Inspection on 19/10/05 for Catterall House

This inspection was carried out on 19th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Catterall House 09/04/09

Catterall House 17/04/08

Catterall House 17/04/07

Catterall House 30/05/06

Catterall House 20/04/05

Catterall House 12/10/04

Catterall House 20/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Catterall House Lancaster New Road Catterall Lancashire PR3 0QA Lead Inspector Ms Jenny Hughes Unannounced Inspection 19th October 2005 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 Catterall House DS0000009690.V259167.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. Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Catterall House Address Lancaster New Road Catterall Lancashire PR3 0QA 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) 01995 602220 01772 816967 rameshvarshagulati@hotmail.com Dr Varsha Gulati Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The registered person shall at all times employ a suitably qualifed and experienced manager who is registered with the NCSC. Registered numbers to include two (2) named people under 65 years of age. 20th April 2005 Date of last inspection Brief Description of the Service: Catterall House is a large, old, house that has been adapted to suit the needs of older people, for example, a passenger lift has been installed and ramps fitted to entrances. It is a two storey house with single bedrooms sited on ground and first floors. Toilets and bathrooms are conveniently located. Set in its own grounds, the home also has an ample sized car park The home is situated on a main road in a rural area, within walking distance of local shops, and a short drive from Garstang. It is also on a bus route. The home provides sufficient communal space, and a separate smokers lounge is provided. Staffing is provided over 24 hours, every day of the year. Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 3 hours, and was one of the two inspections, which must be made each year. Additional inspections may be made if necessary. The inspection was unannounced, in that the owners were not aware that the inspection was to take place. A tour of the home was made, and rooms were inspected at random. Staff and maintenance records were viewed. Four staff on duty were spoken to, and seven residents. The manager was available, and discussed plans for the home’s development. What the service does well: What has improved since the last inspection? What they could do better: The standard of decoration and furniture around the home is poor, not having been renewed for several years. There is ripped wallpaper, scratched paint, cracks in walls and stained carpets. Halls and landings are dark and uninviting. Several bedrooms have old washbasins, bedding and curtains, with tired, stained décor. A few rooms are nicely decorated. There should be a programme of maintenance to plan how and when all of the rooms in the home are to be decorated in turn. Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 6 Some bedrooms in use have not had radiator covers put in place to protect residents from hot radiators. This task needs to continue around the home until all are covered. The activities programme is minimal, and needs to develop to provide opportunities for all residents to join in if they wish. As required at the last inspection, the Policies and procedures of the home need to be reviewed every year, and updated and improved if need be. The procedures should describe what action staff should take in that home, in line with its policy. For example, the medication procedure is not correct as the system of giving medication has been changed, and the written procedure has not been changed. These procedures are for staff to refer to and follow if they are not sure of what to do, so must be correct. Residents and their families are asked for their views about the home from time to time, but a more regular way of getting this information, and showing how things have been acted upon, needs to be in place. 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. Catterall House DS0000009690.V259167.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 Catterall House DS0000009690.V259167.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 The home has a clear assessment that is carried out for all residents. This means that a service is provided that is tailored to the individuals’ needs and preferences. EVIDENCE: The last inspection showed that some pre-admission assessments of need made by the manager for potential residents were not completed in enough detail. At this inspection three files were viewed, and all were seen to have fully completed assessments, from which the manager could check that the staff could give suitable care to the person, and the home was the right place for them to live. Signatures showed that the individual agreed with the assessment. From this assessment, a plan of care was devised, which detailed each person’s individual needs. “I visit people at home, or in hospital, to make assessments. Sometimes they call straight into the home with family members and have a chat and a look Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 9 around.” stated the manager. “The manager came to see me,” said a resident, “but my daughter sorted a lot of it out for me”. Staff spoken to were aware of the care needs of the identified residents, following information passed onto them by senior staff. Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 10 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): 9 The medication at this home is well managed, promoting good health. EVIDENCE: As at the last inspection, the Medication Policy does not reflect the monitored dosage system in use by the home. This needs to be updated to clearly outline all of the procedures used in the home. A named staff member supervises medication storage and ordering, and the medication procedures now used are correct and efficient, staff responding to advice given at the last inspection. Records were complete and up to date. Catterall House DS0000009690.V259167.