Inspection on 15/06/05 for Castleford House Nursing Home

This inspection was carried out on 15th June 2005.

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

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

Other inspections for this house

Castleford House Nursing Home 24/05/06

Castleford House Nursing Home 10/11/05

Castleford House Nursing Home 18/01/05

Castleford House Nursing Home 13/07/04

Castleford House Nursing Home 19/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Castleford House Nursing Home Castleford Hill Tutshill Nr Chepstow Glos, NP6 7LE Lead Inspector Janet Griffiths Uannounced 15 June 2005 10:00 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 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 Version 1.30 D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Page 3 SERVICE INFORMATION Name of service Castleford House Nursing Address Castleford Hill Tutshill Nr Chepstow Glos, NP6 7LE 01291 629929 Telephone number Fax number Email 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 Parsons Care Home with Nursing 57 Category(ies) of Old Age not falling within any other category registration, with number (57) of places Physical Disability (57) Castleford House Nursing Home Version 1.30 D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18 January 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 one stair lift 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 Version 1.30 D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six and a half hours during one day in June 2005. The manager was present during the inspection. Opportunity was taken to tour the premises, examine records and policies and talk to staff and residents. The inspector was also given the opportunity to sample the lunch being provided for the residents. A pharmacy inspection has also been carried out recently and although several requirements and recommendations were made, generally the pharmacy inspector was satisfied with the procedures the home had in place. There were concerns at the last inspection over recruitment procedures and following an immediate requirement being issued, it was reported that this had been improved on. There were still discrepancies found at this inspection and further action will now be considered. An immediate requirement was also issued at this inspection, as there has been only one assisted bath in working order for thirty-seven residents since March 2005. There have also been a number of incidents where the lift has failed and concerns have been raised by Social Services about their clients. This is also to be followed up with the registered provider. What the service does well: Good standards of nursing care are maintain as confirmed by the residents spoken with and as indicated in a recent survey of the local doctors’ practices. 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. The home employs a very motivated activities co-ordinator who ensures that a varied activities programme is available each week. There are regular visits from outside entertainers and one to one activities as well as group activities take place. Castleford House Nursing Home Version 1.30 D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Page 6 Residents and staff confirmed that meals are good and offer variety and choice. What has improved since the last inspection? 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 Version 1.30 D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc 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 Standards Statutory Requirements Identified During the Inspection Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 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 standard(s) 3 The admission process is well managed and residents are given clear information regarding the service and whether it can meet their needs before they move in. EVIDENCE: Each resident/their representative has been given a service users guide. There have been a number of new admissions since the last inspection. Most of these were seen and spoken with and all confirmed that they had settled at the home and that their needs were being met. Several said what a lovely home it was. One, currently occupying a double room said that his wife would be able to come and stay in the other bed if she wished. One also commented that the only time when response from staff was not always so prompt was during the night, but they did appreciate that there were lots of people to attend. One did appear quiet distressed during the day and the manager is considering whether the needs of this resident can be fully met. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 9 Although everyone is admitted on a trial basis, the manager did report that is it often difficult to get regular reviews from social services after someone has been admitted. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 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 standard(s) 7,8,9 Systems are in place in the home for the review of care plans and health care to ensure that the needs of the residents are met safely. The medication procedures at this home are well managed promoting good health. EVIDENCE: Records of six residents were checked on this occasion. All were found to have an assessment completed, based on the activities of daily living but there was no space on the form to sign and date these and where later entries have been made, these should also be signed and dated, as should any record kept. A variety of core care plans and individual care plans are in place and reflected the current needs of the residents and showed evidence of regular reviews, completed with the resident or their representative where possible. Night care plans, moving and handling, nutritional and pressure sore risk assessments are completed. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 11 Daily records are also kept, as are records of doctors and other health related visitors. These records confirmed liaison and referral to other agencies where appropriate. The home has a wide range of pressure relieving equipment and anyone identified at risk is given a pressure relieving mattress and cushion appropriate for their needs. A record is kept in a diary of any wounds that require attention. It was reported that there had been one or two residents who had pressure sores, mainly following admission from hospital but that these were resolved or almost healed. There was however no evidence of wound care charts/mapping or measuring as means of monitoring the wound healing process. It was also advised that where someone is nursed in bed and at risk of pressure sores, a care plan for their management should be written. The manager carries out regular audits of the medication systems and these generally maintain the standards. The records were checked and are well maintained although there were still one or two sticky labels in use and not all handwritten entries have two signatures. A new CD cupboard and British National Formulary are on order. Fridge temperatures are recorded; a sign warning of oxygen storage is in place and stock is well controlled although staff are still forgetting to date liquid medicines on opening them. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 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 standard(s) 12,13,14 Residents enjoy a fairly stimulating and varied life at the home with visitors encouraged, various informal activities made available and good meals. EVIDENCE: An activities co-ordinator is employed for between 12 and 20 hours a week to provide a weekly varied programme of activities for whoever wishes to participate. A programme was on display in the home and is sent out to relatives within the newsletter. A music and movement session was being held before lunch on the morning of inspection and was being enjoyed by all who participated. June activities include a choir, clothing sale, cards and games, bingo, Chepstow Churches together and a song and dance duo called ‘Tickled Pink Productions’. An acrobatics display was recently held in the grounds, given by children and much enjoyed by the residents. Visitors are welcomed and encouraged to join in with activities. The home has spacious grounds and when the weather is fine some go out for walks around the garden. One resident said how much she used to enjoy gardening and still gets pleasure from her walks. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 13 Residents confirmed that they are able to choose how and where they spend their days. A few remain in their rooms, one chose to remain in the dining room for much of the morning and despite two spacious lounges, a large proportion choose to sit in the large reception area where they can watch all the comings and goings throughout the day. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 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 standard(s) 16 & 18 Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: The home has a complaints procedure in place that is accessible to all the residents and their families within the service users guide. It was reported that there have been no complaints since the last inspection. The manager ensures that CSCI are kept informed of any incidents that occur in the home. The manager and administrator are to attend training on protection of vulnerable adults in September and will then cascade this information down to the staff. Policies are in place on whistle blowing and protection of vulnerable adults. The manager and administrator are scheduled to attend training on POVA in September but currently they do not appear to realise the serious implications of appointing staff without necessary Criminal Records checks in place. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 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 standard(s) 19,21 & 26 There has been little change to the décor or furnishings since the last inspection and although the standard of décor and furnishings in most areas are satisfactory, the standard in other areas does not create a pleasing and pleasant environment to live in. Inadequate bathing facilities are not conducive to meeting the needs of residents or offering them choice. Despite the high standards of the domestic staff there are several areas of the home that are difficult to keep clean. EVIDENCE: There is no full-time maintenance support in the home at present because of sickness. Some care staff have been approached to carry out some decorating duties as overtime. Paint cans were noted left in two unoccupied rooms. This could be considered a fire risk. Paint cans should not be stored in the home. Most of the residents’ rooms were in good decorative order although wear and tear to the lower part of doors and door frames was evident on the first floor. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 16 Since April lift engineers have been called to the home 10 times for lift failures which have inconvenienced staff and residents. CSCI have also been informed of concerns from Social services about their clients having to remain either in their rooms or downstairs overnight on these occasions. A letter was sent from the provider to the engineer on 16th May regarding this problem and the CSCI require confirmation form the provider that this problem has now been resolved. It was also reported that one of the two assisted baths in the home has been out of action since March owing to faults with the raising and lowering mechanism. An immediate requirement was issued to have this bath repaired immediately as one bath is insufficient for 37 residents. The cleaners in the home do their best to maintain high standards of cleanliness throughout the home. On the whole they achieve this. However, there is a badly stained carpet in the dining room that can no longer be cleaned to a satisfactory standard. Contract cleaners clean it every 6 weeks, when residents are in bed, but it is filthy at the moment and most unpleasant to look at when eating in the dining room. This matter has been raised on a number of occasions and as the carpet is not worn the providers are unwilling to replace it. A second, cream coloured carpet on the first floor landing is permanently stained, despite cleaning, from continual traffic. It is also raised in one area and should be secured to avoid risk of accidents. Both of these should be replaced. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staff at the home are well trained and supported and employed in sufficient numbers to usually meet the residents needs. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. EVIDENCE: The numbers of staff on-duty during the inspection were sufficient to met the needs of the residents, although on night duty, because of high dependency levels and the size of the home, staff may not always be able to respond to residents calls as promptly as they should (see standard 3). The home now has 3 NVQ assessors and 39 of the care staff have an NVQ 2 qualification. Residents spoken with said that the staff were kind and caring. Staff spoken with, were fully aware of the needs of individual residents and how to meet them. Files of all the staff who commenced employment since the last inspection were seen. It was found that not all the necessary recruitment checks had been undertaken to ensure protection of residents. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 18 Criminal records bureau and POVA checks had not been obtained for three of the four checked, one had a reference from the manager in the home and another from a member of staff, one had no references and two had no application forms with career histories. This is the second inspection where recruitment procedures have been found to be poor. Staff training records are in place and in addition to NVQ training, most staff have undertaken some training this year to include first-aid, fire training, moving and handling, complementary therapies, and qualified nurses have also attended wound care, syringe driver and stoma care sessions. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The manager has a good understanding of the areas in which the home needs to improve to ensure that service users receive a consistent quality of care. EVIDENCE: The views of residents, their relatives and outside agencies are taken into account in a continual quality assurance programme. A monthly newsletter is produced keeping relatives informed and residents spoken with were fully informed of events within the home. As a result of past surveys new procedures have been put into place resulting in better communications between staff and relatives. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 2 x 1 x x x x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x x x x Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 18 Regulation 13 Timescale for action The registered person shall make 15/7/05 suitable arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse Ensure that passenger lifts are in 15/7/05 good working order to enable service users access to all floors of the home;and provide written confirmation to the CSCI that the lift is fit for purpose. Ensure that there are adequate 30/6/05 bathing facilities provided in the home. All parts of the home must be 15/7/05 kept clean, with specific attention to the dining room and first floor landing. 15/7/05 The homesrecruitment policy/procedures to be amended and updated to reflect current legislative changes with respect to employment practice. Since the introduction of the POVA scheme, the amendments to the Care Home Regulations on 27/7/04 for employment checks on staff, the home must obtain the following for future recruited Version 1.30 Page 22 Requirement 2. 19 23 3. 4. 21 26 23 23 5. 29 19 Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc staff: details of criminal offences a) of which the person has been convicted, including any details which have been spent; b) in respect of which he/she has been cautioned by a constable. Criminal Records Bureau disclosure (includng a POVA check where applicable); Two written references, including a reference relating to the persons last period of employment , which involved work with vulnerable adults; Written verification of the reason why the person ceased to work in their last positon ( if it involved contact with vulnerbale adults or children); Documentary evidence of any relevent training and qualifications; Full employment history with satisfactory written explanation for any gaps in employement; Evidence of physical and mental fitness for the purposes of work; Details and evidence of registration with, or membership of, any professioanl body. 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 7 8 9 Good Practice Recommendations All records must be signed and dated. Wound charts/maps and measurements to be used for wound care monitoring. All liquid medicines to be dated on opening; any hand written transcriptions to be signed by two staff; stick-on labels not to be used on MAR charts. Castleford House Nursing Home D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 D51_D03_S16398_Castleford_V231590_150605_Stage4_U.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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