Inspection on 07/09/06 for Castleton Lodge Care Home

This inspection was carried out on 7th September 2006.

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

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

Other inspections for this house

Castleton Lodge Care Home 31/07/08

Castleton Lodge Care Home 29/11/07

Castleton Lodge Care Home 17/01/07

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

Hawkhills

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The Grove Waltham

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Carentan House

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 7th & 15 September 2006 10:00 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.V302095.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.V302095.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) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Ms Elaine Fitzgerald 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.V302095.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 28th February 2006 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 property is set in its own grounds with ample car parking facilities available at the front of the premises. There is a bus service along the main road; service users can register with the Access bus, which will drive up to the home. The 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 home offers care to a diverse group of older people who have various health and nursing needs. The accommodation consists of 60 single rooms, all of which have en suite facilities. The home is divided into two sides known as Cleavin and Mooreside. Cleavin mainly cares for people needing general nursing care and Mooreside care for people with dementia and related mental health illness. There are 8 communal lounges, as well as a large reception area for service users. There are two dining rooms and a central kitchen. There are five communal bathrooms, two showers and eight communal toilets. The weekly fees for services provided in the home vary depending on whether or not the resident is funded by the local authority and have nursing needs. Fees are supplemented by the nursing care component paid by the Health Authority or if they pay privately. Details of exact charges can be obtained from the manager. They range from £376.00p to £510.00p. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by the assessed quality rating of the home. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a visit to the home. All regulated services will have at least one key inspection before 1st July 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people living at the home. All core National Minimum Standards are assessed and this provides the evidence for the outcomes experienced by residents. At times it may be necessary to carry out additional visits, which might focus on specific areas like health care or nutrition and are known as random inspections. This visit was unannounced and was carried out by two inspectors over two days. It started at 9.30am, finished at 3.30.pm on the 7th September 2006, and was completed between 10 am and 2pm on the 11th September 2006 with feedback given to the manager and the regional manager. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents, and to see what progress had been made meeting requirements and recommendations made at the last key inspection. Information to support the findings in this report was obtained by looking at the pre inspection questionnaire (PIQ). Examples of information gained from this document include details of policies and procedures in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. Survey cards were distributed to relatives/ visitors and residents four weeks before the visit was made. CSCI comment cards with post-paid envelopes were sent to the home, to be given to residents and their relatives in order to give people the opportunity to comment on the services provided by the home. At the time of writing this report one resident and six relatives/visitors surveys had been returned to the CSCI. They showed that overall people were satisfied with the standards of care provided. But they also showed that some people thought there were often not enough staff on duty and not enough activities provided. One person said they were not aware of the complaints procedure or that they could ask to see copies of the homes inspection reports. Relatives/visitors surveys did say that they were made to feel welcome and could visit in private if they wanted to. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 6 Records in the home were looked at, such as care plans, staff files, complaints and accidents records. Residents, their relatives and visitors were spoken to as well as members of staff and the management team. What the service does well: What has improved since the last inspection? Since the last inspection, an enclosed area in the garden has been put up to give residents from Mooreside the opportunity to go into the garden independently, without the risk of going out of the grounds. New baths and showers have been installed to provide residents with equipment to meet their needs, and to aid staff with moving and handling of residents at bath time. Bathrooms had either been or were in the process of being redecorated and tiled. Some of the bedrooms had been redecorated, and new curtains are now in place in the sitting area in Mooreside. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 7 The central heating has been repaired, and was said to be working in all areas of the building, and therefore no more portable heaters was being used. Most staff have been given updated training on adult protection. What they could do better: The home had made good progress towards meeting requirements and improving the quality of care provided in the home, which had been acknowledged, this however had not been continued. There are 7 requirements as a result of this inspection. Ten requirements are from the last inspection. This gives a total of seventeen and two recommendations of good practice. The home’s information document did not have any information on the specialist care provided at the home. Work on making the care plans more individual and detailed must continue, making sure that residents and their representatives are involved whenever possible. Residents in the home have medical concerns, such as diabetes, however no training had been provided. Although the visitors and residents were aware of the care plan and their right to be involved in the planning of care, there was no clear indication that this was taking place to ensure residents are safe. Risk assessments must be developed, stating what measures staff must take to reduce and limit the risk. Risk assessments must cover areas such as smoking, the use of hot water bottles, falls, falls from height, low weight, and pressure ulcers. Care plans must be evaluated monthly and a full review of care needs carried out at least annually. Despite being found tidy and comfortable when entering the home the inspectors found that there was an unpleasant odour, which was also in some bedrooms through out the premises. In the main, Mooreside unit was found to have an odour. The practise of signing medication administration sheets after administering all medication must cease. Staff must sign the administration sheets at the time when the medication is given to the resident. There are still concerns about staffing levels particularly on Mooreside throughout the day. During this inspection action carried out by staff was seen to compromise residents dignity. Some residents and relatives said that there did not always seem to be enough staff on duty. The format for social care assessment is given to relatives to complete but this is not always completed and gives the impression that people had no skills in their past life, which could help to plan their social care. A number of relatives said that CSCI inspection reports were not available in the home. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 8 From discussion with staff on Mooreside on days of the inspection it would appear that because of the apparent low staffing levels on this unit, they rely on verbal rather than written information about residents, and this means that vital information could be missed. Some of the residents at the home suffer from dementia; however, staff spoken to on the day of the inspection were unclear about how they would meet the changing needs of these people in their care. Each resident must have a plan of care that is personal to their individual needs for staff to follow, and staff must refer to this document rather than rely on verbal information. Without following a plan, important care needs may be missed There are no regular activities provided; the home must provide more activities for residents. The majority of residents said that they were bored. This aspect of the service needs to be developed to take account of the individual needs, preferences and capabilities of residents. Although there is some recognition of peoples’ spiritual needs, more needs to be done to raise awareness of equality and diversity within the service. A number of requirements and recommendations have been made; the registered manager and the regisrted provider must now take appropriate action to deal with issues raised in this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 9 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.V302095.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home’s information did not give sufficient information about the home and the services provided. EVIDENCE: Although prospective residents and other interested parties have access to information about the home and the service provided, the information seen related not only about the home, but also a large proportion about the organisation. More information is needed relating to the environment, and care provision for people with dementia. Two of the most recent admissions care files seen on Mooreside did not contain evidence to show that either had been assessed prior to admission to the home. The deputy Manager was unable to confirm whether this was carried out and was unable to find the pre assessment documents Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 11 Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Care plans need further information about the individual, so that they are person centred, to enable staff to know the person, and know how to meet their needs. Staff did not have time to access care plans before they start caring for the residents. There are no real plans of care for residents who are in the last days of their life. Staff did not always use/or have access to the information available to them to put together a full care plan of all identified care and social needs. Some of the practices in the home compromised residents dignity. EVIDENCE: Six care files were case tracked three from Mooreside and three from Cleavin The documentation seen on Cleavin showed that each resident had been assessed and care needs were identified and planned for. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 13 Care plans were reviewed monthly and contained some good detail to assist the carers in providing the appropriate care package, however, the home must be more aware of the need to reassess an individual when their care needs have changed. Two of the residents care files seen on “Mooreside” did not reflect the changing needs and therefore were inappropriate. Despite the survery information received from relatives indicating that they were involved in the care of their relatives living in the home, there was no written evidence to indicate this had been carried out. The care files case tracked showed that the residents are thoroughly assessed in areas such as nutrition, tissue viability, continence, falls and oral health. These documents were reviewed monthly. Some residents on Cleavin, whose risk assessments had identified as a potential risk, did not always have a plan of care how they would be managed/ minimised. Those residents on Moorside that were identified as having a high risk of developing a pressure sores had care plans in place to assist the care staff with providing the appropriate care. Two residents identified as needing their positions changed two hourly had turns charts in their rooms for staff to fill in. When these were inspected large gaps were seen where they had not been filled in. One resident that had already developed a pressure sore, was sat out in a reclining chair for long periods of