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 Minimal activities take place in the home. The activity programme needs to be developed to enrich residents’ lives more fully. EVIDENCE: Individual files record the hobbies and interests of residents. The manager stated that activities are mostly not pre-arranged, as they are dependant on how residents feel each day. Decisions are made daily, with the most popular being a game of Bingo. The manager and staff said that some residents preferred to watch videos of films. A physiotherapist calls occasionally, and encourages group exercises. Books and newspapers are readily available in the lounges. A record is kept of the activity of the day, and which of the residents have taken part. The variety of activities recorded is few, and the same small group of residents join in them. There needs to be development of activities to try to include all of the residents in order to have some stimulation to encourage and motivate. “I don’t know what I’d like to do. I like resting” said one resident. “We play Bingo. I like that. I don’t know what else we do. Not a lot”, said another. Catterall House DS0000009690.V259167.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): These standards were not inspected at this visit EVIDENCE: These standards were not inspected at this visit Catterall House DS0000009690.V259167.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, 24, 25 and 26 The standard of the décor within this home is poor, with little evidence of improvement through maintenance or future planning. Therefore the home does not present as an attractive and pleasant environment to live in. EVIDENCE: The large garden around the home is mainly rough lawn, which is mown when needed. A small patio area has some seating for use in better weather, but it was looking untidy and in need of a clean up at the inspection. One named staff member supervises the recording of any minor maintenance needed, and also keeps a record of checks on call bells, emergency lights, and water temperatures. Refurbishment has been required in all parts of the home for a long time, and this has been noted and agreed by the owners on reports they have sent to the CSCI. No work has been done, and the décor around the home has deteriorated further, with cracks in walls, ripped wallpaper, badly marked paintwork, and broken ceiling tiles. In one bedroom used by a resident, the Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 14 washbasin was old and marked, the walls were discoloured, furniture was old and marked, and bedding looked worn and totally mis-matched with odd curtains. Several of the bedrooms are of this low standard. A few of the bedrooms are decorated appropriately. Halls and lounges require decorating, and carpets need regular cleaning to keep to the necessary standard. There was no plan of refurbishment available. Some of the residents’ bedrooms do not have radiator covers in place. This was an ongoing task and needs to be continued. Window restrictors are now in place on some windows. These need to be in place on all windows where there is a risk to the health and safety of the residents. “My rooms alright. You just get used to it. I suppose it could do with a lick of paint”, said one resident, “they keep it clean though”. The laundry area is situated away from the kitchen and dining room, and was clean and tidy. Staff spoken to were aware of the correct way to work to prevent and control infection Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 15 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): These standards were not inspected at this visit EVIDENCE: These standards were not inspected at this visit Catterall House DS0000009690.V259167.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): 31, 33 and 38 The manager has a vision for the home, and is supported well by senior staff in providing clear leadership, with staff demonstrating an awareness of their roles and responsibilities. There are only limited systems for seeking residents’ views, but there is evidence that those views are acted upon. Working practices in the home promote the health, safety and welfare of residents. EVIDENCE: There is no registered manager. The present manager has applied to be registered with the CSCI, and by the next inspection this application should have been successfully completed. The manager has completed her NVQ Level 3 in Care, and has started the Registered Manager’s Award course. “You can’t fault the girls. And the manager will always tell them how they should do things. They’re all kind girls”, stated a resident. Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 17 No further surveys have been used to get feedback about the home from residents and relatives, and the manager stated she aims to further develop this and set up regular use of it. The manager is very welcoming to families and residents alike, and always makes herself available if someone wants to speak to her. She responded happily to phone calls and visitors to the home during the inspection. The manager regularly checks records written by staff. Policies and procedures need to be reviewed every year, as several of them do not reflect the actual practices of the home. Induction training includes safe working practices in the home, including fire safety. Staff spoken to understood their role and action to take if they discovered a fire. Catterall House DS0000009690.V259167.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 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X X X X 1 1 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement The medication policy must reflect the procedures carried out in the home (Previous timescale of May 2005 not met) The activities programme must be developed (Previous timescale of June 2005 not met) The care home must be kept in a good state of repair both internally and externally. All parts of the home must be kept reasonably decorated. Parts of the home where residents have access must be as far as possible free from hazards to their safety. Radiator covers must be fitted to all radiators accessible to residents. A formal system must be in place to review the quality of care provided at the home with regular consultation with residents and their representatives. The results must be made available to them. Must ensure policies and procedures are reviewed DS0000009690.V259167.R01.S.doc Timescale for action 30/11/05 2 OP12 16 30/11/05 3 OP24OP19 23(2) b) d) 31/01/06 4 OP25 13(4) 31/12/05 5 OP38OP33 24 31/12/05 Catterall House Version 5.0 Page 20 annually. (Previous timescale of May 2005 not met) 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 Catterall House DS0000009690.V259167.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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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