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Inspection on 31/07/08 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 31st July 2008.

CSCI found this care home to be providing an Adequate service.

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

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

What the care home does well

The home has good links with health care professionals to support them in people`s care. The manager has an open door policy, which is used by people, relatives and others to discuss any issues they may have. The home has organised group meetings with people who live at home and their relatives, giving the opportunity to discuss any issue that affects the home. One relative told us "we are always told of any changes in my mother`s care." Another relative said, " Dealing with people with dementia is a difficult task, the care home does try." Staff said what they do well is " meet the residents needs when there is enough staff."

What has improved since the last inspection?

What the care home could do better:

Although the standard of people`s written information, such as care plans have improved. These are not constantly evaluated and people`s care is not regularly reviewed with the involvement of people and/or their relatives. Staff still need more information about people from a different culture and the way in which their care should be delivered so they get care and support that meets their cultural needs. People must have a care plan with actions to show how their social care needs will be met. This must take into account the people on the dementia unit and people from different cultural backgrounds. People still need to have access to regular planned social activities that is appropriate for the group or individuals. This must include developing links with the local community and the opportunity for outings where appropriate for all people living in the home. People on the dementia unit are still not getting a good standard of care. This is because of the number of temporary staff who are not familiar with individual peoples needs. This means the peoples weight are not checked and people`s nutritional needs are over looked. Staff must move people as detailed in their care plan. This will ensure that people`s pressure areas are continually monitored. Staff who work on the dementia unit must have access to management that will support and guide them in delivering a good standard of care. Requirement and recommendations have been made.

