Inspection on 05/03/07 for Castleford Home for the Elderly

This inspection was carried out on 5th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Castleford Home for the Elderly 27/08/07

Castleford Home for the Elderly 13/02/06

Castleford Home for the Elderly 12/09/05

Castleford Home for the Elderly 24/01/05

Castleford Home for the Elderly 09/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Castleford Home for the Elderly Queens Road Clitheroe Lancashire BB7 1AR Lead Inspector Mrs Christine Mulcahy Key Unannounced Inspection 10:00 5th March 2007 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 Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castleford Home for the Elderly Address Queens Road Clitheroe Lancashire BB7 1AR 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) 01200 426355 01772 562304 Lancashire County Care Services Care Home 30 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (16), of places Physical disability (6), Physical disability over 65 years of age (6) Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. The home is registered for a maximum of 30 service users to include: Up to 16 service users in the category of OP (over 65 years of age, not falling into any other category). Up to 9 service users in the category of DE(E) (dementia over 65 years of age). Up to 6 service users in the category of PD (physical disability under 65 years of age). Up to 6 service users in the category of PD(E) (physical disability over 65 years of age) 13th February 2006 Date of last inspection Brief Description of the Service: Castleford HFE is part of Lancashire County Care Services and is registered with the CSCI to provide personal care and accommodation for up to 30 older people. There are 3 separate living units that have different functions and provide different levels of care. Recent building and refurbishment work has created a homely and cosy environment for service users to live in. A new conservatory now provides service users with a spacious dining area. Many bedrooms are en suite and there are assisted bathrooms, shower rooms and toilets for service users throughout the home. The service also operates a rehabilitation unit for 6 service users and this is separately staffed. Castleford is located on Queens Road and is close to local shops, supermarkets, train station and other amenities in the town centre of Clitheroe. The home is situated on a main bus route that offers transport to all towns in the Ribble Valley area. Prospective service users receive a copy of the homes service user guide and have access to the Statement of Purpose. The manager was unable to advise the CSCI about the range of fees at the time of the inspection. However she said that service users are billed separately for hairdressing, newspapers and toiletries. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection, including a visit to the home, took place over 2 days on 5th and 6th March 2007 Information was obtained from service user care plans, staff records, management systems, observations of care practices, service user questionnaires and the homes policies and procedures. The inspector also spoke to 9 service users, 4 staff, 3 relatives and the acting manager. What the service does well: What has improved since the last inspection? What they could do better: The health, safety and wellbeing of service users should be clearly identified in each care plan and include risk assessments where the risk is greater. Where possible service users should be consulted about the details of care and this information should be included in the care plan. The information would then be accurate and current and should tell staff exactly how to meet these needs. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 6 Service users who self-administer their medication are currently at risk of mis administration. Service users should have a risk assessment to make sure they are safe in doing this. Care staff should always sign the MAR sheet to confirm they have observed the service user taking the correct medication in the correct quantity and at the correct time. To promote service user quality of life meaningful activity the amount of social and recreational input should be increased as limited recreational stimulation reduces service user quality of life. Activities like books or magazines left on tables, and regular visits to places of interest would encourage more therapeutic activity amongst the service user group. Group living settings highlight the domestic aspects of life and are more easily understood by people with dementia. However the patterned carpet in the communal area highlights a lack forethought and should be re assessed by a suitably qualified person with specialist knowledge of the service user group. This is so it can be shown that the carpet needs to be changed to a more helpful design feature and is more appropriate to the needs of the service users on the unit. All staff must receive regular formal supervision to ensure that staff are aware of their roles, responsibilities and philosophy of the home. 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. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are given a service user guide and admitted following a full assessment so that staff know what their needs are. Care plans are based on these assessments. Intermediate care helps to maximise their independence and return home. EVIDENCE: A service user guide was available in all service users admitted to the intermediate care unit. Care plans examined showed that service user needs assessment had been done before the service user moved into the home. The assessment documentation was always available to staff on the rehabilitation and residential units. This helped familiarise them with the new service user. An intermediate care worker spoken to was aware of the need for service user assessments and knew that these formed the basis of the care plan. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 9 There was a dedicated space for the intermediate service. Staff from relevant professions met the assessed needs of service users admitted for intermediate care. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 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): OP 7, 8, 9, & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all service user care needs were set out in a plan of care. Service users were not protected by the homes medicine policies and procedures and were at risk of harm from mis administration. Care practiced observed showed service users privacy and dignity was respected. EVIDENCE: Case tracking and discussion with care staff confirmed that all service users had a plan of care. Care plans seen lacked personal history detail and none of the care plans contained a photograph of each service user. This means that new staff would not be able to properly identify service users. Care plans viewed did not included sufficient details for staff to meet those need identified and did not detail how identified needs would be met this meant that their personal and health care needs couldnt be properly met. Many care plans were not signed by the service user or their relatives and this meant that service users were not involved in deciding what care should be given to them. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 11 A care plan examined did not include important information about a service user with mental health needs and how to manage the behaviour. This meant that staff were unable to properly support the service user and other service users in the home. Discussion with staff confirmed that the service users behaviour was often difficult to manage and had become progressively worse since admission to the home. There was no risk assessment to highlight the service user needs or the difficult behaviour displayed towards staff and other service users. New or inexperienced staff were not told how to meet those identified needs. This means there were not sufficient safeguards in place to ensure the wellbeing of service users was fully protected. After discussion with the inspector the registered manager said that she would contact the mental health services to seek advice and support. Risk assessments examined on the intermediate care unit and residential unit were not been properly completed. Relevant information was not included and information on risk assessments was inconsistent and failed to define the risk. Risk assessments were not signed or agreed by service users or their relatives. Because this was not confirmed this meant that service users did not know if the identified needs were accurate and staff could not be certain they were fully meeting service user needs. Care plans in the main were not person centred and did not recognise the diverse needs of some service users. The home has a medication policy which is accessible to staff. Examination of the homes medicine files highlighted the lack of photographs on all service user Medication Administration Record (MAR) sheets. This meant that new staff would not be able to identify service users during the medicines round. Also intermediate care service users who self-medicated did not have a written risk assessment and MAR sheets were unsigned. This meant that risks in this area were not identified and self- administering was unchecked by staff. These practices were unsafe, did not follow the homes medicine policy and placed service users at risk of mis-administration. 17 care staff have been trained in the safe handling of medicines (SHOM). Access to other health professionals was given and evidence of district nurse, chiropody and ophthalmic services were seen on care plans. Health and personal care arrangements ensured service user privacy. Evidence seen confirmed that service users health is monitored and professional advice on health care issues is sought and acted on. Aids and equipment necessary to promote service user wellbeing were seen in use in the home. When asked about the clothing they were wearing service users confirmed that clothing worn that day was their own and clothing seen in wardrobes were named accordingly. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 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): OP 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lack of leisure and recreational activities meant that service users social interests cultural and social needs were not fully met. Visiting from relatives and friends is flexible. Service user autonomy and choice was maximised in relation to meals and mealtimes. EVIDENCE: Wherever practicable service users were able to make choices about aspects of their lives. A service user on the residential unit was observed using his bedroom for most of the day and told the inspector, “I always stay in my room, it’s a lovely room. In summertime you can sit out. Sometimes I go out there with the others but I’m not bothered”. Service user files and care plans examined held limited information about their interests and the information that was used was not part of an activity plan. This meant that there was not enough information to provide needs led lifeenhancing activities for the service users. When asked about the amount and variety of activities another service user said, “I don’t like all this sitting about and waiting, I play dominoes but I’m going blind. The staff help me though”. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 13 Activity records were examined and confirmed a small number of activities had taken place but these were repetitive and lacked variety. The acting manager was reminded that all service users must be given the choice of options available and activities must be provided to meet their individual social and cultural needs. Regular attempts must be made to include the preferences of the majority of the service users. This must be agreed with service users and recorded in their care plans. The staff team were all white British and this reflected the current service user group. The manager said that service users religious and cultural needs are met at the home through visits from the local clergy and these were listed on the notice board. She also explained future plans to introduce college volunteer to the home for musical afternoons Menus were changed regularly and service users were reminded of the day’s menu each morning. The inspector observed staff ready to offer assistance in eating to service users. Discussion with service user about meals confirmed that service users were satisfied with the choice and variety available to them. One service user when asked about the meals said, “The meals are nice and I like having a cup of tea made for me”. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 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): OP 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints made by service users were acted on and recorded. Staff were trained in the protection of vulnerable adults. EVIDENCE: There is a complaints procedure that is up to date, clearly written and can be made available in other formats. When asked if service users knew who to complain to they had a good understanding of how to make a complaint. There is an assurance that complaints will be responded to within a maximum of 28 days. Training of staff in the area of protection is regularly arranged and is ongoing at the home. There were procedures for staff to follow if they suspected an incident of abuse had taken place. Abuse training was ongoing and staff knew what procedure to follow in the event of abusive practices. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 15 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): OP 19, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a well-maintained environment that is kept clean and free from offensive odours. Patterned carpets provided on the dementia unit confused some of the service users. EVIDENCE: Case tracking and a tour of the building showed that the home is split into three separate living units each refurbished and redecorated to create an environment that is cosy and homely. A tour of the building confirmed that each living unit was pleasant and safe. However discussions with care staff highlighted that the carpet in the dementia care unit is patterned and often confuses service users who frequently try to pick out the pattern from the carpet. This meant that a more helpful design would be more appropriate to meet the needs of the service users on the unit. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 16 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): OP 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment process ensured the protection of service users. Care staff were trained to carry out duties expected of them. Rotas showed the home was staffed to meet the service user needs. EVIDENCE: The duty rota was examined and showed which staff were on duty and at what times. When asked about the staffing numbers service users confirmed they were satisfied with the numbers of staff on duty. The file of one employee was examined and showed the manager had followed the homes recruitment procedures. All pre employment checks had been carried out and there was accurate recording at all stages of the process. The service provides a comprehensive training programme including safe handling of medicines, dementia care, safeguarding adults and, moving and handling for all levels of staff. A record of training and development by all staff was examined. Only 39 of the care staff was qualified to NVQ Level 2 and above. Two care staff spoken to were very knowledgeable about the service user group and demonstrated their competencies through clear discussion and brief demonstration of their work tasks. Both workers were confident in carrying out their duties and knew the importance of the homes policies and procedures. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 17 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): OP 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interest of service users. The health, safety and welfare of service users and staff are promoted and respected. The lack of staff supervision did not ensure staff could meet the homes aims and objectives. EVIDENCE: The acting manager has the required qualifications and experience and is competent to run the home. She is aware of current developments receiving regular training to update her knowledge. Staff meetings and staff supervision are not held regularly and service user meetings are infrequent. This means that there are limited opportunities for staff and service users to make their views known. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 18 Case tracking and examination of records confirmed the home has sound policies and procedures that are reviewed and updated regularly. There is a clear health and safety policy and records of equipment checks examined were up to date and accurate. Service users are provided with facilities to keep their valuables and money safe. There is a safe system with clear records that are kept to track individual service user finances. Quality assurance systems are in place to ensure services are provided to meet service user needs. Service users are able to take responsibility for managing their own money and there is a safe system and records are well maintained. A record of water temperatures was kept along with other relevant health and safety records. All staff had received mandatory training in safe working practices including moving and handling, food hygiene and first aid. Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 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 3 X 3 X X 2 Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 20 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 OP7 Regulation 15 (1)15(2) Requirement The registered manager must ensure that all service users are provided with a plan of care that is fully completed and sets out in detail the action to be taken by care staff so that all aspects of the health and social care needs are met. Service users or their representatives must be consulted as to how these needs are to be met. Care plans must be properly reviewed at least once a month. The registered manager must ensure the service user plan of care contains a fully completed risk assessment where necessary that is reviewed frequently. The registered manager must ensure that a mental health review is carried out to ensure the needs of the service user can be met properly. The registered manager must ensure there is a risk assessment for service users who self-administer medication. The registered manager must DS0000035278.V302680.R01.S.doc Timescale for action 06/06/07 2 OP7 13(4)(b,c) 03/04/07 3 OP8 13(1) (b) 16/03/07 3 OP9 13(4)(c) 06/03/07 4 OP9 13(2) 06/03/07 Page 21 Castleford Home for the Elderly Version 5.2 5 OP12 16(m)(n) ensure MAR sheets are fully completed by staff after service users have taken their medication. The registered manager must ensure that details about service users current interests are included on the service user care plan and these are included in the homes activity plan. The registered manager must ensure that a suitably qualified person with specialist knowledge of the service user group makes an assessment of the carpet on the dementia unit to demonstrate that the patterned carpet is not a helpful design to service users with dementia therefore inappropriate to the needs of the service users on the unit. 06/06/07 6 OP22 16(1) 11/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Castleford Home for the Elderly DS0000035278.V302680.R01.S.doc Version 5.2 Page 23 - 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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