Inspection on 16/07/07 for Castlemount

This inspection was carried out on 16th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Castlemount 19/08/08

Castlemount 15/01/08

Castlemount 28/09/06

Castlemount 09/05/06

Castlemount 28/10/05

Castlemount 25/04/05

Castlemount 18/11/04

Castlemount 22/07/04

Castlemount 17/05/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Castlemount 54 Manygates Lane Sandal West Yorks WF2 7DG Lead Inspector Gillian Walsh Key Unannounced Inspection 16th July 2007 09:40 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 Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 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. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castlemount Address 54 Manygates Lane Sandal West Yorks WF2 7DG 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) 01924 251127 MANAGER ONLY CastleMountRes@aol.com Mr Abbass Bagheri Satari Mrs Julie Ann Satari Mrs Amanda Margaret Innes Watson Care Home 15 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (15), Old age, of places not falling within any other category (15) Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specific service user over the age of 65, named on variation dated 14th September 2006, may reside at the home. 28th September 2006 Date of last inspection Brief Description of the Service: Castle Mount Care Home is a four-storey grade 2 listed building situated in Sandal on the outskirts of Wakefield. A short distance walk from the home is a bus service running to Wakefield and Barnsley. The home provides care and accommodation for 15 people over the age of 65 years who may have past or present mental health problems. The building is set back in its own grounds, some car parking space is available at the front of the home. Wheelchair access to the home is not available at the moment. The home has nine single and three double bedrooms, ensuite facilities are not provided however communal toilets and bathing facilities are available on all floors, which are accessible, by chair lift. A large entrance hall leads to the two communal lounges and dining area. The provider makes information about the service available to enquirers via a leaflet about the home and the home’s service users guide. The fees charged at the time of the inspection in July 2007 were from £380 to £400; hairdressing chiropody and personal newspapers are charged in addition to the fees. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this full inspection, two inspectors from the Commission for Social Care inspection (CSCI) undertook an unannounced visit to the home. The visit started at 9.45am and finished at 6.30pm on 16 July 2007. The inspectors’ time was spent speaking with people who live at the home and staff, reviewing documentation and looking round the home. One inspector also spent a period of two hours sitting in the lounge with people who live at the home doing a short observation of the of how daily life is for people, particularly those who are unable, due to their condition, to manage their own social and recreational needs. Alongside this, the service provider was asked to supply information about the service, which was returned prior to the visit. Surveys to gain the views of those involved in the service were sent to people who live at the home, their relatives, visiting professionals and GPs. Of 12 surveys sent to people living at the home 3 were returned. Staff had assisted two people to complete these as the people were not able to do this independently and a relative had completed one for another person. Responses were positive although few specific comments were made. Of 12 surveys sent to relatives, 4 were returned. Again these were generally positive but two included comments about the home being short staffed, one about the poor access for wheelchair users and one person felt that people sit down for too long inside without being encouraged or assisted to use the garden. Another person commented on how the behavioral problems of one of the people in the home affect their relative and disturb their visits. No surveys had been received back from professionals at the time of writing the report. Information and evidence was not only obtained by visiting the home but also from notifications and information obtained by CSCI and information about the home supplied by the home manager. A random unannounced inspection visit was made to the home in May 2007 following concerns being raised during safeguarding meetings and another visit was made on 31 July following an anonymous complaint about care at the home. Matters relating to these visits are included within this report. The inspector would like to thank everybody involved for their time and assistance during these inspections. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home needs to make improvements in several areas to ensure that the care and safety needs of all the people living at the home are met. Improvements are needed in assessing people’s needs both before and after their admission to the home and in the care planning process. This is to ensure that staff have all the information they need to look after people and make sure that all their needs are met. Systems for dealing with medications are unsafe and urgent action needs to be taken in order to protect people. To prevent loneliness, boredom and social isolation, people need to be given opportunity for social and recreational stimulation; this must include people who are unable to initiate conversation or take part in organised activities. Staff at the home must work with healthcare professionals and the local authority to ensure that people living at the home are safeguarded from abuse. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 7 To protect people living at the home and staff, a safe system for moving and handling people must be established and maintained. Environmental changes are also needed to give people who use wheelchairs safe and easy access and exit to and from the home. Improvements are also needed to make sure that people’s safety is not compromised by poor fire safety systems and a lack of checking of hot water temperatures. Enough staff need to be available at all times to make sure that peoples needs are met. Staff, including the manager, also need to receive training relevant to their role to give them the knowledge they need to support the people living at the home. 