Inspection on 29/11/07 for Castleton Lodge Care Home

This inspection was carried out on 29th November 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Castleton Lodge Care Home 31/07/08

Castleton Lodge Care Home 17/01/07

Castleton Lodge Care Home 07/09/06

Castleton Lodge Care Home 28/02/06

Castleton Lodge Care Home 17/08/05

Castleton Lodge Care Home 15/02/05

Castleton Lodge Care Home 17/08/04

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Snydale Care Home

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

CARE HOMES FOR OLDER PEOPLE Castleton Lodge Care Home Green Lane New Wortley Leeds LS12 1JZ Lead Inspector Valerie Francis Unannounced Inspection 07:30 29 November & 7 December 2007 th th 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 Castleton Lodge Care Home DS0000044491.V355929.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. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 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 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) 0113 231 1755 0113 231 9789 www.fshc.co.uk Tamaris Healthcare (England) Ltd *** Vacant *** Care Home 60 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability (2), Terminally ill over 65 years of age (1) Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 17th January 2007 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. Basic information about the home and what services are offered is provided in the home’s Statement of Purpose. People who wish to use the service and their families are given a copy of this document. The home is owned and registered to Four Seasons Health Care, as a care home with nursing for up to 60 older people, 30 of whom have Dementia or related mental health problems. The weekly fees for services provided in the home vary depending on whether people are funded by the local authority, have nursing needs and their fees are partly supplemented by the health authority or if they pay privately. Information provided on the day of the visit was that fees range from £377.30 to £ 545.00. depending on the level of care people need. Additional charges are payable for services like hairdressing, chiropody, newspapers etc Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk The inspection started on 29 November and was completed 7 December 2007. The home did not know that this was going to happen. Feedback was given to the manager and the regional manager. Three inspectors, which included a pharmacy inspector, carried out this key unannounced key inspection. As part of the inspection process an ‘expert by experience’ was at also the home An ‘expert by experience’ is a person who has experience of using a service. Because of this they can help an inspector get a picture of what it is like to live in the home. They produce written information for the inspector some of which is included in this report. The purpose of this inspection was to make sure the home was providing a good standard of care for the people living there. The term people who use the service will be used throughout the report when referring to the people who live at the home. The manager has not applied to be registered with the CSCI. The home was sent an Annual Quality Assurance Assessment (AQAA) selfassessment form to complete. This form gives the home and the organisation an opportunity to put forward their views on how they provide their service to people using it or wanting to use it. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand their experience of the home. We call this the ‘Short Observational Framework for Inspection (SOFI). This involved us observing four people who use services for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 6 environment. We also spoke to the manager, staff members, visitors and people who live in the home. The other methods used at this inspection included looking at care records, observing working practices and talking with people who live there, visitors and staff. Before the visit, questionnaires were sent out to the home for people who use the service, relatives and staff. The names and address of the visiting professionals to the home were requested from the manager, survey questionnaires were sent to each of the names given. Two of these have been returned and this information has also been used in this report Six people who use the service, one relative and three staff responded by completing their form and returning it to the CSCI office. The inspectors gave detailed feedback of their finding on areas they inspected to the manager and the line manager on the first day. And on the 30th December a further visit was made. On the 7th December a further feedback of the Expert by Experience finding was given to the manager. Thank you to everyone for the returned survey questionnaires and for the hospitality and assistance on the day of the visit. Requirements and recommendations made during this visit can be found at the end of the report. Some particular areas were poor, but we have taken other positives into account. Unless those areas are corrected by the home, the outcomes in the future may deteriorate. The draft of this inspection report was sent to the provider, following this, they requested a meeting with the CSCI inspector and regulation manager for further clarification of some areas in the report. We said at the meeting that a warning letter would be sent with the final inspection report. This letter highlights the shortfalls of the home and the continued breaches of the Care Homes Regulations. We explained that the continuous breaches may result in legal advice being sought by the CSCI, which could result in enforcement action been taken. It was evident through out the meeting that they were plans to improve the standards of care in the home, with emphasis on the care for people with dementia. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 7 We have taken into account the providers express commitment to improve. A requirement has been made for an improvement plan from the registered provider. This will outline all the short falls and how and when these shortfalls will be resolved. What the service does well: What has improved since the last inspection? What they could do better: Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 8 During the course of the inspection several examples were seen of people care needs were not being met and people were given a poor standard of care and staff failing to meet people needs. • • • • • • • • • • The assessment information for peoples mental health care needs not done. Care plans do not have all people’s needs. There was not enough staff employed to properly look after the people on the dementia unit. Staff had not been trained to meet the needs of people with dementia. Staff are not clear how to care for people with dementia or related mental health illness. Records were not kept up to date. People’s cultural needs not been met. People’s nutritional needs are still not been met. Activities for people on the dementia unit need to be in place. Staff practices in the home put people at risk. Over the period of time the home has shown signs of improvement but this have not been maintained. This has resulted in a “yo-yo” standard of care being delivered at the home. Most recently there have been five complaints about the standard of care people were getting at the home, three of these were referred to Social Services Safeguarding People unit. In September 2007 the CSCI requested an improvement plan from the provider. This was sent to the CSCI in October 2007. We brought forward this inspection two months early, so that we can assess how the home was meeting people’s care needs and the care standard regulations. Further detail can be found in the body of the report and requirements and recommendations are at the end of the report. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 9 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. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 10 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 Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 11 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): 1, 2 and 3 (Standard 6 does not apply to this service) People who use the service experience adequate quality outcomes in this area. Overall, people are provided with enough information to enable them to make an informed choice about the home. The admission process includes preadmission assessments and introductory visits where possible. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home’s information available to people and their relatives had been reviewed, people now have a copy of the Service User guide in their room. However, when questioned some people were not aware of it in their room. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 12 The home gives people who want to use the service a breakdown of all the fees for nursing care. This is good practice. People are welcome to spend time at the home before deciding whether to move in. The Information in the AQAA Annual Quality Assurance Assessment stated that a detailed pre-admission assessment form is completed before people are admitted to the home, information is also collected from a variety of sources. One of the people’s files seen had an Easy Care document. The assessment completed before admission to the home follows the activities of daily living as a framework, which also identified areas where staff support and understanding would be identified. However this was not fully completed on the files seen. The area for mental health assessment was not completed in any of the files seen. On some files other needs were not identified. This means that some needs could be overlooked. For example, particular mental health problems, communication difficulties, religious and cultural needs. Care staff told us that they did not get time to spend to read new care files before providing care for people. They received some information about new people at the handover or the beginning of the shift. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 13 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 the service experience Adequate quality outcomes in this area. Details in care plans were not consistent. There was not enough detailed information about individual needs. This means that care needs were being overlooked. Some medication practices do not protect people living at the home. Staff practices compromise the dignity of the people at the home. We have made this judgment using available evidence including a visit to this service. Some particular areas were poor, but we have taken other positives into account. Unless those areas are corrected by the home, outcomes in the future may deteriorate Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 14 EVIDENCE: Information in the AQAA said that the home had identified that improvements could be made to care plans to make sure that individual care plans were in place for all people living the home. The provider has introduced new documentation; to make sure people’s plan of care is clear with an action plan for staff to follow to meet those needs. Because peoples’ mental health assessments had not been carried out, there was very little or no information about people’s dementia type, their past experiences or other information which would help staff to provide care that meet needs. Three files for people on the general care nursing unit on the ground floor and three people on the dementia unit Moorside were looked at in detail. We saw each person had a care plan in place, which had: • Risk assessments for bed safety rails, which included an agreement with family and health care professionals stating the reason why it was in place. • Pressure sore risk assessments. Mobility assessments, Skin integrity with body map and water low assessment. • Moving and handling risk assessment. Type of moving and handling equipment used. • Fall risk assessment monthly. • Nutritional assessment with, food, fluid and weight charts. • Oral assessment & intervention. • Continence assessment. Type of pads used being identified. • Record of belongings, consent for photo • Easy care assessments, which for two people was relatively new before admission to the home. • Daily progress record. • Records of visits made by health care professionals. • There were risk assessments for falls and referral made to fall clinic. Although some improvement was seen since the last inspection, the level of detail was not enough to make sure staff had enough information about care needs. The gaps in care planning we saw included; • Evidence seen showed that assessments were not always dated or signed for. This makes it difficult to identify when people’s assessments should be looked at again • Weight checks were not consistently carried out or recorded. This would help identify weight loss. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 15 • • • One person’s falls risk assessment monthly evaluation form had not been evaluated over a month despite the person being at risk. Although people’s cultural needs are said to be a priority at the home, a care plan seen for a black person did not reflect this. There was no information for staff to make sure cultural needs would be met. We found Waterlow assessments were been done (dependency check), pressure area risk assessment showed one person at high risk of pressure sore. Although there was a care plan in place, there was no evidence that staff knew the working of a speclist mattress that was been used. It was clear that the standard of recording was variable and there was a lack of specific detail to advise and support staff in knowing how to care for people. This means that there is a clear risk of care needs being overlooked, particularly when there was few staff on duty and new staff are working unsupervised. In terms of healthcare needs, we noted that there was no evidence if pressure relieving cushions were used when people were sitting out in a chair to make sure people’s pressure area was protected. One person had a wound on her foot no care plan was in place on how this is being treated and if the tissue viability nurse was involved in the treatment. People who are cared for in bed do not always have their position changed to stop them getting pressure sores. One person was laid on a special electric mattress. Although this was recorded on the plan the setting for the mattress was not recorded, which could mean that the person may be still at risk of pressure sores. This person had no record on how often his position should be changed. During our observation in the dementia unit several people were observed and we found that people were being given a poor standard of mental health care. As previously stated we saw no evidence that mental health assessment had been completed as part of the home’s assessment for any of the people living there. The observations showed that people’s individual needs were being over looked and staff have little or no knowledge how to care and support theses people. We saw during the observation carried out on the dementia unit that generally it was clear that people who can communicate get more attention from staff and those who cannot communicate easily are left alone apart from when care intervention needed. We saw a medicine policy in the home that has been produced by the company. Staff have access to up to date information and guidance on how Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 16 to manage medication,. A record is kept of signature of staff who give medication, so that any query this staff could be identified. This is good practice. Medication records showed few gaps of people getting their medication. This means that the records show people get their medication as prescribed. Changes made to entries on the MAR chart and handwritten entries were accurately recorded. This makes sure there is clear information on new medicines and changes. Any test and current special medication are kept with the MAR charts. This is good practice and gives staff access to up do date information on people’s medication. Several areas of concern and potentially unsafe practice were identified in relation to recordkeeping. These included: • Several MAR sheets did not have photographs of people. This can lead to people getting the wrong medication • Some records sheet were loose this can lead to people confidential records being lost. • No record was kept of the medication for people who was self medicating, this practice could lead to incorrect administration. • Although gels and creams were recorded on the MAR sheet. They were not signed for. The record must identify the person who administered the medication. • Risk assessments were not carried out for people who self medicate. To make sure the medication is taken correctly and their medical treatment is not affected. Other medication practice, which compromised the safety and/or health of people included: • The record seen showed that the full course antibiotics were not always given. This put people at risk of the infection not treated properly. • Controlled drugs were not always documented properly or stored in a safe place. • We found that people medication was not always given because repeat medication had not been reordered. • We saw the person giving out the medication been disturbed by other staff. This can lead to error and people getting the wrong medication. • There was evidence that medication had been signed for and not given. • Out of date medication had not been returned to the pharmacy. • Paracetamol been being used as homely remedy stock was from a prescription only supply. Only bought medicines should be used as homely remedies. • Some medication stored in the fridge did not need to be. There was evidence that people were having their medication hidden in food, although this had been agreed with their GP there were no records that this was regularly reviewed to make sure that there was no change. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 17 One person was having their tablet crushed but no plan in place to support this and there was no indication that the dispensing pharmacist had been asked if this could be done. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 18 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 the service experience poor quality outcomes in this area. People are supported in maintaining contact with their family and friends and visitors are welcomed at the home. People said that they do not have enough to occupy them through the day and that they were bored. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information in the AQAA states that the home do well by working with residents and their relatives through their meetings, getting feedback from people who use their service and their families about the care given. The information also said they have dedicated activities and food for thought menus. During the visit to the home we did not find any written evidence of these activities. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 19 Although it was noted that trips had been arranged with people for outside activities. There was no real plan for social activities within the home. This was found to be the case particularly for those people with dementia and different cultural backgrounds. The manager said a new member of staff has recently been employed to carry out activities. The Expert by Experience observed during the walk around the dementia unit that an attempt had been made, to provide some stimulation with crossed rackets hung on the wall. However the provision of stimulation and activities for people living at the home is very limited, with some people, once again, saying they were bored. The corridor was hung with bright Christmas decorations, and a storeroom showed evidence that a tree was to be decorated and placed somewhere in the unit. Residents were unoccupied, either sitting and gazing into space, or wondering up and down the corridor. However, there was, in one small room, evidence that a painting session had been held, as 5 or 6 small pieces of paper had been left to dry on a table. The paper was small, but some bright colours had been used. We also observed very little for people to hold and touch or do things with. Reliance on TV and music and that depends on staff turning TV on or putting music on to play. Music was being played in middle lounge but people were not asked what they wanted to hear. It stopped in the middle of the morning and nothing done to put more on, people were left in silent room, with nothing to do or listen to. Downstairs the corridors had pictures, but no notice of planned events. Visitors are welcomed at the home at anytime throughout the day Visiting relatives told us that they were satisfied with the care provided, that the people were frequently taken out ‘now.’ People described the staff as ‘lovely,’ and ‘will do anything’ they are asked to do. Staff knocked on doors and wait until given permission to enter a bedroom, which is good practice. They also, in general, speak to residents in a respectful manner.” We were told that the activity person would be starting a course on social needs for people with dementia and also working closely with the organisations occupational person, to make sure that people get the right social activity to meet their needs. There was no evidence that people from a different cultural background needs were been met. The manager made arrangement with a local community group for advocate to visit these people. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 20 The lunchtime meal for people on the dementia unit meant people getting cold food or not getting enough help. There was not enough staff to support people at meal times. People on the ground floor, although some could help themselves there was little assistance, which for some meant that they could not reach their food. People were seen being fed in a conveyor belt approach, and found it difficult to keep up. Some staff did not look at people who they were assisting to make sure they eat their food. Food for residents not in the dining room was chosen for them by the carers, and taken without the use of a tray. Records showed that people’s nutritional needs were not met, plan of action were not followed to reduce people’s weight loss and how to help them to gain weight. The recording of weights checks were not done in line with the organisation’s MUST tool (Malnutrition Universal Screening Tool) so that the appropriate steps could be taken, such as involving a dietician. There was no evidence that management was working with the cook to make sure people who are at risk have their nutritional needs met. Some nutritional risk assessment that indicated people at high risk, were given fortisips supplement drink. Care plan says give more milky drinks and offer sweets, bananas, cakes, and yogurts between meals. None of the people who were frail and low weight were seen given any additional snacks between meals like milky drinks and cake. They only get biscuits that are passed round with the tea trolley. One person’s relative buys supplement cereal bars, as they were not on corporate buying list. Another person’s nutrition care plan says kitchen aware she needs fortified foods. There was no record if she is getting this. One person who was cared for in bed, written information showed that he was choking on fluid, but there was no mention if GP had being told, so that a plan of action could be put in place. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 21 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 the service experience Adequate quality outcomes in this area. People living at the home are protected from abuse with the majority of staff aware of adult protection procedures. People feel safe at the home. A complaints procedure is available and, overall, people feel that any concerns will be taken seriously. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information in the AQAA stated that complaints are dealt with promptly and fully within the given timescales per the policy. Since the last inspection there has been five complaints made to the CSCI three of which had been referred to Social Services safeguarding Adult unit for vulnerable people, for investigation. Two sent to the organisation for them to investigate. People have access to the home’s complaint procedures and have recently been given in their room written information about the home, which also Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 22 includes a copy on the home complaint procedure. A copy is also displayed on the wall in the home’s entranceway. People who use the service and their visitors said they knew how and who to complaint to, they felt their complaint would be looked into, staff also said if they had a complaint they could speak to the manager. During discussion with staff they indicated that they had not received training on adult protection, but they knew what to do if an incident was brought to their attention. The manager said plans are in place for all staff to attend an in house training course on adult protection. The manager told us that all relatives have been informed that they can visit at any time to discuss any issues they may have. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 23 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 the service experience adequate quality outcomes in this area. Overall people live in a comfortable and safe environment. We have made this judgment using available evidence including a visit to this service. EVIDENCE: 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; people who use the service can register with the Access bus, which will drive up to the home. The accommodation consists of 60 single rooms, all of which have en suite facilities. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 24 There are 8 communal lounges, as well as a large reception area for people who use service and visitors. There are four dining rooms and a central kitchen. There are five communal bathrooms, two showers and eight communal toilets. The building is improving and several refurbishment works has been completed. Since the last inspection the organisation have moved the dementia unit to the top floor, which has created a large area for people to walk around if they wish. Many of the bedrooms were seen to be bare with only the essentials, such as bed, wardrobe and chest of drawers. We were told that people’s relatives had been made aware that they could bring items for people’s room such as furniture, pictures and any other memorable items, that people value. The environment is not enabling for people with dementia there was no clear sign posting and hotel style. People had their names above their bedroom doors. There was no other way for people to know it was their room. The manager said she had ask families to bring in old photo of people, so they could be put on their door, which may help them to know which room was theirs. Manager is aware that this is not the best solution and said the organisation has plans in place to make it more suitable and appropriate. Floor covering varied, there was carpet or laminate floor covering. One person on the ground floor said that they had not been consulted about the floor covering in their room. On the ground floor dining rooms were clean and brightly decorated each table covered with a tablecloth and artificial flowers on each. Tables were set with cutleries and paper napkins. The plates, bowls and cups were a mishmash of crockery. During the inspection of the premises there was a smell of urine in some bedrooms on the dementia unit and on the ground floor, the manager said she has tried to address this by replacing carpets with laminate floor covering, so that floor could be easily cleaned. The call system was checked, staff told us, because of the change to have general nursing on one floor and people with dementia on the top floor, staff was finding it difficult at time to determine which floor the call was coming from. The provider in their meeting with us said they are looking into to this, to resolve this matter. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 25 Although staff told us that calls could be cancelled at the main call box we told during the meeting with the registered provider that the system can only be muted for a short time at the main box and only cancelled at the point of call. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 26 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 the service experience poor quality outcomes in this area. There are not enough staff with the right skills to make sure that the needs of the people at the home are met effectively and consistently. The difficulties with staff recruitment mean that there is a lack of continuity for people living at the home. We have made this judgment using available evidence including a visit to this service EVIDENCE: Information in the AQAA stated that all staff are interviewed following policy and are employed for their skills, their motivation, and their attitudes towards the residents. Several issues relating to staffing, has resulted in complaints about the poor standard of care, people receive at the home since the last inspection in February 2007, and in so much there are a substantial amount of care staff vacancies, such as 72 hours for trained staff. However, one new 38.5 trained staff was due to start work at the home. There were 670 vacant hours for care staff. 88 hours of these hours were due to taken up with the employment of three care staff, the following week after this inspection. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 27 2 Care staff are on suspension, which is equal to 77 hours, which is not included in the vacancy number. All vacancies are covered by overtime or by agency staff. However the result of employing staff in insufficient numbers and without proper experience and skills this mean that the people living at the home are at potential risk of not having their needs met. The regional manager said the use of the dependency assessment rating tool is used to make sure there was enough staff. However, it was clear at the inspection, there was not enough staff on the dementia unit especially during meal times, to meet the needs of the people living there. The difficult in recruiting staff means excessive use of agency staff, which result in the lack of continuity of care for people living in the home. There were five care staff and one nurse in charge on each unit, however this number had been increase on the dementia unit for five care staff and two trained nurses, so that staff would be supervised to make sure people’s care needs were being met, there is also two domestic staff. After 4pm there are four staff and a trained nurse on each floor. Throughout the day there is a member of staff who carries out the laundry duty. There are two cooks one not qualified and have no previous experience of running a kitchen catering for frail elderly people. There was a kitchen assistant, to support the cooks. Most of the staff working with the people with dementia are not employed by the registered provider, which has resulted in people being looked after by staff who do not know them, leaving people at risk of getting poor care and care needs are not being met. The two staff and health care professional that responded to the survey were not positive about the staffing arrangement at the home, they felt too many temporary staff are being used, which they feel have resulted in people getting a poor standard and no continuity of their care. In discussions with staff about training they said although in past months they have had training they feel they could do with training that is specific to the illnesses people have, such as diabetes and Parkinson. There is a training Matrix that gives information on forthcoming training past training and updates. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 28 Several staff have done a twelve week course on dementia, with plans in place for any new staff working on the unit to have this training. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 29 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, 35 & 38. People who use the service experience Adequate quality outcomes in this area. The home is managed and run in the best interests of people living there. There is room for improvement especially around systems of communication between people, relatives, staff and the manager, as this could results in some practices that do not promote and safeguard the health, safety and well being of people living at the home. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The AQAA information states that the new manager in post is a qualified nurse and maintains her registration with the Nursing and Midwifery Council (NMC) Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 30 through regular update. She has completed the registered managers’ award (RMA). The manager at the time of the inspection had not yet applied to become the registered manager for the home. The manager said she is at the home at different times so that she is accessible to relatives visiting people who live at the home. The manager carries out in-house audits to help monitor the service and facilities at the home. The manager has a commitment to safeguarding the best interests of the people at the home. However, the lack of sufficient staff and a stable workforce means that the ability to develop the services and facilities at the home is impaired. Permanent staff and manager would enable to give people a good service. After recent events at the home and discussion with GP, an action plan is in place for monthly visits are made by a Geriatrician to make sure people are getting the care to meet their needs. There has also been meeting with GP’s, community nurses, and regular input from the community matron to support the staff at the home to make sure that people’s care are not over looked and they get the nursing care they require, by working with staff and advising on their training. The manager said that meetings with people and their relatives have started, so that they are kept informed on what is happening at the home and they have a forum to discuss group issues. Audits were carried out for accidents in the home. Accidents reports seen were completed with (good recording format) follow up information in 24 hours However, the 72 hours follow up information to show if any ill effect was noted was not completed. During the walk around the home no real health and safety issues were identified. All periodic safety checks are carried out and records and certificate kept at the home. People’s finances are mainly dealt with by their relatives, solicitors or managed on their own. Some money is also kept by the organisation for two people. A small amount of money is kept in a holding account, which is for all people. This account is non- interest bearing, and the organisation is having discussions with the bank to change this. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 31 A record is kept of all financial transaction, and weekly transaction sheet is completed and a monthly reconciliation sheet is also kept for a clear audit trail of all spending. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 32 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 3 3 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X X X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 33 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 Regulatio n 14 Requirement Although the assessment information has improved and there is some good information. The mental health assessment not completed leaves people with needs not being met. The registered persons must therefore make sure that the person carrying out the assessment, collects information that is enough to put together a care plan that is person centred, which takes into account people’s wishes and all their care needs. Last agreed dates 31/1/06 and 29/05/06. Care plans must be further developed to provide detail of the action, which needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of people living at the home are met. This must also include cultural needs. Staff caring for people must have enough information about the Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 34 Timescale for action 17/02/08 2. OP7 15 20/02/08 people and their care, so that no care needs are missed because of lack of detail information to staff. Last dates given to resolve this matter 31/1/06 & 29/05/06. although some work has started there some shortfalls. 3. OP7 15 The registered provider must 31/01/08 make sure that care plans have with more detail information of the actions which needs to be taken by staff to ensure that all aspects of the health, personal, social care and mental health such as dementia needs of people living at the home and how their needs are to be met. This must also include cultural needs. The registered provider must make sure that the level of details is enough and improve, so that staff have full details about people’s care needs so that they know what action needs to be taken and they understand how to care for people effectively, and understand and can properly support people from different cultural backgrounds. The registered provider must make sure that staff have detailed information on any speclist equipments used for people who use the service. So that they are used effectively. The registered provider must make sure that people identified as needing pressure reliving equipments such as pressure reliving cushions have one in place all times. People who dependent on staff to move must have their position changed regularly to stop them DS0000044491.V355929.R01.S.doc 4. OP22 16 31/01/08 5. OP22 16 05/02/08 Castleton Lodge Care Home Version 5.2 Page 35 6. OP8 13(1) (b) 7. OP12 12 8. OP9 13 (2) 9. OP9 17 Sch3 10. OP12 16 2(m & n) getting pressure sores. The record of changes of position for people must follow the designated timescale and the record kept up to date. Any wound care must have a care plan in place, showing how this is being treated and information that the tissue viability nurse is involved. Staff must make every effort to communicate with people, who have dementia, so that they are given due attention and do not get left alone. All prescribed medication must be correctly administered and recorded as detailed in the medication chart. This means that a person’s medical condition is being treated as prescribed. Care plans must accurately record how a person’s medication is being