Care Home: Castle Park Nursing Home

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What the care home does well Castle Park is all on one level and has wide corridors, which helps people in wheelchairs. It is a nicely decorated home with mainly single bedrooms, eighteen of which have en-suite facilities. There are lots of different rooms for people to use and to see visitors in private. The home is clean and staff work hard to make sure the building is odour free. People said they were happy with their bedrooms and could bring in their own possessions, making it feel more like home. People could have trial visits and respite stays before making a final decision about permanent residency. There were activities to participate in and the staff supported people to be part of the local community. Visitors were welcomed at any time. Staff looked after peoples health needs and made sure they saw health professionals when they needed to. People liked the meals they were offered and told us they had plenty to eat and could always have something else if they didn`t like what was on the menu. The staff tried hard to make sure people remained as independent as possible and people spoken with liked the staff team and said they were, `kind` and `helpful`. People`s finances were managed well and if there were any concerns about people`s wellbeing or allegations of any abuse the manager contacted the appropriate people straight away. The home had good staff recruitment, induction and training to make sure that only suitable people worked at the home and they had the right skills for their jobs. What has improved since the last inspection? The way the home managed medication has improved and the staff ensured people only received the medication they were prescribed for. The home had tried to make things simpler for people like having a complaints procedure in an easily understandable format and using pictures to help explain peoples` care plan to them. The way the home managed peoples` laundry had improved.There had been some re-decoration to the home because parts of it were damaged in the floods last year. The amount of staff that had completed specific training had improved and other staff members were progressing through the training course. What the care home could do better: The home needs to make sure that they always obtain the assessments of need completed by care management and let people know in writing that they are able to meet needs. When staff from the home completes assessments they need to have more information about how the person`s condition affects them from doing things themselves. The assessments are really important as they help staff decide if they are able to look after the person fully at the home. The way that they complete care plans could be improved so that there are clear instructions to staff on how to meet peoples needs. Sometimes they use vague statements, which don`t give staff enough information. On a monthly basis when checking whether the care plans are still meeting peoples needs staff must look at what is written down on a day-to-day basis about service users and use this to help decide if there have been changes in need. One person had some behaviour that could be challenging to others and this needed to be clear in a risk assessment and management plan so staff could be consistent when managing the person`s care. Care staff must have at least six supervision sessions a year. Some staff were not receiving this amount. It was important that staff members were supported and the manager was assured they were doing a good job. The home had a good complaints system but the form they used when people complained could have space to record if the complainant was satisfied with the outcome. Also when they monitored the quality of the services the home provided they could ask staff and visiting professionals what their views about the home were. The family of one service user wanted to have a regulating valve on the radiator in the person`s bedroom. This would better enable them to adjust the temperature, as on more than one occasion it had caused them to be uncomfortable. CARE HOME ADULTS 18-65 Castle Park Nursing Home Noddle Hill Way Sutton On Hull E Yorkshire HU7 4FG Lead Inspector Beverly Hill Key Unannounced Inspection 7th April 2008 09:30 Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 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 Park Nursing Home DS0000000927.V361511.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 Adults 18-65. 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 Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle Park Nursing Home Address Noddle Hill Way Sutton On Hull E Yorkshire HU7 4FG 01482 372404 01482 835651 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) www.barchester.com Barchester Healthcare Plc Position Vacant Care Home 51 Category(ies) of Physical disability (51) registration, with number of places Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd April 2007 Brief Description of the Service: Castle Park is part of the Barchester Healthcare group and is a single storey, purpose built home providing 51 placements for male and female service users over the age of eighteen, who have a physical disability. Accommodation is mainly in single bedrooms, eighteen of which have en-suite facilities. The home does have one shared room. Service users have the choice of three lounges and a dining room for relaxing in with others; designated smoking areas are provided. Other communal rooms consist of a small gym, a sensory room, a rehabilitation kitchen and a computer room. There are four bathrooms, three of which have assisted baths, and two shower rooms. There are also sufficient separate toilets throughout the home. The home has a garden and patio area, which is accessible to those in wheelchairs and with mobility problems. Activity programme workers are employed by the home to ensure service users have the opportunity to participate in a range of social and leisure activities. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are given to every new resident. The latest inspection report for the home is on display in the entrance hall and copies are available from the manager on request. The home charges fees from £368.50 to £1,522.14 per week depending on how much nursing input and 1-1 care is required for each prospective resident. Residents will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available in the service user guide, contract or from the manager. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 3rd April 2007 and a pharmacy inspection on 30th January 2008. It includes information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke to several service users and had a telephone conversation with a relative to gain a picture of what life was like at Castle Park. We also had discussions with the manager and care staff members. Information was also obtained from surveys received from service users and staff members. Comments from the surveys and discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. Since the last visit there has been three formal complaints raised with the Commission for Social Care Inspection. These were investigated by the home and resolved. Eight safeguarding of adults referrals have been made since the last visit, five of these have been made by the home. These have been fully investigated with no further action required. We would like to thank the service users, staff and management for their hospitality during the visit and also thank the people who completed surveys. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The way the home managed medication has improved and the staff ensured people only received the medication they were prescribed for. The home had tried to make things simpler for people like having a complaints procedure in an easily understandable format and using pictures to help explain peoples’ care plan to them. The way the home managed peoples’ laundry had improved. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 7 There had been some re-decoration to the home because parts of it were damaged in the floods last year. The amount of staff that had completed specific training had improved and other staff members were progressing through the training course. What they could do better: 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 Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home did not consistently obtain, or have available, assessments of need completed by commissioners of services. This means that full information about the service user may not be available to the home. This could potentially affect the decision-making about whether they could meet needs. EVIDENCE: We examined four care files during the visit. The manager or deputy manager, both qualified nurses, had completed the homes pre-admission assessments in all cases. When examined these contained basic assessment details that could be expanded to reflect to what degree the assessed need affected the person. The home relied on the community care assessment provided by the local authority for most of the information about the persons needs. The local authority advised the Commission that during examination of various care files community care assessments were not available. Out of the four care files examined only two, community care assessments were in place. The local Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 10 authority assessment information was important to enable the manager and staff team to decide whether the person’s needs could be met in the home. Those residents at the home who receive nursing care have undergone an assessment by a NHS registered nurse from the Health Authority, to determine the level of nursing input required. There was not a consistent formal written process for confirming that the home can meet the assessed needs of an individual. The manager confirmed that it was possible for prospective service users and their families to spend time at the home talking to people who live there, meeting the staff, enjoying a meal or spending the day there. One person confirmed this in a survey stating, ‘I visited and had a meal and talked to staff and other people who live here, which made my decision easy because everyone was really great’. The home also had the capacity to admit people for respite care and short breaks. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some gaps in care plan and risk assessment information could mean that important care will be missed. EVIDENCE: Four care files were examined during the visit. Files were organised into sections and any risk assessments completed were kept with the corresponding care plan for ease of access to staff. The care plans set out the health, personal and social care needs identified for each person. Two of the care plans were quite comprehensive and detailed clear tasks for staff. A third care plan used vague terms such as, ‘special attention required’, but did not state what this was and it also mentioned difficulties with personal care tasks but not what staff needed to do to Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 12 overcome them. A forth care plan identified specific behavioural issues but did not have a clear management plan to ensure a consistent approach for staff to manage them. Risk assessments were seen to cover skin integrity, nutrition, moving and handling, falls, the need for bed rails and activities of daily living. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying were included within the individuals care plan. The funding authorities carrying out yearly reviews of the care provided in the home and minutes of these meetings showed that service users had input into this process, where possible, and family were also invited to the reviews with the persons permission. There was evidence that service users or their representative had signed the care plans at the point of them being written to show they agreed with the content. People were aware they had care plans and the manager showed us how they had tried to make this simpler and easier to read for some service users by completing a collage with them for the plan. Those residents requiring one-to-one input have a diary maintained by the care worker allocated to support them and daily recording in care files for all service users indicated the care people had received throughout the day and night. Generally care plans and risk assessments were evaluated on a monthly basis and updated as needs changed. However this was not consistent in all the care plans examined. For example one persons care plan stated they attended a day centre but this was no longer the case and another had no risk assessment in place when elements of risk had been identified in daily recording. Evaluations need to take into account information detailed in other parts of the care file, for example daily recording. Discussion with service users clearly showed that some people were able to make a number of decisions and choices regarding their lives, and staff respected these and were supportive towards helping individuals achieve independence and privacy wherever possible. Six surveys were received from service users and four stated they were always able to make decisions about what they do each day. One person hadn’t filled in this question and another stated this happened, ‘sometimes’. Resident meetings were available every month and the minutes demonstrated that individuals were able to voice opinions and make suggestions that were listened to and acted on. Five of the surveys stated staff listened and acted on what people said, ‘always’. Staff enabled service users to take responsible risks in their every day lives and information within the care plans included a number of risk assessments Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 13 covering activities of daily living. Via discussions with some service users it was clear that some individuals find it relatively easy to maintain their independence and are able to make their choices and decisions known without a lot of input from the staff. One person stated in a survey, ‘I can do more now than when I was at home, I can do my own washing in the kitchen’. Others require a lot more input from the staff because of communication difficulties, physical support and assistance and this continued to be managed well on a day-to-day basis. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home maintained good links with the local community and provided people with opportunities for joining in activities and educational pursuits. The home provided a range of nutritional meals, which offered choices and alternatives to people. EVIDENCE: Service users were able to take part in different types of activities, both inhouse and within the community. Via discussions with service users and examination of documentation it was clear that people were able to participate within the local community by having the freedom to come and go from the home as they choose. Some service Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 15 users visited the local shops and accessed public transport independently. Also some service users participated in a community drama group. This takes place weekly and the group comes into the home and service users also go out into the community to take part in plays and workshops. There was a poster in the home detailing the last production and who had taken part. One person spoken with was very proud of the part they had played and stated they had really enjoyed taking part. Staff members spoken with confirmed that service users accessed other community facilities such as an Irish Centre, local churches, and one person is completing a diploma course at Hull University. People were able to participate in council elections using postal votes or attending the local polling stations. The home no longer accesses Hull College for basic skills courses, but this is an area they are pursuing. The home employed two activity coordinators and they keep detailed records of the activities people participated in. Information from the care files and discussion with service users indicated that popular activities within the home included, quiz nights, use of the cinema room (one of the lounges with a large screen television on the wall), exercise sessions in the small gym with the physiotherapist, relaxation sessions in the snoozelum, days out in the minibus and daily activities such as games, craft work, and drawing in the dining room. Comments from service users around activities were, ‘the home is lovely, I have made a lot of friends since I came here’, ‘I enjoy the snoozelum, its relaxing’, ‘I like the computer room and we have a good laugh with the physio in the gym’. Since the last inspection one of the activity coordinators offers one to one time one day a week with service users who find it difficult to leave their room and access wider activities. Some people chose not to join in activities and staff members respected this. One person spoken with stated, ‘I prefer to watch television and my DVD’s, I have thirty-two videos and I watch them – its my choice’. They stated they went out of the home for a walk when they wanted to get some exercise. Another stated that they preferred to stay in their sitting room during the day and had various interactive games and television equipment with which to entertain them. Approximately five service users had one to one support for various amounts of hours throughout the day and this was used to support them with activities of daily living and leisure pursuits. Staff members spoken with described how they individually supported people to go to the shops or with cooking and baking in the rehabilitation kitchen. Contact arrangements between the service users, families and friends were clearly documented in the individual care files. People stated their relatives Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 16 could visit at any time and this was confirmed in