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Inspection on 28/01/10 for Castlegate House

Also see our care home review for Castlegate House for more information

This inspection was carried out on 28th January 2010.

CQC found this care home to be providing an Poor service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

On entry to the home we immediately saw that a lot of improvements had been made to the environment and saw that the people who live there looked brighter, happier and well cared for. Two of the residents greeted us and were smiling and told us that they are happy to be there. They were nicely dressed, their hair had been washed and styled and we observed staff having conversations with them as they walked around the home. We spoke with eleven residents who were all happy with the service they receive. Comments included "I like it here", "they look after us well", "I have had a good breakfast", "the staff are very nice", "I am quite satisfied", "they let me do what I like which suits me", "the staff have time to talk to us" and "it is good enough for me". We spoke with three staff who told us "we get much more support than 6 months ago. I didn`t want to come to work in last few months but I really like coming in now as it`s so nice working here. The manager is brilliant, supportive and we get a lot more direction." Another member of staff told us "the home has changed a great deal since the new manager arrived, we have had a lot of training and she has been very supportive. We now have more time to care and we have separate cleaning and laundry staff". Another person said "it is a much more pleasant place to work and I now look forward to coming to work and can see how the improvements have improved the lives of the residents". We looked at a sample of care plans and saw that a completely new care planning system has been introduced. The care plans are reviewed each month and we saw evidence that people`s choices and preferences about their care is included in the plan. Each plan included a photograph, a brief life history, a needs assessment, body map, records of any GP or other professional visits, an assessment of daily living covering all aspects of daily living. The plan also includes the persons personal aims and action to be carried out to ensure that people`s need are met. We saw a falls risk assessment, infection control assessment, continence assessment, personal hygiene plan, information on a person`ssocial life, nutritional screening scheme, a moving and handling assessment, quality time activities and daily records. We also saw that a record summary was made for each person covering personal care morning and afternoon, what the person ate at breakfast, coffee, lunch, tea and supper, daily activities, bed time and night checks. We also saw that where issues had been identified by staff, they had reported these immediately and where appropriate had arranged visits from health care professionals. We saw that people were being treated in a dignified manner, staff spoke to residents in a kind and caring way that was appropriate to the individual. Residents looked clean and their hair and nails were nicely presented. The way in which the food and snacks was served was much more dignified than previously observed where people were being offered drinks in cups and saucers with side plates available to serve snacks. Most of the residents were siting in one of the two lounges where there were small tables on which were drinks, fruit, newspapers and books. The TV was on and during our visit we saw staff sitting with the people and talking to them. We saw some of the people having breakfast in the dining room and as they got up during the morning we saw staff bringing people to the lounge and asking what they wanted for breakfast and passing their requests on to the kitchen staff. The dining room tables had vases with fresh flowers and there was a bowl with fresh fruit. We asked the staff how they ensure that people are suitably stimulated, particularly those who have dementia? They said `It`s about giving people quality time, we can offer them one to one time now and do things such as walk into town, play various games, do nail manicures for people and just chat to people.` We saw that various activities were taking place as a board with photographs and a record of activities has been maintained. This included entertainment, crafts and card making, dominoes, games and time spent with people on a one to one basis. There is a new complaints procedure which is displayed on the wall on entry to the home. There is also a new procedure for logging and investigating complaints. One complaint had been received during the month of January however this had been fully resolved within one day and the action taken by the manager to resolve this had been fully recorded. Since our last visit to the service there has not been any new adult safeguarding Investigations. We interviewed three staff and they told us that they have received training on how to recognise and deal with suspicions and allegations of abuse and neglect. They told us that they feel much more knowledgeable on this and were fully aware of procedures to follow. We noticed that the corridors were free from clutter and hazards, some areas of the home had been redecorated and new pictures had been put up. The entrance looked more welcoming with new colours and the staff desk had been moved near the kitchen. We did not detected any unpleasant odours and the home looked clean throughout. We were shown a newly redecorated show bedroom which had been re carpeted, with a new profiling bed and new bedding. We were told that new bedding and curtains had been provided in all bedrooms. We saw that staff have received a lot of training since the last inspection this includes training on moving and handling, infection control, Mental Capacity Act, equality and diversity, health and safety, fire safety, food hygiene, adult safeguarding, confidentiality,death and dying, everything we do in a caring role, and professional working relationships. Senior staff had also received training on how to supervise staff and all staff confirmed that they now receive regular one to one and group supervision. Extra staff have been recruited including a new full time manager, two extra domestics, one whose role is to carry out laundry duties, and some extra night staff. We saw that all new staff had been thoroughly vetted before being accepted for employment. We looked at the policies and procedures and saw that a complete review had taken place and staff have access to these at all times. Spot checks were being carried out by external managers on a regular basis and a quality assurance survey has been sent out to all residents and their representatives h

What the care home could do better:

All of the previous requirements had been met and we did not make any new requirements. The managers that we spoke with during the visit told us that whilst there have been many improvements, they intend to make further improvements in the future to ensure that people receive a good quality and safe service.

