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Inspection on 17/08/05 for Castleton Lodge Care Home

Also see our care home review for Castleton Lodge Care Home for more information

This inspection was carried out on 17th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Residents are referred to by their chosen name; bedrooms were furnished to the individual taste with their own furnishing which they have the opportunity to bring with them into the home. Residents and their relatives said staff take what little time they had spare to talk to them.

What has improved since the last inspection?

Very little or nothing had improve since the last inspection. However since this inspection was carried out a meeting has taken place with senior management of the home. Systems have been put in place. A new chef was due to take up position at the home, new kitchen equipments have been purchase and new floor covering is being bought for the bedrooms identified. The inspector was told that the administrator post has gone out to an agency with a view of permanent member of staff.

What the care home could do better:

The homes information to prospective residents and others needs to be clear as to the service provided at the home. All residents must have a copy of the homes` written terms of contract of residency. Staff must have access to comprehensive assessment information that would enable them to meet all the care needs of the individual. Residents and their representative must be involved in the planning of care. Risk assessment must be carried out on residents for risk of falls and pressure sores, these must then be linked with a care plan. All resident must have nutritional risk assessments and any identified risk be linked to a care plan to manage the risk. The home must provide residents with social activities that are meaningful and appropriate, taking into account their likes, dislikes, disability and experience and capacity. Privacy locks should be fitted to residents bedroom door. Appropriate floor covering must be fitted in identified residents bedrooms. All staff vacancies must be filled to make sure there is enough staff available to meet resident`s needs. The administrators` post must be filled to allow the manager enough time to carry out her duties as a registered manager. The cook post must be filled to ensure there is someone qualified to cater for residents meals.

