Care Home: Castle Court Nursing Home

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What the care home does well The provider continues to improve the standard of the home environment. A bathroom on the first floor of the home has been refurbished. The provider has a twelve month plan of refurbishment. Sluice rooms on the ground floor of the home have now been fitted with macerators. The provider and acting manager have worked hard to improve the standard of care planning. Assessments and care plans looked at during this inspection provided guidance to staff about how to meet the needs of the person and included evidence of personal choice. What the care home could do better: Following the inspection in June 2010 we issued a Statutory Requirement Notice for failing to make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A Pharmacist Inspector visited the home on 6 September 2010 to check for compliance against thosebreaches in regulation. At this inspection we found further evidence of non compliance. the Care Quality Commission are continuing to investigate the breaches and considering the action to be taken. Following the inspection in June 2010 we issued a Warning Letter for failing to ensure that staff receive training appropriate to the work that they perform. At this inspection we found further evidence of non compliance. The Care Quality Commission are continuing to investigate the breaches and considering the action to be taken. Breaches in regulation have been shared with Redcar & Cleveland Borough Council and the Primary Care Trust. Random inspection report Care homes for older people Name: Address: Castle Court Nursing Home Margrove Road Boosbeck Saltburn-by-Sea TS12 3BL one star adequate service 19/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Katherine Acheson Date: 1 3 0 9 2 0 1 0 Information about the care home Name of care home: Address: Castle Court Nursing Home Margrove Road Boosbeck Saltburn-by-Sea TS12 3BL 01287653990 01287651600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Continuum Healthcare Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 38 Number of places (if applicable): Under 65 Over 65 Conditions of registration: Date of last inspection Brief description of the care home Castle Court Nursing Home is registered to provide personal and nursing care to a maximum number of thirty eight people. The home provides care to both older people and older people with dementia. Castle Court is situated in Boosbeck on the outskirts of Guisborough and Skelton. A bus service is available to transport people locally. The building was formally an old school that has been converted into a care home. The home is divided into two units. The ground floor of the home accommodates twenty eight older people. There is a large lounge, small lounge and dining room. There are twenty eight single bedrooms some of which have ensuite facilities Care Homes for Older People Page 2 of 13 1 6 0 6 2 0 1 0 Brief description of the care home consisting of a toilet and hand wash basin. The first floor of the home accommodates ten older people with dementia. Communal space consists of a lounge, a small kitchen area and a small dining room. There are ten single bedrooms one of which has ensuite facilities. There is a passenger lift. There are panoramic views of the Cleveland hills and surrounding countryside. Care Homes for Older People Page 3 of 13 What we found: This unannounced random inspection took place over two days on 6 and 13 September 2010. This included a pharmacy inspection of the service. The reason for the inspection was to check compliance against those breaches in regulation identified at the inspection of the service on 16 and 29 June 2010. The inspection of Castle Court in June 2010 highlighted serious concerns. Following the inspection we held a management review meeting where we decided to issue a Statutory Requirement Notice for failing to make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A Statutory Requirement Notice was issued for failure to provide the necessary sluicing facilities suitable for the number and needs of people living at the home. A warning letter was issued for failure to ensure that staff received training appropriate to the work they perform and for failure to appoint a member of staff who is appropriately qualified/experienced to supervise a new worker pending receipt of information in relation to a criminal record certificate. A further random inspection of the service took place on 25 August 2010. The inspection took place because significant concerns had been raised at a multi disciplinary meeting that potentially impacted upon the safety and wellbeing of people living at Castle Court. Two new requirements and 4 recommendations were made as a result of this inspection. We did not look at all these areas during this inspection. At inspection on 6 and 13 September 2010 numerous records were examined including care records of people living at the home, risk assessments, medication records, staff recruitment and training records and some policies and procedures . Discussion took place with the acting manager. We walked around the home with the acting manager. Health and personal care The inspections of the service in November 2009 and June 2010 highlighted the need for care plans to be developed to ensure that they were individual and specific to the person, for care plans to be reviewed and updated at least monthly, for assessments to be regularly reviewed and for bed rail risk assessments to be agreed and signed by a multi disciplinary team to confirm that they are the safest option for the person. At the inspection on 13 September 2010 we looked at three care files of people that use the service. Assessments looked at during this inspection contained good detail and were informative. Care plans provided guidance to staff about how to meet the needs of the person and included evidence of personal choice. Care plans had been reviewed and evaluated. The inspection in June 2010 highlighted the need for care plans for those people with dementia to detail the level of dementia and impact that the dementia had on life. Care plans for those people who were aggressive/challenging needed to be updated to