CARE HOMES FOR OLDER PEOPLE
Castlefort Grange 39 Castlefort Road Walsall Wood Walsall. WS9 9JL
Lead Inspector Maggie Bennett Unannounced 8 June 2005 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. Castlefort Grange Version 1.10 Page 3 SERVICE INFORMATION
Name of service Castlefort Grange Address 39 Castlefort Road Walsall Wood Walsall West Midlands. WS9 9JL 01543 371754 01543 374114 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) Castlefort Grange Care Ltd. Mrs Jean Riggs Care Home 23 Category(ies) of DE Dementia (5), OP Old Age (23) registration, with number of places Castlefort Grange Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Requirements as set out in the letter to Castlefort Grange Ltd. of 27th November 2003. Date of last inspection 16th November 2004 Brief Description of the Service: Castlefort Grange is registered to care fo 23 older people, 5 of whom may have been diagnosed with dementia. The home is situated in the Walsall Wood area of Walsall and is within easy reach of Brownhills and Walsall. There are shops nearby, but not within walking distance for the majority of residents. The building has undergone major building work to increase its size and provide new rooms. Several of the existing bedrooms have been extended to provide an en suite toilet, the lounge has been extended and a conservatory added. In total there are 17 single rooms and 3 double rooms. There is a separate dining room. The home has a large garden, which is currently being worked on and should be completed in the near future. Castlefort Grange Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on a weekday day, between the hours of 08.50 a.m. and 6.30 p.m. During the visit 9 residents were spoken to. 2 members of staff were interviewed and discussion took place with the registered manager, deputy manager and registered individual. A number of residents’ care plans were seen and the medication administration was inspected. 3 staff files were seen and other documentation was inspected. A tour of the building took place and a random selection of bedrooms were seen. What the service does well: What has improved since the last inspection?
The medication storage is much improved since the last inspection, making the administration and recording safer for both staff and residents. The garden is improving and although not yet safely accessible for unaccompanied residents, is really taking shape and should be completed in the near future. A pleasant
Castlefort Grange Version 1.10 Page 6 conservatory has been added to the dining room. Residents are now able to eat together in the dining area. The ground floor shower is also completed and this has been of benefit to a number of residents. The employment of additional cleaning staff has made a difference to the general cleanliness of the home. The deployment of 3 staff until 10.00 p.m. is of benefit, particularly as a number of residents like to sit up late. Recruitment procedures have been tightened up, resulting in more robust protection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Castlefort Grange Version 1.10 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 Castlefort Grange Version 1.10 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 and 4 Although there has been progress in obtaining full assessments, the home’s practice still needs to improve in this area. Without good admission procedures there is no assurance that care needs will be met. Further training in dementia care is needed to ensure that all care staff can meet the needs of their residents with dementia. EVIDENCE: The files of recently admitted residents were seen. In the majority of cases there was evidence that a full assessment had been carried out and information received prior to admission. In some cases the home’s own admission form had not been completed in all areas. It was found that self funding residents were not receiving the benefit of a full assessment and this had led to a possible inappropriate admission. Inappropriate admissions may have serious consequences, not only for the resident concerned, but for the remainder of the residents in the home. Some residents commented on incidents that had recently occurred as a result of such an admission. Castlefort Grange Version 1.10 Page 9 From the files seen, it was noted that (as at the last inspection) assessment information did not include all those areas listed in Standard 3.3. Assessment information must form the basis of the resident’s plan of care. It was observed during the inspection that staff were patient and understanding with their residents with dementia. Some of the diary entries, however, demonstrated that some staff need further training in how to care for people with dementia. Staff spoken to said that they had not had any recent training in dementia care. The registered manager stated that she had found it very difficult to access appropriate training as very little seemed to be available locally. The home does not provide a service for intermediate care. Castlefort Grange Version 1.10 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, and 9 There is a good system in place for care planning. The fact that this system is not being fully utilised means that residents’ needs may not be met in some areas. The storage of medication is much improved, resulting in a safer system. Discrepancies noted, however, show that the home still has room for improvement in this area. EVIDENCE: There was evidence that all residents have a plan of care and that where possible this is drawn up with the involvement of the resident. Although there is a system in place, several important elements had not been completed in the files seen. Not all care plans seen contained a completed risk assessment and a falls risk assessment. It was not possible to find evidence that all residents received the benefit of a monthly review of their care plan. One resident had been admitted for respite, but was now on a long-term placement, but there was no record of a review meeting having taken place to confirm this placement. Daily recording was clear, but it was not possible to cross reference the issues identified in the daily records to the care plans. Care plans must be more specific about individual needs and must identify how issues are to be dealt with and the desired outcome for the resident.
