Inspection on 01/06/06 for Castlegate House

This inspection was carried out on 1st June 2006.

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

Castlegate House 28/01/10

Castlegate House 13/10/09

Castlegate House 07/05/09

Castlegate House 21/05/07

Castlegate House 23/11/05

Castlegate House 28/06/05

Castlegate House 05/10/04

Castlegate House 14/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Castlegate House 49 Castlegate Grantham Lincs NG31 6SN Lead Inspector Mr David Bacon Key Unannounced Inspection 10:00 1st June 2006 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 Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Castlegate House Address 49 Castlegate Grantham Lincs NG31 6SN 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) 01476 560800 Castlegate House Rest Home Ltd Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:Old age, not falling within any other category (OP) Old age, having dementia (DE/E) The maximum number of service users to be accommodated is 20. 2. Date of last inspection 23rd November 2005 Brief Description of the Service: Castlegate House is an adapted partially listed building situated a short walking distance from the town of Grantham. The home provides personal care for up to 20 residents. There are 10 single and 5 double bedrooms, which are mainly situated on 2 floors although 2 bedrooms are located between floors accessed by several steps. Access to these floors is by way of a shaft lift. There are 2 lounges and a separate dining area. Further seating is provided in two hallway areas. There is car parking for 4 vehicles at the side of the home and a small fenced terraced area with seats and plants providing an outside area for residents to sit. The range of fees charged by the home is £335 - £448. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken using a review of all the information available to the inspector regarding the service history of Castlegate House, and through undertaking a visit to the home. The fieldwork visit took place over 7 hours. The main method of inspection used was called case tracking which involved tracking the care three residents receive, through the checking of their records, discussion with them and the care staff and observation of care practices and interactions. A tour of the premises was conducted with the acting manager. Documentation relating to the management of the home was also inspected. A pre-inspection questionnaire was received, together with two residents feedback forms. What the service does well: What has improved since the last inspection? There has been good progress in meeting the requirements from the last inspection. The acting manager now writes to confirm to new residents that the home can meet their needs. Hot water temperatures are now monitored on a regular basis, and a risk assessment for the prevention of legionella has been conducted, so that the environment is safer. A record of staff employed, and staffing rotas are maintained. Staff recruitment procedures have improved to ensure that residents are protected. Measures have been introduced to consult residents about the quality of care that they receive, and the owner carries out regular monitoring visits. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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 Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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): 1 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures for assessing residents prior to admission ensure that their needs can be met, but information provided about the home could be improved. EVIDENCE: The previous inspection identified that although a Statement of Purpose and Service user Guide have been produced, they had not been updated to reflect the homes current provision of care. The acting manager has updated the documents, but they do not include all the information required. During the inspection, an enquiry was received from a social worker at Grantham Hospital. The acting manager took basic referral information over the phone, and visited the prospective resident in the afternoon to complete a pre-admission assessment. The assessment covered a wide range of subjects, and the acting manager discussed the admission on her return with staff on duty, to brief them on the lady’s needs. The prospective resident and their Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 9 relatives will usually be invited to visit the home prior to admission, but due to the circumstances, it was not possible on this occasion. A letter is now sent to prospective residents confirming that following the assessment, the home can meet their needs. The acting manager explained that she will not accept emergency admissions without having conducted a pre-admission assessment. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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): 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. Care plans are of a good standard, but some do not fully reflect the needs of residents. There are good arrangements for meeting residents health care needs, but medication storage and administration should be improved to ensure that medication procedures are safe. EVIDENCE: Two of the residents records inspected were of a good standard, containing a range of assessments, with care plans reflecting identified needs. However, one care plan identified that the resident was assessed as being at a very high risk of developing pressure areas, but there was no reference in the care plan as to what action staff were taking to prevent this. There was evidence that care plans are agreed with the resident or their representatives, and they are reviewed on a monthly basis. Residents are registered with one of three local surgeries. A district nurse