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Inspection on 10/11/05 for Castleford House Nursing Home

Also see our care home review for Castleford House Nursing Home for more information

This inspection was carried out on 10th November 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Good standards of nursing care are maintained as confirmed by the residents spoken with and as observed. Staff spoken with responded well to questions about the residents demonstrating that they were fully aware of their needs and how to meet them. The home is very committed to staff training and development and 39% of the care staff have NVQ 2. Staff records confirm that the majority of staff have received some training this year and training planned clearly demonstrates that individual and specialist needs are considered. The quality and choice of food remains very high as observed and confirmed by the residents spoken with.

What has improved since the last inspection?

A new assisted bath has been fitted improving the assisted bathing facilities for the residents and making bathing easier for the staff. With staff awareness of POVA being raised recruitment procedures have greatly improved.

What the care home could do better:

Replace flooring in the dining room and upper floor landings, which would greatly improve the appearance of the home. Provide comfortable armchairs in every room for resident/visitor use. Attend to wear and tear on doors and door frames and redecorate identified areas.

CARE HOMES FOR OLDER PEOPLE Castleford House Nursing Home Castleford Hill Tutshill Nr Chepstow Glos NP6 7LE Lead Inspector Mrs Janet Griffiths Unannounced Inspection 10th November 2005 10:00 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 House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 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 House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Castleford House Nursing Home Address Castleford Hill Tutshill Nr Chepstow Glos NP6 7LE 01291 629929 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) Pinnercliff Limited Mrs Madeleine Frances Parsons Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (57), Physical disability (57) of places Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th June 2005 Brief Description of the Service: Castleford House is situated on the Gloucestershire/ Gwent border overlooking the town of Chepstow and the River Severn. The house is a large red brick building providing accommodation on three floors, which also have mezzanine levels on these floors. There is a shaft lift and two stair lifts providing access to all levels. In the main, the accommodation is spacious with large landing areas on each floor. There is a large reception, which is favoured as a seating area for many of the residents, plus a lounge, a dining room and a library, which is used as a quiet lounge. There is level access to a patio to the rear of the building and a spacious walled garden and well-laid flowerbeds. Bedroom accommodation consists of twenty-seven single and eight double rooms, with fourteen rooms offering en suite facilities. Two assisted bathrooms are situated on the ground floor and assisted toilets on the first floor. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours during one day in November 2005. The manager was present throughout the inspection and one of the three partners of the company arrived during the morning and joined the inspector to walk around the building. A number of residents and staff were spoken with during the inspection to include both new residents and new staff. In addition to this the records of four residents were looked at in detail, as were a variety of other records. What the service does well: What has improved since the last inspection? A new assisted bath has been fitted improving the assisted bathing facilities for the residents and making bathing easier for the staff. With staff awareness of POVA being raised recruitment procedures have greatly improved. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 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 House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 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): 3 The admission process is well managed and with full pre-admission assessments the home ensures that it is able to meet the needs of each service user. EVIDENCE: There have been five new admissions to the home since the last inspection. The inspector met and spoke to all of these. One resident was admitted for respite care with a view to permanent residency. The manager was visiting the local hospital at the start of the inspection to carry out an assessment on someone in order to consider whether the home is able to meet their needs. Records of pre-admission assessments were seen. All of the new admissions appeared to have settled into the home quite well although because of the mental frailty of several of these residents they were not all fully aware of where they were. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 9 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): 7,8,10 There is a clear care planning system in place to provide staff with the information they need to meet service users needs. Residents are well looked after in respect of their health and personal care needs. Residents feel respected and their privacy is maintained. EVIDENCE: Four care record files were looked at in detail and all had an assessment completed from which individual care was planned. A moving and handling and pressure sore risk assessment was also completed. Regular reviews are carried out and daily records noting significant events, are kept, as are night care plans. Not every assessment was signed and dated, but other than that the records were well maintained. The manager has effective auditing systems in place and records of a careplanning audit that took place in August were seen. Conversations with residents and staff and looking at records confirmed that there is multi-agency input wherever required. A doctor from one local practice Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 10 visits each week; reference was made to chiropody visits, a community nurse was visiting during the inspection to carry out an assessment, one resident was seen by a wound specialist when his wound did not appear to be responding to treatment and all residents with diabetes are reviewed at least annually. All the residents who wished had also had their influenza vaccines recently. The home is well equipped with pressure relieving equipment and adjustable height beds and anyone who requires a wheelchair now has their own. Skin assessment and wound care charts were seen in use where necessary. The nursing staff reported only one resident who currently has a very superficial pressure sore. There is just one resident with a supra-pubic catheter and each resident has their continence needs assessed and continence aids provided if required. One resident has a percutaneous endoscopic gastrostomy (PEG) inserted but still takes diet by mouth and although a number require assistance with meals only one requires supplements on occasions. The medications were not checked on this occasion but are audited regularly by the manager and the reports of these were seen, the last audit having just been completed. There are three double rooms being shared at present and another area on the first floor that has the appearance of three single rooms but because the dividing walls do not reach the ceilings they are not totally private. These three residents share one en suite toilet and hand washbasin, but personal toiletries are kept separate and all have their own wardrobes and other furniture. Staff do their best to ensure privacy when carrying out personal care tasks in shared rooms. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 11 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): 15 The meals in this home are very good offering both choice and variety and catering for individual preferences and special dietary needs. EVIDENCE: On arrival at the home, a number of residents were enjoying a leisurely cooked breakfast and several residents commented on how much they enjoyed their bacon and eggs. Cold drinks are available in all the communal areas and residents were observed being offered beverages through the morning. Choices are offered at every meal and the food served at lunchtime with a choice of well-cooked vegetables looked and smelt very appetising, as confirmed by both staff and residents. The kitchen viewed during lunchtime preparation appeared clean, fully equipped and well organised. The Environmental Health Officer had visited last in late 2004 and a report was seen. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 12 Food storage areas were well organised and fully stocked. Several new freezers and other kitchen equipment had been purchased since the last inspection. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 13 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): 18 Policies, procedures and staff training aim to ensure that arrangements for protecting service users from abuse are maintained. EVIDENCE: Since the last inspection the manager and administrator have both been on POVA training and all staff have been given written information on this. All staff have been given POVA literature and all new staff have POVA/CRB checks before appointment. There are plans to organise further abuse training for all staff in the near future. The home is currently engaged in an investigation involving a member of staff who is currently suspended. They notified the CSCI of this event prior to the inspection and will keep them informed as the investigation is completed. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Residents in the home are provided with a clean and comfortable environment to live in with a satisfactory standard of décor, with a few exceptions highlighted at several previous inspections. Planned investment will significantly improve the appearance of these identified areas. EVIDENCE: The standard of décor with one or two exceptions is good. There is a large patch on the upper floor landing that requires redecoration; a wall in rooms 15 and 16, the assisted toilet on the ground floor and several skirting boards showing signs of wear and tear. In addition to this the lower halves of doors and door frames are also badly scratched in some areas through wear and tear and would benefit from protective panels being fitted once repainted/varnished. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 15 The home has had many problems with the shaft lift over the past year resulting in some occasions when residents were unable to move freely up and downstairs. Senior staff have all received training in emergency procedures for manually operating the lift and a lift failure policy was put in place (copy received). The home has recently changed service/maintenance contracts and the new Company plans to totally refurbish the lift in the next few weeks. A new assisted bath has also been fitted since the last inspection, a total of two assisted baths now in place for 36 residents. Staff have previously stated that these are sufficient as baths are programmed throughout the week at varying times. The maintenance man who had been on long-term sick leave has recently returned and the staff reported that they were very pleased to have him back to ensure that day- to- day maintenance is dealt with. There were several worn toilet seats that need replacing as they pose an infection control