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Inspection on 15/09/08 for Castlebar Nursing Home

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

This inspection was carried out on 15th September 2008.

CSCI found this care home to be providing an Adequate service.

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

Senior staff members assess potential residents considering a move into the home to see what help they required and if they had any special needs. This information was used to develop a plan of care for the person and establish a rapport with residents and relatives prior to admission. There was a relaxed calm atmosphere on all the units visited. Residents had access to community health care services. Health problems were monitored and advice was obtained from other professionals if necessary. Residents were appropriately dressed and looked relaxed. They told us that staff maintained their privacy and were polite and helpful. People could choose where and how they spent their time and staff encouraged people to make decisions for themselves where possible. The newly decorated and refurbished parts of the home provide a very bright and airy environment and individual en suite accommodation of a good standard for residents in those areas. The responses from six residents interviewed and from two more who completed questionnaires were generally favourable and positive comments were made about the caring attitude of care staff by many of them.

What has improved since the last inspection?

No requirements or recommendations were made arising from the previous inspection. Since the last inspection the previous manager resigned and a new manager has been appointed, the home has also been granted a variation to registration to include dementia nursing care and this facilitated the relocation of a number of residents and staff members from St Andrews a home operated by the same company but now closing down. A major refurbishment and redecoration of the home has been underway achieving very good results on all the floors with the exception of the ground floor that is next in line for work to be done.

What the care home could do better:

Thirteen requirements were made that must be addressed by the home:An updated Statement of Purpose and Service User Guide must be produced. A copy of the latter document must be given to each resident. The home must confirm in writing to prospective residents that their needs can be met by the home, prior to their admission. Care plans must give "how to deal with" guidance, to staff members in respect of a resident`s identified risks/challenging behaviour. Residents who are significantly losing weight must have food intake monitored carefully and information recorded. Also, Care files must clearly indicate how often staff should change dressings and implement any changed dressings when recommended. Both hot food and hot drink must be served at an appropriate temperature and appropriate equipment such as well functioning heated trolleys provided for staff. Seven other requirements were made to do with ensuring adequate and proper storage especially of linen and confidential files also the care of residents clothing, proper maintenance and cleaning of ground floor bathrooms and several other maintenance issues on the ground floor. Eight recommendations were made within the body of the report including a recommendation that the manager applies to become the Registered manager for the home and a Deputy manager is appointed as soon as practicable.

CARE HOMES FOR OLDER PEOPLE Castlebar Nursing Home Castlebar 46 Sydenham Hill Sydenham London SE26 6LU Lead Inspector Keith Izzard Unannounced Inspection 15th September 2008 10.15 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.V369048.R02.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. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 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 aura.correia@excelcareholdings.com 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 Vacant post Care Home 63 Category(ies) of Dementia (63), Old age, not falling within any registration, with number other category (63) of places Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 63 24th January 2008 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 run over thirty care homes in England. The home is 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 on each floor. Four of the bedrooms have en-suite facilities. All bedrooms are single rooms although couples could live together if they chose to. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 5 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 on Sydenham Hill, just off the London south circular road and is accessible by bus but is some distance from local amenities or a train station. Fees for a place at this home are currently, (September 2008) £595.00 for frail nursing £640.00 for EMI nursing £527.93 for EMI residential and £702.80 for private placements. The home makes the reports of the Commission’s inspections available in the reception area. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and was carried out over a full day on 15/09/08 by two Inspectors and a Regulation Manager. All the units were seen and we received assistance to access information from the Regional manager, in the absence of the recently appointed manager who, regrettably, was unable to be at the inspection. In preparation for the inspection we read all of the information that we had received about the service since the last inspection such as concerns and complaints, comment cards, notifications and the Annual Quality Assurance Assessment (AQAA) form. The latter was comprehensively completed and submitted in good time by the previous Registered Manager. We used this information to plan how we would carry out the inspection and what issues we would look at. During the inspection we spoke with six residents, two relatives, and eight members of staff as well as the regional manager and administrator. The residents that we spoke with on the first floor unit were not able to comment in any detail about the home. We case-tracked four residents and assessed four medication charts/supplies. We observed staff communicating with residents and visitors, supporting residents to eat and drink and take their medicines, in a professional and caring manner. All of the communal areas and several bedrooms were viewed on each of the units that we visited. What the service does well: Senior staff members assess potential residents considering a move into the home to see what help they required and if they had any special needs. This Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 7 information was used to develop a plan of care for the person and establish a rapport with residents and relatives prior to admission. There was a relaxed calm atmosphere on all the units visited. Residents had access to community health care services. Health problems were monitored and advice was obtained from other professionals if necessary. Residents were appropriately dressed and looked relaxed. They told us that staff maintained their privacy and were polite and helpful. People could choose where and how they spent their time and staff encouraged people to make decisions for themselves where possible. The newly decorated and refurbished parts of the home provide a very bright and airy environment and individual en suite accommodation of a good standard for residents in those areas. The responses from six residents interviewed and from two more who completed questionnaires were generally favourable and positive comments were made about the caring attitude of care staff by many of them. What has improved since the last inspection? What they could do better: Thirteen requirements were made that must be addressed by the home: Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 8 An updated Statement of Purpose and Service User Guide must be produced. A copy of the latter document must be given to each resident. The home must confirm in writing to prospective residents that their needs can be met by the home, prior to their admission. Care plans must give “how to deal with” guidance, to staff members in respect of a resident’s identified risks/challenging behaviour. Residents who are significantly losing weight must have food intake monitored carefully and information recorded. Also, Care files must clearly indicate how often staff should change dressings and implement any changed dressings when recommended. Both hot food and hot drink must be served at an appropriate temperature and appropriate equipment such as well functioning heated trolleys provided for staff. Seven other requirements were made to do with ensuring adequate and proper storage especially of linen and confidential files also the care of residents clothing, proper maintenance and cleaning of ground floor bathrooms and several other maintenance issues on the ground floor. Eight recommendations were made within the body of the report including a recommendation that the manager applies to become the Registered manager for the home and a Deputy manager is appointed as soon as practicable. 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. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 9 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.V369048.R02.S.doc Version 5.2 Page 10 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&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Both the Statement of Purpose and the Service User Guide need updating as soon as possible to ensure residents and relatives have accurate information about the home and can make an informed choice. Pre-admission assessments must be fully completed and letters confirming that the home will meet the needs of residents must be sent out prior to their admission. EVIDENCE: Standard 1 We looked at the Service User Guide in a number of residents’ rooms on all units. A number of residents had different issues of the document that were out of date. In some instances documents referred to previous managers and Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 11 the contact details for CSCI were out of date. Similarly the Statement of Purpose for the home now needs updating. The previous inspection report was clearly displayed in the reception area for reference. We acknowledged that the home has had a change of manager and that some residents have been admitted from another home in recent months. See Requirement 1 Standard 3 We examined four pre-admission assessments. The actual format that staff use is good but two of the assessments were only partially completed and one was not dated or signed. The home received a copy of the local authority care needs assessment document for people that were placed and funded by the local authority. These documents were comprehensive and very informative. Letters from the manager confirming that the resident’s needs could be met by the home were absent on four care files examined. Letters must be sent to prospective residents prior to their admission to the home and retained in their care files. See Requirement 2 Standard 6 This Standard was not assessed, as the home does not provide an intermediate care service. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans examined were mostly comprehensive and well recorded. Health care needs were generally appropriately attended to and recorded on residents care files but an omission was noted within wound care and nutrition needs for one resident. Medication was generally well managed. Residents were treated with respect and their dignity maintained. EVIDENCE: Standards 7 and 8 Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 13 We looked at four care plans on residents who we case tracked on each of the units. Two for residents who had been recently admitted to the home, one for a resident who had a pressure sore and one who had been resident in the home for two years. One file included various assessments and records that were either blank or partially completed. For instance, the pre-admission diary, managers audit, care plan confirmation, oral assessment and falls risk assessment documents were blank and the moving and handling and MUST nutritional assessment were only partially completed. Information that was obtained during the pre admission assessment and after the person was admitted to the home had been used to develop a plan of care for the resident. Although the care plan addressed most of the residents needs there was little guidance for staff about what they should do if the resident tried to leave the home or became aggressive (the resident had tried to leave the home and had been verbally aggressive in the past) See Requirement 3 There were some odd comments in the notes, which suggested that some staff might not fully understand what certain words or phrases meant. For instance one person’s social needs were recorded as “her son visits her and they spend quality time together” and when a risk assessment record prompted whether the current safeguards were sufficient, a staff member had written in response “dependency is high”. See Recommendation 1 Another resident was admitted to St Andrews home in 2004 and transferred to Castlebar very recently in 2008. Although some of the assessments for this resident were completed in 2006 they still reflected the resident’s main needs. The exceptions being the nutritional and wound care plans. The nutritional care plan indicated that the resident had a poor appetite but did not acknowledge that they had recently lost a significant amount of weight (40.5kgs –July 2008 and 35.8kgs August 2008) or indicate if staff members were taking any action to address this issue. The care plan dated 2007, stated that staff should monitor the resident’s daily food and fluid intake. There was some information in the daily care notes about the resident’s nutritional intake but the entries were vague and did not specify how much the resident was eating. See Requirement 4 On another care file a similar scenario had been well documented showing that a GP had been consulted, who advised food supplements and the daily intake had been monitored thereafter showing a subsequent gain in weight. One resident had two pressure sores. There was information about the location, size, appearance and treatment of the sores in the wound care evaluation chart and body map but it was not clear how often staff should Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 14 change the dressing. A separate care plan for a pressure sore dated April 2008 suggested that staff should apply a different type of dressing. See Requirement 4 The resident had a pressure relieving mattress and cushion and a referral had been sent to the tissue viability nurse for advice. All the care plans seen had been reviewed regularly. The records generally showed that residents were appropriately referred, seen and assessed by Dentists, Chiropodists and other health care professionals when necessary and in good time. Standard 9 One resident on the ground floor unit did not have a photograph on her medication chart. There were no photographs on the care file for one resident on the first floor unit who had pressure sores. The staff member on the first floor unit told me that she did not know where to find the camera in order to take photographs, this matter should be addressed by management. See Recommendation 2 All residents should have a personal photo on their MAR sheet to aid correct identification and wound photos should evidence the monitoring and progress of pressure sore treatment. See Recommendation 3 Overall, medicines were well managed. Good records were kept about medicines that were bought by residents into the home or were supplied by the local pharmacist. Staff recorded the opening date for medicines that had a limited shelf life. Records of administration were good. There were no gaps on any of the charts that I looked at and staff provided a written explanation if medicines were refused or not given. All medicines were in stock. There were two minor discrepancies on one of the four charts that I checked. I assessed two medicines that required special storage (controlled drugs). The records were up to date and the medicines were stored securely. The home kept a small supply of ‘homely remedy’ medicines such as “Paracetemol” and