time without any pressure relieving equipment being used. The nurse on duty in that unit agreed that the foam mattress was inappropriate for her needs, and agreed that she needed some form of air mattress to help lessen the pressure. The wound care plan was inappropriate for the need of that individual as it was unclear what the nurse had to do and how often. Long gaps were identified with the documenting of the dressing of the wound. One service user, who was assessed as terminally ill, had inappropriate care plans in place. These care plans did not reflect the change in her condition and therefore the staff were not providing the appropriate care package. The homes’ policy for residents who are terminally ill was not followed to ensure her needs were met. No referral had been made to a palliative care nurse to assist with the care package. Another resident identified, as a diabetic had no reference made to this condition in his care plans. He was supposed to have random blood sugars taken but no record was seen to show this had happened. Care staff delivering the care were given no guidance to ensure his diabetic needs could be met. The care files for those residents with dementia show that the home is attempting to meet the physical needs of the individual. However, the primary care need of residents with a diagnosis of dementia is being overlooked. The care files do not attempt to look at the resident as an individual, and there was very little information contained within the care files that will assist residents with their dementia needs. A more person centred care approach is needed. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 14 Overall the care records did not reflect the wishes of the individual other than who would take care of their funeral arrangements. Medications administration sheets were signed for after all medication was dispensed. There were unexplained gaps in medication record charts. The nurse administrating the medication did not use the format to record the reason when the medication was not given. All staff throughout the home were seen to treat service users with respect and attempted to assist them were they could It was clear survey that information received from relatives, indicated that they felt the staff at the home were caring, and they would be contacted if anything untoward occurred with their relative at the home. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. There are little or no social activities provided, which appeared to have created an environment for apathy and boredom. EVIDENCE: Information throughout the home identified that poor social assessment information was in place. The home relied on relatives to complete the social assessment information, which meant that for some residents’ there was no information if they did not have the capacity to provide staff with the information of their life history, or of where and how they would like to spend their time during the day. There was poor provision of activities for a group of residents with primary dementia needs. Routines in the home are regimented and inflexible. Very little was identified to show residents are provided with opportunities for stimulation through leisure and recreational activities. Records examined showed the activities and recreational needs of the residents are not identified and provided for. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 16 Two service users’ relatives said that they were happy with the care provided, however, concerns were raised with regards to the lack of staff time spent with the residents. Relatives said that they are able to visit the home when they wish, and that no restraints are placed on them in this area. No evidence was found to show the home actively involved the local community and voluntary groups. The lunchtime meal was observed during the inspection. Those residents that were able to sit in the dining area were assisted to do so some had chosen to sit in their rooms or in sitting areas. Many of the residents clearly needed assistance with their meals but due to the lack of staff this was not possible and this lead to some residents’ dignity being compromised. During the lunchtime on Mooreside it was seen that dignity was compromised many times during the mealtimes, when staff were trying to feed several residents at the same time. Due to lack of staff those residents needing assistance were not receiving it appropriately. Residents were seen to have stained clothing from food spillages Residents’ mouths were covered with food and not wiped. Residents were wiping their faces with the backs of their hands and their sleeves as there were no napkins and no one there to help. One resident was seen slumped in her chair and using her spoon to scrape her food off the table then eating it. All of these issues compromise the residents’ dignity and should not happen. The organisation needs to address these issues to make sure that people in their care get a service that meets the entire core six principles of care. Dignity, choice, independence, rights, privacy and fulfilment. Staff spoken to on the day confirmed that this was normal and they agreed that they struggled to maintain the standard of care they would like to give. Staff were observed to assist residents with their meals where they could and this lead to assisting two to three residents at a time. One carer was observed to stand over the resident when assistance was being provided, and there was no interaction observed between staff and residents during the meal. The meal was seen to be rushed and chaotic at times. Castleton Lodge Care Home DS0000044491.V302095.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home has the required policies and procedures to make sure that residents are protected. Residents and their visitors feel safe and are confident that any concerns they might have will be taken seriously and acted upon. EVIDENCE: The complaints procedure is displayed in the reception area of the home as well as being included in the homes written information. It is clear, detailed and easy to understand. In discussion with residents, /relatives visitors’, and from surveys information, it was clear that they knew who to speak to if they had any concerns. Residents and certain visitors said that they were confident any concerns they raised would be dealt with promptly and properly, however, information from the survey cards from two relatives indicated that they were not aware of the complaint procedure. The manager was advised to display the procedure in a more prominent place where it can be easily seen i.e. near the signing in book. The information in the Pre Inspection Questionnaire indicated that in the last twelve months, there have not been any complaints. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 18 The homes training records showed that not all staff were receiving training in adult protection issues. Those staff spoken to showed an awareness of adult protection issues and how to respond to them appropriately. Staff have access to the home’s policy and procedure for adult protection, the local authority multi agency procedure and the Department Of Health No Secrets document. Staff have received a copy of the organisation whistle blowing procedure. Castleton Lodge Care Home DS0000044491.V302095.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. No improvement has been made to the environment of Mooreside since the last inspection in September 05. The malodour that continues to be present through out the building needs to be addressed. Residents on Cleavin should now benefit from the heating being installed throughout the home. The wedging open of the front main entrance door during the day could compromise residents and staff safety. EVIDENCE: At the last inspection the inspectors found that several portable heaters were being used, they were told that the reason was the heating system on one side of the building was not working effectively. On this inspection the inspectors were told that this had been repaired. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 20 When the inspectors arrived at the home for the inspection the main entrance door to the building had been left wedged open, although there was a security system in place. The practice of wedging open the door compromises the home’s security. On entering the home there was a strong smell of urine, this was also evident throughout the building in bedrooms, but mainly on the dementia unit. The manager said since the last inspection some of the bedrooms and communal areas had been redecorated. The inspectors were told that there were plans in place for new floor covering for some bedrooms, and replacement of and redecorations of certain areas throughout the home. Domestic staff are allocated to each unit. They said that they had received training in the use of cleaning equipment and products used. They had also received appropriate health and safety training and including COSHH (Control of Substances Hazardous to Health) and moving and handling. Aprons, gloves and equipment are available to reduce the risk of cross infection. Staff were seen using these appropriately. New baths and showers had been installed; some decoration was in progress at the time of the inspection. The environment on Mooreside does not reflect that resident’s independence and choice is promoted. More effort is needed to have memory boards, pictures, and recognisable items that could be placed around the unit that would aid memory and recognition of the people living on this unit. There was nothing special about the environment that would indicate that this was a “specialist unit” caring for people whose memory was impaired. This was discussed at the last inspection. It is acknowledged that there is now an enclosed garden leading from the ground floor of Mooreside which would enable residents to walk into a safe area, the manager said this area would have flower beds and seating areas. On the whole, the home had a welcoming atmosphere, staff welcomed residents’, and visitors’ back onto the unit after trips out. Castleton Lodge Care Home DS0000044491.V302095.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29, 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. There are not always enough staff on duty on Mooreside to make sure that residents specialist needs are met, and that residents’ dignity is not compromised. Residents’ are protected by the homes’ recruitment procedures, however training for staff was limited, and there was no real certainty that staff are supported in developing their skills and knowledge through regular one to one supervision. Care staff training was not up to date. EVIDENCE: On the first inspection day the manager was on sick leave and the deputy manager, who was the person in charge of the home did not have access to staff files for the inspection. So another date had to made to inspect these records During the second day of the inspection when the manager was available, two staff files were inspected. All relevant information was present for the recruitment and selection process, which included information that indicated that enhanced CRB (Criminal Records Bureau) checks had been carried out. Terms and conditions of employment were issued and induction training had been completed, and for nursing staff, there was confirmation that they were registered with the NMC (Nursing and Midwifery Council). Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 22 Staff spoken to confirmed that there were issues regarding staffing levels in the home. One member said that the care provided was compromised by the lack of staff. This member of staff said that residents are not getting the personal care that they need due to this problem. Staff were observed to be very task orientated and were busy carrying out these tasks during the day. There was very little personal contact or one to one care seen on the dementia care unit, this is an area that needs to improve. During feedback to the manager and area manager, it was confirmed that they were aware that the staffing levels on this unit are low, and are looking to increase the staff on the unit next year. Advice was given that this needed to be done immediately, because the present staffing levels compromised the core principals of care to the residents on the Dementia Care Unit. Staffing levels at this time on each unit consisted of, one trained nurse and four care staff. The manager said that the training programme is ongoing and will make sure that all staff receive training appropriate to