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. The summary of this inspection report can be made available in other formats on request. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 8 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 Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Thorough assessments of individuals needs are not being completed prior to their admission to the home. This could result in staff not being able to meet their needs safely and appropriately. EVIDENCE: Pre admission assessments completed by staff from the home were seen within care plan files examined during the visit. These assessments concentrated on physical and social care needs but did not include any assessment of, or information about, people’s mental health needs. As the home is registered to care for people with mental health problems, and in light of recent safeguarding issues related to the home’s ability to meet peoples needs, it is important that this area of need is thoroughly assessed. This is to ensure that Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 10 staff are available in the home, with the appropriate skills to meet these needs prior to a person being accepted into the home. The home does not provide intermediate care. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care plans do not include details of how people’s needs should be met and individual healthcare needs are not always being met. This could result in people not receiving the care they need. People’s right to privacy is not always being maintained which could cause upset and embarrassment and poor systems relating to management of medication could put people at risk. EVIDENCE: Care plan files for five people who live at the home were examined during the visit. All of the files contained various assessments, such as nutrition and moving and handling, care plans and risk assessments. None of the assessments seen, other than some moving and handling assessments completed by an occupational therapist, gave clear detail to staff about the outcomes of the assessments. For example a nutritional assessment Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 12 for one person gave conflicting advice as to whether the person should be receiving a low fat diet. Also information about one person’s nutritional needs recorded elsewhere had not been included in their nutritional assessment. Moving and handling assessments completed by staff from the home gave little detail to staff of how to perform moving and handling safely. An example of this is that one assessment said that a hoist and sling were needed but did not detail which hoist or sling. Another person’s assessment stated that they needed a walking stick to aid safe mobility, but the person was observed, for long periods during the visit, not to have their walking stick. Care plans gave details of people’s needs and preferences but did not detail how staff should give support to meet these needs. Very little was included in care plans about people’s psychological or social needs but concentrated more on physical needs. This was discussed with the manager and the proprietor both of whom agreed that care plans are weak and that the home does intend to improve on them. This has been made a requirement of the last two inspections made at the home. Neither assessments nor care plans are being reviewed adequately to reflect individuals changing needs. Daily records are kept separately to care plans, which has resulted in staff not using the care plans as working documents. This was confirmed by staff spoken with who said that they did not know what was in the care plans but delivered care in the way they thought was best. Generally, documentation shows that people’s healthcare needs are referred to the appropriate healthcare professional such as the General practitioner, district nurse or community mental health services. Concern was expressed however that staff in the home do not always follow the advice of the healthcare professional correctly. One example of this was where a person had been prescribed eye drops to treat an eye infection but the drops had not always been administered according to the prescription. Similarly prescribed treatment to maintain healthy skin is not always being given. Little is available to evidence that people’s mental health needs are being met and recent safeguarding issues have shown that staff at the home do not always follow the advice of the community mental health nurses. Observations during the visit were that staff are in need of further training to understand and meet the needs of people with mental health problems. Two people spoken with during the visit said that staff were kind and gave them assistance, as they needed it. Some observations made during the visit were that staff did not always consider people’s privacy and dignity needs. On a few occasions staff were heard to address people using both their first name and surnames and on several occasions staff talked about people in front of Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 13 them. On one occasion a staff member walked through the dining room and lounge; holding out wet clothing belonging to a person they had just assisted in the toilet. Discussion took place with the manager and the proprietor about how people living in the home could feel uncomfortable and embarrassed by such situations. The manager said that she would address this with staff. Despite the above discussion about the need to be sensitive to people’s feelings, during the visit on 31 June the manager was asked about an allegation made to the Commission that on a couple of occasions when a person who lives at the home had been upset and said “just leave me to die”, the manager had replied “as long as you do it quietly”. The manager said this is something she would have said but intended it to be a joke. Procedures for the storage and administration of medication were looked at during the visit and found to be unsafe. At the beginning of the inspection, one person was observed sitting in a room alone with some of their medication still on the table in front of them. On checking the Medication Administration Record (MAR) sheet, it was found that the medication on the table; had been signed by staff as being taken and the evening dose of this medication had also been signed for as taken. The manager explained that the evening medication had been signed for in