Care Home: Castle Rise Nursing Home

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What the care home does well The home always ensured that peoples` needs were assessed prior to admission. This enabled staff to be sure the home could meet the persons` needs and the clear care plans gave them direction in how to care for them. Staff consistently kept the assessments and care plans under review. Peoples` health care needs were met and they had access to a range of health care professionals for advice and treatment. Any risks to health were identified and addressed in care plans. The home cared for people well at the end of their life and supported family members to remain with their relative during this time. Staff were clear about how they promoted peoples` independence and choice. The staff members knew the residents well and were observed speaking to people in a courteous manner. Residents described staff as kind, caring and `they can`t do enough to help you`. The home provided a range of stimulation for people, although provision was mainly via one to one support as a lot of the residents had quite complex nursing needs. Castle Rise provides a safe and pleasant environment for people. The home is clean, warm, well presented and has plenty of communal space. The company, Barchester Healthcare plc, ensures a process of continual redecoration and refurbishment of the home. The manager responds quickly to complaints and investigates them well. She always tells the Commission or the local authority of any reportable incident. This enable us to monitor situations and check how the home is dealing with them. The company has a good recruitment, induction and training programme. Staff members say they receive the training required for them to complete their jobs. The manager is very well organised and knowledgeable and staff stated they felt well supported. Staff received formal supervision every two months, which enabled them to discuss issues of concern and also enable the supervisor to monitor their practice. The home managed peoples` finances well. What has improved since the last inspection? The home did not have any requirements at the last inspection. The deputy manager won the national, `Nurse of the Year`, which was a personal achievement for her and also evidence of a committed staff team. All residents have electric profiling beds. This enables staff to raise or lower them for ease of access and ensures that if people need bedrails they are safely integrated with the bed.There has been consultation with residents regarding the provision of meals and minor issues resolved. The homes redecoration programme has continued, which means that sections of the home has been refreshed and recarpeted. A new nurse call system has been installed, a shelter built outside for people wishing to smoke and external work carried out on gutters, paths and fences. A new satellite kitchen has been installed. The number of care staff that have gained a National Vocational Qualification in care at level 2 or 3 has increased to 50%, which evidences the company`s and staff members commitment to a trained workforce. What the care home could do better: When nurses handwrite instructions on the medication administration record they should have a witness signature. Sometimes this happens but was not consistent. This will help to avoid any mistakes. One resident had specific medicine that was to be taken, `when required`. The instructions need to be clear so staff know when the person should receive it. It is recommended that privacy locks be fitted as standard when the bedrooms become vacant. Senior staff supervising carers could make sure that the supervision record is more detailed. This will evidence what has been discussed and act as a reminder for the next session. Key inspection report Care homes for older people Name: Address: Castle Rise Nursing Home Wawne Road Sutton On Hull E Yorkshire HU7 4YU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Beverly Hill     Date: 1 8 0 2 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Castle Rise Nursing Home Wawne Road Sutton On Hull E Yorkshire HU7 4YU 01482839115 01482821666 tina.morrow@barchester.com www.barchester.com Barchester Healthcare Plc care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accomodated is: 40 The registered person may provide the following categories 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, maximum number of places: 40 Dementia - Code DE, maximum number of places: 40 Physical Disability - Code PD, maximum number of places: 40 Date of last inspection Brief description of the care home Castle Rise is a Care Home that provides nursing care for people with a range of needs. The home is situated close to the village of Sutton and enables easy access to the local shops and North Point Shopping Centre. There is a bus service to the centre of Hull close by and ample car parking at the front of the home. Care Homes for Older People Page 4 of 29 Over 65 0 40 0 40 0 40 Brief description of the care home The home is registered for forty placements provided over two floors. However, the shared bedrooms are being used as single bedrooms to allow more space for the occupants. Five bedrooms have en-suite facilities. There is a passenger lift and stairs to the upper floor. People have the choice of three lounges and two dining rooms in which they can relax and enjoy the company of others. There is also a hairdressing salon. There are three bathrooms and a shower room and sufficient toilets throughout. Residents also have access to the grounds of the home, which are designed to be accessible to those in wheelchairs and with mobility problems. The home provides a shelter outdoors for those residents who smoke. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are on display in the entrance, and copies are given to every new resident. The latest inspection report for the home is also on display. The homes weekly fees range between £478.30 and £683.41 depending on the type of room required and the nursing input needed. Residents will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that the people that use this service experience excellent quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 13th April 2007 and two Annual Service Reviews on 30th May 2008 and 9th April 2009. It also included a site visit to the home which lasted approximately eight hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Castle Rise. We also had discussions with the registered manager, staff members and relatives. Information was also obtained from surveys received from residents (some of which had been completed by their relatives), staff members and health and social care professionals. Comments from the surveys and discussions have been used in the report. Care Homes for Older People Page 6 of 29 We looked at assessments of need made before people were admitted to the home, and the homes 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. The providers had returned their annual quality assurance assessment (AQAA) within the required timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Castle Rise, the staff team and management for their hospitality during the visit, and also thank the people who completed surveys and had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The home did not have any requirements at the last inspection. The deputy manager won the national, Nurse of the Year, which was a personal achievement for her and also evidence of a committed staff team. All residents have electric profiling beds. This enables staff to raise or lower them for ease of access and ensures that if people need bedrails they are safely integrated with the bed. Care Homes for Older People Page 8 of 29 There has been consultation with residents regarding the provision of meals and minor issues resolved. The homes redecoration programme has continued, which means that sections of the home has been refreshed and recarpeted. A new nurse call system has been installed, a shelter built outside for people wishing to smoke and external work carried out on gutters, paths and fences. A new satellite kitchen has been installed. The number of care staff that have gained a National Vocational Qualification in care at level 2 or 3 has increased to 50 , which evidences the companys and staff members commitment to a trained workforce. What they could do better: 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. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their needs assessed prior to admission which enabled staff to be sure their needs could be met in the home. Evidence: We looked at four care files during the visit. In all cases the home ensured that people had their needs assessed prior to admission. There was evidence of initial enquiry information which was followed up with assessments at the persons home, other residential services or hospital settings. The assessments were completed by the manager or other senior staff. The home always obtained assessments completed by Care Management Teams for people funded by the local authority. The information gathered in assessments was used when formulating care plans. The registered manager advised that, in January 2010, the local Primary Care Trust purchased seven beds for six weeks to help people be discharged from hospital quickly. The short term arrangement is coming to an end but the manager stated it Care Homes for Older People Page 11 of 29 Evidence: had worked very well. She had met with the discharge liaison nurse from the hospital to ensure that the home received appropriate information when people were discharged. People admitted for nursing care have an assessment completed by a nurse employed by the primary care trust regarding the level of nursing care they require. This determines the health authoritys financial contribution to the persons care. There is sufficient information available for people to decide whether the home is the right one for them. As well as the statement of purpose and service user guide, the home has a frequently asked questions leaflet in large print. This gives people information about a range of topics. For example, staff and how to recognise different grades, bringing in items from home, where meals can be taken and the times they are served, choices, visiting arrangements for family and friends, what to do if the person wanted to change their key worker and information about the activity coordinator. The manager had also stressed that they were always available to listen to concerns. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs planned for and met in ways that respect privacy and dignity. Evidence: We looked at four care plans during the visit. The care plans included all the residents needs identified at the assessment stage. The staff completed an initial care plan sheet that gave carers immediate information about the persons needs until a more thorough plan was produced a few days later. The full care plans had clear tasks for staff and indicated the residents preferences and what staff should do to promote people maintaining existing skills. The care plans were updated when needs changed and there was evidence of short term care plans for specific conditions. For example, one person had developed breathing difficulties so a care plan was initiated until the issue was resolved. The care plans were evaluated monthly by staff and more formal reviews took place with residents, family members, staff, care management and health professionals. The manager advised that they were looking at the care plans to see how they could be Care Homes for Older People Page 13 of 29 Evidence: made even more person-centred. We examined the care plan of a person who was cared for in the