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Inspection on 03/10/05 for Castletroy Residential Home

Also see our care home review for Castletroy Residential Home for more information

This inspection was carried out on 3rd October 2005.

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

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

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

What the care home does well

The home provides a good standard of care to service users based on comprehensive pre-admission assessments and regular reviews. Staff treat service users with respect and all attempts are made to maintain their privacy and dignity. The relationship between staff and service users is relaxed and warm. The home is well-managed and service users and their relatives have confidence in the way the home is managed. Comprehensive risk assessments are available to ensure the safety of service users. Service users feel valued by the home as their views are regularly sought on areas relating to food and activities.

What has improved since the last inspection?

One requirement was made at the last inspection relating to weekly fire alarm tests. This requirement was confirmed as met at this inspection.

What the care home could do better:

Care plans must include information on social interests and mental health. Care plan goals must relate to the identified need. Records for a named service user with a pressure ulcer must be maintained up to date and in sufficient detail. All complaints policies must include timescales and the contact details of the CSCI. The carpet at the entrance of the laundry room must be replaced. Staff files must contain evidence of eligibility to work. References must be verifiable and include the reason for leaving if the member of staff worked with vulnerable adults or children. All staff must receive induction and other training in the core areas relating to their work. An individual training plan must be available for all staff. Fire drills must be carried out every three months. Records of all fire drills must be maintained. A formal process to seek the views of service users and other stakeholders on the quality of care offered by the home must be carried out.