cough medicine, which staff could give to residents if they had a minor ailment such as a headache or cough. The list of ‘homely remedy medicines’ was agreed by the GP and there was guidance for staff about the use of these medicines. One discrepancy was noted when I checked the Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 15 homely remedy medicine supplies and records. The book that was used to record when residents were given ‘homely remedy’ medicines was difficult to follow in parts, but was up to date. I advised the staff member to consider carrying forward the balance of all homely remedy medicines into a new book with clear guidance for staff about the information that they should record. Standard 10 We were told by both residents and relatives seen that staff were kind and helpful and we observed some caring interactions between some of the staff and residents. Staff spent time talking with residents and listened to their concerns. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 16 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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities were well organised and good provision was made for residents. Visitors are welcome at anytime, and are able to take part in the life of the home. Residents are encouraged to make their own choices in daily living. A varied and nutritious diet is provided for residents but a requirement was made regarding the temperature of served food and drinks. EVIDENCE: Standard 12 Staff interviewed said two dedicated activity staff members are employed (one of whom was on jury service). Residents confirmed that there were regular group activities such as bingo and quizzes and one of the visitors plays the piano in the lounge twice a week. We could only have a brief chat with the Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 17 activities person on the first floor because of other commitments. We were told that she was still familiarising herself with the home and helping people who had moved from ST Andrews to settle in. She did not have any significant concerns or worries. She was very impressed with the garden and said she hoped to make good use of this facility next year with associated outdoor activities for residents. A number of residents became very animated when Rosie (the activity person) came into the room so we could tell they were very familiar with her. One resident said that she was his “favourite” although he then went on to point out other staff members were also his favourites! The records showed that people were encouraged to attend entertainment sessions and group activities but some people liked to just watch other people taking part. Some residents said they enjoyed and benefited from a programme called SONAS. SONAS is a therapeutic activity that is particularly suitable for older people with intellectual difficulties such as dementia. The aim of the programme, either via group or individual sessions is to enrich the lives of the participants by activating each person’s potential for communication. Standard 13 The four visitors we spoke to with were generally satisfied with the care that their relative/friend was receiving and did not express any concerns about the home except an ongoing issue regarding clothing being mislaid from one relative. This was discussed with the unit manager concerned, who undertook to address the problem. There are no restrictions in respect of visiting times and staff members actively encourage visits, for the benefit of residents. Standard 14 People told us that there were no restrictions about the times that they got up or went to bed but two residents on the ground floor unit said they sometimes had to wait for staff to help them get into bed or to use the toilet. They both emphasised that this was because staff were busy, it was not because staff didn’t want to help them. Standard 15 We observed lunch on the ground floor and residential units. People were able to choose where they sat, with some residents opting to remain in the lounge. The list of residents preferred meal was followed and some residents were asked if they wanted creamed or boiled potatoes. Two residents on the ground floor unit said their meals were not always hot. One person said the temperature was “variable” and the other person said food was “rarely hot”. Hot food was served from cling film covered dishes on a wheeled trolley (not a Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 18 hot trolley). The food that we tasted (after all of the residents were served) (chicken and mashed potato) was not hot and the food that was taken to resident’s rooms on trays was not covered. The operations manager acknowledged there was a problem that had already been identified and said that new heated trolleys were on order. See Requirement 5 Most residents said they enjoyed their meal but two residents told me the meat was sometimes dry or hard (the chicken that we tasted was tender). People were given adequate time and support to eat. We were offered a cup of coffee at around 11.30 whilst talking to a resident. The coffee was cold. As we did not want to say anything in front of the resident we left it on the side. When we left the resident asked why we didn’t drink it, so we explained that it wasn’t very hot. The resident said the tea was often cold and she sometimes had to go to the microwave to warm drinks up. The Operations Manager said staff members on the ground floor unit