home at the end of their life. The home completed the Liverpool Care Pathway, a care plan tool used to record specific care needs and wishes for end of life care. We also spoke to the relatives of the person, who stated they loved the home and had received very good care, The care mum received was completed with compassion - they were absolutely fabulous. They told us a bedroom was provided for the family next door to their relative and they received sandwiches and refreshments thoughout the day and night. They told us that the care they had experienced had helped them to cope with their loss. There was clear evidence that peoples health care needs were met. People had access to a range of health care professionals and qualified nurses delivered nursing care within the home. Monitoring charts were completed for pressure relief and nutritional intake when a problem had been identified, and weight was recorded monthly or more frequently as required. Wound care charts were completed when required and the one seen had an assessment of the wound, clear instructions for the dressings and weekly reviews. There had also been input from a visiting health professional - a Tissue Viability Nurse. One relative told us they were very happy with the care and said, they cleared up her bedsore. Risk assessments were completed for tissue viability, nutrition, falls, moving and handling, and the use of bedrails. Other, more individual issues were also assessed, such as the risk of aspirating food and fluids, smoking and leaving the building. Risk assessments were checked monthly and updated. Recording was generally good and there was an audit trail of decision-making regarding the residents lack of capacity in one of the care files examined. The care files were ordered and easy to read with risk assessments for each area filed with the specific care plan to meet the needs. To improve, the daily records could reflect how the resident was and what they had done during the day rather than an account of the tasks staff have completed. People spoken with and comments in surveys told us that their needs were met and they were very happy with the care they received. Comments were, all the staff have a good relationship with my mum and I believe this, and the very good nursing care she has received, have helped my mum live beyond what her expectation of her life was, the care is very good and the carers, kind and thoughtful to the feelings of their patients, I could not ask for better care - very pleased with time here and care and Care Homes for Older People Page 14 of 29 Evidence: support, she is really well looked after, yes privacy and dignity is respected, you are covered up, the door is always closed and they knock on doors before entering and I am very happy with the care - they keep me informed. Staff members stated they tried to provide, person-centred care and we work to a high standard of care and communicate effectively with outside agencies to ensure our residents are provided with the best care possible. This was confirmed in two survey received from a health professionals and in a discussion with another, I have always found Castle Rise responsive to the care and treatment of wounds identified and always open to suggestions and will take on board any advice on applying national standards into practice. When asked what the home does well one professional wrote, planning care pathways at the end of life. The home managed medication well. Medicines were signed into the home and on administration, and were stored appropriately. Nursing staff were responsible for the administration of medicines and the home had a designated treatment room. The room was clean and tidy. Two Medication Administration Records (MAR) had hand written instructions for medicines that were commenced mid-cycle. These need to have a witness signature to avoid any mistakes. There was also one resident whose specific medication stated, one when required as directed. Although the person had not been receiving it, the instructions need to be clearer for staff so they are aware of when to administer it. There were systems in place for the return of unused medicines and fridge and room temperatures were recorded. It was noted that during the summer months last year some readings for the treatment room were above the required temperature advised by the drug manufacturers. This will need to be monitored and addressed should it occur again this year. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that people had a good quality of life by providing stimulation and the opportunity to make choices, by encouraging contact with family and friends and by meeting peoples nutritional needs. Evidence: The home employs an activity coordinator for twenty hours a week. These tended to be flexible depending on the activities provided. The home had a designated room used for planned group activities although the activity coordinator advised that most interaction was one to one due to the health needs of most of the residents. They had supported one resident to write down their memories. The resident had enjoyed the process and the printed version was given to the family when the person died and had been used during their funeral service. Staff said that it was important to spend time sitting and talking to people and the activity coordinator ensured that each resident had a chat each day. This could be reading the newspaper to them, talking about their family or what was going on in the home. There were various games such as a giant connect four, dominoes and board games and one resident enjoyed completing household tasks such as folding laundry, putting them away in the linen cupboard and washing pots in the kitchen. One person also Care Homes for Older People Page 16 of 29 Evidence: enjoys craft work and making greeting cards. Seasonal activities and celebrations were