Inspection on 21/06/05 for Howard Castle Care Centre

This inspection was carried out on 21st June 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

Howard Castle Care Centre 05/09/08

Howard Castle Care Centre 28/08/07

Howard Castle Care Centre 26/10/06

Howard Castle Care Centre 22/06/06

Howard Castle Care Centre 28/11/05

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Howard Castle Care Home Dacre Street Morpeth Northumberland NE61 1HW Lead Inspector Kathryn Reid Announced 21 June 2005 9:30 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 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. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Howard Castle Care Centre Address Dacre Street Morpeth Northumberland NE61 1HW 01670 510634 01670 513529 None European Care (England) Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Tracie White CRH 40 Category(ies) of OP Old age (40) registration, with number of places Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28 February 2005 Brief Description of the Service: The home is a large two-storey building that has undergone considerable alteration to provide a care home environment. Situated near the centre of Morpeth the home is within easy walking distance of the local shops and local amenities. A small, enclosed car park is available with ramped access to the home. There are large, level landscaped gardens at the front of the house with a spacious and well-used patio area. The home can accommodate up to forty service users including those with nursing needs. The home has thirty-six bedrooms with two registered as double rooms. Fourteen of the bedrooms have en-suite facilities. There is one main dining room and three lounges. There is an adequate number of assisted bathing and shower facilities on each floor and one passenger lift. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this announced inspection; it took place over one day and lasted seven hours. The lead inspector spent time with the manager and examined records and then met with five staff on a one to one basis. The other inspector carried out a full tour of the premises and also examined records. She met with eleven residents and three members of staff. One relative was seen during the visit. Twenty-eight residents were present at the home - seventeen had nursing needs. The inspectors had met with a representative of the new homeowner two days before the inspection. Twelve residents and five relatives have responded to the Commission’s comment cards sent in advance of the inspection visit. This is a low response in comparison to other homes of a comparable size and service. What the service does well: What has improved since the last inspection? Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 6 The manager is very motivated and enthusiastic about the new owners of the home and their proposed changes that include giving her more responsibility and freedom to manage in her own way. There is much better use of computer systems and communications with additional support and input from the homeowner. Good quality and useful policies and procedures are now in place. Progress has been made with care planning and staff training and supervision. This has helped staff to do their jobs well and keep residents safe and well cared for. 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. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 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 standard(s) 1 Prospective residents can access relevant, up to date and useful information about the home. EVIDENCE: The manager was making very good progress with review and update of the new service user guide to reflect the takeover by and provide detail of the new owner. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 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 standard(s) 7,8 and 9 The standard of care planning has improved but health and personal needs are still not fully detailed. The health and personal needs of the majority of residents are met and are kept under review. Residents will be better protected as more staff receive medications training. EVIDENCE: The new owner plans to introduce new nursing and care documents and the format of these looks very promising. Existing individual plans of care were examined and have continued to improve. These have been appropriately reviewed and updated, however there is no evidence of resident or relative input to them. One serious concern was identified where there was insufficient evidence to explain a five-day delay in obtaining suitable medical treatment for a resident who had fallen. This person only had five care plans and care instructions to meet well-identified risk assessments were not available in the absence of a safety plan. The manager was asked to fully investigate this matter and feedback to the lead inspector. It was agreed in view of this incident and some Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 10 concerns over accident records that daily review and progress entries will be made for all residents in an effort to improve communications and peer review. Residents are weighed monthly, or more frequently if required, and nutritional risk assessments are carried out. An overview of any underweight residents is not kept as previously recommended. A range of risk assessments and reviews are undertaken, residents have regular access to health services such as doctor, district nurse, dentist, chiropodist and optician. Some senior carers are going to administer medicines to the residential clients and this positive step will allow the nurses more time for their nursing duties. Medications update for the nurses is planned for. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 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 standard(s) 12,13 and 15 Social care needs are not met and the standard of recreation and stimulation remains inadequate. Residents are supported to keep contact with family and friends but are not given opportunity to maintain links with their local community. The meals are good offering both choice and variety in a pleasant setting. EVIDENCE: A number of residents told the inspector that there was no social and stimulating activities on offer within the home. Their comments included “we do nothing”, “I just sleep”, “we haven’t done anything to celebrate VE Day” and “it makes for long days”. The home does not have a social activities coordinator and, other than some individual one to one work, staff confirmed that they are not providing any activities for residents. Some external entertainers had visited and there was now access to funds that will allow for use of a minibus for outings. Residents spoke of making decisions about visitors and of going into town, but only with their family and visitors. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 12 Residents commented on their lack of community involvement and opportunities to go out “I only go out when my family take me”, “I never get to go out”, “nobody from the town visits and I don’t get into town but it is only minutes away.” The inspectors, once again, spent time with the senior nurses advising how social care and stimulation can and must be improved and that there is no reason why this cannot be provided by the care staff as well as a dedicated activities organiser. Residents were observed enjoying a lunchtime meal that was tasty and nutritious. All commented on the quality and range of food served “ the food is really good”, “ I enjoy the meals”, “ it would be easy to put on weight as the food is so nice”. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16,17 and 18 All complaints are taken seriously and quickly acted upon. Some residents did not perceive that their electoral rights had been met. Residents will be better protected from abuse when all staff are fully trained and correct procedural guidance is in place. EVIDENCE: Staff and residents spoke of their participation, where able, in the recent election process. However, there was some confusion over postal votes, with some residents thinking that these had not been received. The manager agreed to look into this. A complaint from relatives had just been made to the Commission. The manager and another inspector were investigating this. The new adult protection policy was not appropriate or up to date. It made no reference to the Northumberland Adult Protection Procedures and failed to follow national guidance on investigation procedures, preservation of evidence and the management of interviews. Not all staff have received training in adult protection and this must be addressed. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19,20,21,24,25 and 26 Residents live in safe and comfortable surroundings that are clean and pleasant. Further expansion of internal hygiene systems will better protect staff and residents. There is currently little evidence of refurbishment or upgrading of the premises and there are outstanding building requirements. There are sufficient washing facilities and residents have comfortable bedrooms with their own possessions around them. The laundry facilities are not adequate to ensure satisfactory infection control measures. EVIDENCE: Since the last inspection there has been minimal improvements to the décor and carpeting of the home. However this has only been gradual with residents and staff commenting upon the lack of improvements. A domestic told the inspector that she follows her own routine and that bedrooms are thoroughly Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 15 cleaned each week. She was knowledgeable about infection control and good hygiene practises and had just commenced relevant training. She said that she took a pride in her work and would like to have a good-sized cleaner’s area where she could properly store and organise her equipment. The tour of the building and grounds highlighted a number of areas, which require attention. • Several bedroom doors do not have locks with override facilities. Metal bars across some windows detract form the pleasantness of the bedroom. Safety glass has now been fitted and it was agreed that alternative window restrictors could now be fitted as required. • • Wardrobes have now been secured. Some of the en-suites lights were still without shades. Dining table and chairs have not been replaced and staff were struggling to push chairs and residents closer to the dining tables. Worn placemats have not been replaced. Bathrooms and shower rooms are showing signs of wear with damaged tiles and stale smells. The lack of sufficient grab rails and shower curtains continues. Laundry walls and flooring are damaged and are not easy to clean, increasing the risk of cross infection. Towels and sheets are damaged and worn and several are hospital type and should be replaced. A tour of the building indicated that the home is generally well maintained and was clean and free from offensive odours. The standards of cleanliness are good but toilet brushes are still used within the communal toilets and bathrooms. Clinical waste and household rubbish bins are without suitable lids. • • • Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 30 There continues to be a good match of well-qualified staff offering consistency and good standards of care within the home. Residents are kept safe and supported by well-trained, competent and caring staff. EVIDENCE: Other than the post of activities co-ordinator there were no staff vacancies. Staffing levels and skill mix are good for the current occupancy levels and there is no need to use agency staff. The domestic and maintenance rotas were unclear. There had been a shortage with domestic cover and a new domestic was about to commence. Two student nurses were currently on secondment at the home and the inspector met with one of them. Promising new induction programs were in place and ready for new starters. Relevant clinical areas are also covered with good guidance on areas such as nutrition and verification of death. 