Care Home: Castle Dene

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What the care home does well The home provides a warm and welcoming environment to those that live and visit the home. This was evident from the comments we received from individuals and relatives ""welcoming nature of the carers and staff" "its a friendly and nice place to live" "always make our family very welcome". The care planning practice is generally good with staff receiving clear information about the care needs of individuals who live in the home. There is a good effort to provide a range of activities appreciated by the individuals who live in the home: "always something going on" "theres always something going on if I want to do it". The employment of an activities co-coordinator makes a significant difference in the activities being provided. Staff have a real commitment to providing quality care and take pride in the work they do and individuals we spoke with saying how "staff are very good" "all members of staff excellent" "they know their job and there if we need them". Staffing has improved with recruitment of new staff and the reduced use of agency staff which helps in providing greater continuity and consistency. There is a good effort to seek the views of all those who have contact and receive care at Castle Dene and continued improvement in the provision of care and policies and procedures all having an positive effect on the quality of care being provided in the home. What has improved since the last inspection? We looked at practice relating to the two requirements made at the last inspection and noted that these have been met. This has resulted in improvements in health and safety practice in the home. What the care home could do better: This inspection identified that the home needs to make sure its practice around the use of sedative and variable dose medication is more robust. There needs to be guidance about its use thereby protecting individuals and giving greater protection from inappropriate use. As stated above care planning is generally good however there could be more information about the individual relating to their personal circumstances such as family circumstances, previous occupations, particular interests and hobbies and more focus on the impact of physical disability or learning disability. This would make the care plans more person centered. In addition improvement is needed with regard to risk assessments and in making sure they provide all the information needed to alleviate risk and records relating to specific needs such as nutrition must be more detailed so that there is accurate evidence of these needs being addressed. Health and Safety practice relating to the continued practice of having uncovered radiators in all areas of the home must be addressed. There must be clear evidence in the form of risk assessments to evidence that where these present a risk to individuals action has been taken to alleviate or remove the risk. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Castle Dene Throop Road Bournemouth Dorset BH8 0DB     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Clarke     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Castle Dene Throop Road Bournemouth Dorset BH8 0DB 01202397929 01202646540 castledene@care-south.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care South care home 50 Number of places (if applicable): Under 65 Over 65 10 10 40 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 0 50 in the category OP (Old Age) including up to 10 in the categories DE(E) and/or MD(E). The home may accommodate three named service users under the age of 65, one of whom is in the category of PD. Date of last inspection Brief description of the care home Castle Dene is a care home providing personal care and accommodation for 50 older people of whom up to 10 may have dementia or mental health needs. It is operated by Care South, a not for profit organization providing care services across the South West. The home is located in a residential area of Bournemouth within easy reach of the A338 and the Travel Interchange. The home was first registered in 1991 and consists of a two storey building. All accommodation is provided in single bedrooms. There is a passenger lift to all floors making access possible for all service users. Care Homes for Older People Page 4 of 27 Brief description of the care home Visitors are always welcome. Pleasant gardens surround the building, providing safe and easily accessible recreational areas. All meals are prepared in the home. The home has a small shop. There is a programme of activities for service users to participate in and outings are arranged. Castle Dene has suitable aids and adaptations to offer a safe, comfortable and stimulating environment for services users with a variety of needs and abilities. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home as part of our inspection. We looked at a number of records about the care provided in the home including pre-admission assessments, care plans, medication records. We also looked at staffing recruitment and training and health and safety practice in the home. There was also an opportunity to talk with individuals who live in the home and members of staff. As part of this inspection we sent Have Your Say questionnaires to the home we received responses from 11 individuals who live in the home and 8 staff members. The manager also completed an Annual Quality Assurance Assessment which gave us information about the practices of the home and improvements that have taken place since our last inspection in September 2006. We have used this information to help us make a judgment about the quality of the care provided at Castle Dene. Care Homes for Older People Page 6 of 27 Current fee 515-575 pounds depending on level of need. Fee for individuals who ned care because of their Dementia 605 pounds. There is a 10pound supplement for larger rooms. What the care home does well: What has improved since the last inspection? What they could do better: This inspection identified that the home needs to make sure its practice around the use of sedative and variable dose medication is more robust. There needs to be guidance about its use thereby protecting individuals and giving greater protection from inappropriate use. As stated above care planning is generally good however there could be more information about the individual relating to their personal circumstances such as family circumstances, previous occupations, particular interests and hobbies and more focus on the impact of physical disability or learning disability. This would make the care plans more person centered. In addition improvement is needed with regard to risk assessments and in making sure they provide all the information needed to alleviate risk and records relating to specific needs such as nutrition must