CARE HOMES FOR OLDER PEOPLE Castletroy Residential Home 130 Cromer Way Luton LU2 7GP Lead Inspector Georgia Chimbani Unannounced Inspection 3rd October 2005 10:45 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 Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 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. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Castletroy Residential Home Address 130 Cromer Way Luton LU2 7GP 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) 01582 417995 01582 723615 Castletroy Home Mrs Jacqueline England Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70), Physical disability over 65 years of age (8) of places Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service user must not exceed 70. No one falling within the category of OP may be admitted to the home where there are 70 persons of category OP already accommodated within the home. No one falling within the category of PD(E) may be admitted to the home where there are 8 persons of category PD(E) already accommodated within the home. 15 March 2005 Date of last inspection Brief Description of the Service: Castletroy is a purpose built two-storey home situated on the outskirts of Luton in a residential area. The home is registered to care for up to seventy service users over the age of sixty-five years, eight of whom may also have physical disabilities. Single room accommodation with ensuite toilet and washbasin facilities is provided for each service user. There are communal areas on both floors such as a lounge and dining room. Shared bathing and toilet facilities are conveniently located throughout the home. A hairdressing salon and activity room are located on the ground floor. A lift ensures all areas of the home are easily accessible to all service users. There is a spacious and well-maintained garden both at the front and rear of the home. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Present at this unannounced inspection was the registered manager Mrs Jacqueline England. The inspection was six hours in duration. As part of the interview process the inspector was able to speak to six service users and two relatives. Feedback on the quality of care was very positive. The inspector observed that while staff treated service users with respect there was good rapport between them. The atmosphere in the home was relaxed and despite the size of the home felt very homely. One requirement was made at the last inspection relating to weekly fire alarm tests. This requirement is met. Eleven requirements are made following this inspection. The inspector has confidence that these will be met within the timescales set by the CSCI. What the service does well: What has improved since the last inspection? One requirement was made at the last inspection relating to weekly fire alarm tests. This requirement was confirmed as met at this inspection. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 6 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. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Pre-admission assessments ensure that the home admits service users whose needs have been identified and can be met. EVIDENCE: Five service user files were examined, four of which were for service users who had been admitted to the home in the past year. There was documentation on file indicating that preadmission assessments had been carried out by the home. Where a local authority had placed a service user, additional assessment information was sent to the home before their admission. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Information contained in care planning documentation must be improved to ensure that all needs are clearly identified and to provide a consistent level of care for service users. The home ensures that service user’s health care needs are met through the intervention of appropriate health professionals. Service users feel valued by the home because of the positive way in which staff work with them. EVIDENCE: Care plans were seen on all of the five files examined. There was evidence that reviews were carried out on a monthly basis. The current layout of the care plan documentation comprises a section on the problem, the goal[s] and the action to be taken. One service user file contained no information under the section “problem”. Two goals were listed but these were conflicting goals and it was not clear whether the goal was to prevent the service user developing a pressure ulcer or to treat existing ulcers. This conflict in goals was also noted on another service user file. The registered persons must ensure that service Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 10 user care plans clearly identify the needs of service users and goals relevant to those needs. The detail of service user care plans varied according to service user’s needs, however all care plans lacked information on social interests and mental health. The care plan of a service user who is very independent and requires minimal assistance only contained information relating to their personal care. There was no information on mobility, communication, social interests, diet or other needs. In a discussion with the manager, she advised that the Activities Co-ordinator maintained information about service user’s social interests in a separate file. The inspector was of the opinion that this information must also be contained in care plans to ensure that care staff share the responsibility of meeting all of the service user’s care needs. Service users interviewed by the inspector expressed satisfaction with the care offered by the home however there was no indication that they had been consulted regarding their care. The registered persons must ensure that service user care plans include information on social interests and mental health. There must be evidence of consultation with service users regarding the care offered to them. No photographs were available on all of the five service user files examined. The manager advised that she is aware of the need to have this done and is in the process of arranging this. This is required. The care plan of a service user with a pressure ulcer made reference to the regular completion of a fluid and turning chart. Examination of these records revealed that the turning charts had last been completed around the 11th of September 2005. The fluid chart was up to date but it contained no information on how much fluid the service user was drinking. The absence of this information concerned the inspector as this could have a negative effect on the health and recovery of the service users. The registered persons must ensure that up to date and detailed records are maintained on the fluid and turning charts of a named service user. Records examined confirmed that service users have access to various health professionals such as GPs, Chiropodist, Dentist and Physiotherapist. The inspector observed a GP arriving at the home to attend to a service user. Interviews with approximately six service users confirmed that staff treat them with respect and maintain their privacy such as knocking on the door before entering their room. The inspector was able to observe service users during lunch and observed that there were sufficient numbers of staff available for those who required assistance. Staff gave service users assistance with feeding while sitting next to them and in a manner that maintained their dignity. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 By actively seeking their views, the home ensures that there is a high level of satisfaction among service users. EVIDENCE: Documentation examined at the inspection indicated that service users had been consulted regarding preferred times for going to bed and waking up. Minutes of residents meetings were also viewed and these indicated that service users were able to engage in discussions and make decisions about their life in the home. The inspector received very positive feedback regarding the food provided at the home and observed that alternative choices were available at lunch. This was confirmed in discussions with service users. One service user explained that they thought alternative choices were available but they were not sure as they enjoyed the food and hence had never had any reason to ask for an alternative. Discussions with the Cook and inspection of the menu plan indicated that service user’s feedback had been acted on, such as more variety in vegetables. The inspector confirmed that culturally appropriate food was provided for a named service user. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Complaints information available to staff must be consistent to maintain service user confidence regarding complaints. EVIDENCE: The home’s complaints record was examined. There have been seven complaints since the last inspection. Six were made directly to the home and one complaint was made through the CSCI. All complaints were responded to or resolved within the relevant timescales. The complaints procedure was examined and this was found to be satisfactory. The inspector was also given a copy of the employee handbook and separate guidance for staff regarding handling of complaints. Information contained in these documents did not give the timescales for responding to complaints or the contact details of the CSCI. The inspector advised the manager that information on complaints must be consistent therefore these documents must be revised accordingly. Interviews with service users and relatives revealed that they had confidence in the manager and her ability to deal with complaints should the need arise. The registered persons must ensure that all complaints policies contain information on the timescales for responding to complaints and the contact details of the CSCI. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Service users live in a clean and comfortable home. The carpet at the entrance of the laundry room must be replaced to ensure the health and safety of both service users and staff is not compromised. EVIDENCE: The home is a purpose built building that is brightly decorated and well maintained. On going maintenance by a maintenance person ensures that the premises are maintained to a high standard. Service users interviewed confirmed that they were comfortable in the home. An inspection of some bedrooms revealed that service users are able to decorate their rooms with personal possessions. A tour of the building revealed a high standard of hygiene. Cleaning duties are carried out daily by cleaning staff. A programme of spring-cleaning ensures that all areas of the home are regularly subject to intensive cleaning. The home has a laundry room that is well equipped with three washing machines and three dryers. Safety data sheets for products used in the laundry were displayed on the wall. The carpet at the entrance to the door of the laundry room must be replaced as it currently poses a trip hazard. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 14 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): 29 and 30 Recruitment practices at the home have improved, however there are still areas of concern that if not addressed promptly leave service users vulnerable to abuse. It is questionable how the needs of service users can be effectively met when some staff have no training in the core skills required to care for service users. EVIDENCE: A sample of five staff files was examined. Original criminal records bureau [CRB] checks were available for all five staff. Two references were available on all files however not all references could be verified. For example a reference for a member of staff who previously worked in a care home was written on the standard form sent by the home but with no stamp or letterhead of the previous employer to confirm the authenticity of the reference. References of some staff indicated that they had previously worked in a position involving work with vulnerable adults or children but no information was available on why they left this position. The registered persons must ensure that references are verifiable. Where staff previously worked in a position involving work with vulnerable adults and children, written confirmation must be sought for their reason for leaving. No recent photographs were available on all five files. This is required. All staff files contained evidence confirming their identity however two files did not contain evidence of eligibility to work. In discussions with the manager she advise that the named members of staff were students and a letter was available from their college confirming their enrolment as students. A letter from the Home Office was attached seen confirming receipt of the Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 15 member of staff’s visa application. The inspector considered this insufficient evidence as both letters gave no indication of the member of staff’s current immigration status. The registered persons must ensure that evidence of current eligibility to work is available for all members of staff. Three of the five staff files contained a statement by the member of staff as to their physical and mental health. The manager informed the inspector that this information was now included on the recently revised application form. Staff without this information had been recruited before the application form was revised. The inspector considered this to be acceptable as there was evidence that recently recruited staff had this information on file. Training records of the same five members of staff were also seen. There was a wide disparity in the amount of training received by individual members of staff. For example one member of staff had a very comprehensive training record covering all basic training relevant to their position. In contrast a member of staff who had been working in the home since June 2005 had not received any training at all. The inspector expressed concern about this to the manager. The manager assured the inspector that this had been discussed individually with named members of staff and they would be receiving training in the next few months. Documentation shown to the inspector showed that the home has an organisational training and development plan for the rest of the year comprising basic training for care workers. Three of the five files did not contain evidence of induction training. This is required. The registered persons must ensure that all staff receive basic training covering the core areas of moving and handling, food hygiene, basic first aid, infection control, fire safety and adult protection. Individual training plans and induction records must be available for all members of staff. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 33, 35 and 38 The home must implement a quality assurance to ensure that the views of service users and stakeholders are sought and acted upon. Financial practices in the home protect service users from financial abuse. The safety of service user is being compromised thorough irregular fire drills. EVIDENCE: The manager advised the inspector that a quality assurance exercise to seek the views of service users had been carried out in December 2004. Survey forms shown to the inspector indicated that views had been sought from relatives and not from service users and other stakeholders. The manager informed the inspector that a more comprehensive quality assurance exercise including all interest groups would be carried out in the next few months. The registered persons must ensure that a quality assurance exercise is carried out to seek the views of service users, relatives and other stakeholders. A report of Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 17 the findings of this exercise must be available for inspection by the CSCI. Service users at the home are encouraged to administer their finances with support from their relatives where appropriate. The administrator of the home keeps small amounts of money on behalf of service users for the purchase of items of clothing and other incidental expenses. A random check of a service user’s financial records showed that records were accurate, up to date and receipts were available for any expenditure. Documentation was seen confirming the up to date and satisfactory completion of the following health and safety checks; gas, electrical installations, fire equipment, emergency lighting, portable appliance testing, nurse call system, hoists, lift and water storage tanks. Records were seen confirming weekly fire alarm tests. Documentation viewed indicated that the last fire drill had been held in the home in March 2005. The manager advised that a drill had been held recently however in the absence of documentary evidence this could not be verified. The registered persons must ensure that fire drills are carried out every three months and that records are maintained. Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15 Schedule 3 Requirement The registered persons must ensure that service user care plans clearly identify the needs of service users and goals relevant to those needs. Files must contain a photograph of the service user. The registered persons must ensure that service user care plans include information on social interests and mental health. There must be evidence of consultation with service users regarding the care offered to them. The registered persons must ensure that up to date and detailed records are maintained on the fluid and turning charts of a named service user. The registered persons must ensure that all complaints policies contain information on the timescales for responding to complaints and the contact details of the CSCI. The registered persons must ensure that the carpet at the entrance of the laundry room is DS0000015033.V250455.R01.S.doc Timescale for action 03/01/06 2 OP7 15 03/01/06 3 OP7 12(1b 17(1a Sch3 p.m 22(4)(7) 03/01/06 4 OP16 03/01/06 5 OP19 23(2)(b) 03/01/06 Castletroy Residential Home Version 5.0 Page 20 6 OP29 19(1)(a) (b)(c)Sch 2 7 OP29 19(1)(a) 8 OP30 18(1)(a) (c)(i) 9 OP30 18(1)(a) (c)(i) 10 OP33 24 replaced. The registered persons must ensure that references are verifiable. Where staff previously worked in a position involving work with vulnerable adults and children, written confirmation must be sought for their reason for leaving. The registered persons must ensure that evidence of current eligibility to work is available for all members of staff. The registered persons must ensure that all staff receive basic training covering the core areas of moving and handling, food hygiene, basic first aid, infection control, fire safety and adult protection. The registered persons must ensure that individual training plans and induction records are available for all members of staff. The registered persons must ensure that a quality assurance exercise is carried out to seek the views of service users, relatives and other stakeholders. A report of the findings of this exercise must be available for inspection by the CSCI. The registered persons must ensure that fire drills are carried out every three months and that records are maintained. 03/01/06 03/01/06 03/01/06 03/01/06 03/01/06 11 OP38 23(4)(e) 03/01/06 Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Castletroy Residential Home DS0000015033.V250455.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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