and GP visited during the course of the inspection, the GP having been called out Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 11 promptly following concerns about a resident. Chiropodists and Opticians visit periodically, and relatives will usually arrange dental services. Local community psychiatric services are also available. Residents said that staff are prompt to respond to any medical needs that they have, and each resident has a summary of their medical history and medication, which can accompany them, should they be admitted to hospital. Staff know the needs of the residents well, and communicate effectively with them, dealing with any problems sympathetically. A pre-dispensed medication administration system is used, and medication is administered by senior carers. The acting manager is responsible for training staff. Some medication administration records had not been signed, where medication had been initially refused, but had been subsequently administered. Medication requiring cold storage is stored in the kitchen refrigerator. One bottle of medication not requiring cold storage was also found in there. The Royal Pharmaceutical Society guidelines state “A separate, secure and dedicated refrigerator should be available in the home to be used exclusively for the storage of medication requiring cold storage”. Residents confirmed that staff are respectful of their privacy and dignity, and staff were observed to interact in a respectful manner with residents, and offer privacy when carrying out personal care. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some activities for residents to participate in, to ensure that they have a stimulating and enjoyable timetable, but this could be extended to be more varied. Standards of catering are good, and reflect individual choices. EVIDENCE: Residents interviewed confirmed that they make choices regarding their preferred routines and activities. A monthly planner for activities is displayed in one of the hallways. However, this provides little evidence of activities available. The acting manager explained that it was very difficult to engage most residents in activities, but that she had secured the services of a volunteer for 2–3 days per week, who would be starting shortly. Two resident interviewed said that they were able to occupy themselves, and would usually choose not to be involved in group activities. One stated that she enjoyed going into town, and said that the home was very convenient for the town centre. She also attends a club in town on a weekly basis, for “quizzes, activities and a natter”. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 13 A number of relatives visited during the course of the inspection, and one said that she was able to visit at any reasonable hour, and that staff are always welcoming and friendly. A relative said “I can’t fault the staff – there is always a lovely atmosphere”. Staff were able to give good examples of how they facilitate choice for residents who have dementia, and several examples of this were observed. Residents interviewed praised the standards of catering. One said, “The food is very good – all home cooking”, and another said, “The food is smashing – we always get a good dinner. I you ask for something different, they will get it for you”. The home usually employs two cooks, but there is a vacancy for one at the moment. The cook said that she discusses menus with residents, and demonstrated a good knowledge of individual likes, dislikes and dietary needs. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are satisfactory arrangements for dealing with complaints and adult abuse, to ensure that residents are protected. EVIDENCE: There have been no complaints since the last inspection. The complaints procedure is outlined in the Service User Guide, and is displayed in the reception hallway. Residents interviewed said that they would take any complaints to the acting manager, and would have confidence in her to resolve any issues. However, they said that they have not had cause to make a complaint. Staff demonstrated a good knowledge of adult protection procedures, and their responsibilities for reporting allegations. The acting manager was unable to locate the homes own adult protection policy, but a copy of the Lincolnshire Adult Protection Committee policy was on file. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and clean environment for residents to enjoy. EVIDENCE: The home is generally well maintained and decorated, with comfortable communal areas, and well personalised bedrooms. One resident said “I’m very happy here, and very satisfied with my bedroom”. An area of the upstairs hallway is suffering from water penetration, and the acting manager said that this was being attended to. A resident also complained that her call bell was broken. Hot water temperatures are now monitored on a regular basis, and a risk assessment for the prevention of legionella has been conducted. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 16 The home usually employs two cleaners, but only one is in post at the moment. She said that she was finding it “a bit of a struggle” to maintain standards on her own, but the home was very clean and pleasant smelling on the day of the inspection. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are adequate staff to meet the needs of residents, and they receive training to enable them to fulfil their roles, but induction records could be improved. EVIDENCE: There are currently two care vacancies. Whilst the home is maintaining adequate staffing levels, staff said that they are working very hard to cover shifts, but they could do with more staff. Residents said that there are generally enough staff to meet their needs, but a relative commented that with more people being admitted with dementia, staff appeared to be much more busy. A resident confirmed that her call bell is usually answered promptly, and that she valued staff popping into her room regularly for a chat. Relatives commented “The staff are excellent – they always make time for us, even when they are on a break”. Staff confirmed that they receive regular training, and are able to undertake training in National Vocational Qualifications (NVQ). Seven staff have completed NVQ’s, and others are undertaking the training. There is a training programme covering mandatory subjects and topics of special interest, such as dementia, but some annual updates are overdue. Although the home has an Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 18 induction checklist for new staff, this is not detailed enough to evidence that staff been instructed in key areas. The files of three newly recruited members of staff were inspected, and all contained the documentation necessary to protect residents, although some did not contain photographs as required. A member of staff confirmed that she had undertaken a formal recruitment and selection process. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 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 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): 31, 33, 35, 36, 37 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Measures have been introduced to monitor quality and satisfaction in the home. The acting manager would benefit from more supernumerary time to organise the home effectively. Some health and safety concerns were identified, which could potentially put residents at risk. EVIDENCE: The acting manager has been in post since November 2005, and is applying to become Registered Manager. The last inspection identified that residents were not adequately consulted. The acting manager confirmed that she had conducted a quality satisfaction survey in May, and a relatives and residents meeting had been held in April. The Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 20 Responsible Individual for the home visits regularly, and provides the Commission with reports from these visits. Relatives deal with residents finances, and send cash floats in for incidental expenses. Three balances were checked and found to be correct. Staff supervision has been introduced, but is not occurring regularly as yet, with some staff not having received supervision since January. Documentation in the home is not well organised. The acting manager was unable to locate several documents, and appears to have insufficient supernumerary time allocated to set up efficient systems. Some documentation is not stored in a way that maintains confidentiality, and meets data protection requirements. For example, residents records are stored unlocked in a filing cabinet in a communal area, and accident records are stored centrally, rather than in individual residents files. During a tour of the building, a number of health and safety hazards were identified, which put residents at risk: • Hazardous cleaning materials were found unlocked in the kitchen. The acting manager agreed to arrange for these to be stored securely. The kitchen itself is not lockable, and the door was left open when not occupied. The home has a cellar, but although the door to this is lockable, it was left unlocked throughout the day of the inspection. The mains electrical fuse-box is located in the dining room, and this cupboard should be locked. Two bedroom doors are fitted with mortise style locks in addition to the standard door lock, which cannot be opened from the inside without a key. These must be disabled. There was no current fixed electrical wiring certificate. The sheet recording emergency lighting checks was not up to date. The acting manager explained that these tests are conducted on a weekly basis with the fire alarm checks, so the records must be consolidated. The magnetic catch on the fire door to the dining room was broken, and the door was wedged open. • • • • • • Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 2 1 Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 22 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. Standard OP1 Regulation 4&5 Requirement The registered person must ensure that the Statement of Purpose includes all of the information detailed in Schedule 1 of the Care Home Regulations. (This requirement is outstanding from the inspection on 23/11/05, but some progress has been made). The registered person must ensure that care plans fully reflect service users identified needs. The registered person must ensure that medication is stored appropriately and that administration sheets are fully completed. The registered person must ensure that staff receive an induction which documents topics covered. (This requirement is outstanding from the inspection on 23/11/05, but DS0000002342.V294466.R01.S.doc Timescale for action 30/09/06 2. OP7 15 30/09/06 3. OP9 13(2) 30/06/06 4. OP30 12(1)(a) 31/07/06 Castlegate House Version 5.1 Page 23 some progress has been made). 5. OP37 12(4) The registered person must 30/07/06 ensure that service users records are stored in a way that maintains confidentiality, and meets data protection requirements. The registered person must 30/06/06 ensure that the health and safety issues are attended to. 6. OP38 13(4) 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. Refer to Standard OP30 OP36 Good Practice Recommendations It is recommended that staff receive annual training updates in mandatory subjects. It is recommended that staff receive formal supervision 6 times a year. Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Castlegate House DS0000002342.V294466.R01.S.doc Version 5.1 Page 25 - 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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