Care Home: Castle Farm Residential Care Home and Farmhouse

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What the care home does well The expert, who visited with the inspector summarised their experience of Castle Farm `I would rate Castle Farm as an excellent Care Home. The care and support given to residents is of a high standard. The activities programme could be used as an example for similar Homes to follow. I would be delighted if any relative or friend of mine was lucky enough to reside in such a home. The obvious well-being and happiness of the residents is a tribute to Dawn Roessler (the manager) and all her staff - a real team effort!` In the annual quality assurance assessment the manager described what she thought the home does well. This is part of her answer. `We aim to offer value for money for our residents, in an anti-discriminatory environment. We recognise that everyone is different so we adapt our care to suit the individual needs, and the resident`s wellbeing is the central focus. We aim to create the right environment which supports physical and mental wellbeing. The home works upon a person centered approach. We build partnerships between residents, staff and residents` families and friends. We help residents feel a sense of purpose and we enable residents to take control over their lives where ever possible, as they would in their own home. We offer support in all activities of daily living and encourage residents to be independent, so that they can achieve their full capacity which enhances their self-esteem. Residents have expressed pride in their home to family and friends. We are committed to providing professional and respectful care in a friendly curteous manner.` The following is a summary of what was found at the inspection by the Commission. An excellent admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. Assessments and care plans are of an excellent standard. They are kept up to date to make sure that staff know how to care for the residents living at the home. A range of community health professionals support the care staff in looking after the residents and there is a good system for medication administration. Staff were observed throughout the inspection to be treating residents with courtesy, and kindness and residents confirm that their privacy and dignity are respected at all times. There is an excellent programme of activities on offer that residents can join in with if they choose to. Residents are free to spend their days doing as they like. Visitors are always welcome and residents are encouraged to maintain and develop relationships with people in the home and with their families and friends. Meals are varied and a choice is always available. Residents can have meals where they wish. The dining area is both pleasant and comfortable. The complaint and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The home and grounds are very well maintained, comfortable and safe for the residents living there and anyone visiting. The home is kept clean and smells pleasant. Sufficient numbers of well-trained and qualified staff are on duty throughout the day and night to be able to meet the needs of the residents. The home is very well managed and organised. The care and contentment of residents is clearly at the heart of the way the home is run. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Castle Farm Residential Care Home and Farmhouse Castle Farm Road Lytchett Matravers Dorset BH16 6BZ Lead Inspector Debra Jones Key Unannounced Inspection 12th December 2007 11:00 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 Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.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. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle Farm Residential Care Home and Farmhouse Castle Farm Road Lytchett Matravers Dorset BH16 6BZ Address 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) 01258 857642 01258 858402 castlefarmcare@aol.com www.larksleas.co.uk Castle Farm Care Limited Mrs Dawn Roessler Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A maximum of three bedrooms to be used as doubles at any one time, from rooms Nos: 9, 11, 17, 18, or 23. A maximum of two service users to be accommodated in the Farmhouse. Service users who have identified night-time care needs must not be accommodated in the Farmhouse unless additional staffing is provided within the Farmhouse. Any persons providing staffing cover in the Farmhouse must be subject to the same recruitment processes as other staff in the home, with required details held on them. 14th November 2006 Date of last inspection Brief Description of the Service: Castle Farm is registered to provide accommodation to a maximum of 22 adults over the age of 65 years. The farmhouse, which can accommodate 2 people, is not in use at present. In the main home the fourteen rooms being used as singles have en-suite facilities, as does one of the 3 of the rooms large enough to be doubles. There are 5 communal W.Cs, 2 communal bathrooms and one shower. The home has a lounge and conservatory area on the ground floor, with a small staff room and office also in this area of the home. There is a separate dining room. There is a through floor lift and one staircase is fitted with a stair lift. Residents have access to the gardens and patio areas, where seating is available. The home is on the edge of the village of Lytchettt Matravers with access to the local Doctors surgery, library and village store. Castle Farm has a minibus that can accommodate disabled people and has a ramp allowing access for wheelchair users. The current weekly fees range between £500 and £560. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit took place on 12 December 2007. Debra Jones, Inspector, carried out the visit and was accompanied by an expert by experience. This was the expert’s first time visiting the home and they commented. ‘The initial impression on entering Castle Farm is of a clean, bright, welcoming atmosphere. On a very cold day outside, the whole home inside was pleasantly warm without being stifling. There was none of the slight institutional smell that one can encounter in some residential homes. This must be a tribute to the hard work of the cleaning and care staff.’ The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting the requirement and recommendation made previously. A tour of the premises took place and a variety of records and related documentation were examined, including care records. The expert by experience spent time talking with residents in their bedrooms and in the lounge and dining area. Their feedback is included throughout this report. Dawn Roessler, the registered manager assisted the inspector in her work. The inspector and expert by experience were made to feel welcome in the home throughout the visit by all residents and staff members. Prior to the visit the home submitted their completed annual quality assurance assessment (AQAA) to the Commission. This gave information about the service and it’s performance. This document was excellently completed and proved very helpful in the planning of the inspection. The home also sent out questionnaires on behalf of the Commission to get people’s views of the home. Thirty-two questionnaires were returned. Ten were from residents, 14 from relatives/ friends, 5 from health and social care professionals, and 3 from GP surgeries. Those returned were generally very positive about the staff and service provided at Castle Farm and all said that they were satisfied with the overall care provided there. These are some of the comments that were made. ‘Just that Castle Farm is a wonderful example of how a care home should be. The staff are all so caring and go out of their way to be helpful and supportive – probably because of Dawn’s (the manager) inspired leadership. Any chance of doubling all their salaries? I also value this opportunity to express how impressed I am with this ‘home’, which really is a ‘home’ in the true sense of the word. Thank you.’ (a relative) ‘Overall this is a very well run, caring home. It is kept clean and tidy, food good and I am happy my mum is being looked after by them.’ (another relative) Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 6 ‘We have always been happy with the care received and consider ourselves fortunate to have found a place in this home for our relative.’ (another relative) ‘Very good care.’ (a GP) ‘We are always welcomed into this happy and well organised rest home and Dawn (the manager) leads a very successful team.’ (a health professional) ‘We enjoy visiting this rest home. We feel it is managed extremely well. The staff are always hospitable and help us if necessary.’ (another health professional) ‘I have and do visit many care / residential homes. I feel very comfortable and at ease in Castle Farm. I am always offered refreshments at all the homes I visit, for health reasons I normally refuse. At Castle Farm I always accept and enjoy lunch – reading between the lines that just about says it all. Castle Farm is the best care home I visit.’ (another health professional) ‘Generally I have always been impressed when visiting Castle Farm. Staff have been attentive and polite as well as empathetic with their client groups varying health and social needs. The home has a homely feel, is well presented and clean. I believe that all staff strive to provide these vulnerable people with some security and happiness in their twilight years.’ (another health professional) When asked ‘What do you feel the care home does well? Relatives said:‘They really listen. Then act appropriately. They really care. Dawn (the manager) in particular, is extremely caring and intuitive. She gives XX appropriate encouragement and affection regularly, and XX loves it. A hug, given appropriately, as it is, can do far more to help her than all the pills in the world. I feel really grateful she’s in such a loving and caring environment.’ ‘Most things.’ ‘Keeping the residents interested in life. They have arts and crafts, sing songs and even a lovely fete a few weeks ago.’ ‘nourishment, friendliness, personal care and attention, visiting hours, management, access to outside services.’ ‘Everything.’ ‘Treats the residents as individuals.’ ‘Very welcoming to visitors, kind to clients, very clean, healthy, home cooked food, care for the quality of life of their clients, always happy to discuss clients’ health and welfare with relatives.’ ‘Generate a happy atmosphere. Provide entertainment.’ The same question was asked of health professionals, who said:‘Castle Farm seems to offer a ‘home from home’ setting in which the residents enjoy a high standard of care and attention.’ ‘Castle Farm tries to promote a happy home. They have extra activities i.e. memory box arts and craft with a person weekly. Always asks for District Nurse advice.’ ‘Creates a community spirit with activities and even ‘village’ fetes on the summer. I suggest that you try the fete. I took my family and to our amazement we had a great time. Clients, family, care workers, all at play together. Channel 4 would hate it!’ Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 7 ‘Treats residents as individuals. Encourages residents to be mentally and physically stimulated by providing a variety of activities on several days of the week.’ ‘Provides a comfortable, high quality living environment for the elderly. Performs to a high standard with dementia patients care. Promotes interaction between clients and community. Good knowledge of accessing services on clients’ behalf. Quiet pleasant, clean environment. Smaller home allows increased consistency of home life and better overall knowledge of clients needs.’ What the service does well: The expert, who visited with the inspector summarised their experience of Castle Farm ‘I would rate Castle Farm as an excellent Care Home. The care and support given to residents is of a high standard. The activities programme could be used as an example for similar Homes to follow. I would be delighted if any relative or friend of mine was lucky enough to reside in such a home. The obvious well-being and happiness of the residents is a tribute to Dawn Roessler (the manager) and all her staff - a real team effort!’ In the annual quality assurance assessment the manager described what she thought the home does well. This is part of her answer. ‘We aim to offer value for money for our residents, in an anti-discriminatory environment. We recognise that everyone is different so we adapt our care to suit the individual needs, and the residents wellbeing is the central focus. We aim to create the right environment which supports physical and mental wellbeing. The home works upon a person centered approach. We build partnerships between residents, staff and residents families and friends. We help residents feel a sense of purpose and we enable residents to take control over their lives where ever possible, as they would in their own home. We offer support in all activities of daily living and encourage residents to be independent, so that they can achieve their full capacity which enhances their self-esteem. Residents have expressed pride in their home to family and friends. We are committed to providing professional and respectful care in a friendly curteous manner.’ The following is a summary of what was found at the inspection by the Commission. An excellent admissions procedure is in place that ensures that only people whose needs can be met are offered places at the home. Prospective residents and their representatives have the opportunity to visit the home to see if they like it before they move in. Assessments and care plans are of an excellent standard. They are kept up to date to make sure that staff know how to care for the residents living at the home. A range of community health professionals support the care staff in looking after the residents and there is a good system for medication Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 8 administration. Staff were observed throughout the inspection to be treating residents with courtesy, and kindness and residents confirm that their privacy and dignity are respected at all times. There is an excellent programme of activities on offer that residents can join in with if they choose to. Residents are free to spend their days doing as they like. Visitors are always welcome and residents are encouraged to maintain and develop relationships with people in the home and with their families and friends. Meals are varied and a choice is always available. Residents can have meals where they wish. The dining area is both pleasant and comfortable. The complaint and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The home and grounds are very well maintained, comfortable and safe for the residents living there and anyone visiting. The home is kept clean and smells pleasant. Sufficient numbers of well-trained and qualified staff are on duty throughout the day and night to be able to meet the needs of the residents. The home is very well managed and organised. The care and contentment of residents is clearly at the heart of the way the home is run. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? Since the last visit the home have made sure that they have the evidence to show that they have been getting protection of vulnerable adults list checks for new staff before they begin working there. In the annual quality assurance assessment the manager identified the improvements that the home had decided they wanted to make in the last 12 months. This is a summary of their achivements. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 9 They have • Asked residents, or their next of kin, to write ‘life histories’ as a way to value the personal qualities, experiences and talents of residents and as a means to finding new activities that might interest them. • Introduced new review and appraisal forms. • Increased the number of sessions the Activities Organiser delivers. • Had a loop system fitted to aid residents with hearing loss, to help them feel less isolated and to enable them to participate in entertainment. • Improved their check list for new employees, to ensure all relevant information is recorded and filed. • Taken on board new relevant government legislation e.g. the mental capacity act, and are training employees to meet the requirements and to put this new knowledge into practice. • Added an extra easily accessible patio area to the garden where residents can sit, giving more chioce and freedom to the less mobile residents. • Gained grants to improve facilities. What they could do better: Only one requirement was partially carried over from the last inspection report. The only regulation that the home is assessed as not fully meeting is that relating to employment. Prior to any staff working at Castle Farm the home needs to get a full employment history from them and explore and document any gaps in that history. This is to make sure that only suitable people are employed to work there. The home continues to function at the high standard that has been noted at previous inspections and has shown that their improvement plan for the home is not set by standards and regulations but by the commitment of the management and staff at the home to make life better for the residents living in their care. In the annual quality assurance assessment the manager identified their plans for improvement over the next 12 months. This is a summary of that plan. • Train care staff to play a more active part in care planning and risk assessment, so that they can be more actively involved in devising residents person centered care. Make amendments to the admissions procedure regarding the mental capacity act. Involve residents in the recruitment process. Continue to review the induction programme for new staff and improve if and when necessary. DS0000026776.V356250.R01.S.doc Version 5.2 Page 10 • • • Castle Farm Residential Care Home and Farmhouse • • • • • • • • • • • Source more information concerning the mental capacity act for residents and their next of kin. Give information to residents regarding this act so if they wish they can make an advanced directive concerning their future possible lack of capacity. Update the service user guide and residents information pack when necessary and add comments from residents. Make the service user guide available in braille and on audio tape. Also to make quality assurance questionnaires availbale in other formats. Place more emphasis on taking into account residents social, spiritual and emotional needs. Make available a list of other religious groups. Source more resident friendly games to meet all needs. Arrange more activities at week ends, to involve family and friends. Liaise with residents regarding a residents news letter. Introduce more complementary therapies. Continue to work on the refurbishment and development plan to maintain a comfortable home for the residents. Continue training staff to a high standard. Hold more regular staff meetings. Continue to promote feedback from residents in all areas to continually improve the service on offer.’ 