Castlefort Grange Version 1.10 Page 11 Care plans contain details of visits from healthcare professionals and it is clear that the registered manager ensures access to healthcare services. There are no residents with pressure sores. There is evidence of regular input from the continence promotion nurse. The manager has referred some of the residents for community psychiatric nurse advice. Records are kept of residents’ dietary needs and they are regularly weighed. As with the care plans, healthcare needs must be clearly identified and a plan put in place for meeting that need. There was no evidence that such needs are regularly monitored and reviewed. Daily records indicated that one resident was very agitated and at risk of harm, but the care plan did not show how this risk was to be managed. A Medical Profile form was on the file, but it had not been completed and the only information contained on the form was: “No Allergies, Dementia”. There is a policy in place for the receipt, recording, storage, handling, administration and disposal of medicines. A monitored dosage system is in place. Some discrepancies were noted at the inspection where medication had been recorded as given and then crossed out with no explanation. There are no controlled drugs in use at the home. The medication storage has now been moved to the ground floor and is stored in a suitable locked cupboard. This is a great improvement on the system previously used at the home. It is recommended that the shelves are covered in a material that can be hygienically wiped. The majority of staff who administer medication have successfully completed the accredited medication training. Castlefort Grange Version 1.10 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 Entertainment and activities are offered at the home. Greater frequency of activities and more variety would be of benefit. EVIDENCE: Residents spoken to said that they were able to choose whether or not to join in the activities in the home. One resident said she would like to play bingo more often. Opinion was divided among the residents and staff as to whether there was sufficient entertainment provided. Some people said they would like more activities, whereas others felt that there was enough going on, but that not everyone wanted to join in. It is recommended that activities are discussed on a regular basis with the residents and that a greater variety of activities are offered. A singer was booked to visit the home the following evening and “Keep Fit” sessions are held every two weeks. A representative of the local Church visits each month. Various “in house” activities are arranged by the staff, including fish and chips nights. Trips out have been arranged in the past, but nothing had been arranged at the time of the inspection. Information on forthcoming activities is displayed in the home. Castlefort Grange Version 1.10 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 standard(s) 16 and 18 Complaints are handled appropriately, but written records must be kept to ensure proper procedures are followed. The current Adult Protection Procedure is not in line with local procedures or the Department of Health guidance and cannot ensure that people living in the home are protected from abuse. EVIDENCE: The home has a complaints procedure in place. In addition a “comments” book is in the reception area, which is available for people to voice concerns. These concerns are mostly about the physical environment and outstanding repairs. Concern has also been expressed about the possible inappropriate admission of a resident. The home had received one written complaint since the last inspection and had responded in a telephone call. A written record must be kept of all complaints made. This must include details of the investigation and any action taken. There is an Adult Protection Procedure in place at the home, but this is not in line with the Local Authority procedure or the Department of Health guidance, “No Secrets”. This was noted at the last inspection and no progress has been made. It is strongly recommended that staff take part in Adult Protection Training. Castlefort Grange Version 1.10 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 standard(s) 19, 20, 24, 25 and 26 Some improvements have been made to the environment and progress is continuing. This progress, however, is slow and there remain several serious matters outstanding, which put residents at risk and do not provide safe and comfortable surroundings in which to live. EVIDENCE: Castlefort Grange has been subject to major building works for several years. Progress is continuing, but several areas remain outstanding. A requirement made at the last inspection that a written programme of routine maintenance and renewal of the fabric of the building be forwarded to the Commission has not been met and remains outstanding. This must give a clear indication of how and when compliance with environmental standards will be achieved. Progress has been made to the garden, but it is still not safely accessible to unaccompanied residents.