CARE HOMES FOR OLDER PEOPLE Castleton Lodge Care Home Green Lane New Wortley Leeds LS12 1JZ Lead Inspector Valerie Francis Key Unannounced Inspection 31st July 2008 09:30 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.V369447.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.V369447.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 castleton@fshc.co.uk 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.V369447.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 29th November 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. The home is owned and managed by Four Seasons Health Care Ltd. The property is set in its own grounds with ample car parking facilities. There is a bus service along the main road. People can register with the Access bus, which will drive up to the home. 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 which have dementia or related mental health problems. 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. There are two dining rooms and a central kitchen. There are five communal bathrooms, two showers and eight communal toilets. The fees are £388:96 to £573. These fees were given in July 2008. Items not covered by the fees are hairdressing, chiropody, toiletries, newspaper and taxis. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. Two inspectors carried out this unannounced inspection between 9am and 5.45 pm. After the last key inspection we sent the provider a warning letter about the standard of care on the dementia unit. We also requested an improvement plan to show how the requirements made in the report would be resolved. We received a plan covering how care would improve. As a result of the previous inspection and our concern about the standard of care to people, we decided to visit the home in an early timescale to carry out a key inspection. The purpose of this visit was to assess whether people’s care had improved and the home was acting upon their improvement plan. We looked at all the information received about the home since the last inspection. An Annual Quality Assurance Assessment (AQAA) self-assessment form was sent to the home to complete prior to this inspection. People who use the service, staff and health care professionals were sent surveys to complete. Relatives who were visiting at the time of inspection were also given surveys to complete. During the inspection we spoke to people, staff, relatives and visiting health care professional. Additionally we looked at care records and observed working practices. 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 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 environment. We gave detailed feedback of our findings to the Manager and Regional Manager. However, not all the evidence gathered in the inspection is included in this report. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There have been improvements in most areas since the last inspection such as: • • • • • • • • Staff have had training on specialist equipment used for people, so that they can use them effectively. People who need pressure relieving equipment such as a pressure relieving cushion now have one in place at all times. There are care plans and body maps in place for wound care treatment, which shows the involvement of the Tissue Viability nurse. People who have their medication hidden or crushed now have a care plan in place for this action. A record of the amount of controlled drugs destroyed is now available. People now get the food they need to meet any special dietary and cultural needs. All accidents are now followed up within 72 hours in accordance to the organisation’s accident recording procedures. Some work has been done on the nurse call system to resolve the issue of staff getting the correct information from the main call alert box. DS0000044491.V369447.R01.S.doc Version 5.2 Page 7 Castleton Lodge Care Home This means that some people in the home now get a better standard of care. However, more improvement is needed so that everyone gets the care they need. 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. The summary of this inspection report can be made available in other formats on request. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People receive the information they need to be able to make a decision about moving into the home. Anyone wanting to use the service has their needs assessed before they are admitted. EVIDENCE: Since the last inspection the home has reviewed their information that is available to people who wish to use their service. This now gives people a better understanding about the home and the care provided. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 10 In the home’s AQAA they said, that they have improved the quality of information available and ensure that any prospective resident receives their brochures in a timely manner. Relatives spoken to at the inspection said they had been given written information about the home before their relative moved in. We were told that all new people have a comprehensive assessment by the manager or designated nurse from the home, using the organisation’s DART tool (Dependency Assessment Rate Tool) before they move in. This is to make sure people’s care needs can be met by the home. We looked at assessment information for the last 3 people who moved into the home and found the assessment process and documentation had improved. This now shows people’s care and social needs in good details. Mental health needs were also identified. Additionally, we saw assessments for moving and handling, risks, falls, nutritional, mobility, pressure sore, skin integrity with body maps to identify any skin damage. We also saw copies of people’s Easy Care Assessment that had been carried out by the placement agency before the involvement of the home. A health care professional said: • “Care staff skills and experiences are fine on the ground floor, however on the EMI unit staff lack the skills to deal with this client group.” When we spoke to visitors who were visiting their relatives, they all indicated that they had been involved in the assessment process before their relatives moved in the home. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Some people at the home do not get the care they need. People are not always protected by some of the medication practices. EVIDENCE: In the • • • • AQAA the home said what they do well are: Give a good standard of care. Promoting Person Centred Care, individual assessment of needs. Individual Risk assessment. Regulation 26 reports monthly report on the home from the regional manager. DS0000044491.V369447.R01.S.doc Version 5.2 Page 12 Castleton Lodge Care Home • Risk Monitor reports. During the inspection we saw several examples of people not getting a good standard of care on the dementia unit (Moorside) and staff failing to meet people’s needs. We looked at three people’s care plans. We found that generally the written information was good and staff had action plans to follow, to meet people’s care needs. However, we found that people were at risk of their care being overlooked. Care plans had not been reviewed; to make sure people’s needs had not changed, or if they were changes in people’s needs there were no plan of care in place. We were told that one person’s care needs had changed. However, there was no plan in place to support this. There was also none or very little information about people’s social care needs so that people get the stimulation they require. Although people had some information about their funeral arrangements, there were no plans in place for their end of life care. This is to make sure that people get the care and support they would like at that time. In most cases all identified risks had a plan of action to show how the risk would be minimised or managed. There was evidence that people had a nutritional risk assessment carried out. Although there was information showing what to do to meet people’s nutritional need, such as involvement of the dietician and weekly or monthly weight checks. Some people’s weight had not been checked within the timescale stated in their plans. This should be done so that any significant weight loss can be dealt with. We also found that people could be at risk of becoming dehydrated. For example, charts to record fluid intake, showed that some people were getting less than a litre of fluid in 24 hours. We found that charts to record hourly change of people’s position were not kept up to date. Therefore, it was difficult to assess if people were being moved in the timescale laid out in their care plan. We were also told that care plans are written with people and their relatives. However, when we spoke to some relatives, not all knew that their relatives had a care plan. Additionally, neither people nor their relatives had signed any of the care plans seen, to indicate they agreed with the plan of care. The home is well supported by health care professionals who visit the home almost daily or monthly. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 13 These are some of the comments made by health care professionals who had some concerns about the care people are getting on the dementia unit. • • • “Weights “swing” from month to month with little apparent intervention from qualified staff.” “Dependent patients on the EMI unit need close supervision or help with eating & drinking and toileting.” “On the nursing unit, care is reasonable good and on the EMI unit it is not very good. If patients have complex medical conditions these are less well reported and dependent patients on the EMI unit need close supervision.” We carried out a SOFI observation on the dementia unit, we saw that some people got more attention from staff than others. People who were less able to communicate got very little attention. This was also evident in the dining room while people were waiting for lunch. For some people the only time staff spoke to them was when there was a task to perform, for example giving someone a cup of tea. Not all relatives were happy with the standard of care their relatives were getting. Some said that they were satisfied with the care and attention their relatives were getting at the home and if there were an issue with their relative they would be told. However, some said, “Staff are not always around to assist people to the toilet or with their meals.” We saw staff’s approach to people was calm and kind and they maintained people’s dignity and privacy when assisting them. We looked at safe handling of medication and we found that the arrangement for storage of medication was satisfactory. There were no photographs on MAR sheets for a lot of people on ground floor. Some gaps on MAR charts, creams are not always signed for and eye drops are not always dated when opened. Weekly audit for medications were not always carried out in accordance with the organisation’s procedures. We noted that the last date this was carried out on the dementia unit was the 27th June 2008. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 14 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 & 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are supported in maintaining contact with their family and friends and visitors are welcomed at the home. People on the dementia unit do not always get suitable planned social activity to occupy them during the day. EVIDENCE: The home told us in the AQAA that: • There are various activities that are tailored to specific residents abilities, likes and dislikes. • Social activities co-ordinators work on each unit. Residents are encouraged to participate in family events and visits outside. • There are home cooked meals, with a choice at each mealtime, food Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 15 • • alternatives available at every meal. Home baking daily. Chef reviews the menus and the meal timing regularly in order to ensure residents have as much input as possible. Encourage families to discuss their relatives past interests to enable completion of life history’s particularly on the dementia unit. We found that people’s care file had information on their likes and dislikes and some had information about their past social interests. One person’s family had written a “pen picture” about their relative’s previous life. This gives staff some background information about the person they are caring for. Two new members of staff are employed to carry out social activities. Although we saw a sing along session with people, there were still very little social activities taking place for people with dementia. The manager said time is being spent with people to determine what activities would be appropriate for them, and this information would be put into their care plan. The dining rooms have round tables, which were set with tablecloths and cutlery. None of the tables set had condiments with salt & pepper so people could add to their meals if they wish. We noticed after lunch that the TV was on but no one seemed to be watching it, some people were asleep, some just gazing into space. It was clear that some people get more attention from staff than others, and people who are less able to communicate get very little attention. This was also evident in the dining room while people were waiting for lunch. For some people the only time staff spoke to them was when there was a task to perform, for example giving someone a cup of tea. Another lunch the activities organiser came into the lounge, but she didn’t seem sure what to do or how to engage with people. She sang some songs, which some people clearly enjoyed. However, other people showed no reaction or interest and there was no evidence of staff trying to engage these people. The manager said she recognised that these staff needed additional training and she planned to send them to another home in the organisation to work along side the activity organiser. Also she planned for them to have formal training that would assist them in their work with people especially those with dementia. We were told that the home works closely with the community dietician, who had recently visited the home, to provide care and catering staff with training on nutrition. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 16 Although we were told that supplements were given to people to increase their weight, half the people on the dementia unit were under weight, weighing less than 50 kilo grams. We spoke to the cook who said all effort is being made to increase people’s weight, by fortifying food with extra cream and cheese, for people to gain weight. We observed that in the afternoon some people were given a milky fruit drink but this was not monitored by staff to make sure people drank it. We saw that people’s intake of food was being recorded, but there was no evidence that these records were monitored. For example, in some cases there were large gaps when people did not have anything to eat, typically these were between the evening meals and breakfast. Some charts showed that other people were offered supper, for example sandwiches, at about 8.30 pm and it wasn’t clear why everyone isn’t offered this. One relative said, “My husband’s condition does not allow him to communicate his needs, for example if he is still asleep in the morning, the carer will let him sleep on and he misses breakfast.” Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 17 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 & 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. 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. There is a complaints procedure, overall concerns are always taken seriously. EVIDENCE: Information in the AQAA said: • The organisation’s quality survey results showed a large number of relatives were not aware of the complaints policy despite this being on the wall in reception and in everyone service user guide issued to all new residents. • They respond quickly to any concern/complaint raised, adhere to Company policy when responding to complaints and sustained low level of complaints. We found that the home had a clear and accessible complaint procedure, which is displayed on the wall in the entrance of the home. At the time of this inspection we had not received any complaints about the home. However, some complaint have been made at the home. These have Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 18 been investigated using the home complaint procedure. We saw copies of the investigations reports and the outcome letters sent to complainants. People and their relatives said if they had any concerns or complaint they would talk to the manager or one of the nurses in charge, and were sure their complaint would be dealt with. Not everyone who returned surveys knew how to make a complaint. We were told in surveys: • • The manager and the head of downstairs unit seem to react to concerns and liaise with families. The manager is very good at listening to concerns and learning lessons. However, sometimes the same mistakes occurred repeatedly, mainly related to the different cohorts of staff who are temporary. The home has procedures in place and staff have had training on safeguarding protection of vulnerable adults, to make sure that people are safe. Staff spoken to knew what to do if a safeguarding incident occurred. A copy of the Adult Protection procedure is displayed on the staff notice board in the staff room. The home told us that response is made in a timely fashion to any allegations made around safeguarding protection issues. And they liaise with appropriate authorities when required. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 19 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 & 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Improvements are being made to make sure that the home is a safe, pleasant, and suitably equipped place for people to live. Good levels of specialist equipment ensure that people’s independence is maintained. EVIDENCE: The manager said there is a replacement and redecorating programme for the home and a handy person to carry out some repair and redecorating. There were some odours in places on the dementia unit (Moorside) but there were systems in place to manage this. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 20 On Moorside we saw good signage and items on the walls for people to interact with. Plans were still in place to complete the area, by personalising people’s bedroom doors with past photos and some life history about them, which would help people to recognise their room. We had concerns about people’s information being shared with others in this way, we were told that this had been discussed and been agreed with people and their families. The home has a designated smoking room for people who live there, although the windows in this room were open, some people complained that they could smell smoke in the corridors and in their rooms. It would appear that additional ventilation is needed in this area. Since the last inspection most of the bathrooms had been refitted with new assisted baths and a shower room had been redecorated. Plans are in place to replace baths and redecorate all bathrooms. Some people had personalised their room with furniture, fitments and memorabilia of their life. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 21 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 & 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People do not always have access to staff that can provided them with continuity of care. This is to make sure that people’s needs are met effectively and consistently. EVIDENCE: The staffing levels for Moorside have increased since the last inspection, there are now 2 nurses and 8 care staff during the morning and 1 nurse and 5 care staff in the evening. Staffing levels for (Cleaven) the ground floor unit, in the morning there is 1 nurse and 5 care staff and during the evening 1 nurse and 4 care staff. During the night there are 2 nurses and 4 care staff to cover the entire home. The home follows the organisation’s recruitment and selection procedure, which makes sure that staff employed are suitable to work with people living in the home. We looked at 3 staff files and they showed that the home had Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 22 worked in accordance with the organisation’s procedure and had completed all the required checks before new staff started work. Health