obtain hot water for drinks from a water heater but staff members on the other floors use a kettle. The Operations Manager felt this was significant, and the likely cause of the problem. The staff member that made the drink also asked why I the coffee was drunk we explained and she offered to warm it up in a microwave or get a cold drink. See Requirement 5 Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems were in place to manage complaints and ensure residents’ protection. EVIDENCE: Standard 16 Since the previous inspection of the home in January 2008 the home has had a small but significant number of complaints affecting the care of residents. It was noted that all had all been responded to appropriately in terms of an investigation. The previous Registered manager and the Operations Manager had when necessary provided comprehensive responses to complainants, addressing issues of safeguarding and protection in full. Letters were on file to evidence that the Provider’s representatives had responded appropriately. Management of the process of recording complaints would benefit from the development of forms to indicate that a clear and consistent path is taken in every case e.g. identifying those who have been involved and/or contacted, providing a recorded outcome and that timescales have been adhered to. See Recommendation 4 Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 20 Standard 18 We spoke with six members of staff about safeguarding. They had all received training during the past two years and said they would report allegations to the team leader, manager or person on call outside office hours. From a protection perspective the homes recording procedures for investigating complaints are satisfactory. Staff members follow the multiagency adult safeguarding procedures as they apply to the local authority that has lead responsibility for managing investigations of alleged abuse or poor standards of care provided by care providers. The outcome of the complaints considered suggested that standards were being maintained in this area. Management of the process of safeguarding documentation would benefit from the development of forms to indicate that a clear and consistent path is taken in every case e.g. identifying those who have been involved and/or contacted, providing a recorded outcome and that timescales have been adhered to. See Recommendation 4 The further development of good supporting procedures combined with regular monitoring of the process and outcome would enhance the integrity of the investigations undertaken. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 21 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): 19-26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives were satisfied with the private and communal space provided. The home was mostly kept clean, one area of the home was neglected, however a rolling programme of maintenance and redecoration work was being implemented. Systems and equipment was in place to enable staff to practice infection control. The home was mostly clean, comfortable and welcoming except for one area. EVIDENCE: Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 22 Standards 19-26 The first and second /upper floor units were clean and tidy and had been very nicely redecorated and refurbished but unfortunately, attention to detail (deep cleaning) was poor on the ground floor unit, especially in the bathrooms and hairdressing room. The skirting boards, the areas behind the doors and the bars under tables were dirty and dusty. There was a pool of water on the floor under the sink in the hairdressing room and on both sides of the “Parker bath” in the ground floor bathroom. The home needs to investigate this issue promptly. See Requirement 6 There were tiles missing on the floor in the ground floor bathroom, handles missing on the chest of drawers in room 5, there was a hole in the radiator cover in the ground floor bathroom and the curtains in room 5 were hanging off the rail. See Requirement 7 The mattress in room 6 on the ground floor was very thin. The base of the bed could be felt through the mattress. See Recommendation 5 Staff had left a sheet on the floor and used personal clothing on a shower chair in the ground floor bathroom. Clean linen was stored in a cupboard on the ground floor. As there was not sufficient shelving for all of the linen some of the bedding was piled on the floor. See Requirement 8 Storage cupboards were untidy and disorganised. One cupboard on the ground floor looked like everything had been thrown in (wheelchairs, tools, commodes etc). There were confidential records in some unlocked filing cabinets in the linen cupboard on the ground floor. See Requirement 9 Resident’s bedrooms were different sizes and shapes. People could bring their own furniture and personal items into the home with them if they wished. Most of the rooms that we visited contained personal items such as family photographs, ornaments and paintings. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 23 Hand washing facilities were good on the ground floor but most of toilets and bathrooms that we visited on the first and second floor units did not have any soap and some did not have any hand towels. See Requirement 10 Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 24 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): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are being met by the numbers and skill mix of staff, and they are in safe hands at all times. Residents are protected by the home’s recruitment policy and practices, and staff members are trained and competent to do their jobs. EVIDENCE: Standard 27 Five staff members were on duty when we arrived on the ground floor unit (am-x1 RGN and four carers) and four on the first floor unit (pm- one RGN and three care assistants). On the third floor one senior care staff member and three care assistants were on duty both am and pm. The staff members on duty were checked against the duty roster. Staffing levels appeared satisfactory. The home hardly ever uses agency staff, having bank staff to call upon to cover leave and absence. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 25 The Regional manager stated that a deputy manager would be sought and appointed as soon as possible. It is strongly recommended that this be implemented as soon as practicable. See Recommendation 6 Standard 28 Over the required 50 of the care staff that worked in the home had a National Vocational Qualification in Care (NVQ Level 2). The number of care staff with a recognised care qualification had increased and this is commendable. A large number of people that we interviewed or received written comments from within CSCI questionnaires, said the home had some very good staff, for example “most staff are kind and helpful” “the staff respect privacy and are patient”. Standard 29 Three personal staff member files were examined, in relation to recruitment and training. Records seen indicate that there are sound recruitment procedures in place to protect residents living in the home. Standard 30 Staff members were satisfied with the training arrangements. They said they could attend internal and external training sessions and found the sessions very interesting. All of the staff that I spoke with had attended at least three training sessions during the past year. The training matrix showed that relevant training had been provided for staff members and had been planned the future. Staff members had received induction and mandatory training such as Fire, Moving and Handling, both yearly. Other training had covered infection control, first aid, POVA, food hygiene, falls, Health and safety, MUST, medication and end of life care. Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 26 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The newly appointed manager has provided good continuity of care for residents and staff following the resignation of the Registered Manager, but a new appointment of Registered Manager should occur as soon as possible. There were systems in place to monitor and improve the quality of care provided in the home and to safeguard people’s money. Health and safety issues were not always well managed. EVIDENCE: Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 27 Standard 31 Staff said the new manager was approachable and visited the units regularly. Most staff had attended a staff meeting with the new manager. The manager will need to apply to become the Registered manager for the home as soon as possible and a Deputy manager should also be appointed. See Standard 27. See Recommendation 6 Standard 33 We looked at 3 Regulation 26 reports (June, July and August 2008). The Regional Operations Manager visited the home each month to talk to residents and staff and looked at some of the records held in the home. We looked at five recent care plans, medication and health and safety audits. Although no significant concerns were identified action plans and timescales were not always recorded and there was no system in place to check if issues recorded were addressed. See Recommendation 7 Standard 35 The system for dealing with residents’ personal finance was examined and a good audit trail was seen and no errors found in respect of the three examples that were individually examined. Receipts are obtained for service user expenditure and an ongoing ledger records all money credited and debited in respect of individual service users. Individual plastic zip wallets contain the outstanding balance of cash and receipts obtained for any purchases made and the envelopes retained in a locked safe. The system examined was accountable with a good audit trail. There were clear procedures for staff to follow and money records were checked during monitoring visits and audits. Standard 38 In two of the rooms (5 GF and 30 FF) that we visited there was only one bedrail on the bed. If the resident was to push the bed away from the wall they could fall or become trapped down the side of the bed. If people require bedrails they must be fitted to both sides of the bed. See Requirement 11 The cleaner’s cupboard on the ground floor unit was unlocked as was the cleaning cupboard on the top floor because the lock was deficient. Urine neutraliser, kettle de-scaling fluid and cream cleaner were stored in the ground floor cupboard Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 28 See Requirement 12 In two of the rooms that we visited on the first floor (room 46 and one of the shower rooms) and room 62 on the third floor, the window restrictors were either broken or not in place. The nurse in charge said she would ensure the maintenance dept were advised about this issue urgently. See Requirement 13 The home had a dedicated maintenance person. The maintenance person carried out regular health and safety checks and routine repairs within the home and grounds. Health and safety records were sampled. All of the records seen were up to date and corresponded with the information that was provided by the acting manager in the Annual Quality Assurance Assessment (AQAA) report. Hot water temperatures were tested regularly. It was recommended to the manager that dated stickers be attached by visiting service engineers, to all moving and handling equipment, including specialist baths, to facilitate easy reference that equipment had been examined within the required six-monthly time frame. See Recommendation 8 Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 29 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 30 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. 