error the previous evening, but no record had been made to explain this error. Stocks of Paracetamol for six people were checked. Four balances could not be tallied, as staff had not documented how many tablets were available when the MAR sheet was started. Two balances were incorrect, for one the MAR indicated that 42 tablets should have been in stock but only 24 could be found, and for the other the MAR indicated that 81 tablets should be in stock but 172 tablets were in the trolley. The manager could not offer any explanation for these anomalies. Other problems were that medication prescribed for one person was not being given and medication was in the trolley for another person but it was not prescribed on their MAR sheet. Stock medications not kept in the trolley are stored on an open shelf in a room in the cellar. This room has a very damp and foisty atmosphere and is not suitable for storing medication. The manager was informed during the visit that this medication must be stored in a locked cupboard in a more suitable room. The proprietor said that this would be done later that day. All of these issues were discussed with the manager as people living at the home could be put at risk through such poor management of medications. An immediate requirement was left at the home requiring that attention be given to make sure the medication system was safe within 24 hours of the visit. However during the visit on the 31 July, it was noticed that the immediate requirement notice had not been complied with. A blister pack of Lorazepam Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 14 was on the manager’s desk in an unlocked office and a large number of medications were still being kept the room identified above. The manager was not able to explain why the required actions had not been taken and confirmed that she had not yet completed any audits of medication systems. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. For some of the people living at the home there is minimal social and recreational stimulation and their individual needs in this area are not being met which could result in social isolation. Not all people receive diet and fluids in a way, which meet their individual needs. EVIDENCE: During the visit one of the inspectors undertook a two-hour observation of how people who live at the home spend their time and what their interactions are with other people and their surroundings. Four people who, due to their conditions, have difficulty in initiating interactions or maintaining their own social and recreational needs were observed in particular. During the observation staff only interacted with two of the people when they gave them a drink for the remainder of the two hours neither of these people received any stimulation at all and both sat with their heads down throughout the observation. Both were seated at the side of the television, which was playing loudly, but neither were in a position to see the screen. The other two Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 16 people were spoken to occasionally, but for one person this was only in passing when the staff member said “are you alright” but had walked past before the person answered and did not hear them say “No, I want to get up”. The manager said that three of the people being observed very rarely spoke but two of the people were observed to speak twice but this was not acknowledged by staff. Through reading documentation, it was discovered that one of the people who did not speak at all, does not have English as their first language and when one of the inspectors spoke to them in their own language, the person looked up and smiled. A carer said they knew that English was not this person’s first language but there was no evidence that anything was being done about this in the persons care plan. Other people sitting in the lounge were watching television, reading magazines or conversing with staff. One member of staff was cutting people’s fingernails in the lounge area and was chatting with them as this was being done. The manager’s attention was brought to the fact that whilst one persons nails were being cut, the clippings were landing in the persons fruit bowl. Other than this, no meaningful activity took place during the morning. Some people joined in a game of bingo during the afternoon but again this was for people who were able to manage this activity. One person was heard to say on a few occasions during the visit that they wanted to go outside but this was never acknowledged by staff. Although some record is made in care plans of people’s social, recreational and lifestyle needs and preferences, there is little evidence in daily records that these needs are being met. One person spoken with said that they got bored but said they were not complaining as they thought that this was just the way things were in a care home. Very little is included in care plans of people’s religious needs. Relatives who completed surveys gave mixed views about the availability of activities in the home, one person felt they were good, another felt that they were limited for their relative due to their physical condition and another said they thought staff should try to take people out more as “sitting down all the time” is causing mobility problems for their relative. It is clear from speaking to people who live at the home, staff and surveys that relatives and friends are welcome to visit the home and are encouraged to be involved in their relatives care. Mid morning, everybody was provided with a hot drink. The drinks were brought from the kitchen already made. Staff said that there is a list in the kitchen of how people like their drinks although nobody was asked what drink they would like on that occasion. One person was given their mug but was observed not take a drink from it at all before another care assistant took the mug from them. The lunchtime meal was observed during the visit. A choice of Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 17 either gammon or shepherds pie with fresh vegetables was given to everybody. Two people were observed being fed their softened meal by a care assistant. One person was fed very quickly, using a large spoon, which was overfilled for each mouth full. When the care assistant had finished giving the person their meal they stood up and said loudly “one down” before moving on to assist another person. This person ate very slowly but throughout, the care assistant was pushing the spoon of food into their lips whilst the person was still chewing the previous mouthful. One person who was sitting in an easy chair in the dining room had been given their meal on a very low table to the side of their chair. The person was apparently unaware of their meal and became angry when a care assist kept calling to them to eat their meal. Other people who were able to manage to manage their meals independently were observed to enjoy the mealtime. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience Poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Processes for dealing with complaints are adequate but staff do not take sufficient actions to protect people living at the home from abuse. EVIDENCE: The manager said that no complaints had been received by the home since the last inspection and none were recorded in the complaints book. However information from the home was sent to the Commission after the last inspection that a person living at the home had complained about the way in which they were treated on one occasion. This situation was dealt with and information about this was forwarded to the Commission but nothing had been recorded in the complaints book. Relatives who responded in surveys said that they felt confident that they could speak to the manager about any concerns they may have. Since the last inspection there have been three referrals made under multiagency safeguarding procedures, two of which resulted in staff being dismissed by the provider. At the time of the visit, there were outstanding matters being dealt with through multi-agency safeguarding procedures. These matters concern the home accepting placement of a person whose needs the staff were not meeting and the effect this is having on the overall safety of all of the Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 19 people at the home. One relative commented in a survey that they felt that some behaviour people display at the home “is not fair on the other residents” and said that it was fortunate that their relative has limited sight and hearing so that they “miss a lot of what goes on”. However other people who live at the home have expressed their distress at witnessing assaults on staff and hearing verbal abuse targeted at staff and themselves Although inter-agency safeguarding meetings continue to be held, the home’s representatives at these meetings are failing to take the advice of professionals involved in the process, which could result in people’s safety needs not being met. After a requirement made at the random inspection in May 2007, all suspicion of, or actual abuse is now being reported appropriately although staff training records show that some staff are in need of updates in recognising and reporting abuse of vulnerable people. After the visit of 16 July and prior to the visit of the 31 July, the Commission had received information that a previous resident of the home had been locked in their bedroom when an incident, had occurred. The incident had involved the person pulling furniture over in their room and becoming stuck. Documentation relating to this incident was seen and confirmed that a staff member had locked the bedroom door with a key after taking the person to bed. The bedroom door was seen to be fitted, on the inside, with a twist mechanism, which would have unlocked the door, but it is not known whether or not the person would have been able to operate this. Documentation also showed that staff were delayed in getting into the room after the incident, because they could not find the correct key to the room from the large bunch of keys in their possession. Whilst the incident had been notified to the Commission, it had not been made clear in the notification that the door had been locked by a member of staff. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Some issues with the environment make it difficult for some people to safely receive the care they need. Lack of appropriate checks and equipment could put people at risk. EVIDENCE: During the visit, inspectors looked around the home to check the safety and hygiene standards of the environment. At the start of the visit, it was noticed that doors, including the kitchen door clearly marked as fire doors, were being propped open. The home’s environmental risk assessments say that this should not be happening other than the kitchen door being propped open when food is being served at Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 21 lunchtime. The manager said that lounge doors were propped open whilst a resident was in the room and closed when nobody is in there but confirmed that staff are not working to the risk assessment. Discussion took place with the manager about revisiting the risk assessments with staff and to confirm the safety of the risk assessments with the fire service. It was also suggested that the home should consider fitting self-closing devices to appropriate doors. The manager said that a consultant had visited the home to identify areas of risk but the manager completes all environmental risk assessments despite not having received any training in this. The fire risk assessment includes a weekly checklist, which includes the checking of smoke detectors. When the manager was asked how she would confirm that they are working she said that she would “assume” that they were, but they are checked six monthly by the servicing company. When asked how fire drills are done, the manager said that she would pretend that the alarms are sounding and ask individual staff what they would do. Fire drill records were seen but gave little clear information as tippex had been used to cover information from previous drills. Concern was expressed about aspects of fire safety, particularly in view of the home being set over four floors. Water temperatures were checked in several areas and in some were found to far exceed the recommended safe level of 43 degrees C and in one bathroom the water was not running warm enough for people to have a comfortable bath. Wash hand basins in three of the bedrooms checked did not have any water at all running from the hot tap. The manager was unable to give an explanation as to how people in these rooms would have had a wash that morning. A requirement was made that water supply and temperatures be corrected within 24 hours in order to protect people from scalding. Concerns were also