care professionals said they were concerned about the amount of temporary staff used on the dementia unit, to care for this highly dependent group of people in the home. Staff employed by the home said, “Agency staff don’t know residents and don’t know how to care for them or know their likes and dislikes.” They also said “mostly there are six care staff on the first floor and the home gets agency staff if necessary, usually we have one or two agency staff on shift.” Additionally we were told by relatives that there are far too many agency staff for continuity of care to be successful. “There is enough staff but not permanent staff.” The manager said she was aware of the problem and tries to get the same agency staff to get continuity of care for people. The manager also told us that they have been unsuccessful in recruiting the right calibre of staff, to make sure people are well cared for. However, after a recent advertisement for staff they were interviewing the day after the inspection for care staff and a nurse for the first floor. Health care professionals said, “the bottom floor is fine but the EMI unit lacks consistent, permanent and high calibre staff; a lot of agency input makes it feel very reactive and disjointed.” “The EMI unit still struggles. I think getting good quality staff is difficult, but continuity of care is important in this patient group.” “Due to so many agency staff on the EMI unit there is a lack of consistency and issues “slip through the net.” “The EMI unit needs high calibre, substantive qualified nurses who can provide the experience that such a unit needs.” Conversation with a member of staff, said she had a good induction, was allocated to work with senior care assistant and was given a workbook to go through. She also had 2 days dementia training along with other staff and “we feel we have learned a lot.” One other member of staff said, “ There was no time for detailed induction and I do not feel I have been given training to do the job.” “However, some Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 23 training has been given which is useful knowledge on the client group but my professional development has not been discussed or considered.” Not all staff have (NVQ) National Vocational Qualification. The manager said this is arranged for staff and there is ongoing training with updates for such as moving and handling, infection control, health and safety and fire safety. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 24 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. We have made this judgement using a range of evidence, including a visit to the service. Some people’s care and support is not well managed. Communication between the organisation and management of the home, people and relatives must continue. EVIDENCE: We were told that what the home does well is encourage people and their relatives to approach managerial staff whenever they wish. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 25 They also told us that the home has a friendly and open atmosphere which is conducive to people and their visitors expressing their views. The manager has been in post for over twelve months and has recently applied to become the registered manager for the home. The regional manager is a regular visitor to the home to oversee the care provided and support the manager with the management of the home. The home management team now includes a deputy manager, who when in post, will support the manager. We were told that each unit has a designated nurse in charge so that staff are managed and supported to give people the care and support they need. At the time of the inspection only the nursing unit had a nurse allocated to take charge and manage the unit. Visiting professionals and staff told us because of lack of management, leadership and staff supervision on the dementia unit, people do not get continuity of care from staff who are well managed and supported to meet their specialist needs. The organisation’s yearly quality audit questionnaires give people, relatives and health and social care professionals the opportunity to give their views on the service provided at the home. However, participants are not always made aware of the findings of the audit. The manager said the outcome action plan is discussed with staff at their meetings. A copy of the outcome report should be made available. The home has systems in place to make sure all safety checks are carried out in a timely manner and a record kept of each. During the walk around the building we noted that several fire doors were wedged open, some doors have been fitted with door closures that are activated by fire alarm. The regional manager said in the near future all doors would have these fitted. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 26 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 X 3 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 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 X STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 (2) Requirement All prescribed medication given must be signed for on the medication administration chart. If medication is not given the reason why must be recorded on the medication administration chart. This will make sure that people received the medication they are prescribed. Previous timescale 31/01/08 Appropriate and suitable activities and social interaction must be provided for people with dementia. This will make sure that people have the opportunity to socialise and join in with activities. Previous timescale 31/01/08 People’s nutritional needs must be assessed, monitored and reviewed. People must receive the diet and fluids they need to meet their nutritional needs and their weight must be monitored in accordance with their care plan. This will make sure that people’s nutritional needs are met. DS0000044491.V369447.R01.S.doc Timescale for action 18/10/08 2. OP12 12 18/10/08 3. OP8 12 (3) 18/10/08 Castleton Lodge Care Home Version 5.2 Page 28 4. OP27 18 Previous timescale 28.02.08 There must be sufficient suitably qualified and experienced staff employed to meet the needs of people with dementia. Previous timescale 28/02/08 The registered person must send to the CSCI an improvement plan stating how all issues raised, in this report will be resolved. 18/10/08 5. RQN 24 18/10/08 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. Refer to Standard OP9 Good Practice Recommendations Photographs should be attached to medication administration charts to make sure that medication is given to the correct person. Castleton Lodge Care Home DS0000044491.V369447.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V369447.R01.S.doc Version 5.2 Page 30 - 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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