include the triggers to the aggression/challenging behaviour and measures/action to take to manage the problem. One care plan looked at during the inspection did highlight Care Homes for Older People Page 4 of 13 that the person could be aggressive and detailed triggers and actions to take to support this person, however the information was documented within a number of different places within the care file and would be better written within one care plan. The acting manager agreed that one plan of care would be more useful. Two of the three care files looked at during the inspection had core care plans (pre written plans of care that can be utilised for a number of people). Where these plans are used there is a need to ensure they contain additional information to ensure that they are more specific to the individuals needs. The inspection in June highlighted the need for bed rail risk assessments to be agreed and signed by a multi disciplinary team to confirm that they are the safest option for the person. The inspection also highlighted the need for the risk assessments to include best practice safety measures that need to take place prior to the use of bed rails and safety checks that need to take place whilst the bed rails are in use. The acting manager said that action had not been taken to address the two recommendations in relation to bed rails. The acting manager said that recent inspections had highlighted the need for a number of improvements/actions and as such had not got round to addressing the recommendations regarding bed rails. She said that bed rail assessments and risk assessment would take place within the next few weeks. A Pharmacist Inspector visited the home on 6 September 2010 to check for compliance against breaches in regulation. At this inspection we found further evidence of non compliance. The Care Quality Commission are continuing to investigate the breaches and considering the action to be taken. We looked at arrangements for receiving, storing, administering, recording and disposing of medication. We also looked at the Medication Administration Records (MAR) and talked to the acting manager, owner and staff about the systems in place. The recording of medicine administration was poor. Whilst there were very few gaps on the MARs, an audit of medication records in the home and stock showed that some medication had been signed for but not given. One medication in liquid form had been signed for on the MAR on seven occasions but had never been available in the home in the strength specified on the MAR. Medicines which were prescribed with a variable dose did not always have the amount given at each administration noted on the MAR. Some medication had been given at a dose different to the dose specified by the prescriber. MAR records showed that medication prescribed five times daily for one person had only been administered four times daily. MAR records for another person who was prescribed a medicine as a cream were incomplete and it was difficult to determine whether medication was given as prescribed. For another person the quantity of antibiotic medication supplied should have been sufficient for two weeks of treatment but MAR records were marked course complete after one week. The MAR for one person who had refused an antibiotic prescribed in tablet form, had a note saying that a liquid had been ordered however this was still not available four days later on the day of the inspection. The disposal records for one medicine did not match the records in the Controlled Drugs Register. Care Homes for Older People Page 5 of 13 Some people were not given medicines because they were asleep at 10pm when the bedtime medication round takes place. For three people medication prescribed twice daily was only given once daily. For another person who was prescribed two different eye drops once daily at bedtime and twice daily, twelve out of nineteen bedtime doses were not given because the person was asleep. In some instances these were the same people highlighted in the last inspection report. Records were kept of fridge and room temperature. However some medication which should be stored at room temperature was stored in the fridge and some, which the manufacturer recommends storage in the fridge, was stored either in bedrooms or on the trolley at room temperature. Medication for one person should have been stored in the refrigerator between two and eight degrees centigrade, as recommended by the manufacturer, this was stored on the trolley. The same medicine had been given for six days after the expiry date on the bottle. Handwritten entries had improved and now included the amount supplied and the signature of a second person who had checked the entry. Daily Life and Social Activities The June 2010 inspection highlighted that more activities should be available for people who reside on the dementia unit. The acting manager said that she had appointed a new activity co-ordinator to arrange and take part in activities and outings for people that use the service. The activity co-ordinator is to work Monday to Friday from 10am until 3pm. Complaints and protection A recommendation made at the June 2010 inspection in relation to updating the complaints procedure had been addressed. The complaints procedure had been updated to include the contact details of the Primary Care Trust. The acting manager said that the recommendation to update the adult protection procedure to link to No Secrets, Teeswide inter-agency policy/procedure and practice guidance had not been done. Environment We walked around the home during the inspection. The provider has continued to make improvements to the home environment. The acting manager said that there is a plan of refurbishment for the next twelve months. A bathroom on the first floor of the home had been refurbished. Other bathrooms in the home are also to benefit from refurbishment over the next 12 months. The inspection of the service in June 2010 highlighted the need for window restrictors to be fitted to the first floor kitchen window, this had been done. A key pad locking system is fitted to the kitchen door on the dementia unit to ensure the safety of people that use the service. At the June 2010 inspection we asked