75 of the staff have achieved NVQ at levels 2 and/or 3 and this is ongoing. Individual training records were examined for the six staff that were interviewed. These were not fully up to date and some were blank but staff were able to describe what training they had had. Statutory training was up to date but there had been a halt to first aid training that needs to be addressed. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37 and 38 The manager is professional and impressive. She now has a clear development plan and vision for the home. She is highly thought of by her staff and provides clear leadership that benefits and supports the best interests of the residents. Staff are now being very well supervised. Health and safety standards are generally good and efficient and well-organised record keeping further protects residents. EVIDENCE: After some initial anxiety the manager and staff are very positive and enthusiastic about the change of owner and the proposed improvements to the home. It is anticipated that the manager will have a lot more autonomy and the freedom to utilise her management skills and experience with improved access to budget and staff management. All of the staff spoke very highly of their manager. Comments included ‘I see Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 18 her every day’, ‘she is always available to help and listen’ and ‘ she is a very good manager’. The new owner has introduced up to date and comprehensive policies and the manager was busy downloading, sorting and sharing these with her staff. As discussed these should be dated. Impressive new corporate quality assurance audits and guidelines are now in place that the manager was preparing to introduce. The admissions register is up to date. As discussed all entries should include the full address of care managers, referring authorities and next of kin. Some staff are not recording accidents properly and there is inadequate evidence that correct procedures have been followed. The manager is to address this with the relevant individuals. Very well detailed and impressive supervision and appraisal records were seen for care and ancillary staff. As discussed the date of supervisions should be pre-planned. Also opportunity can be taken to review and update individual training during these sessions. The external drive and car park is pot holed and presents a risk to residents, staff and visitors. Carpets throughout the building are raised, damaged, badly worn and several present as trip hazards. Details were given to the manager. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 2 x x 2 x 2 STAFFING Standard No Score 27 4 28 4 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 2 1 4 4 3 x x 4 2 2 Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 20 Yes 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 7 Regulation 15 Requirement Provide evidence of the residents or their representatives input to care plans. All health, personal and social needs must be set out in the individual care plans. The nurses must ensure that any urgent health care needs are met promptly. Keep daily written statements on the health and condition of all residents. Provide adequate facilities and staff for social activities and recreation. Maintain records of social care provision and circulate information to all residents. (PREVIOUS TIMESCALE OF 31 MAY 2005 NOT MET). Enable residents to engage in local, social and community activities. Ensure all staff receive training in adult protection. Provide the Commission with a copy of the homes revised Adult Protection Policy. Provide the Commission with a full audit of the condition of the premises together with written Timescale for action 30 September 2005 2. 8 12(1) 31 July 2005 3. 12 16(2)(n) 31 August 2005 4. 5. 13 18 16(2)(m) 13(6) 31 August 2005 30 September 2005 31 August 2005 Page 21 6. 19 23(2) Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 7. 8. 9. 19 21 24 23(2)(b) 23(2)(j) 23(2)(e) proposals and timescales for redecoration, recarpetting, upgrade and refurbishment. Make good any holes and uneven surfaces in the external grounds. Provide bathroom 44 with drop down handrails and a suitable shower screen. Fit suitable locks to all bedroom doors. Provide residents with towels of a satisfactory quality. Provide suitable light shades in areas used by residents. Upgrade the laundry floor and walls to provide impermeable and readily cleanable finishes. Provide lidded and foot operated waste bins.l Following urgent risk assessment ensure that all carpetting is made safe through repair or replacement. Provide first aid training to ensure a first aider is on duty at all times. Improve and maintain the standard of care planning. 31 August 2005 31 August 2005 30 September 2005 31 August 2005 31 October 2005 31 August 2005 31 August 2005 31 October 2005 10. 11. 12. 13. 25 26 26 38 23(2)(p) 13(3) 13(3) 13(4)(a) 14. 38 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 8 9 17 19 24 Good Practice Recommendations Collate and maintain an overview of any residents who are underweight. Progress medications update and training for the nurses. Ensure that residents have been enabled to vote in elections. Consider the conversion of an unused toilet to a walk in cleaners and COSHH cupboard. Remove bars from windows and fit suitable window B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 22 Howard Castle Care Home 6. 7. 8. 26 30 37 restrictors. Review the practice of using toilet brushes in communal areas. Replace worn and damaged tablemats. Ensure individual staff training records reflect the staff training provision. Ensure the admissions register contains full postal addresses. Include review dates on policies and procedures. Howard Castle Care Home B53-B03 S63758 Howard Castle V230644 210605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR 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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