CARE HOMES FOR OLDER PEOPLE
Howard Castle Care Centre Dacre Street Morpeth Northumberland NE61 1HW Lead Inspector
Janet Thompson Key Unannounced Inspection 28th August 2007 10:30 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.V338148.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.V338148.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 Lesley Jane Smailes 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.V338148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th October 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 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 is available in the home. This contains the statement of purpose and previous inspection reports. Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. How the inspection was carried out: Before the visit we looked at: Information we have received since the last inspection visit. How the service dealt with any complaints or concerns since the last visit. Any changes to how the home is run. The manager’s views of how well they care for people. The views of people who use the service and their relatives or friends. This was given to us in the form of questionnaires. Ten were sent out and returned. During the unannounced visit on 28 August 2007 we: Talked with people who use the service and some of the staff. Looked at the information about people who use the service and how well their needs are met. Looked at other records the home is required to keep. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, comfortable and safe. Checked what improvements had been made since the last inspection visit. The manager was present at the inspection. What the service does well:
There were adequate amounts of staff on duty to meet residents’ needs. Good recruitment procedures are followed and staff are thoroughly screened before they are employed at the home. Staff training was up to date. There were good training plans in place. In surveys returned there were many positive comments made by residents about staff. They said, “there are very good staff, couldn’t be nicer”. “The staff are really kind and happy”. Medication was well managed. All records were up to date. The manager checks the medication systems regularly. Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 6 Records about residents care were very good. All care needs were clearly identified and planned for. Residents confirmed that they were well looked after and had their needs met. All health and safety checks for the home were up to date. The place smelled fresh and looked clean and tidy. Good efforts are made to consult with residents and their relatives. The manager sends out a letter telling everyone when meetings are due to be held. She has put a communication book in the foyer for relatives to write to her if they don’t see her. The manager regularly sends out quality surveys. Residents said they feel able to complain but have “little to complain about”. Complaints received were acted upon quickly and were well documented. Residents monies were properly managed. What has improved since the last inspection?
All of the requirements made at the last inspection have been met. A service user guide is now available. This gives very good information about the home to residents. It is very easy to understand, written in plain English and in large print. All bedrooms have now been fitted with a lock to the door. This means residents now have the choice of whether or not to keep their door locked when they are out. Lockable facilities have also been provided in the rooms for residents to keep valuables in. The laundry has not been moved into the main building, but work has begun to improve it. A laundry press has been purchased and the sheets did look less creased. The treatment room, where drugs and dressings are stored, has been refurbished. It was clean and tidy. The surfaces were made smooth so that it can be easily cleaned to prevent the spread of infection. Staff are receiving regular formal supervision during which their performance is reviewed and progress monitored.
Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 7 There are a lot more activities on offer. Individual records are kept of who has participated and whether they enjoyed it. The building looks a lot nicer and more comfortable for residents. New dining furniture has been bought. Some areas have been redecorated and new carpets bought. New baths have been purchased and one has been fitted. These are designed to assist residents with mobility problems to have a more comfortable bathing experience. 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. The summary of this inspection report can be made available in other formats on request. Howard Castle Care Centre DS0000063758.V338148.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.V338148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given good information to help them decide about moving into the home. People have their needs and wishes assessed before they move into the home to ensure staff can meet their needs. EVIDENCE: A very good service users guide has been written. It is written in plain English and in large print. The information is clear and concise. The use of pictures makes it interesting to read and it is very personal to Howard Castle. One resident confirmed that she had received information before admission. She said “and I had a lovely visit and stayed for lunch”. Residents admitted to the home do have their needs assessed. Information from other professionals is included in this. The needs assessment forms part
Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 10 of the care planning. Three pre-admission assessments were examined. Good information was recorded and residents’ individual needs were clear. These included resident’ wishes regarding how they would like to be addressed and any gender preferences they express. Howard Castle Care Centre DS0000063758.V338148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of care planning is good and gives a good level of information to staff to support meeting residents needs. Care is planned with residents in a way they prefer and in a sensitive manner. EVIDENCE: Four plans of care were examined. Two of the people whose care plans were seen were also spoken with or seen by the inspector. This is called case tracking. The care plans contained enough information about residents to enable staff to meet their needs. All care plans contained up to date information and had been regularly evaluated. Care plans that were case tracked showed a good reflection of the residents’ current needs. Care plans reflected the diverse range of residents’ abilities, likes, dislikes, social needs and aims as well as
Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 12 their physical needs. Residents had been asked how they wished to be addressed and about their preferences with regard to personal care. This was clearly recorded. Residents looked clean and well cared for. All residents spoken to said they were well looked after. There was evidence in care plans that residents can see a doctor when they need to. Other health professionals such as psychologists, therapists, opticians and dentists had been involved in the care of residents. Medication administration records were examined. Medication management was satisfactory. All administration records were correctly filled in. The manager regularly audits medication. Two amounts of controlled drug were checked and found to be correct. In their surveys residents said they were well looked after and treated respectfully. One resident said “I sometimes have to wait if they are busy but they always come and tell me how long it will be”. The inspector observed staff talking politely to residents and offering them choice about where to sit and what to do next. Howard Castle Care Centre DS0000063758.V338148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are encouraged to be as independent as they wish. They access social activities in the home and wider community. Choice and rights are promoted as well as healthy living. EVIDENCE: The provision of social activities has really improved since the last inspection. Residents are now saying that there is enough to do. Social care plans were very good and they were clearly written in plain English. These plans stated residents likes and dislikes, past hobbies and current abilities. They also explained the extent to which the resident had joined in various activities and whether they had enjoyed it or not. In surveys residents said the staff “try hard to keep us happy and entertained”, “my family are all made welcome”, “I like it here, and the atmosphere is nice”.
Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 14 It was observed that relatives visiting the home appeared to be relaxed and familiar with staff and the environment. Care records did contain information about resident choices. Resident’s opinions are regularly sought through questionnaires, daily contact and meetings. The manager has set up a communication book for relatives to use if they wish, so that they don’t feel that they have to wait until she is on duty to raise anything. Dining tables were well presented. New furniture has been purchased. The dining chairs now have arms to ensure residents sit safely and ‘skids’ to assist them to slide their chairs up to the table easily. Menus were varied and choices were available. The food looked good. A resident said about the meals “we do have a choice and I sometimes ask for something different”. All residents said they liked the food. Howard Castle Care Centre DS0000063758.V338148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear procedures are in place to protect residents from risk of harm and enable their concerns to be effectively dealt with. EVIDENCE: All residents spoken to said that they knew who to complain to. Residents pointed out that there was little to complain about. There have been four complaints in 2007. All were quickly resolved to the satisfaction of the complainants. Adult Protection procedures are available in the home. All staff have received training in adult protection. There was one issue referred to adult protection that was found to need no further action. Howard Castle Care Centre DS0000063758.V338148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building is clean and generally well maintained. Recent refurbishment has resulted in a more comfortable setting for residents. EVIDENCE: The home was generally clean and tidy. Bathrooms and toilets were clean and tidy. The décor in these rooms has recently been improved. Residents said they liked the results of the new decoration. Two new baths have been purchased and one is already fitted. The manager reported that residents are finding it much easier and more comfortable to wash in the new bath.
Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 17 The home has passenger lifts and level access to all areas for residents. Although it is an older building and not purpose built it has been adapted to suit older people of all abilities. One resident questionnaire commented that the heating in her room was unable to be controlled because it was not on an individual thermostat. The manager confirmed that the heating was controlled in areas rather than individual rooms. This is the downside of the older building and an old heating system. The manager has agreed to look at whether the radiators are suitable to have individual thermostats fitted. Some redecoration of the premises has taken place with very good results. Communal rooms look attractive and comfortable. Maintenance and repairs did seem to be carried out promptly. Staff reported that they had all the equipment they needed to do their job. A gardener keeps the extensive grounds tidy. There were no offensive odours in the home. Residents confirmed that the home was usually clean, tidy and fresh smelling. The laundry area is currently being refurbished to make it easier to clean. It is sited in the yard and is not an ideal location. Howard Castle Care Centre DS0000063758.V338148.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are protected by recruitment and selection procedures that are properly followed. Staff are supported through training and supervision to provide care to people in a way that meets their individual needs. EVIDENCE: The usual staffing for Howard Castle is: Two qualified nurses all day. Five 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. Over 50 of the home’s staff are qualified to NVQ level 2 or above. A training programme is in place. This provides an overview of training achieved and required. Staff reported that they have done or been offered
Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 19 training. All statutory training is up to date. Vocational training is taking place for nurses, and carers have done some. The manager reported that the carers could do more but there are difficulties funding time away from the home to do this. They have received enough training to meet the requirements of this standard but it could be exceeded if more training were given. Three staff recruitment files were examined. One was for a new staff member, one for a registered nurse and one for existing care staff. All files showed that a suitable application form had been used. Two references were obtained. Criminal Records checks and Adult Protection checks were done. There was evidence that staff’s identity had been checked. The home aims to give all applicants an equal opportunity of employment. Standard forms are in place to ensure that everyone goes through the same process at application. A diversity monitoring form is used to ensure the equal opportunities policy is adhered to. Questionnaires received back from residents and relatives were full of praise for the attitude of the staff. They said “they are very good, couldn’t be nicer” and “The staff are really kind and happy. The manager always has a kind word and listens to what we want”. Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well run which benefits the people who live there. They are consulted about what goes on in the home through meetings and day-to-day contact. People living in the home and staff are protected through good health and safety procedures and checks. EVIDENCE: The manager is a registered nurse and has many years experience both as a nurse and as a manager. The manager is registered with CSCI. Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 21 The manager has made a lot of improvements to the home since her appointment. She regularly checks on the work of staff resulting in better and safer systems. She has also tried to encourage residents and relatives to be involved in the home and it’s running. One resident survey mentioned the manager as being very good, and someone who listens to what residents want. Staff say the manager is very supportive and thorough in her monitoring of their work. The manager and staff attempt to run the home in the best interests of the residents by consulting them about issues affecting their lives. Residents meetings are held. Resident surveys are regularly carried out. The results of one have just come back. They have not been analysed yet but the inspector read them. The comments were positive. Records relating to resident’s monies were checked. Accounts are held individually. Receipts are kept for all expenditure. Three amounts of money were checked and were correct. Staff have received training in health and safety. A quality assurance system is in place. This includes auditing of safety as well as quality of records and procedures. Fire safety checks and tests were up to date. Checks of bedside rails, window closures and hot water temperatures were also up to date. Safety certificates were available for gas systems, water chlorination and electrical appliances. There were no unsecured hazardous substances. All fire exits were clear. There were no obvious trip hazards. Generally the systems for managing the home were well organised. Due to a misunderstanding some first floor windows in the home are fitted with restrictors that do not look strong enough. This impacts on resident safety if they are at risk of falling out. Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 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 4 4 4 X 3 X X 2 Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 23 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 OP38 Regulation 13(4)(a) Requirement Ensure that all window restrictors in the home meet the standard set by the health and safety executive. Timescale for action 01/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP26 Good Practice Recommendations Give serious consideration to the re-siting of the laundry facility. Howard Castle Care Centre DS0000063758.V338148.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Howard Castle Care Centre DS0000063758.V338148.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
