Inspection on 23/11/05 for Castlegate House

This inspection was carried out on 23rd November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Castlegate House 28/01/10

Castlegate House 13/10/09

Castlegate House 07/05/09

Castlegate House 21/05/07

Castlegate House 01/06/06

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 Unannounced Inspection 23rd November 2005 08:00 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 Castlegate House DS0000002342.V267296.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. Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 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.V267296.R01.S.doc Version 5.0 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 28th June 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 outiside area for residents to sit. Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and it took place over 4½ hours. The inspector spoke with five service users, two service users representatives, two District Nurses, four staff members as well as the homes acting manager who has recently taken up this role. The main method of inspection was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them or their representatives and the homes care staff. Also, a tour of the premises was conducted and staff records were inspected. What the service does well: What has improved since the last inspection? What they could do better: Several of the homes administrative systems are not being adequately maintained overall. This is partially due to the new manager not receiving a comprehensive induction and therefore being unaware of some of the homes procedures. It is acknowledged that the acting manager and proprietor are working hard to address this. Staff recruitment procedures are not fully adequate and service users are placed at risk as a result of this. Staff are not formally supervised or inducted properly when commencing work at the home and any areas of poor staff practice must be properly addressed. The Community Nurses with whom the inspector spoke expressed concerns regarding communication systems within the home and some care practices. A risk assessment is required for all areas of the home including the regulation of water systems and fire tests and drills must be maintained as per fire safety Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 6 regulations. Health and safety procedures are not being fully followed by staff and service users are being placed at risk as a result of this. The Registered provider must visit the home each month to assess the service provided and compile a report following this. Service users were satisfied overall that staff promoted their dignity and that they are treated with respect although they are not fully supported to express their views regarding life within the home and standards of care. 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.V267296.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 Castlegate House DS0000002342.V267296.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): 1, 2, 3, 4, 6 Procedures and administrative systems are in place for the introduction of residents to the home, which are followed overall although some alterations are needed. Information is made available to prospective service users to enable each individual to make informed choices about admission to the home although minor alterations are required regarding this. EVIDENCE: A statement of purpose and service users guide have been produced although these have not recently been updated to reflect the homes current provision of care and the service users guide is not provided to service users. Two service users personal files were seen, which evidenced where preadmission assessments had been undertaken including identifying any risks. Care records documented where service users or their representatives had been consulted with regarding their plan. Terms and conditions of residence contracts were maintained on each of the service users files inspected. Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 9 There was no written confirmation given to service users stating that the home was able to meet their care needs although the home were not aware of the need to do this. The home does not provide intermediate care services. Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 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, 10, Care records provide staff with sufficient information overall to meet service users care needs and service users feel that they are treated with respect although communication systems must be improved to ensure that service users health care needs are consistently met. EVIDENCE: The service users and representatives spoken with confirmed that staff respected their privacy and dignity. Comments included: “The staff here are good, I have no complaints about them”. “They look after us all very well and they treat you respectfully”. “They are a good lot, they treat you how you would want and there are no restrictions or rules that I’m aware of”. “The care here has been okay, there have been occasions when we’ve not been quite so satisfied and we’ve told them but overall its good”. The health professionals spoken with expressed concern regarding the homes communication systems, staff care awareness and hygiene practice. For example, nurses said that any given instruction or advice was not always followed, that some care staff were unaware of basic hand hygiene procedures and that staff awareness regarding pressure area prevention was poor overall. The manager disagreed with the majority of comments made but confirmed Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 11 that they had requested awareness training regarding tissue viability and was keen to address the concerns. Service users care records gave an indication as to service users health care needs but information was basic overall. Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 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): These outcomes were not inspected during this visit. EVIDENCE: Castlegate House DS0000002342.V267296.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): 16, 18 The service users spoken with feel able to express their views regarding the care they receive and complaint guidelines are in place. Staff are made aware of the homes whistle blowing and abuse policies and procedures. EVIDENCE: Complaint policies and procedures are in place and information regarding these is provided to service users and displayed in the home. The majority of staff have attended abuse awareness training and policies and procedures regarding these subject matters are in place. The service users and the representatives spoken with said that they felt able to voice any opinions regarding the home and that any comments would be acted upon. Comments included: “I don’t want to complain but I would just tell one of the girls or the manager”. “There have been a few changes recently that concerned me but overall the care has been satisfactory”. “I’m sure that I would speak with any of them and it would be dealt with”. Castlegate House DS0000002342.V267296.