be more detailed so that there is accurate evidence of these needs being addressed. Health and Safety practice relating to the continued practice of having uncovered radiators in all areas of the home must be addressed. There must be clear evidence in the form of risk assessments to evidence that where these present a risk to individuals action has been taken to alleviate or remove the risk. Care Homes for Older People Page 8 of 27 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs of the individual. Individuals are given the opportunity through the admission assessment, pre-admission visit and trial period to make an informed decision that the home is suitable and can meet their needs. Evidence: We looked at a number of pre-admission assessments they showed good information as to the health, physical and social needs of the individual. Where individual known to social services a copy of their assessment is obtained by the home. One individual we spoke with said they had visited the home before moving to live there permanently. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning and arrangements for meeting health care are satisfactory providing staff with information so that the health and social care needs of residents are met. However there is a failure to consistently provide full and detailed information so that specific care needs can be fully met. Arrangements for managing medication make sure that residents health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. Evidence: We looked at a number of care plans (5). Assessment of needs and abilities, physical and mental health, personal values, leisure interests. All had been reviewed regularly, risk assessments completed regarding pressure care (Waterlow), Nutritional, Moving and Handling assessments. Not all had signature of the individual. For one individual no risk assessment had been completed regarding aggressive behavior. Fluid and Nutrition goals with diet intake charts had limited information as how to respond if dietary needs not being met. Charts did not record how much with regard to amount Care Homes for Older People Page 12 of 27 Evidence: of fluids and other foods. For one individual there was no pen picture of the individuals disability as stated in the homes audit. For another there was no information as to the needs in relation to their learning disability and for one where needs are identified as where possible to stimulate mentally no information as to how this could be achieved. Records illustrated the involvement of health professionals in their care; physiotherapist. Referrals made for nutritional assessment through dietitian. Individuals who live in the home have access to community health services such as chiropody, dental and community nursing services. Individuals who live in the home who responded to the Have Your Say questionnaire said they always 7 usually 4 Receive the medical support you need? Medication administering records were looked at and had been completed as required with no gaps. As needed medication (PRN) recorded. Controlled drugs recorded in controlled drug register stock was checked against record and found to be accurate. Two signatures when given as required. For one individual who had diazepam as required there was no instruction or guidance in its use. Refrigerator for medication which required this storage. High level of stock and this was discussed with staff member responsible for medication who was aware of need to limit stock of medication. New supplier had been arranged and this was in part cause of excessive stock. We spoke to number of individuals about the approach of staff and all said how they felt staff were all very good treat me as I would want to be treated cant fault. Staff were observed throughout our visit talking with and assisting individuals in a respectful and sensitive, supportive manner. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The homes practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. Evidence: We spoke with a number of individuals who live in the home about the activities provided. They spoke of a range of activities including quizzes, flower arranging, crafts, outside entertainers. The home has also arranged trips out to see local panto and in the summer months to local attractions. One individual said they always enjoyed the activities and another said I try and do as much as I can. The home employs an activities organiser. The home has purchased a Nintendo Wii and encouraged the use of the garden in the summer months. Individuals who live in the home and responded to the questionnaire said there are always 3 usually 6 sometimes 2 to Are there activities arranged by the home that you can take part in?. Care Homes for Older People Page 14 of 27 Evidence: One individual commented that they would like more trips out and another said there are frequent activities covering a range of interests. Individuals said they felt the home always made their visitors feel welcome and that the home was a friendly place and visitors can come when they like theres no restrictions. One relative said that the home makes myself and all the family very welcome. We can visit whenever we like. We spoke to a number of individuals about the meals provided in the home and all were very positive about the choice and range of food: always very good, give me things that I like always a good choice fantastic food at all times. Menus showed there is a variety of meals provided in the home and the cook clearly had a good understanding of the importance of food and providing appetizing meals. Those who needed assistance with meals were seated in separate dining area with member of staff available to give support. Staff were observed providing assistance in a discreet and sensitive manner.Individuals who responded to the questionnaire said that they always 4 usually 7 liked the meals at the home. Individuals we spoke with said they felt they could choose how they spent their day can get up when I want its up to me what I do. One individual told us they felt there was no restrictions in the home staff always very flexible and listen to what we want to do. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing Safeguarding training to all staff. Evidence: We spoke to a number of individuals about what they would do if they were unhappy about anything or had worries about the care they were receiving. All spoke of can talk to staff or would speak to the manager. We asked if they knew about the homes complaint procedure and they did with one individual saying that I have never needed to make a complaint but would if I had too. There was one recorded complaint since our last inspection this was dealt with in a professional manner within the time period set by the homes complaint procedure. The complaint resulted in a change in the homes practice and written response had been sent to the complainant. The home has procedures in place regarding responding to any allegations of abuse. Staff receive Safeguarding training. We spoke to a group of staff about their understanding of abuse and they were able to give a clear understanding of the nature of abuse and where it may be considered abuse in a care setting; inappropriate Care Homes for Older People Page 16 of 27 Evidence: touching, not giving the care individuals needed or refusing care, ignoring individuals, use of in-appropriate language. All said they would definitely report any concerns to their manager. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. Evidence: In walking around the home it was evident that there is a good standard of decoration and maintenance with rooms being re-decorated regularly and communal lounge areas well decorated and fitted with homely furnishings and seating. A new fire bell system has been installed and there are plans to install new call bell system. At the time of our visit the home was clean and individuals we spoke with all commented on how clean the home is and well kept. Staff have received infection control training. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. Evidence: We examined recruitment records for five members of staff. All had Criminal Record Bureau checks, POVA checks, two references had been obtained, full details of employment. Staff had completed mandatory training: moving and handling, fire safety. Other training undertaken by staff were Dementia, End of Life care, Infection Control, Safeguarding (though not all had completed latter). Staff we spoke with said there was lots of training if we need it we get it. We received questionnaire responses from 8 staff members and all said they received the training they need for the work they do. Comments made by staff included; training is first class the training I receive from Care South is very good they keep us up to date in all our courses. Of the 26 staff employed by the home 17 have completed NVQ professional qualification at level 2 or 3. All staff undertake the Skills For Care induction Care Homes for Older People Page 19 of 27 Evidence: programme and records seen confirmed this. On the day of our visit there were 5 care staff on duty am (7:15-2.45) and 5 (included two agency staff) 2.15.9.45 with care team manager. There are two waking night staff and shift leader. Staff who responded to the questionaire said there are always 2 usually 5 and sometimes 1 to the question Are there enough staff to meet the individual needs of all the people who use the service?. There has been historically high use of agency because of staff vacancies but following recruitment this has improved and staff confirmed this is now better then previously. We spoke to individuals who live in the home about the staffing arrangements and availibility of staff all said that they found staff very quick to help always there if I need them. Individuals who live in the home who responded to the questionaire said that there are always 3 usually 7 staff available when you need them. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for those who live in the home and others to express their views about the service they receive. There are procedures in place to monitor the quality of the services and practices followed by the home so that weaknesses can be identified and the quality of the service can be improved. The practices of the home help to protect the health and welfare of those that live and work in the home. Evidence: The manager of the home has extensive experience of working in a care setting and has been at the home for three years. She has the Registered managers Award. People we spoke with described her as someone we can talk too always around if we need to speak to her very caring. The manager always has an open door policy for staff, residents and relatives (staff member). There is an annual quality assurance system in place undertaken by independent organisation however results of last questionnaires were not available and we Care Homes for Older People Page 21 of 27 Evidence: requested these to be sent when received by the manager. The home introduced an internal audit system where they look at different areas of the service on a monthly basis. This helps to make sure policies and practice remains effective and consistent. Compliments received by the home included the care and attention given by your staff was second to none kind and professional care could not be faulted staff courteous and polite at all times. good team spirit. Records confirmed regular servicing of fire system and equipment in the home. A fire risk assessment has been completed and reviewed. Fire training and drills take place as required. It was noted that there are uncovered radiators throughout the home and there were no risk assessments relating to these radiators. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 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, Care Homes 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 7 12 The registered manager to make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals who live in the home. This refers to the need to provide full information associated with meeting care needs such as dietary intake, specific needs around physical, mental or health conditions. 30/03/2009 2 7 13 The registered manager to 27/02/2009 make sure that unnecessary risks to the health and safety of individuals who live in the home are identified and as far as possible eliminated. This refers to completing risk assessments and identifying as part of the risk assessment how identified risk can be alleviated or Care Homes for Older People Page 24 of 27 eliminated such as when responding to aggressive behavior, managing dietary needs. 3 9 13 The registered manager to make sure there are arrangements for the safe administration of medication. This refers to having specific instructions as part of care plans as to the use of medication which is presribed as required. This will ensure that there is consistency in its use and protect the welfare of the individual through in appropriate useage of such medication in this instance sedative medication. 4 38 13 The manager to make sure 31/03/2009 that unnecessary risks to the health or safety of individuals who live in the home are identified and so far as possible eliminated. This relates to the uncovered radiators in the home which may present a risk to some individuals. Risk assesments for individual rooms and other areas of the homewhere there are uncovered radiators must be completed to identify the level of risk and where action is needed to eliminate the risk. 30/01/2009 Care Homes for Older People Page 25 of 27 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 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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