1 Standard OP1 Regulation 4,&5 Requirement An updated Statement of Purpose and Service user Guide must be produced. A copy of the latter document must be given to each resident. The home must confirm in writing to prospective residents that their needs can be met by the home, prior to their admission. Care plans must give “how to deal with” guidance, to staff members in respect of a resident’s identified risks/challenging behaviour. Residents who are significantly losing weight must have food intake monitored carefully and information recorded. Also, Care files must clearly indicate how often staff should change dressings and implement any changed dressings when recommended. Timescale for action 01/12/08 2 OP3 14 (d) 01/12/08 3 OP7 13 (4) c 01/12/08 4 OP8 13 c 01/12/08 5 OP15 16 (2) i Both hot food and hot drink must 01/12/08 be served at an appropriate temperature and appropriate equipment such as well DS0000007013.V369048.R02.S.doc Version 5.2 Page 31 Castlebar Nursing Home 6 OP19 16 & 23 functioning heated trolleys provided for staff. There was a pool of water on the floor under the sink in the hairdressing room and on both sides of the “Parker bath” in the ground floor bathroom. The cause must be investigated and resolve the problem promptly. The following matters must be attended to: There were tiles missing on the floor in the ground floor bathroom, handles missing on the chest of drawers in room 5, there was a hole in the radiator cover in the ground floor bathroom and the curtains in room 5 were hanging off the rail. Staff members must ensure that residents’ clothing is looked after properly. Also ensure that adequate shelving is provided in order to store bed-linen appropriately and not piled on the floor. Storage cupboards must be maintained in a tidy and organised fashion and be appropriately separated in respect of the contents stored. Unlocked filing cabinets containing confidential records must be stored appropriately in order to maintain confidentiality. Hand washing facilities were good on the ground floor but most of toilets and bathrooms that we visited on the first and second floor units did not have any soap and some did not have any hand towels. If people require bedrails they DS0000007013.V369048.R02.S.doc 01/12/08 7 OP19 16 & 23 01/12/08 8 OP19 16 & 23 01/12/08 9 OP19 23 &37 01/12/08 10 OP26 16 & 23 01/12/08 11 OP38 13 c & 23 01/12/08 Page 32 Castlebar Nursing Home Version 5.2 must be fitted to both sides of the bed for safety reasons. 12 OP38 23 COSH procedures must be implemented and cupboards used for storage of hazardous chemicals locked at all times for health and safety reasons. All windows must have restrictors and be regularly checked for proper functioning. 01/12/08 13 OP38 23 01/12/08 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 3 Refer to Standard OP7 OP9 OP9 Good Practice Recommendations Senior staff should identify any unclear recording by care staff and assist them to develop through supervision and training, to be clear and concise. Senior staff members should ensure care staff members are aware of where to find equipment, such as, a camera, for the purpose of recording wound progress. All residents should have a personal photo on their MAR sheet to aid correct identification and wound photos should evidence the monitoring and progress of pressure sore treatment. Management of the process of recording complaints and safeguarding matters would benefit from the development of forms to indicate that a clear and consistent path is taken in every case e.g. identifying those who have been involved and/or contacted, providing a recorded outcome and that timescales have been adhered to. The mattress in room 6 on the ground floor was very thin. The base of the bed could be felt through the mattress. All mattresses should be checked for comfort and their suitability for individual residents. A deputy manager should be sought and appointed as DS0000007013.V369048.R02.S.doc Version 5.2 Page 33 4 OP16 5 OP19 6 OP27 Castlebar Nursing Home OP31 7 OP33 soon as possible Action plans and timescales were not always recorded and there was no system in place to check if issues recorded were addressed. It is recommended that dated stickers be attached by visiting service engineers, to all moving and handling equipment, including specialist baths. This would facilitate easy reference to check that equipment had been examined within the required six-monthly time frame. 8 OP38 Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Extracts may not be used or reproduced without the express permission of CSCI Castlebar Nursing Home DS0000007013.V369048.R02.S.doc Version 5.2 Page 35 - 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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