general observation and discussion one relative and staff members. Relatives and friends were invited to functions held at the home. The home enabled one married couple to have two single bedrooms, one of which was made into a sitting room for them. The catering manager explained that the home worked with a four-weekly rotating menu. There was always a minimum of two choices at lunch and the evening meal, and a side menu with alternatives. The housekeeper checked service users requirements each morning and the catering manager stated they tried to accommodate people as much as possible. There were no issues with budgets and the home had sufficient equipment. Dietician support was available for those who were identified as having a risk of nutrition deficiency and the kitchens provided a number of meals for those with diabetic, low fat, and soft food needs. Service users spoken with were complimentary about the meals provided, ‘the food is very good’, ‘I got fish today as an alternative’, ‘the food goes down very well, I eat what I’m given’ and ‘there’s plenty to eat and drink’. One staff member was observed assisting a service user to eat, whilst standing next to them. Sitting next to the person and making eye contact would be a much more sensitive and effective way of assistance. This was mentioned to the manager to be brought up with staff. The home has won the ‘Healthy Heartbeat’ award ten years in a row for ensuring that there is always a healthy option. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of the residents are clearly documented and continue to be met by the service and staff. EVIDENCE: There was information within the care plans examined that showed preferences and wishes regarding care giving. People spoken with were happy with the care they received although one person did mention that sometimes staff knocked and then walked in without waiting for them to say, ‘come in’. This was mentioned to the manager to remind staff to be aware of this. One relative stated in a survey, ‘I am very happy with the care she is getting and I think that staff do a good job looking after people in this home’. Service users confirmed in discussions that staff looked after them well. The care files showed that people received input from a range of health professionals and specialist services including local GP’s, hospital consultants, the Huntington’s specialist nurse, dieticians, physiotherapy, speech therapy, Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 18 audiologist services, community psychiatric nurse, tissue viability nurse, epilepsy nurse, dentists, chiropodists and opticians. In emergencies staff called on the assistance of emergency care practitioners. Staff received information and guidance from these experts as part of the multi-disciplinary team working within the home. The staff maintained records within the care file of health appointments and treatments received by service users. The home employs a counsellor for six hours a week to work with service user who require this service but would have to wait if referred via a GP. There was evidence that an issue was picked up quickly after discussion with the counsellor and although the home did not complete any risk assessment or care plan for this, medical attention was obtained. One person spoken with felt that staff could have been quicker to respond when their relative developed a chest infection and stated it was only after their prompting that a GP was consulted and medication prescribed. When checked daily records did not reflect there was any health issue until the day the medication was prescribed. This could indicate a sudden onset, missed signs or a recording issue. This was mentioned to the manager who was aware of the issue. Entries in the care files specify where individuals have dietary needs, including requiring nutrients via a percutaneous endoscopic gastostomy (PEG) site, supplement drinks and pureed diets. Staff members weighed people on a regular basis and evidence showed that dieticians were called out if the home had particular concerns about an individual. Monitoring charts such as nutritional intake, bowel care and pressure relief were completed. The nurses within the home carried out specialist tasks and treatments such as PEG tube feeding regimes and wound dressings. One care file examined indicated that the wound plan was working well and problem areas were healing. Pressure areas were monitored during personal care tasks and measures put in place to prevent fragile skin deteriorating, for example special mattresses and seat cushions, and pressure relief routines. Equipment was available within the home to assist service users in maintaining their independence, this included computers, hoists, stand aids, electric wheelchairs, talking books, specialist beds and mattresses, personal safety equipment, bed rails with protectors and gym equipment with input from a physiotherapist to maintain mobility and promote safety. The home also has a rehabilitation kitchen that service users can use to promote their independence. A pharmacy inspector completed an inspection of medication practices on 30th January 2008. They found some errors with recording and storing medication. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 19 They also found a discrepancy in the administration of a service users’ particular medication that had been prescribed after a hospital visit but not followed up with repeat prescriptions from their GP. There had been improvements in the way that medication was managed and requirements issued after the visit by the pharmacy inspector had been met. Checks of the records and stock levels showed that these were up to date and correct. Controlled drugs were monitored and recorded in a controlled drug register and refrigerated medication was stored appropriately. No one living in the home managed their own medicines at the time of the visit, but risk assessments and procedures were in place should this be requested in the future. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that people feel able to complain. The manager uses the homes safeguarding procedures to report incidents of concern to the local authority. EVIDENCE: Examination of the complaints record showed that complaints received by the home had been investigated and appeared to be resolved. There was a complaints form completed that had space for the details of the complaint and action taken by the home. The form would benefit from a section that details the complainant is satisfied with the response. The local authority had advised the Commission that during examination of various care files some information relating to complaints was recorded in the daily records and not in the complaint files. Although this was not seen on the day, the manager did appear to recognise this as they stated in the homes annual quality assurance assessment that an improvement they could make would be to ensure all care staff receive training in how to react to and pass on any complaints. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home in a simplified version. Service users spoken with showed a clear Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 21 understanding about how to make their views and opinions heard and said, ‘I have no worries, I would go to Elaine (manager) if I had any problems’, ‘I would tell Elaine, she would sort things out’ and ‘I would tell the manager, oh yes I would definitely complain’. Five of the six surveys received from people indicated they knew how to complain and all six stated they knew who to go to if they were unhappy. Staff in discussions and surveys also demonstrated they knew what to do, and how to record it, if someone complained to them. The four care staff members spoken with during the day displayed a good understanding of the safeguarding adults procedure. They stated they would check the service user was all right, report any issue to the senior in charge or the manager to deal with, and document what had happened. They were also aware that a referral would be made to the local authority or police for investigation and that the Commission would be notified. All four staff stated they had received safeguarding training and this showed in their knowledge and understanding. Staff training files confirmed safeguarding of adults training had taken place and was an ongoing process. The manager had completed safeguarding training with the local authority and was aware of their referral responsibilities. This was confirmed in practice as there was evidence that the manager had been active in reporting five allegations to the safeguarding team to be investigated. Three other allegation received by the safeguarding team had been investigated with no further action required. The home had policies and procedures to cover safeguarding adults from abuse, whistle blowing, aggression, physical intervention and restraint, and management of residents’ money and financial affairs. Discussion with two service users indicated they had some concerns about an incident that had occurred with another service user. The manager was aware of the incident and it was one of the safeguarding referrals the manager had made to the local authority. Action had been taken to prevent the situation occurring again. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a clean, safe, comfortable and homely environment for people to live in. The home provides a good range of communal space and provides the opportunity for people to personalise their bedrooms. EVIDENCE: The home’s annual quality assurance assessment document stated that there was an ongoing programme of refurbishment and renewal for communal areas and bedrooms. The manager confirmed that about a third of the home had to be completely refurbished due to last years flood damage of the area and the remaining foyer and corridors were being repainted and re-carpeted. The décor was bright and cheerful and corridors were decorated with a variety of pictures and artwork to capture the interest of the service users. Scuffing from wheelchairs was evident in the corridors and the manager stated they were trying to source a protective finish for the doors and frames. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 23 As well as three lounges service users had access to other rooms. These included a sensory/relaxation room (snoozelum), a rehabilitation kitchen, where service users can do their own washing and cooking if they choose, a computer room that also doubles as an occupation therapy room and a small gym with cycle machine, stairs and walkway with handrails for mobility practice, and a range of small exercise equipment. The dining room is also used as an activity room and the manager confirmed plans had been passed to convert this into a themed American style diner, with a seating booth at one end and a jukebox. The home has four bathrooms and two shower rooms. One bathroom has been refurbished with a new bath. Service users spoken with confirmed they were able to bring in small items of furniture, ornaments, pictures and personal items and this was seen to varying degrees throughout the bedrooms. One married couple had two single rooms and chose to use one as a sitting room. This gave them extra space and was decorated and furnished to their taste. During the visit the home was clean and tidy with no malodours. Five of the six surveys received from service users indicated that the home was fresh and clean, ‘always’. The remaining survey stated, ‘sometimes’. People spoken with were happy with the cleanliness of their bedrooms and communal areas. Prior to the visit we had spoken with a relative who was concerned that the radiator in the bedroom could not be adjusted and on several occasions this had posed a problem for the occupant. This was discussed with the manager who assured that a regulating valve would be fitted as soon as could be arranged. The laundry service for the home is sited in the grounds of the Castle Care Complex, it deals with the laundry for four homes and has a twenty-four hour turnaround on clothes and linen sent in daily. Each home has its own colour co-ordinated bags and there is a housekeeper on site who oversees the laundry work and care of the washing within the homes. The system is efficient and effective and a survey carried out by the home, since the last inspection visit, showed there had been improvements in how clothes were managed. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are supported by robustly recruited staff that have been, inducted well and provided with good training opportunities. Some gaps in staff supervision were highlighted and more work needs to be done in this area. EVIDENCE: The manager advised that the staffing ratio was dependent on the needs of the service users and several people had extra on to one support, funded by the local authority, for a varying number of hours throughout the day. There was generally one nurse and three care staff on duty on each of the two units in the home, in addition to the one to one support for approximately five service users. Care staff spoken with and surveys received from them stated there was generally sufficient staff on duty to meet needs. Occasionally sickness created gaps, however staff acknowledged this was difficult to predict and, ‘management try hard at these times to bring in more staff’. One person did comment that the home could employ more experienced staff. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 25 Service users spoken with and the six surveys received from them were complimentary about the staff. Five stated care staff listened to them and acted on what they said, ‘always’ and indicated the care staff treated them well. One person indicated this was, ‘sometimes’. One person spoken with did comment that one staff was overheard being unhelpful when asked to do a task for them by another staff. This was mentioned to the manager to address. Other comments were, ‘the nurses and carers are lovely and help me a lot’, ‘the staff are kind and speak in a nice way’, ‘the staff are all right I can’t complain, they are doing their job’, ‘I get on well with them’ and ‘yes the staff are very nice’. The home continues to offers staff a wide range of training, in addition to a comprehensive induction and foundation programme, which meets the Skills for Care standards. Staff members receive in excess of three days paid training per year and the home has individual staff training plans that are discussed through supervision and appraisal. Staff via surveys indicated that they received training that was relevant for their roles, helped them to understand peoples’ needs and kept them up to date. The amount of care staff, trained to national vocational qualification level 2 and 3 in care was sixteen out of forty-three, which equated to 37 . When this was added to the numbers of qualified nurses the home has employed it brought the percentage up to 51 . A further eighteen care staff were progressing through the course. These figures were a good achievement and reflected the company’s commitment to having a trained workforce. Training files and the home’s training plan contained evidence of a variety of courses provided for staff aimed at meeting the needs of the service users. These include mandatory training such as, moving and handling, first aid, fire, basic food hygiene, infection control, health and safety and safeguarding of adults from abuse. It also included service specific such customer care, stress awareness, continence promotion, challenging behaviour, communication, diversity, care planning and care of the dying, as well as conditions affecting people such as epilepsy and Huntington’s disease. Staff in discussions and surveys stated the company offered, ‘good support and training to staff’. Ancillary staff were also encouraged to complete training and a discussion with the catering manager evidenced that training was a priority in all groups of staff. The catering manager had completed a national vocational qualification (NVQ) in management at level 4 and was also an assessor of training. They had also completed mandatory training including safeguarding adults from abuse. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 26 The home has a separate recruitment department on site, which organises and monitors the recruitment and employment procedures. There is a comprehensive recruitment policy and procedure and the recruitment department follows the procedure, and ensures the interview process, police and criminal record bureau checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Checks of two nurses’ files showed these are up to date and reviewed regularly. There had been some slippage in formal staff supervision since the last inspection. Four staff files were examined and it was clear that staff were not on track to receive the required six supervision sessions per year. However the deputy manager was aware of this and had developed a supervision plan for the coming year, which should address the problem. Discussions in supervision covered training, attendance at work and ‘other issues’. There did not appear to be any discussions regarding the service users that staff members were key workers for or the general philosophy of the home. This was confirmed in discussion with care staff who stated supervision covered, training, problems they had, and any strengths or areas for improvement. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally the home was well managed and a safe place for service users to live in and staff to work in. EVIDENCE: The registered manager for the home manages three units on the same site, and each unit has its own unit manager. The registered manager has held this post for a number of years and has an up to date registration with the Nursing and Midwifery Council (NMC). She has also achieved suitable management qualifications. The registered manager undertakes periodic` training and development’ to maintain her knowledge, skills and competence, whilst managing the home. The unit manager advised that the company have decided Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 28 to change the management system and each unit manager will be the registered manager. Applications have been made to the Commission and this process is underway. The unit manager is also a registered nurse and has completed a range of training and updates. She has the qualifications, experience and competencies needed to run the home and meet its stated purpose, aims and objectives. Staff members spoken with described the unit manager as thoughtful, understanding, approachable and very supportive. They stated she sorted out problems. Surveys received from staff stated they felt supported and they met with the unit manager on a formal basis, ‘regularly’ or ‘often’. The home has an up to date quality award from Investors in People, the local councils quality award (QDS) parts one and two and the local councils Heartbeat award for healthy eating. The home had a quality assurance system in place, which consisted of monthly audits of the home, for example, accidents, health issues, personal care, documentation, medication etc and questionnaires to people. There was some evidence that questionnaires had been sent out to some service users and relatives but other stakeholders such as commissioners of the service, visiting health professionals and staff members had not been consulted. It is recommended that the unit manager broaden the quality assurance system to incorporate these questionnaires to enable a range of views to be obtained on the management of the home. The manager had completed the annual quality assurance assessment (AQAA) required by the Commission and it evidenced their analysis of what the home does well and the improvements they needed to make. Resident meetings were held on a regular basis and minutes circulated to people living in the home. There was also evidence of staff meetings at which they were able to make suggestions and voice their opinions. Staff also confirmed they were able to meet with senior managers when they completed visits in line with regulation 26 of the care homes regulations. Maintenance certificates were in place and up to date for all the utilities and equipment within the building and fire alarm checks and drills were carried out. Accident books were filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff members have received training in safe working practices. The AQAA detailed the change in how the home now managed service users personal allowance handed over to them for safekeeping. These were now held in the individuals’ lockable facility and only the service user or their family had a key. The trained nurse on duty carries the keys for those service users unable to do so. This system was explained to us but not checked on the day. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement Timescale for action 31/05/08 2 YA2 14(1)(d) 3 YA6 15 The registered person must ensure that the home completes comprehensive initial assessments and consistently obtains care management assessments competed by the local authority. The manager must audit the files and obtain community care assessments for those missing from the care files. The assessment information is important in the decision making process about the homes capacity to meet needs. The registered person must 30/04/08 ensure that the home consistently writes to service users or their representatives following the initial assessment to let them know formally that, having regard to the assessment, the home is able to meet their identified needs. This confirms to service users or their representative that the home feels their needs can be met there. The registered person must 31/05/08 ensure that care plans consistently contain clear tasks DS0000000927.V361511.R01.S.doc Version 5.2 Castle Park Nursing Home Page 31 4 YA9 13 (4) & 15 5 YA36 18(2) for staff and evaluations take into consideration information in other parts of the care file that indicate changes in need. This will ensure that care is not missed. The registered person must ensure that a behaviour management plan and risk assessment for one specific service user is formulated with clear guidance to staff on how to manage the behaviour and minimise any risks to the service user. It is important that identified risk is clearly recorded to give consistent guidance to staff. The registered person must ensure that care staff receives a minimum of six formal supervision sessions per year. All care staff to have had at least one session within the timescale for action date. This will enable staff to be supported and their work monitored. 09/05/08 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The unit manager should consider how the statement of purpose and service user guide could be produced in different formats suitable for the needs of those living in the home. This standard was not assessed during this visit but the AQAA document states the home has plans to address this during the next twelve months. The complaints form would benefit from a section that details the complainant is satisfied with the response or DS0000000927.V361511.R01.S.doc Version 5.2 Page 32 2 YA22 Castle Park Nursing Home 3 4 YA24 YA36 5 YA39 outcome of the investigation. The registered person should ensure that radiators have valves that enable service users or their representatives to adjust the temperature of their bedroom. The manager should consider broadening the topics covered in staff supervision to cover service user issues, key worker role, documentation and the philosophy of the home. The registered person should consider broadening the quality assurance programme to include consultation with staff and visiting health and social care professionals. Castle Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Park Nursing Home DS0000000927.V361511.R01.S.doc Version 5.2 Page 34 - 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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