Care Home: Castelayn

What the care home does well The home always made sure that people had their needs properly assessed before they were admitted to the home. This made sure that they were able to meet their needs and prevent people having to move on soon after admission. They also gave people the opportunity to have trial visits to get the home before a decision about permanent residency was made. The provision of day care and respite stays helped this process. The staff knew the residents needs well and formulated good plans of care, which gave staff guidance in how to care for people. This enabled them to support people the way they liked to be supported. The home has a friendly atmosphere and staff members were described as delivering care that promoted privacy and dignity. They also made sure that health professionals were called when required. The home provided a good range of activities for people in and outside the home and maintained a log of who had participated. Staff also tried to make sure that people could make choices about aspects of their lives. Staff had access to a range of training, which enabled them to develop their skills and knowledge. This helped them to understand peoples` needs more fully. Training included customer care and how to safeguard people from abuse. This helped them when dealing with complaints and when ensuring that people were protected in the home. The home was a clean and tidy with no malodours. The manager was seen about the home and staff stated she was approachable. They did state they would like to see more of her but recognised how busy she was. The team leaders offered management support to the staff in addition to the manager. The home had a quality assurance system that helped staff, via audits and questionnaires, to see where they needed to improve the service. What has improved since the last inspection? There has been some improvement with the provision of meals but it is still not quite right for everyone yet. The way the home records complaints has improved.The deficiencies in the call system have been addressed and there are more pagers available for staff. There is increased numbers of regular bank support staff and less reliance on external agency staff. Hand paper towels have been supplied in communal toilets to prevent the spread of infection. Some communal areas in the home and several bedrooms have been redecorated. Seventeen bedrooms have received new floor covering. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Castelayn 2 Leighton Drive Sheffield South Yorkshire S14 1ST Lead Inspector Beverly Hill Key Unannounced Inspection 4th March 2009 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 Castelayn DS0000002946.V374394.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. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castelayn Address 2 Leighton Drive Sheffield South Yorkshire S14 1ST 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) 0114 239 8429 0114 239 8216 diana.oak@sheffcare.co.uk www.sheffcare.co.uk Sheffcare Limited Mrs Diana Oak Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (4), Physical disability of places over 65 years of age (4) Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 4 PD beds can also be for people who are PD(E) and are situated in a separate wing. 23rd January 2007 Date of last inspection Brief Description of the Service: Castelayn is a purpose built home sited in a residential area of Sheffield with good access to public services and amenities, for example, bus services, shops, pubs, etc. It is situated over three floors, each accessed by a passenger lift and stairs. The home is registered to provide personal care for thirty-six older people. In addition up to four people with physical disabilities can be supported in a designated area. All the bedrooms are single without any en-suite facilities. The home has a shower room, two bathrooms with bath hoists and two bathrooms with specialised parker baths. There is an ample supply of toilets throughout the home. The ground floor has a large lounge with two dining tables at one end and is used to provide day care facilities, although is also accessed by permanent residents. There are three additional communal rooms on this floor, one of which is used for people wishing to smoke, and a kitchen with dining tables. The first floor communal rooms consist of one lounge, a kitchen/dining room and a hair dressers room. The second floor has a large lounge/dining room and a separate kitchen. There are also quiet seating areas in the entrance and on each floor. The garden and patio area are secure and there is ample car parking at the front and rear of the building. Information about the service is provided to service users on admission and displayed in the home. Information about fees can be obtained from the manager. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 23rd January 2007 and the Annual Service Review on 11th March 2008. It includes information gathered during a site visit to the home, which lasted approximately eight hours. Throughout the day we spoke to several residents to gain a picture of what life was like at Castelayn. We also had discussions with the registered manager, the activity coordinator, several care staff members and domestic staff. Information was also obtained from surveys received from people that live in the home, staff members, health professional visitors and social services reviewing officers. Comments from the surveys and discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were, activities provided, nutrition, complaint’s management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. The providers had returned their annual quality assurance assessment, (AQAA) on time. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 6 We would like to thank the residents, staff and management for their hospitality during the visit and also thank the people who completed surveys and had discussions with us on the day. What the service does well: What has improved since the last inspection? There has been some improvement with the provision of meals but it is still not quite right for everyone yet. The way the home records complaints has improved. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 7 The deficiencies in the call system have been addressed and there are more pagers available for staff. There is increased numbers of regular bank support staff and less reliance on external agency staff. Hand paper towels have been supplied in communal toilets to prevent the spread of infection. Some communal areas in the home and several bedrooms have been redecorated. Seventeen bedrooms have received new floor covering. What they could do better: The way the home records medication needs to improve and one resident did not receive the medication as prescribed for them. They also need to store controlled drugs in line with new guidance for residential homes. Some people were still not completely happy with the provision of meals. This needs to be checked out with people and resolved quickly, as meals and mealtimes are an important part of peoples’ day. Two people were still concerned that water dripped into their bedrooms from above the window when it rained. This had been attended to once but it does not appear to be fully resolved yet and needs to be checked out quickly. Some people also stated the home continued to be draughty in places and some of the windows needed replacing. The home in general was clean and tidy but part of the décor was looking jaded. Some domestic staff also fulfilled a dual role of completing care tasks. The manager needs to make sure they have completed relevant training for this, especially moving and handling. During the day there are sufficient staff members in the building but at night there is only two staff on duty. This is not sufficient given the layout of the building (over three floors) and the complex needs of some of the residents. People told us they had to wait a long time for support at night. Staff members were supported by the manager and team leaders but they need to have formal supervision for a minimum of six times a year. In some instances they were not receiving this amount. The home needs to make sure two references are in place for newly recruited staff prior to the start of their employment and when staff start after a povafirst, but prior to the return of the full criminal record bureau check, this is in exceptional circumstances and not as a matter of routine. The exceptional circumstances need to be documented. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 8 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. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 9 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 Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that people’s needs are assessed prior to admission. This enables staff to be sure their needs can be met in the home. EVIDENCE: We looked at four care files during the visit, one of which was for a person recently admitted to the home for respite care in an emergency. There was evidence that the home obtained assessments of need and care plans produced by the local authority and also completed an in-house assessment. This process gave the staff information about residents’ needs, on which to base a decision about whether they can be met in the home. This helps to prevent the need for the resident moving to another home or a return to hospital. The home needs to write to residents or their representative following the assessment to formally state whether their needs can be met in the home. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 11 In surveys people stated they had been provided with sufficient information about the home prior to their admission. People were able to have trial visits and respite stays in order for them to become accustomed to the way the home provides care. This in addition to the day care facility for between eight to ten people each day assisted people in their decisions about permanent residency. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally residents had their health and personal care needs planned for and met in ways that respected their privacy and dignity. Management of medication in respect of recording and in one instance administration must improve to ensure clear records are maintained and people receive their medication as prescribed for them. EVIDENCE: Generally the plans of care formulated to meet residents’ needs were comprehensive and included references to likes and dislikes and preferences. The care action plans were in tick box format with further enhanced plans for each resident. There were some missing dates and signatures of the person formulating the plans and little evidence that the residents or their representatives had signed agreement to them. The care plans were evaluated monthly and reviews took place with the resident, their family and other interested parties. There was evidence that Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 13 care plans were adjusted when needs changed, although comments from two care managers indicated this could be improved. Care files were organised into sections and were easy to read. Separate files were maintained for contracting and initial local authority assessment and review information. Risk assessments were completed for a range of issues with guidance for staff in how to minimise any identified risk. In one instance a risk assessment had identified some of the issues but could have had a fuller analysis of all the risks and a behaviour management plan so staff could support in a consistent way. There was evidence that people had access to health professionals for advice and treatment and staff completed a log of visitors, dates and advice. People spoken with stated that their health and personal care needs were met in ways that protected their privacy and dignity. It was noted that one person was not able to rise at their preferred time due to staffing at night and their need for early appointments. Some comments from residents and professional visitors were, ‘they always ask for advice’, ‘privacy and dignity is always