Care Home: Castle Grange

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What the care home does well Record keeping in the home is extremely organised and efficient. All information is held securely where appropriate. Pre admission assessments and care files are detailed and informative. Staff are provided with full information regarding the needs of the service users and the daily records provide evidence of the actual care given. Service users spoke highly of the staff and referred to them as ‘kind, caring, will do anything for you and what a lovely bunch of girls’. The home is maintained to a good standard and safety is maintained. The environment is homely and clean. What has improved since the last inspection? The environment continues to improve through redecoration and refurbishment. The number and range of activities have increased to provide service users with stimulation and entertainment. What the care home could do better: The home should continue to provide a high level of care for the service users whilst improving the environment through regular review.Castle GrangeDS0000025093.V377429.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Castle Grange 9 Haymans Green West Derby Village Liverpool Merseyside L12 7JG Lead Inspector Jeanette Fielding Key Unannounced Inspection 2nd September 2009 10:10 DS0000025093.V377429.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle Grange Address 9 Haymans Green West Derby Village Liverpool Merseyside L12 7JG 0151 226 5676 0151 256 8237 castlegrange@schealthcare.co.uk 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) Southern Cross Operations Limited Ann Woods Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 41 Date of last inspection 16th June 2008 Brief Description of the Service: Castle Grange is a large modern purpose built care home providing 41 beds to support older people with nursing and social care needs. The home is located near to West Derby village close to shops, churches and other amenities with public transport links to the city centre 5 minutes walk from the home. The care home is owned by Southern Cross Healthcare. Accommodation is provided on three floors with lift access to each floor. There is a pleasant garden to the rear of the premises and shrubbery to the front. Car parking facilities are located to the front of the building. All rooms are single Six rooms have en-suite facilities and 38 rooms are at least 12 sq metres in size. There are two lounges, one used as a quiet lounge and the other being a large area with good views over the rear gardens. There is a large L shaped dining room, which affords more than adequate space for all the people living in the home to dine in comfort. Fees are between £330.00 - £715.00-per week. A top up fee of £15 per week is charged for rooms with en-suite facilities. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means that people who use the service experience excellent quality outcomes. This unannounced key inspection was undertaken on one day and a period of seven hours were spent in the home. As part of the inspection process, all areas of the home were viewed including many of the service user’s bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. Four service users were case tracked to evaluate their care and obtain their views. Discussion took place with the registered manager, staff, service users and visitors to the home. The manager completed an Annual Quality Assurance Assessment form prior to the inspection to give additional information regarding the home. What the service does well: Record keeping in the home is extremely organised and efficient. All information is held securely where appropriate. Pre admission assessments and care files are detailed and informative. Staff are provided with full information regarding the needs of the service users and the daily records provide evidence of the actual care given. Service users spoke highly of the staff and referred to them as ‘kind, caring, will do anything for you and what a lovely bunch of girls’. The home is maintained to a good standard and safety is maintained. The environment is homely and clean. What has improved since the last inspection? What they could do better: The home should continue to provide a high level of care for the service users whilst improving the environment through regular review. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 6 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 7 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 Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 8 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to assess prospective service users individual needs to ensure that a suitable service is provided based on personal needs and preferences. EVIDENCE: The home has produced a detailed and informative information pack for current and prospective service users. The statement of purpose and service user guide are issued to all prospective service users and their relatives to give them full details about the services and facilities provided by the home. Prospective service users and their relatives are invited to visit the home prior to making a decision regarding their care provider. During these visits, service Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 9 users have the opportunity to view vacant rooms, meet with other service users and staff, and to meet with the manager. Any questions can be answered during this time. In the foyer of the home is the statement of purpose, service user guide and previous inspection reports. Copies of these documents are available on request. All prospective service users are fully assessed prior to admission to the home. This is to ensure that the home is fully aware of the service users’ health and social care needs to confirm that these needs can be met. These assessments are undertaken by the manager or one of the nurses and all information is recorded on the pre-admission assessment form. Information is gathered from the service user, their relatives and any other person involved in their care. Details are also recorded about any equipment necessary to care for the service user to give the home the opportunity to have everything in place prior to admission. Information about dietary needs, mobility and preferences in respect of daily routines is gathered to give staff full information in preparation for admission and to enable the plan of care to be prepared. The pre-admission assessment forms for two service users who had recently been admitted to the home were inspected and the records were found to be extremely detailed. From the information recorded, it is possible to prepare a plan of care and meet the service users’ individual needs and preferences. Castle Grange does not offer intermediate care. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The healthcare needs of service users are well managed to ensure that they receive the care and support they need whilst having their privacy and dignity respected. EVIDENCE: Individual care plans are prepared for each service user. Service users and their relatives, where necessary, are involved in the preparation of the plan and sign to indicate their agreement with it. The initial plan of care is prepared from the information gathered at the preadmission assessment. This is updated on the service user’s admission to the home when a further assessment is undertaken to identify changes in their care needs since the initial assessment. Risk assessments are undertaken to Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 11 identify potential risks and risk management plans are put in place to remove or reduce those risks. The care plans cover all aspects of daily living, together with special needs including personal care, mobility, nutrition, falls, continence, moving and handling together with any specialist care required. Individual preferences are clearly identified such as preferred time of going to bed and rising, daily routines, food and the gender of staff to provide personal care. Details are clearly recorded about how the required level of care is to be given by the staff. Staff have full access to the care files to ensure that they are aware of each service users needs and of any changes to their care that are identified. All care plans are reviewed each month by a qualified nurse and when their needs change. Regular 3 and 6 monthly reviews and audits take place with the service users and relatives, if appropriate. The staff prepare a life history of the service users to encourage the service users to talk about themselves and to give staff greater insight into the life that they have enjoyed. Records are held of visits to and by GP’s and other healthcare professionals i.e. optician, dentist, chiropodist, dietician and tissue viability nurse specialist. Care plans are updated in accordance with the advice and information given by these persons. Daily records regarding the actual care given are completed by the staff. Records are also completed for service users who require regular monitoring of their fluid and dietary intake. All records inspected were found to be well maintained and up to date. The registered manager and the Operations Manager from Southern Cross, the owners of the home, audit the care files on a monthly basis to ensure that they contain full and up to date information. Medications are administered to service users by the qualified nurses. Service users may hold and administer their own medications following a full assessment of ability. The Medication Administration Record sheets (MAR’s) were inspected and found to be well maintained. Detailed records are made of all medications entering and leaving the home. The medications storage areas were clean and organised and security is maintained. Monthly audits are made on the medications to ensure that the home’s policy and procedures are followed. Observation of the practices within the home provided evidence that service users privacy and dignity are respected at all times. Bathroom and toilet doors are closed and staff were observed to knock on doors, and wait for a response, before entering. One service user said that she had received a high level of care and was really happy at the home. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience excellent 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 high number and range of activities so that service users have the opportunity to participate in stimulating and meaningful activities of their choice. EVIDENCE: The home employs an activities co-ordinator for 30 hours each week. A full programme of activities is prepared and service users are involved in the preparation of the programme. Regular parties are held and entertainers visit the home on a regular basis. The home has access to a minibus and some events shared with service users from other Southern Cross homes. The home also has a partnership with Everton Football Club for social events. Activities that take place include computers, baking, games, gardening, skittles, quoits, competitions and table top football. Both group and individual activities are provided. Some service users go out with their relatives and some are taken out by the staff. The home also has links with a local school. The mobile Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 13 library visits the home regularly and Clergy visit on a regular basis to provide services for individuals or groups. The activities programme is well supported by relatives. The home has a hairdressing room and the hairdresser visits weekly. Visitors are welcome at the home at any time. One relative said that she visited the home most days and that the staff always made her welcome. They were always available to discuss the care of her relative. Meals are taken in the dining room, the lounge or the service users own bedroom as they wish. The dining tables were attractively laid and a selection of condiments was readily available. The menu is displayed and a choice of meal is offered. The chef holds details of any special diets and service users’ individual preferences. The meal served on the day of the inspection looked and smelled appetising. One service user said ‘the food here is wonderful, its just like a hotel, but better’. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good knowledge and understanding of safeguarding issues to ensure that service users are protected. EVIDENCE: The home has a robust complaints policy and procedure. Information on how to make a complaint is displayed in the foyer and is detailed in the statement of purpose and service user guide. The home has only received one complaint in the last twelve months and this was dealt with appropriately and in a timely manner. Staff spoken to during the inspection were able to demonstrate that they knew the procedure to be followed in the event of a complaint being made. All staff have been given training on the protection of vulnerable adults and evidence of this is held in their individual training file. This training is given during the induction training programme, with further training and updates on a regular basis. Staff spoken to were able to demonstrate that they knew the different types of abuse and of the action they should take if this was suspected or reported to them. All staff are given a copy of the home’s whistleblowing policy during induction. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 15 Service users spoken to said that they had no cause for concern and would be comfortable in speaking to the manager if necessary. One service user said that she would speak to her relative if she had any problems and was confident that her relative would speak to the person in charge. Risk assessments are undertaken on the service users and the premises to ensure that no-one is placed at risk. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continued investment in the home has ensured that service users are provided with a comfortable and safe environment in which to live. EVIDENCE: Castle Grange is a purpose built care home which provides accommodation for up to 41 older people. All service users are accommodated in single bedrooms, six being provided with en-suite facilities. The programme of redecoration continues. Bedrooms are redecorated prior to the admission of new service users and whenever necessary. Plans are in place for the quiet lounge to be redecorated in the very near future. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 17 The home provides two lounges. The main lounge is provided with a television and is decorated and furnished in a homely style. The smaller lounge is a quiet area where service users can spend time reading or with their relatives. The dining room is decorated and furnished to a good standard and provides a pleasant place for service users to take their meals. Service user’s bedrooms are bright and pleasant and service users are encouraged to personalise their bedrooms with small items of furniture, pictures, photographs and items of memorabilia. Individual bedroom keys can be provided on request and lockable bedside cabinets are provided in all rooms. One service user said that she likes to spend time in her room as it was so pretty. Plans are in place for one of the bathrooms to be fitted with a specialist bath to assist service users who have mobility difficulties. The garden is secure and is laid out with lawns which are bordered with shrubs and plants. Seating is provided and service users are free to use the gardens at any time. All areas of the home were clean and bright and there were no unpleasant odours. The home is maintained to a good standard and all health and safety issues are addressed as soon as they are identified. The home employs a Maintenance person who attends to repairs. Fire risk assessments have been prepared and tests are made on all fire detection equipment on a regular basis. Moving and handling aids are provided and all staff have been given training in the use of the equipment. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training needs have been identified and appropriate training given to ensure that all staff have the skills necessary to meet the needs of service users. EVIDENCE: The home has a structured staff team. The registered manager is supported by a deputy manager, qualified nurses, care assistants, domestic, catering and laundry staff, an administrator, a maintenance persona and an activities coordinator. The home has a robust recruitment procedure and the care files of new staff provided evidence that the procedure has been followed to ensure the protection of the service users. All prospective staff are required to complete an application form prior to being called for interview. Two references are taken and checks are made through the Criminal Record Bureau and Protection of Vulnerable Adults registers. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 19 All new staff are required to complete a comprehensive induction training programme. Staff are provided with a contract of employment, job description and handbook. At present, 55 of the care staff hold NVQ qualifications and additional staff are currently working towards these. Training continues to be provided for all staff. A sample of five staff files were inspected and all were found to contain full information as required. Detailed records are held of the training that staff have undertaken and the manager has a matrix to identify the training that staff have undertaken. The matrix also identified when updates in training are necessary. The records show that staff have undertaken a high number of training courses. Training in specialist care is provided when this is identified as necessary to meet the needs of the service users. All staff have regular supervision and annual appraisals are undertaken. Staff files are regularly audited to ensure that full information is held. Staff meetings are held regularly and provide a forum for open discussion and the dissemination of information. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being run in the best interests of the people who live their and their welfare is promoted and protected. EVIDENCE: The registered manager is a qualified nurse and is very experienced in the management of care services for older people. She holds the Registered Managers Award and is able to provide evidence that she has continued to develop her knowledge and skills through continued training. She has completed appropriate training and is now a regional trainer. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 21 Staff spoke highly of the manager and said that she was extremely knowledgeable and supportive. The manager has an open door policy and is available to speak with service users, visitors and staff at all times. Service user’s finances are dealt with by relatives or through an individual bank account available in the home. Service users receive interest on monies held in the bank account and monthly statements are issued. Regular service users and relatives meetings are held and quality assurance systems are in place. Questionnaires are sent to service users, relatives and staff on a regular basis to obtain their views of the home and the service provided. Information gathered is used to identify areas for improvement within the service which are then implemented where necessary. Regular checks are made on the premises and the equipment used within the home and certificates prepared following these checks are held in the home. The record keeping within the home is extremely organised and easily accessible. All records were well maintained and up to date. The manager is well supported by the owners and regular visits are made to the home by one of the senior managers from Southern Cross. Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 4 4 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 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 X X 3 Castle Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Grange DS0000025093.V377429.R01.S.doc Version 5.2 Page 24 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. 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