risk as they are. Most of the carpeting throughout is clean and in excellent condition. One major exception to this is still the dining room carpet which appeared very dirty on this occasion but was due to be cleaned the following Monday evening. It was reported that quotes for alternative flooring for this area are currently being accepted. One other area noticeably stained is the upper floor corridor carpet which being cream stains easily. Both were mentioned at the last inspection. Generally the standard of furnishings in the home is very good, and several new small commodes were noted. However, it was again pointed out that in a number of rooms there is no armchair for either the resident or their visitors to sit on other than a commode chair which from an infection control and a comfort point of view is not satisfactory. The proprietors however do not share this view. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 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): 27,28,29,30 Staff at the home are well trained and supported and employed in sufficient numbers to meet the residents needs. The procedures for the recruitment of staff have improved providing better safeguards to offer protection to people living in the home. EVIDENCE: Throughout the day the home has two qualified staff on duty and on this occasion also had the manager working in a supernumerary capacity. In addition to trained staff there were six care assistants during the early shift and five on the late shift. One qualified nurse and thee care staff work through the night. In addition to care staff there were two cleaners, a housekeeper, a laundry assistant, two cooks, a kitchen assistant and the maintenance man on during the morning. An activities co-ordinator also works between 12-20 hours each week but was not on-duty on this occasion. As the majority of residents spend their days in one of the communal rooms on the ground floor there is a greater staff presence in these areas for most of the day. Staff were observed going about their work in a professional and efficient manner, and responded well to questions about service users, all demonstrating they are fully aware of the needs of each service user. All of the residents spoken with were happy with the care received and had a good rapport with the staff. There was no indication from anyone that their needs were not being met. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 17 Staff files were seen of the three new staff appointed since the last inspection; one qualified nurse, one carer and one cleaner who has since left. All had evidence of POVA/CRB checks being completed. All had completed an application form and all had the required documentation in place with the exception of one reference from the past employer of one employee, but this employee has since left and there was evidence on file that this reference had been followed up. The manager also reported recent training undertaken and future plans. All qualified staff are currently doing venepuncture and male catheterisation training, the manager and one other nurse will be attending a 3-day palliative care course. There is currently one care assistant with NVQ 3, seven with NVQ 2 and three undertaking NVQ 2 currently. The home has two assessors, another member of staff doing the assessors course and the manager who is one of the current assessors is also an internal verifier for NVQ. In addition to POVA training, the manager and administrator have attended a customer care awareness day; some other staff have attended wound care training sessions and all mandatory training is up to date with fire training being most recent. Infection training was unfortunately cancelled and is to be rebooked and first aid training is booked for January with the possibility of abuse and challenging behaviour training also being arranged. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 18 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): 35,38 Service users financial interests are safeguarded. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: Procedures are in place to ensure that any financial transaction undertaken on behalf of a resident is recorded and receipts are kept and are available for residents/their representatives. It was reported that one of the providers does act as appointee for some residents, and this has been discussed in the past, but the records were not available to be seen on this occasion. Any personal money/valuables held by the home at the resident/ their representatives request is held securely. There were no health and safety hazards noted during the inspection. One of the providers is responsible for the health and safety of the building. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 19 Moving and handling risk assessments were in place as were risk assessments for the use of bed rails and bumper pads where these were used. A new portable hoist has been purchased recently. Copies of certificates in staff files confirmed that mandatory training to include fire, and moving and handling were up to date. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 20 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP19 OP26 Regulation 23 23 Requirement Ensure that all parts of the home are kept well maintained and reasonably decorated All parts of the home must be kept clean, with specific attention to the dining room and first floor landing (timescale of 15/7/05 not met). Timescale for action 10/01/06 10/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations All records must be signed and dated. Castleford House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 House Nursing Home DS0000016398.V260442.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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