Castlefort Grange Version 1.10 Page 15 A large number of combustible materials were found stored in an unlocked room, which contained the water tank and central heating controls. An immediate requirement was made that the materials be removed and the room provided with a lock. All the requirements of the Fire Officer must be met. There is no evidence that this has been achieved. Since the last inspection a conservatory has been added to the dining room, which now provides sufficient space for all the residents. Carpets in the lounge area require cleaning. Some armchairs need replacing. The first floor bathroom needs attention: the shower in this room should be removed as it is unsuitable for the residents and could be hazardous. Suitable storage must be found for the portable hoist currently stored in this room. The room needs to be re-decorated. The following individual rooms need attention: Room 9 – there is a leak from the toilet; Room 5 – there is no cover to the radiator, the heating in here needs checking as currently a portable heater is needed, chests of drawers need replacing as they are chipped and worn; Room 4 – rubble from the building work is piled outside the window of this room and is very unsightly for the resident, the radiator cover is broken and the window handle is broken; Room 17 – the window cannot be opened as the key is broken in the lock; Room 16 – requires a new easy chair. In several areas of the home radiator covers have still not been provided. Water temperatures at outlets accessible to residents were found to be dangerously high in some rooms (54 degrees). This was dealt with at the inspection. These temperatures must be checked on a weekly basis and recorded. On the day of the inspection the home was clean and free of any offensive odours. Extra cleaning staff have been employed and this is clearly of benefit. The home still needs to employ a person to carry out laundry duties. Staff spoken to at the inspection expressed concern about the lack of availability of cleaning materials and protective gloves. One resident said that she often ran out of toilet rolls in her en suite toilet. Several of the toilets did not contain liquid soap. A separate storage area must be found for mops and buckets, rather than in the laundry. The laundry remains very hot, despite the fact that it has recently been fitted with an air-cooling system. Castlefort Grange Version 1.10 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 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. 29 and 30 Care staff are employed in sufficient numbers, but insufficient ancillary staff are employed. This means that there is a risk of residents’ needs not being met. Residents are protected by the home’s recruitment procedures, which have very much improved since the last inspection EVIDENCE: At the time of the inspection there were 3 care staff on duty, in addition to 2 cleaners and 1 cook. Rotas seen showed that at night (from 10.00 p.m. to 8.00 a.m.) there are two waking night staff. There has been some improvement in staff ratios, in that there are usually 3 care staff on duty up until 10.00 p.m. The numbers of staff deployed in the afternoons, however, are still insufficient, as there is no tea-time cook and a member of care staff has to prepare this meal, leaving only 2 care staff with the residents. When the cook goes on holiday, cooking is done either by the manager or deputy manager. This means that they are taken away from their managerial duties. There has been no progress in employing a laundry person. Residents spoken to were complimentary about the staff. Some ladies said they were not always happy that night staff were often male and that they would be unsure about requesting help with personal care from a male. One female resident, however, spoke of a male carer being very sensitive and discreet when he assisted her. Castlefort Grange Version 1.10 Page 17 The majority of care staff now have an NVQ qualification and two more have recently enrolled. Recruitment procedures have very much improved since the last inspection and there was evidence that all the required checks had been carried out prior to appointing new staff. Staff spoken to confirmed that they had received induction training. The home were, however, unable to provide written evidence of this for newly arrived staff as they had run out of induction packs. Castlefort Grange Version 1.10 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 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) 38 There are systems in place to promote the health, safety and welfare of residents and staff. Improved records and the provision of a Fire Risk Assessment and statement of the policy, organisation and arrangements for maintaining safe working practices will assist with protecting residents and staff. EVIDENCE: Evidence was seen of regular staff training in the core health and safety areas. Not all staff files seen, however, contained copies of certificates and these must be available. There was evidence that all fire checks are carried out at the required intervals, apart from the recording of regular Fire Drills. The manager stated that Fire Drills were carried out, but had not been recorded. A Fire Risk Assessment must