administered. This includes risk assessments for those who self-administer and detailed information on why a person’s medication is hidden or crushed. All though a designated member of staff has been employed to meet the social and recreational needs of people. The registered provider must make sure that there is a care plan with an action to be taken to meet social care needs in place for all people taking to account the people on the dementia unit and people from the different cultural backgrounds. So that People at the home will not be bored and will have more stimulation and occupation. There must be on going planned social activities so that there is on going stimulation that is appropriate for the group and DS0000044491.V355929.R01.S.doc 06/02/08 31/01/08 31/01/08 31/01/08 05/02/08 Castleton Lodge Care Home Version 5.2 Page 36 11. OP15 12 (3) 12. OP15 18 13. OP8 13 (4)(c) & 15 14. OP15 15 (4) (i) 15. OP15 16 (2) (g) 16. OP18 18 individual. This must include developing links with the local community and the opportunity for outings where appropriate. last agreed timescale 25/05/06. The manager must work more closely with catering staff to make sure that culturally sensitive meals are offered to residents from a different cultural background. Last agreed timescale 15/05/06 The registered provider must make sure that people on the dementia unit have access to enough staff to support people with their meals. And their meals are eaten in a relaxed atmosphere and not hurried. Staff should make sure that any specialist aids used, enable people to be independent is used appropriately and people given all due support. The registered provider must make sure that all identified risk such as choking has a plan of action such as monitoring when people are being help with fluid and meals and what to do in the event of this happening. Although people’s nutritional needs had been assessed and there was a plan in place, there was no evidence that the identified needs were being met on a day today bases. The registered provider should provide people with Cutleries and crockery that matches and is appropriate for people who use their service. The registered provider must make sure that all staff have training on safeguarding adults, so that they know the procedure to follow if an incident occurred. DS0000044491.V355929.R01.S.doc 31/01/08 05/02/08 31/01/08 31/01/08 28/02/08 31/01/08 Castleton Lodge Care Home Version 5.2 Page 37 17. OP19 23 18. OP26 23 19. OP27 18 The registered provider must give staff support in providing Moorside the dementia unit with equipments and decorations that will meet the specialist care needs of the people living in this unit. And people to be enabled by signage so they could visit their room independently if they could. The last agreed timescale 22/05/06 The registered provider must make sure that effort is made to take away the bad smell in the areas identified. There must be sufficient staff with the skills and experience, employed to meet the needs of people living at the home, taking into account the people with dementia. This must include kitchen staff and domestic staff. 28/02/08 31/01/08 28/02/08 20. OP30 18 21. OP27 18 This is to make sure that that there is proper provision for the health and welfare of people living at the home. 28/02/08 Arrangements must be made to make sure that all designations of staff have the training they need to meet the needs of the people living at the home, taking into people’s specialist care needs. This is to make sure that that there is proper provision for the health and welfare of people living at the home and they care needs are not missed. The registered provider must 28/02/08 make sure that staff have specific training to meet the current needs of people living in the home, for such as dementia and Parkinson, to make sure they have the knowledge to care for people. Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 38 22. OP28 18 The home must continue with the system in place to have 50 of staff with an NVQ. Previous timescale 30/11/06 The registered provider must make sure that the management in the home and to the home improves the practices in the home, so that it promotes and safeguard the health, safety and wellbeing of people living at the home. The registered organisation must put systems in place to make sure that there are consistence management in the home, so that it continues to run for the best interest of the people living there. The registered person must send to the CSCI an improvement plan stating how all issues raised, in this report will be resolved. 31/05/08 23. OP31 10 28/02/08 24. OP32 10 28/03/08 25 RQN 24 06/02/08 Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 39 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 OP15 OP9 OP9 OP9 Good Practice Recommendations Some consideration should be given to have a system in place to remind people who use the service what meals are on offer for the day. The amount of controlled drugs destroyed must be recorded. This information is required so a detailed record of these drugs can be kept. Photographs should be attached to MAR charts to make sure that medication is given to the correct person. A system should be in pace to make sure that the person doing the medication rounds is disturbed as little as possible. This helps to reduce the risk of medication errors. The organisation should make sure they provide all food required for people, so that all dietary needs are met. The contact with health care professional should continue, so that any change in people’s care is quickly taken care of. People should be given the choice of floor covering that is appropriate to meet their needs. The registered provider should make sure that issue around staff suspension is resolved to minimise the use of temporary staff. The registered provider must make sure that all accidents are followed up within 72 hours after as per the organisation’s accident recording system. The registered provider should make sure that the nurse call system in the home works effectively and people are not put at risk when wanting help. And staff are clear who is requesting help when the nurse call is used. 5. 6. OP15 OP8 7. 8. OP24 OP29 OP38 OP19 9. 10 Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Castleton Lodge Care Home DS0000044491.V355929.R01.S.doc Version 5.2 Page 41 - 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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