CARE HOMES FOR OLDER PEOPLE
Howard Castle Care Centre Dacre Street Morpeth Northumberland NE61 1HW Lead Inspector
Janet Thompson Key Unannounced Inspection 26th October 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Howard Castle Care Centre DS0000063758.V302919.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. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Howard Castle Care Centre Address Dacre Street Morpeth Northumberland NE61 1HW 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) 01670 - 510634 01670 - 513529 www.europeancare.co.uk European Care (England) Ltd Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd June 2006 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, four of which are 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. The fees for the home range from £389-£430. Further information about the home can be obtained from the service user guide, which will soon be available in the home. This should contain the statement of purpose and previous inspection reports. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on a weekday. One inspector carried out the inspection. The manager was present. During this inspection the inspector briefly walked around the premises. Residents and staff were spoken to. Care records were examined. Two resident questionnaires and two relative questionnaires were received prior to the inspection. What the service does well: What has improved since the last inspection?
Individual care plans have continued to improve. All care plans were up to date and contained clear information. This helps staff give residents the care they need. The redecoration and refurbishment of the home has improved its appearance. Residents have a more pleasant environment to live in. The manager has made many positive changes in the home. Staff made a point of saying how happy they were with the changes. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 6 The manager has put a lot of effort into meeting the requirements set at the last inspection. The ones that are not met are to some extent beyond her control and require financial input from the proprietor of the home. Suitable waste bins have been provided. Soap is now available in all dispensers. Wardrobes have been fixed to the wall to prevent them tipping onto residents and rotten windows have been replaced. The staff duties were properly recorded on the duty rosta. The manager is now carrying out audits of all systems. A record of social and leisure activities for residents is now in place. It contains basic information. The manager has plans to improve this. Safety checks have been carried out on the electrical wiring systems. These checks showed that parts of the home required rewiring. This is in the process of being done. Tablecloths have been provided and the dining room looks much more attractive. Some residents are still drinking from beakers rather than cups and glasses. The manager has tried to reverse this practice and continues to liaise with relatives to establish a respectful alternative. What they could do better:
The arrangements for the laundering of linen were still not good. All bed linen looked a little improved but was still creased and crumpled. The laundry assistant still did not have a press for ironing sheets. The laundry itself was dirty. This area is not easy to clean in its current state. The proprietor has been asked to consider moving it to the main building, which they do not want to do. It should now be refurbished if it is to stay where it is. There were still areas requiring improvement to prevent or control the spread of infection. This was mostly the laundry and the treatment room, which was dirty. The floor of the treatment room has recently rotted and had to be fixed. There are still some bedroom doors without suitable locks. There are still bedrooms without lockable compartments. This means that residents do not have the choice as to whether to lock their doors or not. Residents are not able to store valuables in their rooms. Staff supervisions have started but are not happening regularly yet. Staff have indicated that they need some training in this area.
Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 7 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 Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 The quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to the service. Prospective residents are not given enough information about items such as fees as the service user guide is not completed. Residents have their needs assessed before entering the home in order to establish if they can be met. EVIDENCE: Pre-admission plans contained good information to ensure that the home can meet the needs of the prospective resident. The Manager is involved in the decisions and in the majority of instances visits the residents herself prior to their admission. Pre admission assessments are obtained from other professionals such as social workers, psychiatrists and health workers. An inhouse assessment is also completed. The care plans must consistently reflect all the assessed needs. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 10 The service user guide and statement of purpose are in the process of being updated. The manager reported that they are almost ready to give to residents. These will contain information about the fees and any additional charges. Requirements are outstanding regarding this. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to the service. The health and social care needs of service users are being met. Staffs’ management of the administration of medication protects residents but the layout of the treatment room does not provide safe storage of all medication. Residents feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Three care plans were examined and have improved greatly since the last inspection. One care plan was case tracked and showed a good reflection of the needs of the resident. The assessment tools such as pressure care, falls, nutrition and moving and handling were well completed. The care plans about social needs contain basic information. This is an improvement as there was previously very little information. The manager has plans to improve these and this was discussed at length. All care plans had been evaluated regularly. Attempts are now being made to include residents and families in the care planning process.
Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 12 Contact with social and health professionals is good. Residents said in their questionnaires that they were well looked after. Residents have access to GPs, physiotherapists, speech therapists and chiropodists. The medicines in the home are generally well managed and safely disposed of. The treatment room floor had recently collapsed due to rot. It has been replaced but not yet recovered. The tiles in this room were all broken or cracked. The grouting was brown. This makes the room difficult to clean properly. There was dust on all surfaces and the room was very untidy. More shelves are needed for storage. In it’s current state the room cannot be cleaned adequately to stop the spread of any infection. It must be repaired, redecorated, tidied and cleaned. The manager agreed to raise the cleaning issues with nurses at their supervision. Staff were seen to treat residents with respect. Personal care was given in privacy. Staff used residents preferred name at all times. Residents were complimentary about the staff in the home. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 13 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, and 15. The quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to the service. Resident’s social needs are being addressed. Residents maintain contact with family/friends/representatives and the local community as they wish. Residents are helped to exercise choice and control over their lives. Residents generally receive a wholesome, appealing and balanced diet EVIDENCE: Residents said in their questionnaires that they were generally happy and enjoyed being able to move freely around the home. The manager has received a complaint from a relative about the lack of social activities. There are activities in the home but the provision is the minimum that a care home is expected to provide. The manager, quite rightly, would like to provide more than minimum and is currently looking at ways to do that. At the last inspection it was noted that social care needs were not documented at all. This is now done. Again, the manager has plans to improve this.
Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 14 Relatives reported that they are welcome in the home and feel free to voice their opinion. Residents’ and relatives’ opinions are sought in meetings. The minutes of the last residents/relatives meeting held in September showed some very positive feedback on the way the home is run. The residents’ bedrooms were personalised reflecting individual choices and preferences. Lunch served appeared satisfactory. The meal was good and all of the residents seemed to enjoy the food. Table cloths have been provided in the dining room and it looked very attractive. Some residents are still using children’s drinking beakers. The manager reported that their relatives provided these. The relatives are resisting a change to a more adult drinking cup and various options were discussed. The inspector was happy that the manager has the best intentions and will attempt to resolve this issue to the satisfaction of everyone. The manager has reviewed the amount of dietary information received by the kitchen staff. This ensures that they are kept up to date with special dietary needs. The Cook has started training in Intermediate food hygiene and the Assistant Cook is doing basic food hygiene. The manager and some staff have done training in “safer food better business”. Residents can have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to see them. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 15 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 and 18. The quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to the service. Residents knew how to complain. The policies and procedures regarding adult protection were good enough to protect residents. EVIDENCE: Residents said they did not have any complaints but would be happy to speak to the manager if they did. There have been three complaints since the last inspection. One was about lack of social activities, which is being addressed. One was because the hot water was running cold. A new thermostat has been fitted. The last complaint was about smoke smells from the staff room drifting to a resident area. The home has now become a no smoking area. All complaints were dealt with promptly and all complainants were happy with the outcome. All staff have had, or are about to receive, training in Adult Protection. Local guidance on Adult Protection procedures is available in the home. This is needed to inform the home’s own policies and ensure that staff know the course of action to take in event of an incident. The manager is going to produce a simple flow chart for staff to use in her absence in the event of an incident. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 16 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 and 26 The quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to the service. The maintenance of the home has improved. The home was clean and pleasant but not fully hygienic meaning infection could be passed to residents. EVIDENCE: Recent redecoration and refurbishment of parts of the home has improved its appearance. Residents have a more pleasant environment to live in. Suitable waste bins have recently been provided. Soap is now available in all dispensers. Wardrobes have been fixed to the wall to prevent them tipping onto residents and rotten windows have been replaced.
Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 17 Safety checks have been carried out on the electrical wiring systems. These checks showed that parts of the home required rewiring. This is in the process of being done. The areas in the home that residents use looked and smelled clean. The arrangements for the laundering of linen were still not good. Bed linen looked a little improved but was still creased and crumpled. The laundry assistant still did not have a press for ironing sheets. The laundry itself was dirty. This area is not easy to clean in its current state. The proprietor has been asked to consider moving it to the main building, which they do not want to do. It should now be refurbished if it is to stay where it is. There were still areas requiring improvement to prevent or control the spread of infection. This was mostly the laundry and the treatment room, which was dirty. The floor of the treatment room has recently rotted and had to be fixed. There are still some bedroom doors without suitable locks. There are still bedrooms without lockable compartments. This means that residents do not have the choice as to whether to lock their doors or not. Residents are not able to store valuables in their rooms. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 18 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 and 30. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There were enough staff on duty to care for residents. Staff are well trained. Residents are protected by thorough recruitment procedures. EVIDENCE: The usual staffing for Howard Castle is: Two qualified nurses all day. Four care assistants all day One qualified nurse and three care assistants at night. The off duty rosta for the home showed that these staffing levels were being met. The manager reported that more than 50 of the home’s staff were trained to NVQ level2 or above. A staff-training matrix has been developed. This lets the manager see at a glance how many staff need training and when updates are due. One staff member has been recruited since the last inspection. That staff recruitment file was checked and showed evidence of good recruitment procedures.
Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 19 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, 36 and 38. The quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to the service. The manager has applied to become registered with CSCI. The home does seem to be run in the best interests of residents. Resident’s money is well managed. Staff are not yet formally supervised on a regular basis. The health and safety of all is not fully promoted. EVIDENCE: The manager is a first level registered nurse. She has applied for registration with CSCI but has not yet been assessed as “fit”. The inspector could see no reason why she would fail the “fitness” assessment. The manager has made many positive changes in the home and the overall standard of living for residents has improved. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 20 There was evidence that the home is run with the resident’s interests foremost. This has been demonstrated by the involvement of residents in care planning. Satisfaction surveys have been sent out and resident meetings held. The feedback from these meetings was very positive. Records relating to resident’s monies were examined at the last inspection. Records were clear and all transactions were well documented. Accounts are held individually and receipts kept of monies spent. The system remains the same. The manager has started a series of formal supervisions with staff but has not yet got into a programme covering all staff. She has allocated some supervisions to qualified staff. They have asked for training in this area and it is recommended that this is provided. The health and safety issues in the home have been covered in various sections of this report. These include inadequate laundry facilities and dirty drug storage areas. The handyman checks hot water temperatures weekly. His records have been improved to reflect the actual temperature of the hot water. Some problems have been experienced with the water temperature being too low. This has mostly been resolved by replacement of valves. Fire safety checks had been carried out. A quality assurance system is in place in the home. Different areas are audited on a monthly basis. This has resulted in improvements in the running of the home. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 21 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 2 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 4 and 5 Requirement Provide residents with an up to date service user guide and statement of purpose. (OUTSTANDING NOVEMBER 2005) Ensure that details of the current fees and criteria for charges are available. (OUTSTANDING FROM NOVEMBER 2005) Fit suitable locks to all bedroom doors. (OUTSTANDING PREVIOUS INSPECTION) Provide lockable facilities in bedrooms. (OUTSTANDING JUNE 2006) 4. OP26 13(3) Upgrade the laundry floor and walls to provide impermeable and readily cleanable surfaces. (OUTSTANDING PREVIOUS INSPECTION) Provide the laundry with suitable ironing equipment. (OUTSTANDING JUNE 2006) This requirement also applies to Standard 38
Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 23 Timescale for action 01/01/07 2. OP2 5 01/01/07 3. OP24 23(2)(e) 01/01/07 31/12/06 5. OP9 13(2) The Registered person must review and refurbish the treatment room to provide safe storage for all medications. Staff should receive formal supervision six times per year. (OUTSTANDING JUNE 2006) 01/12/06 6. OP36 18(2) 01/12/06 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. 2. Refer to Standard OP26 OP36 Good Practice Recommendations Give serious consideration to the re-siting of the laundry facility. Provide staff with training on how to carry out supervision of other staff. Howard Castle Care Centre DS0000063758.V302919.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office 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
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