the work they are to perform. Information given in the PIQ said that training given over the last twelve months has included Dementia care, death and dying, healthy eating, safe handling of medication, safety compliance, Protection of Vulnerable adults, health and safety which included moving and handling, customer service, supervision, development, fire safety, Fire Warden, First aid, NVQ and Infection control. COSHH training had also been planned for August 06 and wound and pressure area care scheduled for the September 06. Information in the PIQ said that out of the thirty-two care staff, fourteen have achieved a qualification equivalent to NVQ (National Vocational Qualification) 2 or higher. However on the day of the inspection the inspectors were told that there was six care staff with an NVQ qualification. The training records were examined and it was identified that there are large gaps with the provision of mandatory and specialist training provided by the home. It was not clear from the training Matrix seen, if care staff received a minimum of three days training per year. The information was out of date therefore it indicated that there was no structure or plan in place for care staff training. Additional training must also be given to all staff on, care planning, falls, aggression management, and managing challenging behaviour. Although staff are given moving and handling training, the manager said that because of some of the poor practices by staff, she has had to provide further training in this area for several staff. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 23 The inspector advised that manager that moving and handling facilitators for the home must also have regular updated training to make sure that their training information given to staff is correct, and their skills are updated. It was clear from discussions with some care staff that they were unsure of what the care needs of residents suffering with dementia were, and indicated that they would like to be provided with training in the specialist areas of care that are relevant to the residents’ needs. The manager was advised that there must be a training plan for all staff caring for people with dementia and any associated illness. The manager said that these were mainly new staff and that she was aware that if the training is not given to staff they would not be able to deliver a person centred care for the individual. Castleton Lodge Care Home DS0000044491.V302095.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The registered manager must make sure that all staff have regular supervision and training because the lack of training and supervision will allow staff to become complacent. The registered provider and the manager must make sure that the home is run in the best interests of the all the residents’ in their care. EVIDENCE: The management structure for the home is the registered manager, a deputy manager/senior nurse to Cleavin. The deputy manager who facilitated on the first day of the inspection told the inspectors that she was leaving the following week. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 25 The manager has the relevant qualification and experience to manage the care home and was well supported by the deputy. During the past three years they have both made many changes and have worked hard with residents their relatives and staff to provide a better service at the home. However, during the course of this inspection, it was apparent that there was some aspects had deteriorated in the home management. It was clear that the manager needs a deputy that has some management time. This would enable her to carry out her role and manage the home, making sure that staff deliver a good standard of care to the people living in the, taking in to account their vulnerability, and to address formal supervision. During discussion with the regional manager it was said that the organisation has agreed to put in place supernumerary hours for the deputy in the next year. The inspectors advised that this was needed now, and that the vacant deputy manager position must be filled as soon as possible, so that the home is well supported by a full management team. The manager said that questionnaires are sent annually to residents, relatives, and professionals who have an input in the home, to get their views on the service provided at the home. No result of the surveys’ finding is available or given to participants. The manager is an appointee for two residents living in the home. This is not advised and should be reviewed to appoint another individual outside the organisation. There is an ongoing police investigation with regards to resident monies going missing. Evidence showed that the systems adopted to protect residents’ monies were poor, and did not properly protect the two residents for which the manager was appointee. All financial accounts at the home were being audited due to a police investigation. It was identified that the home pools all residents’ personal monies in a non interest bearing account. This is poor practice and should be reviewed to ensure all residents receive interest on their monies where possible. The home had recently set up a system of selling toiletries to the residents. Although it was a good system that enabled resident the opportunity to purchase their own toiletry and for some fund raising exercise for the residents fund it was identified that residents were not buying the toiletries for the price they were bought for. But in some cases there was a mark up of 300 to purchase the goods. The manager said that the difference was put into the resident’s fund. However, no evidence was provided to show consent was obtained to do this or appropriate records kept to show that had happened. The high mark up price was seen as poor practice. The manager agreed that this was poor practice, which she said would cease immediately. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 26 Although during the inspection the manager and the deputy said staff had received regular formal supervision, staff on duty at the time were unsure what formal supervision was and if they had received it. This matter was discussed with the manager, that clear information must be given to staff regarding one to one supervision. All staff must be given one to one supervision at least six times a year, which include appraisals. During the inspection of the premises flammable equipment was seen stored under the stairs. Poor moving and handling techniques were observed on two occasions, and the wrong advice for the use of hoist slings was being given to care staff, by a person who stated she was a moving and handling trainer. A resident was seen being pulled up out of a chair in an inappropriate way that could have lead to an injury. This matter was brought to the attention of the home manager, who agreed and said that up date training was needed for staff moving and handling facilitators, and that she had had to put some staff on additional moving and handling training due to their poor practices. Although the information in the Pre-inspection Questionnaire (PIQ) stated that staff had received fire training, from discussion with staff it was apparent that appropriate up to date training was not been provided to all staff working in the care home. The home has a “handy person” whose job is to carry out health and safety and maintenance checks throughout the building. All defects are recorded with a record made of all work and checks carried out. It was clear from discussion with domestic staff that they follow the organisation’s policy procedure for cleaning up bodily fluids safely, to make sure infection control is not compromised. Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 2 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 3 2 2 3 3 3 3 2 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 2 2 X 2 2 2 2 Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The home’s information must have information on the specialist care provided at the home. 29/05/06This timescale was given at the last inspection. The registered manager must make sure that the person carrying out the assessment collects information that would provide them enough information to put together a person centred plan of care, which also take into account the last wishes of the resident. Previous timescale agreed 29/05/06 & 31/1/06 Timescale for action 30/11/06 2. OP3 14 31/10/06 3. OP7 15 31/10/06 Care plans must show in detail how residents’ needs in respect of pressure area care, nutrition, falls and specialist health care needs (e.g. Dementia) are being identified and met. With the action to be taken to manage/minimise potential risks. The registered manager must Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 29 make sure that the cultural needs of residents living the home are identify and met. This timescale was agreed at the last inspection, 29/05/06 (Unmet) 4 OP12 16 2(m & n) All effort must be made to meet the social and recreational needs of residents in the home. A designated staff must be provided, so that time is given to provide residents on the specialist unit with appropriate meaningful social and recreational activities, to meet their needs, preferences and capacity. This timescale was agreed 25/05/06. (Unmet) The manager must work closely with catering staff to make sure that culturally sensitive meals are offered to residents from a different cultural background. Taking into account their wishes and preferences. Last agreed timescale 15/05/06 (unmet) The registered provider must make more effort to support the manager and staff in providing Moorside with equipments and decorations that will meet the specialist care needs of the residents living in this unit. This timescale was agreed 22/05/06. The home must continue with the system in place to have 50 of staff with an NVQ qualification. 30/11/06 5. OP15 12 (3) 15/11/06 6. OP19 23 30/11/06 7. OP28 18 30/11/06 8. OP24 23 Door locks have not yet been 27/06/06 provided to service users’ private DS0000044491.V302095.R01.S.doc Version 5.2 Page 30 Castleton Lodge Care Home accommodation. Last agreed date 07/02/06 9. OP36 18 (2) A system for staff supervision must be implemented and staff must receive supervision at least six times a year. (Previous timescale of 28.2.05 unmet). Records required by regulation must be maintained up to date and accurate. Records of fire training and fire drills must be maintained. 16/11/06 10 OP37 17 (2) 30/11/06 11 OP38 23 (4) (d) 15/11/06 12 OP28 18 All staff must receive fire training and instructions at intervals of no more than 6 months. The registered person must 31/03/07 ensure that a minimum of 50 of care workers have achieved NVQ level 2. The registered person must make sure that staff continues to receive training appropriate to the needs of the service users. This must include all areas of health and safety related training, induction and foundation training to Skills for Care standards and specialist training such as dementia. The training needs of qualified nurses must also be addressed. The registered persons must make sure that the systems for managing medication are safe. The registered persons must make sure that the home is run in a way that promotes the privacy and dignity of residents. 20/12/06 13 OP30 18 14 15 OP9 OP10 13 (2) 12.4 08/11/06 18/10/06 Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 31 16 OP27 18 17. OP33 24 The registered person must make sure that there are, at all times, enough suitably qualified and competent staff on duty to meet residents needs. Further consideration must be given to the staffing levels on the dementia unit. So that residents have enough staff available to them over 24 hours. Timescale agreed at the last inspection (unmet) The registered persons must provide the CSCI with a written improvement plan. The improvement plan must set out how they intend to make improvements to the service and the timescale within which this will be achieved. 28/10/06 06/11/06 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 OP3 Good Practice Recommendations Detailed records should be kept of all assessments carried out. Some consideration should be given to have a system in place to remind residents what meals are on offer for the day. And food that is severed is appropriate to meet the needs of the residents in the home. 2. OP15 Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Castleton Lodge Care Home DS0000044491.V302095.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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