-to-date name and local address of CSCI, which people could contact. This was pointed out during the inspection and the documents were being amended as the inspection was being conducted. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 15 The requirements are not repeated, but the effectiveness of the action taken to address them would be followed up at a future inspection. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 16 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, 20, 21, 23, 24, 26 The change of double bedrooms into single and the extensive redecoration of the home, had addressed the previous issues regarding the environment supporting privacy, dignity and choice. Bedrooms seen were satisfactorily furnished and efforts had been made to assist the residents to personalise them. EVIDENCE: Accommodation was in a large building, which dated from the nineteenth century and had four floors, divided into two main units: one residential and one nursing unit. The home had extensive grounds surrounding the property. There was a lift. Castlebar, as all homes operating before 1 April 2002, was exempt from the national minimum standards’ expectations about en-suite facilities. Only two of the bedrooms had en-suite facilities, but an additional one was being created to better meet the changed needs of a resident. Bathrooms and toilets were located on each floor. The home was in the final stages of an extensive decoration programme. Therefore the previous requirement was almost complied with. (This related to Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 17 the home undertaking a full maintenance and decoration programme, prioritising the ventilation, maintenance and decoration of the toilets and bathrooms). The time scale was not yet expired and the requirement (reworded to take account of the progress already made) is restated. Residents and relatives commented that they were pleased with the improved environment. Changes had also been made, in consultation with residents or relatives, about the layout of some of the communal areas. This was to create an environment more conducive to socialising or to have a range of activities, suited to individual preferences. Staff said that residents and relatives had expressed much satisfaction with the changing of double rooms into single occupancy only. Sharing would only happen if it were the expressed preference of both sharers, which, the manager said, was a rare occurrence. No health and safety issues were noted and the manager confirmed that a senior member of staff conducted weekly health and safety checks, including monitoring of water temperature. (Safety records were not checked). There had been an occupational therapist’s assessment of the building during the past year. (Although the work to address the outcome for standard 19 was not fully finished, no requirement is imposed/re-stated because of the progress already made, which was ongoing). Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 18 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 So as to better meet the needs of residents, the provider had taken steps to ensure that staff would achieve a national vocational qualification and had restored the staffing levels on one unit, which had been previously cut. Individual training plans for staff were to be drawn. Steps had been taken to make the recruitment procedure more robust, to better protect residents. However there was not enough information available to assess whether all previous weaknesses identified had been remedied. EVIDENCE: The organisation had supported staff to achieve a care national vocational qualification (NVQ) and about 80 of care staff had achieved this already. In fact the managers said that they aimed for all care staff to achieve this and in particular they were aiming for a NVQ at level 2 for carers and at level 3 for senior carers, as a minimum. There had been a reduction in staffing levels during the past year. It was not clear why this was done and both the manager and staff considered that the levels on one of the units had been inadequate. Anonymous complaints were received just before the previous inspections from people who said to be staff. This was then reiterated by staff and relatives during the last inspection. At the time some staff said that there were not normally enough staff on duty to ensure the safety of residents or to engage them with stimulating individual activities. They said that the stress of work was getting too high. Some relatives also had said that they were concerned that there were not enough Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 19 staff on duty and that they had seen staff, on occasions, becoming irritable with each other due to the strain of this. It was noted at the previous inspection that the organisation had not reviewed and risk assessed the staffing reduction, which had taken place on May 2005. A requirement to this effect was imposed. The manager and the regional director confirmed that following a review the staffing levels had been restored to the ones preceding the reduction of May 2005. They said that they had monitored accidents and falls before and after the increase and had already noted a significant improvement. Discussion with staff on the unit, which had been affected, confirmed what the managers said. Staff said that they felt less stressed and were starting to devote some time to support residents with individual activities. However the increase in staffing had been very recent and it had not been possible yet for management to assess whether the increase would be sufficient to adequately support the residents. While it was positive that the levels of staff had been restored to the original levels before the reduction in May 2005, the concerns relating to lack of appropriate support to residents pre-dated the reduction of staff. It is therefore important that management continues to closely monitor staffing levels to ensure they are adequate and that they can satisfactorily support the individual care plans. The monitoring would need to keep into account residents, relatives and staff’s views as well as evidence such as accidents and falls. There was a previous requirement regarding the vetting of staff. This was followed up at the previous inspection and it was found that the system had been made more robust, but some weaknesses remained about references. A new requirement was imposed. There was also a previous recommendation regarding ascertaining the skills and competencies of prospective staff. The manager explained that since December 2005 all files would have to be sent to the head office where a personnel manager would look at the checks and references done by the home manager. Head office would make additional checks if necessary, before giving the go ahead for the applicant to start work. However at the time of inspection there was not yet clarity about who was responsible for what (i.e. between the home manager and the head office) and it could not be ascertained whether the recruitment and vetting procedure had bee made satisfactory. This would need a review of the new system with the relevant people at the head office. The requirement and recommendation are therefore repeated in the meantime. At the previous inspection it was found that individual training plans were not drawn up and a requirement was imposed. The time scale had not yet expired and the requirement is restated. Recommendations have also been made regarding training on promoting residents’ rights and equalities. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 20 It was understood that Excelcare was appointing training officers across the organisation as part of their corporate improvement plan. Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 21 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, 38 Residents benefited from a home managed by suitably qualified and experienced persons, who were taking steps to make things better for the people living at Castlebar. However both the manager and the regional director had resigned from their posts. The provider was to put new management arrangements in place to ensure that residents would benefit from a well run home. The manager had acted on previous requirements so as to ensure that the health, safety and welfare of residents were promoted. EVIDENCE: Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 22 The registered manager of the home, in day-to-day control, had the relevant experience and qualifications in care and management and was a qualified nurse. The organisation had a management structure that included senior managers external to the home. CSCI had been concerned about Castlebar’s ability to meet requirements imposed; this was improving. Overall there was evidence that the registered manager and her senior were working more closely with CSCI and other stakeholders to improve standards of care. However, more improvement was still necessary to address all the areas previously identified, some of them requiring longer-term work. It was difficult to assess the home’s potential to continue improvement as both the manager and her senior had resigned. The manager was transferring within the organisation, while the regional director was leaving the company. There had been instability in senior management during the past two years. At the previous inspection it was found that there were some monitoring and quality assurance systems within the home. These were not comprehensive enough to ensure that the home was run in the best interests of the residents. The time scale for the requirements imposed had not expired and they are repeated. At the previous inspection it was found that generally the health, safety and welfare of residents were promoted. Requirements were imposed regarding the recording of weekly fire tests and the need to ask the local fire department to undertake an additional assessment of the building and fire practices. This part of health and safety was followed up and it was found that the home had complied with the previous requirements. The home had started to liaise with relatives to discuss with them how best to use residents’ money, held by relatives, in the best interest of the resident (which was a previous requirement). Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 23 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 x x x N/A 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 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 3 3 x 3 3 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 3 Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) (2) Requirement Timescale for action The registered provider must audit the way the reviews of care 28/02/06 plans are conducted and recorded, to ensure that they are holistic and consistent with the stated ethos and values of the organisation. In particular that: - Care plans give a picture of the person as a whole, with emphasis also given to cultural and other identity issues. - Guidelines are developed for staff supporting users with maintenance and developmental goals. - Developmental and maintenance objectives are separated from tasks, to enable clearer monitoring, evaluation, review and update of objectives. - Recording includes what is learnt from supporting the service user. - When there are communication issues, (to help establish how the user can best be supported), information is kept around what the person does, what the staff Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 25 think it means and when it happens. (This requirement was imposed in the previous report and the time scale had not yet expired). The registered provider must ensure that individual activities or programmes of development are in place for service users, which are based on their identified interests and needs and are designed to usefully engage and stimulate them. 2 OP12 12(1)(a) 15 18(1)(a) 28/02/05 3 OP27 18 (1) (a) (This requirement was imposed on the manager in the previous report. The time scale had not yet expired. The requirement has been amended and it is now imposed on the provider). The registered provider must continue to monitor staffing 07/03/06 levels to ensure that they are adequate to meet residents’ needs and to implement the care plans. The monitoring must take account of residents, relatives and staff’s views as well as of evidence such as accidents and falls. (The time scale refers to when the monitoring has to be in place from) The registered provider must ensure that efforts are made to ensure the validity of references. This must include receiving references on headed notepaper or with organisational stamps and recording any verbal verification of references on the applicant’s file. (This requirement was imposed on the manager in the previous report. The requirement has 4 OP29 19 (1) (c) 28/03/05 Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 26 5 OP30 1(1)(c)(i) been amended and it is now imposed on the provider, with a new time scale). The registered provider must ensure that all staff have an individual training programme in place that establishes core/compulsory training and additional training necessary for them to effectively offer care to this service users’ group. This plan must be reviewed annually. (This requirement was imposed in the previous report and the time scale had not yet expired. The requirement has been amended). The registered provider must ensure that a comprehensive quality assurance tool is in operation in the home. 28/02/06 6 OP33 24 (1) (2) (3) 28/03/06 7 OP33 24(1) (This requirement was imposed on the manager in the previous report. The time scale had not yet expired. The requirement has been amended and it is now imposed on the provider). The registered provider must ensure that the outcomes of all 28/02/06 action taken to improve care offered at the home is reviewed and recorded. (This requirement was imposed in the previous report and the time scale had not yet expired. The requirement has been amended). Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 27 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 OP18 OP29 Good Practice Recommendations That management investigates and accesses appropriate additional advocacy for the identified service user who voiced concerns over their care. That management ensures that when the information (given by prospective staff on the application form for a job) or the references do not give enough evidence of the relevant skills or experience necessary for the job, a record is made on the staff file of how the person’s suitability for the position was established. This is a repeated recommendation from a previous inspection, which could not be followed up on this occasion. 3 OP30 That management ensures that training on promoting residents’ rights, delivered by expert trainers in this field, external to the organisation, is provided for all staff. That management ensures that equalities would become integral to any consideration of the service provided to individual residents and to the conduct of the service generally. 4 OP30OP33 Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Castlebar Nursing Home DS0000007013.V274998.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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