that a risk assessment be carried out to determine if there was a need to fit a key pad locking system to a door in the activities lounge that Care Homes for Older People Page 6 of 13 leads to some stairs up to the dementia unit. The acting manager said that she had consulted with the fire authority who have said that it would not be advisable to fit a key pad locking system. On the day of the inspection the home was observed to be clean and odour free. Since the last inspection two new macerators have been fitted to sluice rooms on the ground floor of the home. Staffing At the time of the inspection there were nineteen people using the service. The acting manager said that she and the provider had looked at the individual needs of people that use the service and reviewed staffing levels. The number of people using the service has decreased since the inspection in June 2010. The acting manager said that during the day and evening, people that reside on the dementia unit are coming down to the ground floor of the home and integrating with people from the older persons unit. She said that having everyone together ensures that the needs of people are met. We looked at duty rotas during the visit which informed that during the day and evening there are three care staff and a nurse on duty. On night duty there are two care staff and a nurse. The staff files of three newly recruited staff were looked at during the inspection. Records were evidenced to confirm that Criminal Records Bureau checks had been received before the staff commenced work. Following the inspection in June 2010 we issued a Warning Letter for failing to ensure that staff receive training appropriate to the work that they perform. At this inspection we found further evidence of non compliance. The Care Quality Commission are continuing to investigate the breaches and considering the action to be taken. What the care home does well: What they could do better: Following the inspection in June 2010 we issued a Statutory Requirement Notice for failing to make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A Pharmacist Inspector visited the home on 6 September 2010 to check for compliance against those Care Homes for Older People Page 7 of 13 breaches in regulation. At this inspection we found further evidence of non compliance. the Care Quality Commission are continuing to investigate the breaches and considering the action to be taken. Following the inspection in June 2010 we issued a Warning Letter for failing to ensure that staff receive training appropriate to the work that they perform. At this inspection we found further evidence of non compliance. The Care Quality Commission are continuing to investigate the breaches and considering the action to be taken. Breaches in regulation have been shared with Redcar & Cleveland Borough Council and the Primary Care Trust. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication Must be given as prescribed and a record made at the time it is given. This will ensure that people receive their medication correctly and treatment to their medical condition is not affected. REPEAT REQUIREMENT PREVIOUS TIMESCALE FOR ACTION NOT MET WE ARE CONSIDERING THE ACTION THAT WE ARE TO TAKE. 19/11/2009 2 23 13 The doors to the sluice rooms must be kept locked when not in use. This will ensure that people living at the home cant access these areas and are kept safe from any areas of risk. 30/09/2010 3 30 18 Staff must receive mandatory training and training appropriate to the work they perform. In particular staff must receive training in first aid, food hygiene, health and safety, fire, infection control, dementia awareness and challenging behaviour. 10/09/2010 Care Homes for Older People Page 9 of 13 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This will make sure that staff have the correct knowledge and skills to care for people that use the service. PREVIOUS TIMESCALE FOR ACTION OF 31/01/2010 NOT MET 4 30 13 The registered person must 31/01/2010 ensure that mandatory training is up to date and that certificates are on file to confirm that training has taken place. This will help to ensure that staff are trained and competent to do their job. 5 38 13 The emergency lighting must 30/09/2010 be serviced and records must be in place to show this has taken place. Action must be taken in respect of the five year electrical installation report. This will ensure that the systems are fully operational and provides safety to the environment. Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be stored safely at the temperature recommended by the manufacturer, and a system must be in place to check expiry dates of medicines. This makes sure medication is safe to administer 06/09/2010 2 19 23 Continue with the plan of 30/12/2010 action to refurbish bathrooms and toilets on the ground and first floor and bedrooms on the first floor of the home. To enhance the environment of people that use the service Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Where core care plans are used, these should be amended to include specific details about the individual needs and interventions. Page 11 of 13 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 8 Bed rail risk assessments need to be updated to include best practice safety measures that need to take place prior to using bed rails and safety checks that need to take place on a regular basis whilst bed rails are in use. The use of bed rails should be discussed with a multidisciplinary team to confirm that they are the safest option for the person. Evidence of discussion should be available within the bed rail risk assessment. More activities should be available for the people that reside on the dementia unit so that people are given appropriate social and leisure activities. The adult protection procedure should be updated to link to No Secrets, Teeswide inter-agency policy/procedure and practice guidance. Consideration should be given to improving the lighting to one of the ground floor corridors. A system should be in place to show when the maintenance and servicing of equipment is next due. 3 8 4 12 5 18 6 7 23 38 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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