Inspection on 25/04/05 for Castlemount

This inspection was carried out on 25th April 2005.

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 16/07/07

Castlemount 28/09/06

Castlemount 09/05/06

Castlemount 28/10/05

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 Yorkshire WF2 7DG Lead Inspector Susan Vardaxi Unannounced 25 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Castlemount Address 54 Manygates Lane Sandal West Yorkshire WF2 7DG 01924 251127 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr & Mrs A Satari Amanda Machins registration application is currently being processed. Care Home 15 Category(ies) of 15 Old age, 15 Mental disorder over 65 years registration, with number of places Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18th November 2004 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. The home provides care and accommodation for 15 older 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. Due to the steep steps leading up to the front door the home is only accessible by wheechair from the side door leading onto a side road. The home has nine single and three double bedrooms, ensuite facilites are not provided however communal toilets and bathing facilities are avaiable on all floors which are accessible by chair lift. A large entrance hall leads to the two spacious communal lounges and dining area. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection, carried out by two inspectors took place over a eight hour period. The home had received 2 unannounced inspections for the inspection year April 2004 to March 2005, one being as a result of concerns raised. Two further visits were made in relation to complaints made in October 2004 and January 2005 and the provider is currently investigating a complaint made in April 2005. Twenty-one requirements were made at the last inspection in November 2004 and one of the two providers who live abroad has attended the Brighouse Area Office to discuss the Commissions concerns re care planning, staffing, health and safety and equipment issues. The manager’s application to register is currently being processed. Time was spent talking with the residents, lunch was sampled and the interaction between staff and residents was observed throughout the inspection. A partial tour of the building occurred and records were inspected. Eleven residents, the manager, four staff and a visiting district nurse were spoken with. What the service does well: What has improved since the last inspection? The provision of training has increased and staff appear eager to pursue these improved opportunities. Eleven staff have achieved NVQ level 2 qualifications and the manager now has a NVQ level 4 management qualification. The manager is working hard to improve the service provided although all the requirements made at the last inspection have not been met. Some redecoration had been completed. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 6 Staff appear willing and assisted residents appropriately with personal care tasks during the inspection, however the residents would benefit from more interaction with the staff on an ongoing basis. The standard of record keeping has improved, however further development is needed. The standard of cleanliness throughout the home has improved. Appropriate action had been taken to address issues arising out of concluded complaints. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4, Whilst the staff qualifications and pre admission assessments are satisfactory the service users guide needs to be developed. EVIDENCE: The statement of purpose was seen and is now adequate however, the service users guide did not include all information required and the manager acknowledged this. Files sampled demonstrated that the home now provides a copy of the terms and conditions on admission to the home. Discussions with the manager and records checked found that pre admission assessment procedures are satisfactory and a re assessment is planned for one resident to consider if they are appropriately placed. Staff said training in the care of residents who have specialist needs is now being provided. Whilst the home is not registered to receive people whose primary care need is dementia, staff said four staff are currently undertaking dementia care training to meet the needs of residents who have developed dementia. The manager said eleven staff have achieved NVQ level 2 which is over 50 of the care staff. Intermediate care is not provided at the home. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 There has been some improvement in the standard of care planning since the last inspection, however further development is still required to ensure that all needs are identified and met appropriately and recorded. Health care professionals’ arrangements are appropriate, however some aspects of personal hygiene and hair care are not adequate. EVIDENCE: Sampling of some individual care plans demonstrated that some progress has been made to generally ensure that assessed needs are met and reviewed regularly. However, a named resident’s assessed needs were not consistent with the care plan which had not been reviewed since November 2004. At 9:05 inspectors found eleven residents dressed in the lounge and had been served breakfast, most of them were asleep. The times that residents choose to get up and go to bed should be included in their care plan, and worked to by staff. The residents’ daily records did not include that the needs identified in the care plan had been met. There was no evidence to demonstrate that residents or their representatives had been involved in care planning or reviews. Records checked identified that GPs district nurses and other health care providers visit the home as required. A visiting nurse said that she had no concerns about the residents’ health care. Some residents cannot be weighed as the current Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 10 weighing facilities are household type and not appropriate for residents who are frail or have disabilities. Some residents’ fingernails were long and required cleaning. The home employs a hairdresser however from observations during the inspection residents’ hair had not been cut and styled to an adequate standard. The hairdressing room is one of the communal lounges, which is not appropriate for protecting individual privacy and dignity and communal and individual health and safety issues. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The choice of social activities need to be improved to resource and meet residents’ needs. The provision of meals is satisfactory. EVIDENCE: Some residents said that they just sit in the lounges all day as there is nothing else to do, staff said that they sometimes help to provide some activities including floor games and bingo in the afternoons. An entertainer visits. Staff rosters indicate that staffing levels have not always been adequate to provide many activities particularly as afternoon care staff are responsible for preparing and serving the evening meal. The manager said there is no budget for community-based activities and this provision relies on staff fundraising. There is petty cash for in house entertainment. The meal sampled at lunchtime was cooked and presented to a good standard and provided nutritious meal. The portions served were adequate and there was very little wastage. Special dietary needs were met and staff assisted residents appropriately.Residents said that they are satisfied with the meals provided. It was observed that generally staff did not interact with the residents on an ongoing basis, they were observed sitting together in the dining room when residents were in the lounge. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a satisfactory complaints system however when requirements have been made in relation to risks to residents’ safety immediate action has not always occurred. Advocacy arrangements are required for the residents who are unable to make informed choices. EVIDENCE: The Commission has received three complaints regarding the provision of care, staffing levels, health and safety and equipment within the past twelve months, the Commission investigated one complaint made in October 2004 and one in January 2005. The outcomes of the investigations were that 9 issues within the complaints were upheld, 2 were not upheld, 2 were partially upheld and 9 issues were unsubstantiated. The providers are currently investigating the third complaint received by the Commission in April 2005 in relation to care and health and safety issues. The providers did not address all the requirements made following the investigations within the required timescales. The homes complaints procedure was seen and has been reviewed to include timescales for dealing with complaints. There were no complaints recorded in the homes new complaints book. Care assessments of some residents unable to make informed choices did not detail advocacy arrangements in respect of the handling of their finances. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,25,26 The general standard of cleanliness and decor within the home provides a comfortable environment for residents to live in however, there is no written evidence of future planning for replacement of fabrics, furnishings and maintenance. The external environment is pleasant however free access to the garden is not possible due to safety issues. EVIDENCE: The manager said most residents are unable to exit the building from the front door to walk in the gardens without staffs’ assistance as the steps up to the home are very steep and there would be a risk from falling. Wheelchair access to the building is by a side entrance only. However staff said that residents may sit on a balcony located at the front of the home when the weather is good. Two spacious communal lounges and a dining area seen provide a comfortable environment for residents to sit in. The bedrooms checked were decorated and cleaned to a satisfactory standard. No record of an annual programme of renewal and maintenance was seen. There was an odour of urine in the Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 14 entrance hallway which is the designated smoking area. The odour from the automatic air freshener dispenser located in the hallway was overly strong. Some running hot water temperatures exceeded the recommended 43 degrees Centigrade. Some of the emergency call cords seen were tied up and residents would have had difficulty in calling for assistance if needed. The manager said that the system could be heard wherever staff were working in the home however, when the inspectors checked the emergency system from the basement the call from the panel could not be heard. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The current staffing arrangements are not adequate if the homes staff are unable to cover for sickness and vacancies. The homes procedures for obtaining information, POVA and CRB checks when recruiting staff do not ensure that residents are fully protected. The provision of staff training has improved since the last inspection and is adequate. EVIDENCE: The staff rosters checked and discussions with the manger identified that the home has been short staffed on some occasions since the last inspection due to sickness and staff vacancies. The manager said agency staff have not been used. Rosters checked show that some care staff are working ten-hour shifts and no cook had been employed for the evening and weekend meals. The manager said a weekend cook is due to start working at the home. The manager said she and staff have worked extra hours to cover the shortfalls in staffing levels however on some occasions there have only been two care staff on duty. Three staff files checked identified that staff had commenced employment prior to CRB checks and POVA first checks being obtained. The homes forms seen that are sent to referees do not ensure that ensure that references received are authentic Staff spoken with said that they are enjoying the training and opportunities to obtain qualifications being provided. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,35,38 The manager is making progress towards improving the service provided however support from the providers is required to enable her to excise her duties effectively. Development needs to occur to ensure that residents health and welfare is protected EVIDENCE: The manager said that she has recently obtained the NVQ level 4 management qualification. The Commission have not received any reports of the registered person’s monthly-unannounced visits to the home despite discussion with one of the providers at a meeting at the Brighouse Area Office in February 2005. The manager said the registered persons telephone her occasionally. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 17 The registered persons still have not sent confirmation of financial viability to the Commission. Inspection of some residents’ records for monies held by the home on their behalf identified that receipts had not always been obtained for purchases made and despite some residents being unable to make informed choices advocacy arrangements had not been made in respect of their finances. The residents’ care plans were seen unattended on top of a cupboard in the dining room. The chair lifts to the first and second floors that had not been in working order for approximately 3 months have now been repaired. It was observed that when the chair seats are stationary the space between the chair and stair step is minimal and could cause an accident from tripping. The material covering the chairs was seen to be split and torn which could tear residents and staffs’ skin. Records examined showed that a fire risk assessment has not been completed since 2003. A fire drill was recorded as completed in January 2005, however fire system checks had not been made regularly. Fire system checks had not been recorded to demonstrate that they had been completed regularly. The electric box located in the hallway in basement near some residents’ bedrooms was seen not to have a cover fitted on the front and the electrical cupboard was unlocked. A handrail that was fitted from floor to ceiling in a bathroom was seen to be loose and the maintenance person secured the rail during the inspection. Flannels, towels and a tablet of soap were seen in a communal bathroom. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 3 COMPLAINTS AND PROTECTION 1 3 x 1 x x 1 1 STAFFING Standard No Score 27 1 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 2 3 1 x x 1 x 1 1 Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1-3) Requirement That an up to date service user guide be made available to all existing and prospective service users and/or their representatives, which meets current legislation. Care plans must be generated from an assesment of residents needs and residents/representaives involved. Nuitritional assessments must be completed for all residents and an appropriate weighing facility provided. Residents finger nails must be checked, cleaned and manicured on a regular basis. The standard of hairdressing needs to be improved and arrangements for hairdressing made that gives privacy to residents. Activities and outings must be provided regularly that are suitable to meet the residents needs and abilities. The provider must make funds available within the budget to provide social activities and outings Timescale for action 30 June 2005 2. OP7 15(1) 25 April 2005 & Ongoing 30 June 2005 25 April 2005 & Ongoing 3. OP8 13(1)(b) 4. OP10 12(4) 5. OP12 16(2)3(b) 25 April 2005 & Ongoing 25 April 2005 & Ongoing 6. OP13 16(2) Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 20 7. OP19 23(1) (2)(a)(b (n)(o) 8. OP22 9. OP27 10. OP29 11. OP32 12. OP34 The residents accommodation both private and communal should be easily and safely accessible to all people admitted.Timescale of 18 November 2004 not met. 23(2)(n) The residents must be able to 16(1) access the emergency call cords at all times. The emergency call system must be located in an area in the home that enables staff to hear the call wherever they are working in the home. (18)(1)(a) The registered persons must ensure that at all times suitably qualified, competant and experienced persons are working at the home in such numbers that are appropriate for the health and welfare of service users. 19 That new staff are supervised schedule until the receipt of a satisfactory (2)(4) (7) CRB check. That new staff do not work in the home prior to the receipt of a satisfactory POVA first check. That employment is confirmed only following the receipt of 2 satisfactory written references. Previous timescale of with immediate effect not met. The registered person must ensure that all references received are authentic. 26 The registered person must complete monthly unannounced visits to the home and provide a copy of the report to the Commission.Previous timescales from 2002 not met. 25(1)(2)a The registered persons must (b)(3)(c) provide the Commission with confirmation of finacial viability.Previous timescales from 2002 not met. J51J01_s6172_Castlemount_v220573_250405.doc 25 April 2005 25 April 2005 25 April 2005 & Ongoing. 25 April 2005 & Ongoing 25 April 2005 25th April 2005 Castlemount Version 1.30 Page 21 13. OP35 13(6) 14. OP37 17(1)(b) 15. OP38 13(4) 23(4)(a) (i)(ii(iii) 16(2)(j) The registered person must ensure that advocay arrangements are made to ensure the safe handling of residents finances, particularly for those who are mentally frail and unable to make informed choices. That all confidential records are stored in accordance with the Data Protection Act 1998 and other statutory requirements.The previous timescale of 18/11/04 not met. The registered persons must ensure that the chair lifts seats are are in the upright position when not in use. The covering on the chair lift seats must be replaced so that risks of skin tears or other injuries are elimiated. The registered person must ensure that fire system checks are completed weekly. The fire risk assessement must be reviewed. The electical box located in the basement must be made safe. The electric cupbard located in the basement must be kept locked. Flannel, towels and tablets of soap must be removed from communal bathrooms to prevent the risk of cross infection occurring. 25 April 2005 & Ongoing. 25 april 2005. 25 April 2005 & Onoging. 16. OP16 22(4) The registered persons shall 25th April ensure that any complaint is fully 2005 & investigated and action taken Ongoing. within the required timescales particularly when risks to residents have been identified. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 22 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. 5. Refer to Standard OP7 OP12 OP14 OP18 OP26 Good Practice Recommendations The daily records should include that the actual assessed needs have been delivered. The residents would benefit from more interaction with staff Residents relatives should be given information on how to arrange advocasy when required. Advocacy arrangements should be made when residents are unable to make informed choices regarding the handling of their finances. Consideration should be given to removing the automatic air freshner located in the hallway on the ground floor. Castlemount J51J01_s6172_Castlemount_v220573_250405.doc Version 1.30 Page 23 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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. 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