CARE HOMES FOR OLDER PEOPLE Castleton Lodge Care Home Green Lane New Wortley Leeds LS12 1JZ Lead Inspector Valerie Francis Unannounced 17 August 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. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Castleton Lodge Care Home Address Green Lane New Wortley Leeds LS12 1JZ 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) 0113 231 1755 0113 2319789 Four Seasons Home Ms Elaine Fitzgerald Care home with nursing 60 Category(ies) of Dementia - over 65 (30) registration, with number Old age (30) of places Terminally ill (1) Physical disability (2) Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The place for TI(E) is for the service user specified in the NCSC letter dated 17 December 2003. The places for PD are specifically for named service users Date of last inspection 25/02/05 Brief Description of the Service: Castleton Lodge Care Home is a detached purpose built property located in Armley, which is on the outskirts of Leeds. The home is owned and managed by Four Season Health Care Ltd.The property is set in its own grounds with ample car parking facilities available at the front of the premises. There is a bus service along the main road; service users can register with the Access bus, which will drive up to the home. The offers care to 60 older people most of whom reciive nursing care; 30 of which have Dementia or related mental health problems, within these numbers there is registration for specialist care and for a service user who is under 65 years old. The accommodation consists of 60 single rooms, all of which have en suite facilities.There are 8 communal lounges, as well as a large reception area for service users. There are two dining rooms and a central kitchen.There are five communal bathrooms, two showers and eight communal toilets Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Regulated care homes have a minimum of two inspections a year; these may be announced or unannounced visits. The last inspection was announced and took place on the 15th February 2005. There have been no further visits until this unannounced inspection, which was carried out by two inspectors, which started at 9.30am and ended at 3.45 pm. The people who live in the home use the term residents therefore this is the term that will be used throughout this report. Both the registered manager or the deputy was not on duty on the day of the of the inspection, one of the registered nurses was the person in charge of the home at the time, the regional manager was alerted about the inspection visit. The person in charge did not have access to records relating to staff and other relating to the running of the home. The inspectors examined resident’s records, and other records that were available. Some areas of the home were seen: kitchens, lounge and dining rooms and some bedrooms were inspected. Care staff were observed carrying out their work, and discussions were held during the day with members of staff, and residents, and their visitors. Some visitors were somewhat concerned about the absence of the manager for several weeks to another establishment. It was evident at the time of the inspection that there was lack of leadership at the home. The matter was discussed with senior management at a meeting following the inspection and at such time the inspector was assured that the manager is now back at the home and would only be managing Castleton Care home. What the service does well: Residents are referred to by their chosen name; bedrooms were furnished to the individual taste with their own furnishing which they have the opportunity to bring with them into the home. Residents and their relatives said staff take what little time they had spare to talk to them. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: The homes information to prospective residents and others needs to be clear as to the service provided at the home. All residents must have a copy of the homes’ written terms of contract of residency. Staff must have access to comprehensive assessment information that would enable them to meet all the care needs of the individual. Residents and their representative must be involved in the planning of care. Risk assessment must be carried out on residents for risk of falls and pressure sores, these must then be linked with a care plan. All resident must have nutritional risk assessments and any identified risk be linked to a care plan to manage the risk. The home must provide residents with social activities that are meaningful and appropriate, taking into account their likes, dislikes, disability and experience and capacity. Privacy locks should be fitted to residents bedroom door. Appropriate floor covering must be fitted in identified residents bedrooms. All staff vacancies must be filled to make sure there is enough staff available to meet resident’s needs. The administrators’ post must be filled to allow the manager enough time to carry out her duties as a registered manager. The cook post must be filled to ensure there is someone qualified to cater for residents meals. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 7 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. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 & 4. The written information, the Statement of Purpose and Service User Guide needs amending, so that realtives and residents have full information about the nature and the purpose of the home and the service it provides and to whom. The home pre assesssment documents were not completed, to allow a comprehensive care plan to be put in place. The home does receive a social work assessment, however, in most of the cases seen they were out of date prior to the person moving into the home. EVIDENCE: The home statement of purpose still needed amending to make sure those prospective residents and their representatives have access to good information to make an informed choice, when choosing a home. One relative visiting said they had been given the opportunity to visit the home and was given information about the home before her relative moved into the home. A resident who had recently moved into the home was not aware of having a contract of terms and condition of residency. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 10 Although the format to record pre-assessments met with the standard, these were found to be incomplete, with the omission of the name or the signature of the person completing the document, date and very little information that would enable a comprehensive care plan to be put together. Residents and their relatives were aware that after six week a review would be carried out to which they were invited to attend. At the time of the inspection a review was taking place, which involved the resident, relative, social worker and funding authority and the nurse in charge of the unit. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8. Care plans had very little or no information on the plan of care and the action to be taken of how the individual care needs would be met. EVIDENCE: The inspectors assessed six care plans i.e. for people with dementia; general nursing and social care need. Although there was a good format to record pre-assessment both inspectors found that in most cases these were not completed in full for, one person who had recently moved into the home, care plan did not show how their health care would be met. The extent to which social care needs are addressed varied. There is six monthly care reviews where residents and their representative are invited to attend and discuss the care being provided, however the format used to record these meeting does not make it clear who was involved in the review and if the care plans were discussed and agreed. There were some pressure sore risk assessments and nutritional risk assessments carried out, however this was not done in all cases. There was no plan in place to support any identified risks or equipment that would be used, it was not clear if the home pressure area care policy is based on the guideline issued by the National Institute for Clinical Excellence (NICE), to ensure that staff are working in accordance to the requirement NICE. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 12 Although there were risk assessments carried out for residents who was at risk of falling, in some cases there were no care plan in place how the identified risk would be managed. The daily records tended to focus on aspects of physical care and gave little indication of how people spend their time. One resident daily note read showed that she “had a seizure which lasted approximately one minute and recovered quickly and slept well”, there was no follow up information, care plan or action plan detailing how staff would managed and meet her care needs. Several residents had an extra mattress at the side of their bed. When staff were asked about this, they indicated that this was to stop people falling out of bed. This matter was discussed with the manager and senior management of the home, the inspector advised that risk assessments must be carried out and the appropriate equipment put in place i.e. bed safety rail if this id deemed appropriate to ensure that residents are protected from falling out of bed. The Waterlow dependency tool is used to identify residents at risk. There was no evidence on files to indicate that residents have contact with dentists or chiropodist. It was however, evident from the records seen that staff are in contact with health and social care professional such as GPs, physiotherapists, Tissues Viability Nurse and social workers, for help and support. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 13 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 &15. Social activities for residents are limited and provide very little variety, to the point where residents were saying they were bored and at the time of the inspection they looked bored. EVIDENCE: It was obvious from the records seen that there is little or no social stimulation that is appropriate for the resident group. During the inspection of care files the inspectors found that there were no records of social care plans despite there being a social care assessment carried out. Discussion with resident and from records seen there were no records of the preferred time to get up and to bed. Several residents told one of the inspectors that there were no activities on their unit. The inspector was later told that activity organiser is based on “Mooreside” and residents from Cleven are always invited to attend. One resident said that during the good weather she enjoyed setting outside or go for a walk, however this she said was not always possible because of the lack of staff. Several residents and relatives said visits take place at any time and in private. Relatives said that the unit “Cleven had a family atmosphere” and they felt that staff cared for them as well as caring for the residents. One visitor said Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 14 they are kept fully informed about their relatives care and said the staff were kind. Residents said the breakfast is good and they enjoyed the cooked breakfast that is provided. Sandwiches, pork pie, buns or cakes is served at lunchtime, the evening meal is a cooked meal. One resident said that the food is often cold when it is served; when this was mentioned to staff it improved for several days then went back to being cold again. A record of special dietary requirements was available, but likes and dislikes were not recorded. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 15 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) This standard was not inspected at this time. EVIDENCE: During the inspector’s discussion with visitors regarding their awareness of the complaint procedure, it was clear from their comments that they were aware of how to raise any concern with the manager. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 16 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 The building was showing signs of wear and tear indicating that replacement and redecoration was needed in some areas. EVIDENCE: From the inspection of the premises the overall impression was that bedrooms and communal areas were reasonably clean. However, odour control appeared to be a problem as you entered the home; it was clear that the odour was a problem in some bedrooms, where carpets needed replacing. Some residents still do not have locks to their bedrooms to ensure that resident have the opportunity to maintain their privacy. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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. The registered provider needs to look at improving the staffing levels, because of the high care needs of the people living at the home. EVIDENCE: The inspector was told at the meeting with senior management team of the home that the staffing level was enough to meet the needs of residents at the home. On the day of the inspection there were four care staff and a trained nurse on Moorside and the same on Cleven during the day, during the night there were five staff two of which are trained nurses. During the inspection and from feedback from both residents and their visitors, they said that “there were not enough staff and residents had to wait a long time for the call bell to be answered”. It was apparent that some consideration is needed for the registered provider to look at the staffing levels, to make sure that there are enough staff to meet the needs of residents especially those with Dementia over the twenty-four hour period. The inspector was told that there was 138 care hours vacant that included trained staff and 35 hour for an administrator. Residents and their visitors made positive comments about the staff and the care given at the home. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 18 Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) This standard could not be fully assessed at this inspection because of the availability of the manager and the deputy manager, these standards will be assessed fully at the next inspection. EVIDENCE: During discussion with residents and staff and from observation, the inspector was told that the chef was due to leave the employment at the end of the week of the inspection and the person due to replace him was no longer taking up the post. Leaving some uncertainty about catering in the home. The inspector was told that trained and care staff have not had any formal supervision. Staff said they had received training in Dementia care and challenging behaviour. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 20 They all felt that the training had help them in the care to residents, giving them a better understanding on residents behaviour and their dementia. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 1 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 x COMPLAINTS AND PROTECTION 1 x x x x x x x STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The registered person must revise both the Statement of Purpose and the Service User Guide in order to ensure that these documents contain all required information in sufficient detail (previous date 31st January 2005) Residents must have a copy of the homes contact of terms and conditions, which must be signed by all self funding residents or their representative. Staff must have assess to comprehensive information that would allow them to put together a care plan how needs would be met. The registered manager must ensure that each resident have a plan of care that is developed from a comprehensive assessment. The plan must set out the action to be taken by staff to ensure that all aspect of health, personal and social care needs are met. The plan must be drawn up with the involvement of the residents and/or representative. and recorded in a style accessible to the resident J52 S44491 Castleton V238060 170805 Stage 4.doc Timescale for action 15th November 2005 2. OP2 40 15th November 2005 15th November 2005 15th November 2005 3. OP3 14 4. OP7 15 Castleton Lodge Care Home Version 1.40 Page 23 5. 19 23 6. 7 12 & 13 7. OP24 23 8. OP27 18 9. 10. 11. 12. 13. 14. 15. OP27 18 and agreed and signed by the residents or their representative where possiable the care plan must be reviewed by staff at least once a month and updated to reflect the change in needs. (previous 30th January 2005). the bedroom flooring identified as having an odour problem must be resolved with the replacement of suitable floor covering. The registered manager must maintain the necessary records to demonstrate that the health care needs of residents are being appropriately identified and met. Nutritional screening must take place with an appropriate care plan developed for those residents identified at risk. Risk assessments must be made for who are at risk or have a history of falls, and those at risk of developing pressure sores, with care plan in place to link. The registered persons must arrange for residents’ bedrooms to be fitted with suitable locks to offer them the choice to be private but also be accessible to staff in emergencies. The registered provider must make sure that there is enough staff to meet the needs of residents. All staff vacancies must be filled. The registered person must employ a suitably qualified cook. 30th November 2005 15th November 2005 30th December 2005 15th November 2005 2nd November 2005 Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 24 16. 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. 6. 7. Refer to Standard OP3 OP15 OP19 OP9 OP27 Good Practice Recommendations staff assessing prospective residents must complete the assessment document in full. A record of residents likes and dislikes must be available in the kitchen. The registered person must put together a programme of refurbishing and replacement, a copy of which to be sent to the CSCI area office. Residents should be given the opportunity to self medicate if this is deemed to be appropriate after a risk assessment. The registered manager should have access to administration staff that would assist her with her administration role. Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Castleton Lodge Care Home J52 S44491 Castleton V238060 170805 Stage 4.doc Version 1.40 Page 26 - 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. 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