observed’, ‘sometimes care plans need updating’, ‘staff are very good at the assessment of clients needs, for example pressure relieving equipment and mobility aids and always ask for advice and make thorough referrals to the appropriate heath care teams’, ‘we have regular manicures but chiropody gets lost now and then’, ‘yes (very emphatically) they respect privacy and dignity’, ‘I prefer a female carer, I’m given the choice’ and ‘staff know how to look after me’. Generally recording was completed satisfactorily but there were instances when dates and signatures were missing from documents and weight charts and daily recording of care were completed more vigilantly by some staff than others. There were some areas of the management of medication that needed addressing – mostly this was to do with recording. Staff members need to use the codes on the medication administration record (MAR) in a consistent way when medication is omitted for whatever reason. There must be two signatures and full manufacturer’s instructions when handwriting details onto the MAR, for permanent residents and those receiving respite care. The remaining amounts of medication, not dispensed in monitored dosage systems, need to be brought forward onto the new MAR so it can be accounted for and the use of prescribed topical products needs to be recorded on the MAR. Staff should use the reverse of the MAR to record any specific instructions or changes. Medication was signed into the home but care needs to be taken when signing out medication returned to the residents admitted for respite. It was noted that on six separate occasions a resident had not received important medication prescribed for them due to the prescribed time conflicting with the residents retiring to bed. Staff must be proactive in Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 14 contacting the GP for advice about addressing this to ensure the resident receives medication as prescribed. The medication was stored appropriately, although the home did not have a controlled drugs cupboard that met legal requirements. This needs to be discussed with local pharmacy support to ensure the correct one is obtained. There was also an issue of a resident taking weekend breaks away from the home. However, staff members were secondary dispensing the medication which is to be avoided. This must be discussed with the local pharmacy supplying the medication to make alternative arrangements. Information needs to be inputted into the persons risk assessment and care plan. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a range of activities to afford people social stimulation and links with the community. They assisted people to make decisions about aspects of their lives and to maintain contact with family and friends. The provision of meals did not meet all the resident’s expectations and requires further investigation to address the shortfalls. EVIDENCE: People confirmed the home had flexible routines and visitors were welcomed at any time. There was a weekly activity plan in place facilitated by an activity coordinator and individual logs are maintained of the people that participate. The company has four activity coordinators for thirteen homes and each home has three visits a week from them for approximately two hours each time. The plan includes various activities such as, arts and crafts, reminiscence, floor and table games, dominoes, skittles, quizzes, visiting entertainers, exercise sessions, aromatherapy, dancing, and, one to one chats. There are competitions held between the homes in the company and coffee mornings and tea dances hosted by the home in turn. The home has its own minibus and the Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 16 company has two additional mini-buses to use for organised trips to local facilities. A holiday is planned this year to Blackpool for those residents wishing to go. The activity coordinator confirmed about 4-5 residents will attend the first week and later in the year a second group would go. The home has three computers for residents to use set up in two of the lounges on the ground floor. One resident also has installed their own computer. The home has a collection of large print books and one resident regularly receives talking books. Residents meetings were held in order for people to express their views and to have some control over what activities are provided. There were other instances where residents had some control over aspects of their lives. There were no set times of rising and retiring, although for one person this was not as they would choose due to staffing and early appointments. People could choose where to sit in an array of communal rooms and there were two choices at meals with extra alternatives if required. Bedrooms were personalised and people were able to bring in small items of their own furniture; some people had their own telephones with which to keep in touch with families. Some residents managed their own finances and some people chose to visit family and friends at the weekend. There had been some improvement in the provision of meals since the last inspection but it does not appear to be quite right yet for all. Those meals seen were nicely presented. Comments from people living in the home were, ‘the food is alright’, ‘it’s lovely, we get plenty to eat – we can make our own drinks’, ‘it’s not bad at all, they come round the day before and ask us what we want’ and ‘it’s quite alright, I wouldn’t make any changes’. We received six surveys from residents and two people stated they liked the meals, ‘usually’, three people said this was only, ‘sometimes’ and one person declined to answer the question. One comment in a survey was, ‘meals have not been very good since the regular cook has been away – I don’t always like the look of the food’. It would be useful to conduct an in-house survey or hold discussions with people in small groups or, on a on to one basis, to try to find out the reasons for the discontent some residents have with the provision of meals. These will then need to be addressed. When discussed with the manager they were aware of some of the comments and were trying to address them. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided an environment where people felt able to complain, and were protected from abuse by training and adherence to safeguarding policies and procedures. EVIDENCE: The company had a corporate complaints policy and procedure, which was on display in the home and included timescales for acknowledgement, investigation and resolution. The home had only received one formal complaint since the last inspection and this had been resolved. Staff members spoken with were aware of what to do if a resident or family member raised a concern or complaint with them and the home had a complaints form for documenting them. The manager maintained a log for auditing purposes. Residents spoken with, and surveys received from them, indicated they knew how to complain and would feel able to do so if required. Most named specific staff members they would approach. Comments were, ‘I have nothing to complain about’ and ‘none at all’. The home had access to multi-agency, safeguarding vulnerable adults from abuse, policies and procedures and those staff members spoken with were clear about how and to whom they would report any incidents of concern or abuse. Staff had received appropriate safeguarding training. The manager was aware of her responsibilities regarding alerting the local authority to any issues Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 18 and there was evidence that safeguarding procedures were followed when the staff team were unhappy with a poor discharge from hospital for one resident. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided a clean and warm environment for people. Areas of the home need updating and in some instances repairing, to fully ensure the continuing welfare of people living in there. EVIDENCE: Castelayn is a large home situated over three floors, which are accessed by stairs and a passenger lift. There were areas of the décor throughout the home that were looking jaded, however staff tried hard to maintain a homely environment for people. It was clean and tidy with no unpleasant odours. The home had an ongoing redecoration and refurbishment plan and some shortfalls identified at the last inspection had been attended to. Fourteen bedrooms, one ground floor corridor, one middle floor corridor, two dining areas, a kitchen and a staff kitchen had been decorated in the last two years. Seventeen bedrooms had had replacement flooring or new carpets in the last two years and a new Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 20 carpet had been fitted in the second floor lounge. Extra staff pagers have been purchased. Repair work had been completed to the ceiling in the wing designated for people with physical disabilities and the main kitchen had received attention in line with requirements following the last environmental health visit. One resident in the wing told us that the situation had not been fully resolved regarding the ceiling repair, as the previous few days’ inclement weather had caused a reappearance of water dripping in her bedroom near her window. This needed to be addressed quickly and staff had made the manager aware. The manager had identified where redecoration and refurbishment was required, had submitted a budget requirement plan to headquarters and was awaiting reply. Some of the windows were in need of replacement; a resident described them as, ‘draughty’ and stated, ‘the maintenance engineer shores up things’. It was recognised that this could be an expensive project but one that will need addressing in the near future to improve the environment for people. There was also some work to bedroom doors to be completed in line with requirements issued during a recent visit by the fire safety officer. The home had ample communal rooms for sitting and relaxing, for participating in activities and also a designated room for people that wished to smoke. The sitting rooms were provided with televisions, DVD‘s and music centres. One room also had a computer for the residents’ use, a WII machine for electronic games for people of all ages and a piano. The ground floor lounge was also used to provide day care services for approximately eight to ten people each day. Permanent residents also used the day care facilities and joined in some of the activities on offer provided by designated staff. Each floor had a dining area and kitchen in order for residents, where possible, and their families to make their own drinks. Dining tables were nicely set out with table cloths and place mats. The home had bathing and shower facilities throughout and had an ample supply of toilets close to communal areas. There was a designated wing specifically for four people with physical disabilities. Three of the bedrooms and the bathroom had ceiling track hoists and the bathroom had a specialised parker bath. The wing had its own small sitting room with a dining table insitu, and incorporating a kitchenette for staff and residents to use. All the bedrooms were for single occupancy and those seen were personalised to varying degrees. Some residents had brought in small items of furniture, ornaments and pictures to make their bedroom more homely. People spoken with were generally happy with their bedrooms and their home. The laundry and sluice facilities were appropriate for the size of the home. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 21 Staff and residents told us that there had recently been three incidents of theft of property, mainly portable items such as televisions from the lounges and from one residents’ bedroom. The residents’ property had been replaced, the police had been informed, and advice had been taken. The manager has been reviewing security arrangements and is monitoring the situation closely. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes staff induction and training plan ensured that care staff had the required skills to care for vulnerable people. All domestic staff performing care tasks will need appropriate training. There were gaps in recruitment processes and staffing numbers at night that could place people at risk and may mean they receive insufficient care or their preferences are not met. EVIDENCE: In discussion staff stated that there were four or five care staff and a team leader (sometimes two) during the day shifts and the manager was supernumerary. However, there were only two care staff members on duty at night with an on-call system. The staffing numbers at night are insufficient for the size and layout of the building and the numbers, and increasingly complex needs, of the people living in the home. This may mean that residents are put at risk of insufficient or delayed care at night and at least one persons’ preferred time of retiring to bed could not be met. There are some staff vacancies but the home has increased the recruitment of flexible bank staff, which has alleviated the need for agency staff and improved consistency of care. There are additional care staff members on duty specifically for day care support. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 23 In discussions with staff and surveys received from them, there were comments that there had been a high staff turnover but the homes annual quality assurance assessment form (AQAA) states only four care staff have left in the last twelve months. They also told us that domestic staff worked dual roles at times and assisted in supporting people up in the mornings. When checked some staff had not completed specific moving and handling training so care must be taken to ensure they are not providing support and care outside their skills, training and knowledge. Staff felt that despite their best efforts there could be a, ‘rushed atmosphere’ for residents and, ‘heavy demands’ placed on staff, leaving them, ‘overstretched’. Staff surveys indicated there was sufficient staff to meet residents needs, ‘sometimes’. A health professional in a survey commented on there not being sufficient staff on duty at times and the impact this had on their ability to spend the appropriate length of time with more dependent people. Six surveys were received from residents and four of them stated staff were available and met their needs, ‘usually’, the remainder stated this was, ‘sometimes’. One person stated, ‘too long to wait’. Four stated that staff listened to them and acted on what they had to say, ‘always’, whist two commented this was, ‘sometimes’ and, ‘it depends who is on duty’. One resident spoken with on the day told us they had to wait a long time at night as staff were very busy. There were generally positive comments about the friendliness of the staff and how they created a pleasant environment, ‘a very happy, helpful team’, ‘friendly and respectful of people’, ‘the staff are always available to discuss anything’, ‘the staff are alright – so so’, ‘the staff are kind, they see you’re alright’ and ‘they are very good’. Residents in the wing described a family atmosphere and stated they were all very happy with the staff team and the care they received. The home had a staff training plan that covered induction for new staff, mandatory and service specific training. Induction consisted of two days at headquarters completing a range of mandatory training and gaining information about the company and ways of working. Other mandatory training such as moving and handling and fire safety is continued during supernumerary shifts in the home and is overseen by team leaders. New staff work through skills for care induction standards and have continual appraisals and assessments until deemed competent. Information showed that service specific training included dementia care, healthy eating, customer care, falls awareness, catheter care, understanding Parkinson’s disease, chronic obstructive pulmonary disease and intermediate care. The latter was an initial two day course covering a range of topics Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 24 relevant to the role of carers. This was followed by a further two day course and covered issues such as dealing with behaviours that could be challenging and equality and diversity. Several team leaders had completed moving and handling trainer’s courses to enable them to facilitate training to staff. The home has thirty care staff and eleven have completed a National Vocational Qualification in care at level 2 or 3. This equates to 36 . The home needs to aim for 50 of care staff trained to this level. The manager described a recruitment process that was sound. However when checked there were some documents missing from recruitment files so it was difficult to audit this fully. Staff completed application forms and were selected via an interview. Three staff files were examined; one had two references and the other two only had one reference. It was clear that criminal record bureau checks had been completed and a checklist stated that povafirst checks were clear – these records were held at headquarters. The checklist did not have the date when the clear povafirst was received. However, it was also clear that staff had started on shift after the return of the povafirst but before the return of the full criminal record bureau check. This is acceptable in exceptional circumstances but only when all other checks have been completed, for example two references (one from a previous employer), gaps in employment explored and povafirst checks returned as clear. The exceptional circumstances need to be documented. Shortfalls in the recruitment record keeping need to be addressed. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed and the views of residents and those of other interested people were sought to help improve the services provided. EVIDENCE: The registered manager has worked for the company for three years and has completed her Registered Managers Award and relevant management courses. She has also undertaken refresher first aid training, moving and handling and safeguarding adults from abuse for managers. She has also attended briefings in the implication of mental capacity legislation and deprivation of liberty. There is a tier of management she can contact for advice and support and a peer group of managers within the company. The Responsible Individual is the Quality Assurance Officer and they visit the home each month to check progress. Staff members were unable to say whether they had had any Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 26 conversations with the Responsible Individual during their visits, as they all worked differing shifts. All stated they would be able to approach the manager with any concerns. Staff did state they would like more access to the manager and commented that although they felt their issues were listened to, sometimes things could take a while to be resolved. They appreciated the manager was busy, having the responsibility of overseeing more junior managers in other homes, and were aware they could pass information up via team leaders, who were, ‘always available’. The homes quality assurance system consisted of audits across a range of items and questionnaires to residents, relatives, professional visitors and staff. Action plans were produced to address any identified shortfalls and the home had key performance indicators to meet. The process was overseen by the company’s Quality Assurance Manager and computerised records were maintained. There was evidence that the auditing of accidents had impacted positively on the care and support for one resident with a history of falls. The home had completed and returned its AQAA in the required timescale. It was a self-assessment and identified what the home did well and how they evidenced this, what improvements they had made in the last year and the plans they had to address shortfalls and make further improvements in the following twelve months. This self analysis was important and the welfare of people living in the home will continue to improve even further when the home completes the tasks identified as required. The home appropriately managed the finances of the people living in the home. This was not fully assessed at this inspection but the manager described the systems the home used. Accounts were managed via a computerised system and individual records maintained. Receipts were obtained for deposits and expenditure. The home had a, ‘comforts fund’ specifically for the residents. This was managed by staff and a relative. Finances were subject to monthly checks by the manager and audited by the company. There had been some slippage regarding formal staff supervision. There was a supervision and appraisal system in place and delegated responsibilities to team leaders. However, records indicated that care staff members were not receiving the required minimum of six supervision sessions a year. It was important for staff to have a forum to discuss issues, exchange information and plan their training needs with their line managers. The home was a safe place for residents to live in and staff to work in. Equipment was serviced and maintained and repairs completed as soon as possible. Risk assessments had been completed and fire alarm tests were carried out. Staff had policies and procedures to guide practice. Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 27 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 3 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13 Requirement People must receive their medication as prescribed for them, to ensure their optimum health. Medication returned to people leaving the home after a shortterm stay must be signed out of the home and prescribed topical products must be signed after application. This will help ensure correct auditing of medication. Action must be taken to ensure that any maintenance work on windows, to prevent leaks and draughts, must be effective in the long term or windows replaced as necessary. Maintenance and repair of the building must take place to prevent leaks during bad weather. There must be staff in sufficient numbers at night to meet the needs of residents taking into account the layout of the home and the increasing complexity of residents needs. Two references must be place DS0000002946.V374394.R01.S.doc Timescale for action 06/04/09 2 OP9 13 06/04/09 3 OP19 23 30/04/09 4 OP27 18 17/04/09 5 Castelayn OP29 19 06/04/09 Page 29 Version 5.2 6 OP30 18 prior to the start of employment. It is possible for staff to be recruited after a povafiirst check but before the return of the CRB but this must be in exceptional circumstances only and not as a matter of routine. Stringent supervision arrangements must be in place if this occurs. The manager must make sure 06/04/09 that any domestic staff members fulfilling care tasks have completed the correct mandatory training. This refers especially to moving and handling. 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 OP9 Good Practice Recommendations Staff should ensure that full instructions and two signatures are used when handwriting information onto the MAR and consistent codes used when medication is omitted. The staff should discuss the issue of secondary dispensing for one resident and the need for a legitimate controlled drugs cupboard with the local pharmacy support. The amount of remaining medication not in monitored dosage systems should be brought forward to the next months MAR and any specific changes or instructions should be detailed on the reverse of the MAR. The manager should continue to establish whether the catering services are meeting the needs of residents in view of surveys received from them. The home should continue to work towards 50 of care staff trained to NVQ level 2 or 3. Care staff should receive a minimum of six formal supervision sessions per year. 2 3 OP9 OP9 4 5 6 OP15 OP28 OP36 Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Yorkshire and Humberside PO Box 1254 Newcastle upon Tyne NE99 5AR National Enquiry Line: Telephone: 03000 61 61 61 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.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 Castelayn DS0000002946.V374394.R01.S.doc Version 5.2 Page 31 - 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. 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