Random inspection report Care homes for older people Name: Address: Castlegate House 49 Castlegate Grantham Lincs NG31 6SN zero star poor service 14/10/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alison Jessop Date: 2 8 0 1 2 0 1 0 Information about the care home Name of care home: Address: Castlegate House 49 Castlegate Grantham Lincs NG31 6SN 01476560800 01476565672 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Castlegate House Rest Home Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 20 Number of places (if applicable): Under 65 Over 65 0 20 dementia old age, not falling within any other category Conditions of registration: 20 0 The maximum number of service users who can be accommodated is 20 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not faling into any other category - code OP Dementia - Code DE Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 2 of 9 1 4 1 0 2 0 0 9 Brief description of the care home residents. The bedrooms are mainly situated on the ground and first floors although two bedrooms are located between floors and are accessed by several steps. Access to the upper floors is by way of a shaft lift. There are two lounges and a separate dining area. Further seating is provided in two hallway areas. There is car parking for four 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. Fees charged by the home for care range from: £351.00 - £435.00 per week. A copy of the service user guide and statement of purpose can be obtained from the manager or staff. Care Homes for Older People Page 3 of 9 What we found: This was an unannounced visit which formed a random inspection, focusing on issues that we picked up at the previous key inspection and information that we have since received, which have the potential to affect the health, safety and welfare of the people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission. The visit lasted approximately four hours by two regulatory inspectors and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of three people through their care records and assessing their care. We spoke to eleven people who use the service, and three members of staff. The new manager was not at the home on the day of the visit as she was attending a training course. The deputy manager was on duty and a senior manager from MPS Care also assisted with the inspection. Feedback was given about the good outcomes at the end of the visit. What the care home does well: On entry to the home we immediately saw that a lot of improvements had been made to the environment and saw that the people who live there looked brighter, happier and well cared for. Two of the residents greeted us and were smiling and told us that they are happy to be there. They were nicely dressed, their hair had been washed and styled and we observed staff having conversations with them as they walked around the home. We spoke with eleven residents who were all happy with the service they receive. Comments included I like it here, they look after us well, I have had a good breakfast, the staff are very nice, I am quite satisfied, they let me do what I like which suits me, the staff have time to talk to us and it is good enough for me. We spoke with three staff who told us we get much more support than 6 months ago. I didnt want to come to work in last few months but I really like coming in now as its so nice working here. The manager is brilliant, supportive and we get a lot more direction. Another member of staff told us the home has changed a great deal since the new manager arrived, we have had a lot of training and she has been very supportive. We now have more time to care and we have separate cleaning and laundry staff. Another person said it is a much more pleasant place to work and I now look forward to coming to work and can see how the improvements have improved the lives of the residents. We looked at a sample of care plans and saw that a completely new care planning system has been introduced. The care plans are reviewed each month and we saw evidence that peoples choices and preferences about their care is included in the plan. Each plan included a photograph, a brief life history, a needs assessment, body map, records of any GP or other professional visits, an assessment of daily living covering all aspects of daily living. The plan also includes the persons personal aims and action to be carried out to ensure that peoples need are met. We saw a falls risk assessment, infection control assessment, continence assessment, personal hygiene plan, information on a persons Care Homes for Older People Page 4 of 9 social life, nutritional screening scheme, a moving and handling assessment, quality time activities and daily records. We also saw that a record summary was made for each person covering personal care morning and afternoon, what the person ate at breakfast, coffee, lunch, tea and supper, daily activities, bed time and night checks. We also saw that where issues had been identified by staff, they had reported these immediately and where appropriate had arranged visits from health care professionals. We saw that people were being treated in a dignified manner, staff spoke to residents in a kind and caring way that was appropriate to the individual. Residents looked clean and their hair and nails were nicely presented. The way in which the food and snacks was served was much more dignified than previously observed where people were being offered drinks in cups and saucers with side plates available to serve snacks. Most of the residents were siting in one of the two lounges where there were small tables on which were drinks, fruit, newspapers and books. The TV was on and during our visit we saw staff sitting with the people and talking to them. We saw some of the people having breakfast in the dining room and as they got up during the morning we saw staff bringing people to the lounge and asking what they wanted for breakfast and passing their requests on to the kitchen staff. The dining room tables had vases with fresh flowers and there was a bowl with fresh fruit. We asked the staff how they ensure that people are suitably stimulated, particularly those who have dementia? They said Its about giving people quality time, we can offer them one to one time now and do things such as walk into town, play various games, do nail manicures for people and just chat to people. We saw that various activities were taking place as a board with photographs and a record of activities has been maintained. This included entertainment, crafts and card making, dominoes, games and time spent with people on a one to one basis. There is a new complaints procedure which is displayed on the wall on entry to the home. There is also a new procedure for logging and investigating complaints. One complaint had been received during the month of January however this had been fully resolved within one day and the action taken by the manager to resolve this had been fully recorded. Since our last visit to the service there has not been any new adult safeguarding Investigations. We interviewed three staff and they told us that they have received training on how to recognise and deal with suspicions and allegations of abuse and neglect. They told us that they feel much more knowledgeable on this and were fully aware of procedures to follow. We noticed that the corridors were free from clutter and hazards, some areas of the home had been redecorated and new pictures had been put up. The entrance looked more welcoming with new colours and the staff desk had been moved near the kitchen. We did not detected any unpleasant odours and the home looked clean throughout. We were shown a newly redecorated show bedroom which had been re carpeted, with a new profiling bed and new bedding. We were told that new bedding and curtains had been provided in all bedrooms. We saw that staff have received a lot of training since the last inspection this includes training on moving and handling, infection control, Mental Capacity Act, equality and diversity, health and safety, fire safety, food hygiene, adult safeguarding, confidentiality, Care Homes for Older People Page 5 of 9 death and dying, everything we do in a caring role, and professional working relationships. Senior staff had also received training on how to supervise staff and all staff confirmed that they now receive regular one to one and group supervision. Extra staff have been recruited including a new full time manager, two extra domestics, one whose role is to carry out laundry duties, and some extra night staff. We saw that all new staff had been thoroughly vetted before being accepted for employment. We looked at the policies and procedures and saw that a complete review had taken place and staff have access to these at all times. Spot checks were being carried out by external managers on a regular basis and a quality assurance survey has been sent out to all residents and their representatives however none had yet been returned. We saw that monthly health and safety checks and meetings were taking place and risk assessments were in place and had been reviewed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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