be carried out and a copy forwarded to the Commission. Castlefort Grange Version 1.10 Page 19 Evidence was seen of regular maintenance checks and gas safety checks. The water system is annually checked for legionella. The manager must forward to the Commission a risk assessment for all safe working practice topics and a written statement of the policy, organisation and arrangements for maintaining safe working practices. Accidents and illnesses are correctly recorded and reported to the Commission. Castlefort Grange Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 x N/A 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 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 2 x x x 2 1 2 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x x x x x x 2 Castlefort Grange Version 1.10 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 3 Regulation 14(1)(a)( b) Requirement All residents must have the benefit of a full assessment prior to admission. Self funding residents must be assessed by staff from the home and all those areas detailed in Standard 3.3 must be covered. (Previous timescale of 16/11/04 not met). Care staff must receive regular, ongoing training in the needs of people with dementia. All care plans must include a risk assessment, with particular attention to prevention of falls. Care plans must be regularly reviewed and updated. (Previous timescale of 31/12/04 not met). Care plans must set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the residents are met. They must indicate how issues are to be dealt with and the desired outcome for the resident. There must be no discrepancies in the recording of the administration of medication. Records must be kept of all
Version 1.10 Timescale for action With immediate effect. 2. 3. 4. 4 7 7 18(1)(c)(i ) 13(4) 15(2)(b) 31/07/05 31/07/05 31/07/05 5. 7 15(1) 31/07/05 6. 7. 9 16 13(2) 17(2) With immediate effect. 330/06/05
Page 22 Castlefort Grange 8. 18 12(1)(a) 9. 19 23(2)(b) 10. 19 13(4)(a) 11. 19 23(4) 12. 13. 20 21 16(2)(c) 23(2)(d) 14. 15. 16. 22 24 25 23(2)(l) 16(2)(c) 13(4)(a) 17. 26 16(2)(j)(k ) complaints made and include details of the investigation and any action taken. The home must update its Adult Protection Procedure to ensure that it is in line with the Department of Health guidance No Secrets and the Local Authority Procedure. (Previous timescale of 31/01/05 not met). The home must forward to the Commission a written programme of routine maintenance and renewal of the fabric of the building. (Previous timescale of 31/12/04 not met). Combustible materials must not be stored in unlocked rooms containing water tanks and heating controls. The registered person must ensure that all the requirements of the Fire Officer are met. (Previous timescale of 31/01/05 not met). Carpets must be cleaned in the lounge area. Any torn armchairs must be replaced. The first floor bathroom must be redecorated and the floor covering replaced. The shower must be replaced with a suitable shower or removed. (Previous timescale of 28/02/05 not met). Suitable storage must be found for the portable hoist. (Previous timescale of 31/03/05 not met). All those areas listed as needing attention in individual rooms must be dealt with. Water temperatures at outlets accessible to residents must not exceed 43 degrees. These temperatures must be taken on a weekly basis and recorded. Sufficient cleaning materials and protective clothing must be provided. All toilets must be
Version 1.10 31/07/05 30/06/05 With immediate effect. 31/07/05 31/07/05 31/08/05 31/08/05 31/07/05 With immediate effect. With immediate effect.
Page 23 Castlefort Grange 18. 19. 25 27 13(4)(a) 18(1)(a) 20. 21. 22. 27 38 38 18(1)(a) 23(4) 23(4) 23. 38 12(1) provided with sufficient toilet rolls, liquid soap and paper towels. Mops and buckets must not be stored in the laundry. All radiators and pipework must be guarded. A cook must be employed during the afternoon shift to prepare the tea-time meal. An extra member of staff must be employed when the cook goes on holiday. This duty should not be undertaken by the manager or deputy manager. A person must be employed to carry out laundry duties. Fire Drills must take place at regular intervals and be recorded. The registered manager must carry out a Fire Risk Assessment (previous timescale of 31/01/05 not met). The registered manager must provide a written statement of the policy, organisation and arrangements for maintaining safe working practices (previous timescale of 31/01/05 not met). 31/07/05 31/07/05 31/07/05 With immediate effect. 31/07/05 31/07/05 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 9 12 18 Good Practice Recommendations It is recommended that the shelves in the medication cupboard are covered with a wipeable material. It is recommended that leisure activities are discussed with the residents on a regular basis and that a greater variety of activities are offered on a more frequent basis. It is strongly recommended that staff take part in Adult Protection Training. Castlefort Grange Version 1.10 Page 24 Commission for Social Care Inspection West Point Mucklow Office Park Mucklow Hill Halesowen. B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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