expressed about the availability of equipment in the home for safe moving and handling. At the moment, the manager said that only one person is in need of using the hoist for all manoeuvres and they have their bedroom on the ground floor where the hoist is situated. However no safe access or exit is available to or from the home for people who are unable to manage steps. Staff confirmed that for those who need it, staff carry the person, in their wheelchair, up and down the five steps to the back door as no stair lift is fitted to these stairs. The manager and proprietor said that plans were in place to fit suitable adaptations to enable wheelchair access to the home. Staff also confirmed that hoists are not available on three floors, which has resulted in staff having to lift people when they have fallen. The hoist that is available in the home does not fit into the bathroom, which means that the person, who needs it, is unable to have a bath. The proprietor Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 22 said that this problem would be dealt with as part of the refurbishment programme. Not all bathroom and toilet doors can be locked from the inside and do not have indicators to show whether they are engaged. To protect the privacy and dignity of people living at the home, suitable locks and indicators are needed. The proprietor said she would address this. Due to a recent leak, parts of the ceiling in a corridor leading to a bathroom are missing and wallpaper is peeling off the walls. The manager said that the insurance company have been to see this and that it would be repaired as soon as possible. Surveys returned from relatives and people who live at the home indicated that the home is usually fresh and clean. Although generally clean and tidy on the day of the visit, there was an odour of urine in some areas. Bathrooms are carpeted and give off an unpleasant odour; also the bath hoist seat is in need of a deep clean. The proprietor said that bathroom carpets were to be removed as part of a refurbishment programme. No cleaner was working in the home on the day of the 16 July visit and therefore care staff were undertaking cleaning duties. It was of concern that a chair in the lounge was left wet with urine for some time despite this being pointed out by one of the inspectors. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care staffing levels and a lack of appropriate training has the potential to put people at risk. EVIDENCE: The manager said that staffing levels are kept under review in line with the needs of the people living at the home. Review and maintenance of appropriate staffing levels in the home has been a requirement of the last two inspections and also of the ongoing safeguarding procedures. Information from staff and observations during the visit were that staffing levels appear adequate to meet people’s needs during the morning of the 16 July visit but, in the afternoon, when care staff are also responsible for preparing and serving the evening meal, the availability of staff is reduced and some staff said they are not always able to respond as quickly as they would wish to peoples needs and wishes. Two relatives who responded in surveys said that the home is often short staffed; one person said this is particularly the case at weekends. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 24 Two people who live at the home said that the staff are lovely but are very busy. A staff-training matrix indicates that training is ongoing in areas such as first aid, moving and handling, dementia care and protection of vulnerable adults. The manager also informed the Commission that nine of the fourteen care staff hold the National Vocational Qualification (NVQ) level 2 in care and a number are currently studying for level 3. Although training is taking place, no record is available of the content of the training being given. This is particularly relevant to moving and handling and managing medications, where despite training being given, some poor practice was observed during the inspection visit. None of the staff have received training in mental health issues or in managing challenging behaviour. As the home is registered to take people with mental health problems and in light of recent safeguarding procedures, training in this area should be arranged to help staff understand and meet the needs of people. In addition, none of the current staff, including the manager, have received training in care planning, again this and any other training needed to meet peoples needs, should be arranged as soon as possible. A sample of staff recruitment files were checked on 16 July and confirmed that the home follows good recruitment procedures, which includes taking appropriate checks to safeguard people. However during the visit of 31 July it was seen that a person under sixteen years of age was in communal areas with people who live at the home but not accompanied at all times by another member of staff. The manager explained that this person was undertaking an apprenticeship arranged via a local company. The manager did not have any information about this person but said that the company arranging the placement had given verbal conformation that appropriate checks had been undertaken. No documentation of any interview with the manager, details of what duties could be undertaken by this person, any induction or information given to the person had been completed. Discussion took place with the manager about, particularly in view of current and past safeguarding issues at the home, the need for confirmation of appropriate checks for all people working in the home. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Management processes regarding health and safety of people at the home are not sufficient and could put people at risk. EVIDENCE: The home’s manager has been in post for almost two years. She is currently studying for the NVQ level 4 in care and has enrolled to start the registered managers award next year. Some confusion in relation to staff roles regarding the management of the home has been highlighted as a problem in recent safeguarding meetings. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 26 From speaking to staff it appears that this situation continues and should be sorted out without further delay. There has been some delay reported to the commission in relation to the referral of incidents through interagency safeguarding procedures. This has been discussed with the manager and she says that appropriate referrals are now being made. However, as mentioned in the safeguarding section of this report, incidents are highlighting that there are areas of management of the home that must be developed to ensure appropriate care. This includes ensuring robust assessments, and monitoring of these, are carried out to ensure that people are only accepted for placement that staff have the skills to meet their needs. It was noted that despite the issues relating to the running of the home, formal recorded supervision is not in place for all staff including the manager, to support them and plan future learning development. Some evidence is available that the opinions of people who live at the home and their relatives are sought as part of the home’s quality monitoring processes. This process is yet to be formalised with the production of a report and action plan in response to the results of the quality monitoring. Records seen show that one of the proprietors makes monthly visits to the home to check on quality matters and she maintains phone contact with the manager; however the review of current issues relating to the running of the home should consider how support to the manager and overseeing of the running of the home can be improved. Concerns, referred to throughout the report, relating to safe moving and handling, water temperatures, fire prevention, medication procedures and lack of appropriate equipment in the home, all have the potential to compromise the safety of people living and working at the home Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 27 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 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 1 Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1) Requirement Assessment prior to admission should include peoples mental health needs and people must only be admitted to the home and cared for if the registered persons can ensure that needs can be appropriately met. Care plans must include all assessed needs, including psychological needs, and the action to be taken by staff to ensure needs are fully met. Timescales of 30/10/06 and 30/06/07 not met. The registered person must ensure that people are protected by the home’s policies and procedures relating to medications. The registered person must ensure, through training and supervision that staff actions do not compromise peoples right to privacy and dignity. People living at the home must be consulted about and receive social contact and recreational activities of their choice to DS0000006172.V338435.R01.S.doc Timescale for action 31/08/07 2. OP7 15(1) 13(4) 31/08/07 3 OP9 13(2) 16/07/07 4. OP10 12(4) 31/08/07 5. OP12 16(2)(m)( n) 31/08/07 Castlemount Version 5.2 Page 29 6. OP15 16(2)(i) 7. OP18 13(6) 8. OP18 13(7) 9. OP25 OP38 13(3) prevent boredom and social isolation. This must include people who are unable to actively join in organised activity. The registered person must ensure that all people, particularly those who are unable to manage their own needs, are appropriately supported to receive adequate diet and fluids to maintain their health and well being. The registered person must make arrangements to prevent people living at the home being placed at risk of harm or abuse. The registered person must make sure that people are not contained in rooms, which they do not have the ability to get out of. The registered person must ensure that: Running hot water temperatures must be maintained to deliver to 43 degrees centigrade to avoid scalding. Previous timescales of 30/06/06 and 22/05/07 not met. 31/08/07 10/08/07 10/08/07 16/07/07 10. OP19 11. OP19 12. OP38 OP19 23(4)(c-e) The registered person must, 31/08/07 after consultation with the fire authority, ensure that: all reasonable precautions are taken to prevent people at the home being placed at risk from a fire within the home. 23 (2) (n) The registered person must 31/08/07 make safe arrangements for people using wheelchairs to enter and exit the home. Previous timescale of 30/06/07 not met. 13 The registered person shall 31/08/07 make suitable arrangements to provide a safe system for moving and handling to prevent injuries DS0000006172.V338435.R01.S.doc Version 5.2 Page 30 Castlemount 13. OP27 OP30 to people living at the home and their carers or relatives. Previous timescale of 08/06/07 not met. 18(1)(a)(c The registered person must 30/08/07 ) ensure that appropriately trained staff are available, at all times, in sufficient numbers to meet the needs of the people at the home. 19 To safeguard people living at the home, confirmation should be obtained that appropriate checks have been undertaken for all people working within the care home. The registered manager, and registered providers, must ensure that the running of the home ensures people are appropriately cared for. 31/08/07 14. OP29 15. OP31 10(1) 30/09/07 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. 4. Refer to Standard OP8 OP15 OP16 OP26 Good Practice Recommendations Staff at the home should ensure that advice given by healthcare professionals is followed to ensure the health and welfare of people living at the home. When supporting people to eat and drink, staff should give assistance in a manner and at a pace appropriate to people’s needs. All complaints and concerns received by the home, any actions taken and outcomes should be recorded. The registered person must ensure that all areas of the home are clean and free from offensive odour. Staff should be reminded about the risk of cross infection if cleaning does not take place in a timely fashion. The content of any training undertaken by staff should be recorded and the manager should, through supervision, check staffs’ understanding of the training they have DS0000006172.V338435.R01.S.doc Version 5.2 Page 31 5. OP30 Castlemount 6. OP33 7. OP36 received. Quality monitoring should be developed and continued to make sure that the views of all people concerned with the home, and in particular, those who live at the home, are taken into account. To make sure that staff are working effectively, all staff, including the manager, should receive, formal recorded supervision at least six times each year. Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Castlemount DS0000006172.V338435.R01.S.doc Version 5.2 Page 33 - 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!