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, 20, 24, 25 The standard of the physical environment within the home continues to improve and is seen by service users as comfortable and homely. The management of some health and safety procedures within the home puts service users at risk. EVIDENCE: The service users and representatives spoken with were satisfied with the physical environment. Comments included: “It seems nice enough, it’s clean and tidy”. “I’m satisfied here, it’s comfortable enough and clean”. Service users can gain access to all areas of the home. The home was clean and tidy and several areas have been recently refurbished. For example, four bedrooms, the main lounge and hallway and office. Service users personal accommodation was viewed, which was cleanly decorated and demonstrated where service users had personalised their room. Furniture is of a domestic style and is in good order. Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 15 Action has been taken to minimise risks to service users who may be prone to wandering. This includes the fitting of keypads to external doorways and individual risk assessments are undertaken for each service user. Water temperatures and systems are not currently monitored although the temperature of radiators is restricted. The acting manager confirmed that the requirements placed upon the home following the most recent inspection visit from the environmental health officer’s inspection have not yet been fully met and fire safety tests were not undertaken as per fire safety regulations. Castlegate House DS0000002342.V267296.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 Recruitment procedures are in place although these are not fully followed, which places service users at risk and records do not demonstrate the staff on duty or that staff receive an adequate induction when commencing work at the home. EVIDENCE: Eight staff members have attained National Vocational Training to level 2 and two staff have been identified to undertake this training. Two staff have attained this training to level 3 and the acting manager has attained the assessors award. A copy of rota was not available during the time of the inspection although this must be available at all times. There were no staff records for one staff member working within the home. There was no evidence that criminal or employment checks had been undertaken, that the individual had been interviewed, inducted or received supervision. It is acknowledged that this issue partially occurred prior to the acting manager commencing work at the home. Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 36, 38 The home is well maintained overall although health and safety procedures are not fully followed. Service users are satisfied with standards of care overall but not fully consulted with regarding life within the home. Staff are satisfied with the management of the home but they are not sufficiently supervised. EVIDENCE: The service users and representatives were satisfied overall with standards of care and how service users were treated although concerns were expressed about the homes communication systems and service users and their representatives did not feel that they were fully supported to express their views regarding the home. Comments included: “I can’t say that we are Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 18 included in having a say in how the home runs”. “No, we don’t meet to discuss the home but the staff are generally very good”. Quality satisfaction questionnaires have been devised although these have not recently been sent to service users or their representatives and service users’ meetings have not recently been held. During the visit cleaning staff confirmed that some cleaning products were stored inappropriately and therefore placing service users at risk. The manager said that some action has been taken regarding this although no formal supervision records are maintained. The staff members spoken with were satisfied with the overall management of the home although they do not receive adequate supervision. The registered provider has not yet forwarded monthly written reports on the conduct of the home since purchasing the home. Records are maintained where equipment in the home is serviced. Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Stand Score ard No 1 2 2 3 3 3 4 2 5 X 6 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 3 11 N/a DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X 3 2 X STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X X 2 X 2 Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 4(1)(2) 5(1)(2) Requirement It is required that the statement of purpose is to include all of the items detailed within standard 1 and schedule 1 of the care home regulations and that this is made available to current and prospective service users along with a service users guide. The regisered person must confirm in writing to the service user that the home can meet the care needs. Service users health care needs must be met. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Therefore, hot water temperatures must be monitored. Confirmation is required detailing what action is being taken to minimise risks of legionellosis. Confirmation is required that any requirements placed upon the home by the environmental health officer must be met. The registered person shall DS0000002342.V267296.R01.S.doc Timescale for action 31/01/06 2 OP4 14 (1)(d) 31/01/06 3 4 OP8 OP25 13 (1)(b) 16(2)j 23(2)p 31/12/05 31/12/05 4 OP25 23(5) 31/12/05 Page 21 Castlegate House Version 5.0 13(3)(4)a 5 OP27 Sch 4 (6)(7) 6 OP29 19 & Sch 2 7 OP30 12(1)(a) 8 OP32 18(1)(a) 12(1)(a) 9 OP33 12(2)(3) 24 26 10 OP36 18 (2) ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Therefore, hot water temperatures must be monitored. Confirmation is required detailing what action is being taken to minimise risks of legionellosis. Confirmation is required that any requirements placed upon the home by the environmental health officer must be met. A record of all persons employed at the home must be maintained. A copy of the home staffing rota must be maintained in the home and available for inspection. Staff recruitment procedures must be followed to ensure that a POVA, CRB and reference checks are undertaken for all staff prior to them commencing work within the home. Staff must receive an induction and ongoing training to give them the skills to promote and make proper provision for the health and welfare of service users. Communication systems must be improved to ensure staff are fully aware of service users care needs and that any health care instruction is followed. Therefore, it is required that service users meetings are offered and quality satisfaction questionnaires are provided. Also, the registered provider must undertake regulation 26 visits each month and compile a report on the service provided by the home. The registered person shall ensure that at all times suitably qualified competent and DS0000002342.V267296.R01.S.doc 01/12/05 24/11/05 31/12/05 31/12/05 31/12/05 31/01/06 Castlegate House Version 5.0 Page 22 11 OP38 23(4)a,c 13(4)a experienced persons are working at the home. Therefore, all staff must receive supervision and records regarding this must be maintained. The Health and safety of service users must be maintained at all times. Therefore, all fire systems must be tested as per the instructions of the Fire Safety Officer. Also, all substances hazardous to heath must be appropriately stored. 23/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Castlegate House DS0000002342.V267296.R01.S.doc Version 5.0 Page 23 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.V267296.R01.S.doc Version 5.0 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!