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. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 11 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 Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A thorough pre admission procedure is in place and assessments are undertaken to ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: The home has an excellent service user guide which contains a wealth of information of interest to the residents. Not only is there information about the home, but also about local services that residents can access and how they can access them. Since the last visit the home have improved their admission procedure, now finding out about prospective residents’ infection history and about what immunisations they have had. Files for two residents who had recently moved into the home were reviewed. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 13 Both files contained pre admission assessments. Both residents had been assessed at the home they were staying in prior to Castle Farm. The pre admission assessments were excellently completed and showed a real interest in getting very specific things right for the person, ensuring that not only their needs, but also their preferences would be met from the word go. After the assessments were completed and the manager was sure that the home could meet the needs of the residents they were issued with letters confirming this. All ten residents who returned questionnaires to the Commission said that had been issued with a contract. They also all said that they had enough information before they moved in to the home so they could decide if it was the right place for them. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a clear, consistent care planning system in place, which provides staff with the information they need to meet the needs of residents. The health needs of residents are well met with evidence of good support from a range of community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents confirm that they are treated with respect and their privacy and dignity are promoted at all times. EVIDENCE: Files sampled contained thorough care plans, which were clearly laid out and specified the needs of the residents. A preliminary care plan is put in place when residents first move to the home and then the full care plan is drawn up when the resident has been at the home for about a month. Care plans cover Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 15 the same general areas for all residents but are tailored to the individual e.g. where there are specific conditions, individual needs, these are covered. One resident had care plans specific to each eye. Preferences are also taken into account, showing the commitment of the home to deliver the best possible service through knowing their residents very well and really making them comfortable e.g. one resident was noted as liking 3 pillows and another liked to keep their dentures in at night. Care plans are backed up by a variety of assessments. Each file contains a range of risk assessments e.g. pressure areas, hoists, falls prevention, manual handling. Since the last inspection new assessment tools have been put in place in respect of mobility and pressure ulcers. Where risks are identified practical measures are put in place to reduce risk. For example one resident was identified as being at risk of tearing their skin and had had foam tubing put around the furniture in their room. Plans were excellent in the way that they cross-referenced within the plan. For example one mobility plan cross-referred to the section on eyesight. Daily notes demonstrate how the care plans are delivered, and any follow up action that is needed is clear. Each part of every care plan and all assessments are reviewed every month. At the care plan review residents and relatives are asked if the care plan has been effective. When asked ‘do you get the care and support you need?’ Nine of the 10 residents who returned questionnaires prior to the visit replied ‘always’, with the other saying ‘usually.’ When asked ‘do the staff listen and act on what you say?’ All 10 residents said ‘yes.’ Of the fourteen relatives who responded by comment cards 12 said that the home ‘always’ gave the support or care to their relatives that they expected or agreed. The other two said that this was the case ‘usually.’ ‘I really do believe they go out of their way to be helpful and supportive. One member of staff has even suggested he gives up some of his own free time to take XX and presumably others too – out in the mini bus that caters for wheelchairs. It does feel like ‘one big family’ there, and Dawn (the manager) is brilliant at making each one feel like an individual within that family who matters. Their feelings are heard, listened to and acted upon wherever feasible. It is not at all easy and I believe they do a brilliant job.’ Care records also showed the interventions of community professionals. The home is very well supported by local GP surgeries and residents have good access to community services such as nurses, chiropodists, dentists and opticians. All residents see a GP at least every 3 months to ensure that their health care needs are met and medication prescriptions are up to date. Care plans show how the treatment of residents is supported by staff at the home between the visits of health professionals e.g. the nurses. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 16 One new resident had arrived with broken glasses and the optician was seeing them the next day. ‘We try and make the extra effort to do everything we can.’ (the manager) Residents are assessed and where appropriate aids are made available to them to help them around the home, or in and out of bed, e.g. hoists, pressure cushions, bath seats, wheel chairs, zimmer frames etc. These were seen to be near at hand. All ten of the residents who returned comment cards said that they ‘always’ received the medical support they needed. When asked do you feel the home meets the needs of your relative? Ten of the 14 said ‘always’, 3 said ‘usually’ and the other ‘sometimes.’ ‘Yes. I do. I think they are brilliant.’ ‘My mother’s health and well being has improved enormously since going in to the home in February this year.’ ‘My mother is both largely deaf / blind and unable to walk for long. This condition is difficult to cater for by anybody. However physical needs are well catered for and the atmosphere is relaxed and caring.’ When asked are individual health care needs met by the care service? All 5 health professionals who responded by questionnaire said ‘always,’ comments included:‘Dawn (the manager) leads a very proactive team.’ ‘Very high standard of care. Patients turned regularly and always look clean and comfortable. Always appear happy and content. Any wounds or tissue viability issues referred to District Nurses.’ ‘Full co-operation – staff / chiropodists / NHS.’ ‘The care staff take note of residents’ concerns about their health and via the manager report these to medical staff.’ ‘In my experience of treating some of the residents at Castle Farm the staff strive to do their utmost at all times regarding health needs. If a patient asks for dental services then the staff are quick to react in referral to our service if necessary.’ The 3 GP surgeries that returned comment cards to the Commission said that the home communicated clearly and worked in partnership with them. They also said that the home took appropriate decisions when they could no longer manage the care needs of residents. All said that staff demonstrated a clear understanding of the care needs of residents. Health professionals were asked does the care service seek advice and act upon it to manage and improve health care needs? The 5 who responded said yes ‘always,’ and commented ‘Has regular District Nurse input each week on Tuesday. Has regular GP input and always phones for advice from health care professionals.’ Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 17 ‘Care staff report concerns over medical concerns promptly to the medical /health care staff.’ ‘Very thorough with complete audit trail,’ ‘All staff have always been polite and attentive. Dental needs are detailed in care plans and attention is paid to try and improve the oral health and education of residents.’ Medication at Castle Farm is only administered by trained members of staff and a sheet with their signatures is kept as per good practice. Medication administration records (MARs) sampled were up to date and properly completed. Any allergies known were clearly recorded, and where there were none known this was noted. The quantities of medicines coming to the home were signed as received on the MARs. Where staff had made handwritten changes to the MARs another member of staff had appropriately countersigned these entries. Most medicines at the home are delivered in monitored dosage packs and medicines seen that were still available matched the records. Where medicines are in ordinary packets a simple system is in place at the home to enable anyone to know how many of these tablets there should be in the home. Medication was tidily stored in appropriate places e.g. medication cupboards, trolleys and in the fridge. The temperature of the fridge is monitored to ensure that the medicines in it are stored at the right temperature. Records are kept of the medicines that are returned to the pharmacy. Each care plan contains a section on medication and a history of the medicines that the resident has been prescribed. In the last year the home have introduced a monthly self audit of medication. Records are kept of these audits and were seen at the visit. No medication errors have been detected. The GPs and health professionals who returned comment cards, and felt able to comment, said that in their opinion medication was appropriately managed in the home. Having spent time talking with residents during the day the expert by experience commented that ‘Residents are treated with just the right mixture of respect and humour.’ Staff were seen to treat residents in a respectful and dignified way during the course of the inspection and were polite and courteous. All those who returned comment cards to the Commission confirmed that they were able to see residents in private when they visited. Health professionals told us about their experiences of visiting residents. ‘Always knock on door and screens are used where possible.’ ‘Staff always knock before entering. Screens are always used if necessary.’ ‘Residents are seen by medical / nursing staff in private areas usually their own rooms.’ ‘I think management and care staff do a good job in sometimes challenging circumstances. It is very difficult in these environments to respect a person’s privacy and dignity 100 of the time, but every effort is made.’ Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ lives are enriched by the choices they are able to exercise in their daily lives, the wide range of social opportunities afforded by their visitors and the activities and entertainment available in the home. The meals in this home are very good offering both choice and variety and are served in a pleasant environment. EVIDENCE: The expert by experience spent time talking with residents and fed back as follows ‘It was apparent that a wide range of activities were in place to stimulate and entertain the residents. On the day I visited a team were getting ready to visit a neighbouring Home to contest an indoors bowls match. This was obviously a keenly anticipated outing that rivalled any local derby in the Premiership. On a regular weekly basis there were Extend Exercises, Memory Box activities and Drama Therapy. Entertainers from outside were a frequent occurrence, and staff also conducted bingo sessions. Quizzes, games and parties also formed Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 19 part of a regular programme. The Homes mini bus regularly took residents on shopping expeditions or visits to places of local interest. Visits from outside professionals such as hairdressers, chiropodists and opticians were a regular feature.’ Preparations are being made for Christmas and an invitation to residents and relatives to come to the Christmas high tea was on display in the entrance hallway. The home are only too aware of the potential flat feeling after the build up to Christmas and have already organised some activities for the end of the year and the new year for residents to look forward to. All 10 residents who returned comment cards said that they it was ‘always’ the case that there are activities arranged by the home that they can take part in. As stated in previous inspection reports Castle Farm is run in a manner that supports residents to live their lives as they choose. Residents are never hurried and are supported during the day to do what suits them. Staff spend upwards of 30 minutes with some residents getting them ready for the day, spending quality time together and enabling residents to do as much for themselves as they can. The expert by experience commented ‘It was clear that a significant amount of staff time was taken in preparing residents for the day ahead.’ The staff group are very responsive to the needs and preferences of residents and recently the morning routine has changed to accommodate more residents wanting to get up earlier. Visitors are welcome to come at any time. The visitors’ book confirmed the number and range of visitors to the home. Seven of the 14 relatives who returned questionnaires said that it was ‘always’ the case that the home helped their relative keep in touch with them. Most of the others did not find this question applicable to them. Nine out of the fourteen said that they were ‘always’ kept up to date with important issues. Two said they were ‘usually’ and one ‘sometimes.’ ‘If mother goes to hospital they will always contact me.’ Most residents have the support of families or supporters / solicitors to help them with their affairs. Residents at this home are well able to make their choices and opinions known to staff and are in control on how they live their lives. There is even a choice of 3 visiting hairdressers. Relatives were asked if the home gave support people to live the life they choose. Of those who replied nine said ‘always’ and 2 said ‘usually.’ Comments included ‘The home treats the client as a person who matters and allows them to lead their life as they want to.’ ‘Yes. XX seems free to join the others or stay in her room, or go out in the garden or (when she was mobile enough) to come out in my car.’ ‘The care home is very good at putting on activities.’ Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 20 ‘In our experience.’ Health professionals said ‘‘There may be some ‘limitations’ but ‘always’ where possible.’ ‘Encouraged to keep up their hobbies and independence.’ ‘Residents concerns / wishes are always listened to and taken into consideration.’ ‘Castle Farm seems to encourage a ‘village’ feel and clients seem happy and not overly ‘institutionalised.’ ‘They always seem to encourage their clients to live comfortable lives in a warm, caring environment. The service is well connected with the local community and helps provide residents with a vital link to the outside world.’ The expert by experience, who spoke with residents about food, and shared lunch with them said ‘Residents could choose to have their breakfast, and other meals, either in their own rooms, or in the dining room, or at individual tables in the main lounge. A good choice of food was available, and the lunch that I shared was hot and nutritious. There was a good choice of soft drinks available and residents could also have their own favourite tipple.’ Menus are based around the known likes and dislikes of the residents, on providing a good wholesome diet and delivering appropriate meals for the time of year. Alternatives are always available. Residents are offered meal choices on the day. The lunch on the day of inspection was roast chicken, stuffing, roast potatoes and parsnips. This was served with mixed vegetables and broccoli. Dessert was a choice of treacle tart and custard, or jelly and cream. Diabetic and soft diets are currently being catered for. Supper was to be fish casserole or couscous or sandwiches. The chef meets daily with the residents to find out what they thought about the food. Appropriate food records are kept of what residents have eaten. The Commission received ten comment cards from residents prior to the inspection. Eight of the 10 said that they ‘always’ liked the meals at the home and 2 said that they liked them ‘usually.’ ‘Always offered an alternative meal.’ ‘Castle Farm cooks always find an alternative menu if I don’t like what is on offer.’ The local Environmental Health office carried out a food premises inspection in June 2006. As a result of this visit the home got an award for their high standards in food hygiene, the cleanliness of the premises and food safety management. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A system is in place to deal with complaints that are made by residents and their representatives. The home’s adult protection policy, pre employment checks and ongoing staff training demonstrates the homes commitment to understanding abuse and of protecting residents. EVIDENCE: The home has a complaints policy / procedure that is available to residents and their supporters; a copy is given to prospective residents, is in the service user guide, available in residents’ rooms and is on display in the entrance hall. No complaints have been received by the home in the last 12 months. The questionnaires sent to residents asked the questions ‘Do you know who to speak to when you are not happy?’ And ‘do you know how to make a complaint? Ten residents sent back cards. All answered ‘always’ to these questions. Twelve of the 14 relatives / friends who returned comment cards said that they would know how to make a complaint if they needed to. People commented:Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 22 ‘I’m sure I could easily find out if I needed to! – however with this particular home I think it highly unlikely I would ever need to.’ ‘I have never needed to make a complaint but I am sure they would tell me how if I ever needed to.’ ‘I feel if I have worries about my mother I can go to the manager and discuss it with her and usually my worries are solved.’ When asked if the service responded appropriately if you or your relative have raised concerns about their care ten said ‘always’ and the others said the question was not applicable to them. Comments received included ‘I am invariably very impressed by the way all the carers – particularly Dawn (the manager), xx and xx– listen and take on board any points I raise. ‘We’ve never raised concerns about her care, so cannot comment. They do respond appropriately to other questions.’ ‘Have had no reason to complain about anything at the present time.’ ‘They have always discussed any problems with me although I haven’t always had the answers I would like.’ ‘Neither I nor my mother have ever had any reason to worry about the standard of care provided.’ ‘We (my sister and I) have only had to make minor complaints – mainly about the care of clothes.’ The same question was asked of health professionals who commented ‘I have always found that Dawn’s (the manager) main concern is that the patient’s needs are always met and responded to quickly.’ ‘I have never really encountered any concerns. The staff always take on any suggestions we make.’ ‘Always very good.’ The home has an adult protection policy and there was evidence to show that staff had had training in this area. Prior to any members of staff commencing employment at Castle Farm the Protection of Vulnerable Adults list is checked to ensure their suitability. Evidence was seen of this. Since the last inspection visit the home has not made any referrals to the Protection of Vulnerable Adults list. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Castle Farm manages to create an environment that is homely, comfortable and at the same time safe for the residents living there and for anyone visiting. Bedrooms are well decorated, well furnished and personalised to suit the residents. Adequate communal facilities are available to meet the number and needs of the current residents. The home is kept clean and smells pleasant thereby enhancing the daily life of all at Castle Farm. EVIDENCE: The expert by experience gave his impression of Castle Farms’ environment. ‘The communal facilities in the Home were varied and of a uniformly high standard. Apart from the main lounge and dining room there was a large conservatory, and general seating area on both floors. The outside area was Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 24 very pleasant with both a Sensory Garden/Greenhouse and Secret garden. Residents I spoke to fully appreciated the opportunity to use these facilities when the weather allowed. The newly fitted communal bathroom that I inspected on the ground floor was of a very high standard, with an impressive array of aids to help residents and care staff. The personal rooms of the residents were extremely pleasant - airy, bright and often with high ceilings and beams due to the original nature of the building. The majority of rooms had en-suite facilities. Residents were able to personalise their rooms by bringing in their own pictures, pieces of furniture etc. Due to the rural location of the Home many of the rooms had pleasant views over the surrounding countryside.’ There is a passenger lift in the home, enabling easy access between the floors. A stair lift has been installed to make getting up and down a set of stairs in the older part of the house easier. There are emergency alarm bells throughout. Since the last inspection the home have made some improvements. • The downstairs communal bathroom has been completely refurbished. The new bath enables some of the less mobile residents to have a bath and due to it’s raising ability, the potential risk to the staff is reduced. • One of the shared rooms has been changed into a single occupancy room, and an ensuite has been added. • The kitchen has been completely refitted with stainless steel and new appliances have been purchased. • A new patio area has been built in the garden, giving more choice to residents of different areas to sit in. Garden areas have been extended and new garden furniture purchased. • Lighting has been improved in rooms where residents have poor vision. On the day of the visit the home was clean and there were no unpleasant odours. The laundry was clean and tidy. It is equipped with suitable washing machines. All laundry is done at the home. All of the 10 residents that returned questionnaires said that the home is ‘always’ fresh and clean. Both of the home’s cleaners have achieved NVQ level 1 in cleaning. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient, well-trained care staff are employed and deployed to ensure that the needs of residents can be met. Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. EVIDENCE: The expert by experience commented on staffing arrangements ‘It was apparent that the residents enjoyed a close and supportive relationship with the care staff. All the staff that I met displayed a friendly and helpful attitude towards the residents. Residents were treated with just the right mixture of respect and humour. As one resident told me were so lucky to be here . Even a resident who admitted to me that she would still rather be in her own home also said the staff are very caring.” Duty rosters are kept showing who is on duty and when. Three health care assistants are on duty throughout the day (from 7am to 8.30pm) along with the manager and her deputy. At night there are always 2 health care assistants. Daily there is are cook and cleaner on duty. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 26 Residents were asked are the staff available when you need them? All 10 of the residents who responded said ‘always.’ All 3 GPs who responded to the questionnaires said that there was always a senior member of staff for them to confer with when they needed to. Seven of the twelve members of care staff at Castle Farm have achieved a National Vocational Qualification at level 2 in care. (The target set by the Department of Health is for 50 of care staff to have this qualification). Three are working towards level 3. Of the fourteen relatives who returned comment cards 6 thought that the staff at the home ‘always’ had the skills and experience necessary to look after their relatives properly while 5 thought this was the case ‘usually.’ ‘As far as I can tell.’ ‘I think the care staff at Castle Farm are just lovely.’ ‘I have absolute confidence in the staff.’ ‘The staff are very nice. I call at different times of the day. They are all very good.’ ‘I find the staff speak and spend time talking with the residents, this appears to be very genuine.’ Health professionals were also asked this question. Three of the 5 who responded thought that care staff ‘always’ have the right skills and experience to support social and health care needs, 2 thought so ‘usually.’ A system is in place to monitor ongoing staff training and to identify when refresher sessions are needed. Recent training has included person centred care, moving and handling, medication and first aid. Records are kept of staff induction. The home’s induction programme is based on that developed by Skills for Care (the industry standard). Three staff files of newly employed care staff were sampled to see how the home manages recruitment. All prospective staff had completed application forms and had been interviewed. Pre employment checks had been carried out, including checking the Protection of Vulnerable Adults (POVA) list (held by the Department of Health). All files contained 2 written references. The only shortfalls noted were incomplete employment histories. The home has a recruitment checklist to prompt the collection of employment documentation and a new recruitment policy was available. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is extremely well organised and the daily management and running of the home centres round the care and contentment of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: Dawn Roessler is the manager of Castle Farm and has been for the last 7 years. She has a nursing background and keeps her registration ‘live’ on the National Midwifery Council register. Mrs Roesssler also has the Registered Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 28 Manager’s award, an accepted management qualification equivalent to the NVQ 4 in management. Health professionals commented about her as follows ‘I have always found Dawn to be very supportive of individuals needs, both social and health care.’ ‘Mrs Roessler is a very efficient and able nurse. She shows genuine affection towards the clients and they all adore her!’ Prior to this inspection visit the home completed an annual quality assurance assessment (AQAA), which they submitted to the Commission for Social Care Inspection. This was excellently completed, identified what the home felt they did well and set out their plans for improvement over the next twelve months. The home sent out and made available questionnaires for the Commission as requested before this visit. Comments came back from 10 residents, 14 relatives, 3 GPs and 5 health professionals. All were generally positive about the home. A range of policies and procedures underpin the care delivered at the home. The home confirmed that all were reviewed in 2007. The home is owned by Castle Farm Care Ltd, which in turn is part of the Royal Bay Care Homes group. The Responsible Individual registered with the Commission for this company – Russell Wilson – lives in the same grounds as the home. He is closely involved in the day-to-day life of the home. The manager described his as a ‘good boss.’ The home holds some small amounts of money belonging to residents. This is kept safely locked away. Records of expenditure and balances were seen. Regular audits are undertaken. All records kept in the home were made available to the inspector as requested and are appropriately stored. The registration certificate was clearly displayed, as was the home’s insurance certificate. Prior to the inspection the home submitted information to the Commission that showed that they are up to date with their maintenance checks to ensure safety in the home. Since the last inspection the checking of bed rails has been built into the regular maintenance checks. Records evidenced the regular weekly and monthly checks of fire safety equipment. Records also show that staff have fire training at appropriate intervals. Information about what to do in the event of a fire is clearly displayed in the entrance hallway. The home has completed a fire risk assessment that is regularly reviewed. The date of the last review was May 2007. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 29 Dorset Fire and Rescue last visited the home in September 2007 and the standard of safety was assessed as satisfactory. Accident records were looked at. Records were well completed and an accident analysis is carried out every 4 months. Where appropriate measures are put in place to minimise the risk of future accidents occurring. Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 30 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 4 X 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X 3 3 Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement All documentation as specified in the regulations must be kept on file and be available for inspection in respect of all staff employed at the home. Full employment histories must be obtained prior to employment. Any gaps in employment must be explored and reasons documented. Timescale for action 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Castle Farm Residential Care Home and Farmhouse DS0000026776.V356250.R01.S.doc Version 5.2 Page 33 - 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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