arranged, such as Christmas and birthday parties and a recent Valentines meal. The home had a vegetable patch and one resident enjoyed pottering and digging in the garden, whilst others preferred to watch. The home also had access to a minibus and one day each week they had an outing. Sometimes this was on a one to one basis, shopping or traveling to the residents home area but sometimes this included more residents for mystery tours, a trip to the coast or local beauty spots. People were able to make choices and decisions about aspects of their lives, such as rising and retiring, where to eat their meals and what to have, where they would like to spend their day and what items to bring in from home to personalise their bedrooms. Relatives told us they were welcomed at any time and always offered refreshments. Residents, relatives and staff commented on the warm and friendly atmosphere, the atmosphere is happy and unstressed and the staff are always welcoming and obliging, the staff were very caring and looked after me and my brother and sister when mum was gravely ill for a week, I feel as though all the staff and residents and relatives are like my extended family, I have been for respite in another home - this is far better, I have been here two years and when I first came here I was unsettled but it feels like home now, I have a bit of fun with the staff - they are like family and you have to wait a bit longer when they have handover so I changed it and have the night staff get me up. Catering was completed centrally and the food distributed in commercial hot trolleys to the four homes that make up the Castle Care Village. Staff served the food in each of the homes so were able to provide people with the portion size they required on the day. The menus rotated on a four weekly basis and the home had won a heartbeat award for the last fifteen years for providing a health option. Residents could have a cooked breakfast if they chose to and there were two choices for the main meals. There was also a list of alternatives on display and available in bedrooms if residents preferred a different meal. People spoken with enjoyed their meals and said they had plenty to eat, the food is very good, Id like to have burger and chips, very nice meals, my son came yesterday and had a meal with me and you get fresh juice or milk daily, and coffee and tea throughout the day. Although they were very happy with the care provided one person did comment in a survey that they thought the meals for their relative Care Homes for Older People Page 17 of 29 Evidence: could have been tailored more to their specific needs and because the meals arent made on the premises what she could eat or ordered seemed to go astray somewhere along the way. We observed two staff members supporting residents to eat their breakfast. This was completed sensitively with the staff sitting close, reminding them of what was being served, chatting to them and taking their time between mouthfuls. The dining room was set out for a, fine dining experience with table cloths, napkins and wine glasses. The manager advised that as part of their National Vocational Qualification at level 4 in management she had chosen fine dining experience as her project. This was in part because some residents had decided to remain in their bedrooms and the meal for them, although their own choice, was a solitary occasion. Residents are encouraged to share a meal together in a restaurant type setting with sherry aperitifs and relatives present for special occasions. One recent celebration meal for Valentines day had been well received and more people chose to dine at the table. The manager advised they are to try this once or twice a week and make the experience a pleasant and sociable occasion for residents. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided an environment where people felt able to complain and were protected from abuse by staff training and adherance to policies and procedures. Evidence: The home had a complaints policy and procedure that was displayed in the entrance. The complaints form was available for residents and visitors to complete and covered areas such as the nature of the complaint, the investigation process and how it was resolved. We saw evidence that in the last twelve months the home had received five minor complaints and all had been resolved appropriately. The manager also records any niggles that people may have and how these have been addressed. In discussions and surveys received from residents it was clear that people knew how to make a complaint and who to speak with if they were unhappy. Comments were, I know who I have to go to, to get things done and that is the manager Tina, I would see Tina, there is always someone there to complain to if needed and it is an easy complaints process - they recently dealt with one perfectly. All seven staff surveys stated they knew what to do, and how to record it if someone complained to them about the service. All staff had received training in how to safeguard vulnerable adults from abuse. In discussions they were clear about what constituted abuse and what to do should they witness any abuse or poor practice. The manager, deputy manager and nurses had Care Homes for Older People Page 19 of 29 Evidence: completed the local authority training specifically for the managers role in referral and investigation. The manager was very clear about her referral and investigation role and had demonstrated this by sending appropriate alerts through to the local authority. The manager was proactive in making safeguarding referrals and keeping the local authority and Care Quality Commission aware of any issues. She had made eight safeguarding referrals in the last year. Five related to incidents between residents and were monitored by care management teams. Two related to medication practices, however, one of these was found to be a mistake and no further action was required. Staff received further instruction in recording in the other. The last referral resulted in further staff supervision and training for one person. The prompt reporting means that the appropriate agencies are alerted to incidents quickly and can check how they are being managed. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, warm and safe environment for people. Evidence: The home has an ongoing redecoration and refurbishment plan. In the last twelve months an outdoor shelter has been erected for people wishing to smoke, a new nurse call system has been fitted and a kitchen installed. Bedrooms have been redecorated and repairs made to the guttering, pathways and fencing. Communal areas and bedrooms were nicely decorated and the home was clean and fresh throughout. The manager advised that maintenance personnel completed a daily walkabout to check all areas and complete any tasks that staff had highlighted. The communal areas consisted of two lounges downstairs and one upstairs, a hair dressing salon and two dining rooms, one of which is mainly used for group activities. Residents can access a communal garden at the rear of the home and there is a courtyard with furniture to use in warmer weather. The home is registered to provide nursing care for forty people. However, the manager advised that shared bedrooms were used as single bedrooms so the number of people resident when the home is full is thirty-six. Five of the bedrooms have ensuite facilities, all have lockable facilities and some bedrooms have privacy locks. It is Care Homes for Older People Page 21 of 29 Evidence: recommended that privacy locks be fitted to bedroom doors as standard when the bedrooms become vacant. There are three bathrooms with equipment to help people in and out, and the home also has a walk-in shower room. There are sufficient toilets throughout the home and two sluice rooms. The home has three staff offices and a staff room with lockers and domestic appliances for staff use. The laundry is managed from a central building and is appropriate for the size of the home. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by a well recruited and well trained staff team. Evidence: The home had four teams of staff and each had a named nurse, an associate nurse and between 2-4 carers in each. There were two nurses and five carers on duty for the morning shift, one nurse and four carers in the afternoon and one nurse and three carers at night. The deputy manager is supernumerary for twelve hours a week and each nurse has one supernumerary shift weekly to enable them to complete administration tasks. The manager is supernumerary throughout the week. The home has two domestic staff for four and a half hours each day and two kitchen assistants to help with serving meals. Catering staff are employed in the kitchen on the main site, as the meals are prepared centrally. Comments from residents spoken with, and from surveys, were complimentary about the staff team, the staff are very friendly, the staff are really good - first class, yes, they look after you - there are no words to describe how good the staff are, they always say, if you need anything tell us, I like them, they are busy but they do come when they can, the staff are always welcoming and obliging, I am very happy with the care - they are smashing girls and they are very nice - they cant do enough to help you. Care Homes for Older People Page 23 of 29 Evidence: The home has a training plan that includes a range of training courses and methods. The latter includes e-learning to be completed on site or at home if preferred, inhouse training with a dedicated training team, distance learning and access to courses facilitated by the local authority, primary care trust or Hull university. The manager advised that the training team also designed the staff training in relation to the needs to residents. The training plan covered mandatory training and service specific areas such as Parkinsons disease awareness, person centred care, palliative care, non violent crisis intervention, postural and bowel management, how to support people with enteral feeding regimes, nutrition and healthy eating, the use of dietary risk assessments tools, continence care, the use of syringe drivers and epilepsy management. Other courses included stress awareness, equality and diversity, customer care, communication skills, oxygen training, mental capacity legislation and deprivation of liberty safeguards. All staff had individual employee learning and development records which detailed the training they had completed and when updates were due. Staff spoken with and surveys received from them all stated they received the training they required to complete their role and task. They told us they enjoyed coming to work, I feel very proud to work at Castle Rise, we have good team work and the training provided is excellent. The home had 50 of care staff that had gained a National Vocational Qualification in care at level 2 or 3, which was a good achievement and met the national minimum standard. Staff induction met skills for care requirements and competency was assessed on completion. The company had a good recruitment system. All checks were carried out prior to the start of employment and there was a system in place to verify that nurses had a valid registration. On the rare occasions that staff started their employment prior to the return of the full criminal record bureau check (CRB), a check was made against the list barring people from working with vulnerable adults. The manager confirmed that by the time their induction had been completed the CRB had usually been returned or the staff member would pair up with another until they were completely cleared. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed with residents consulted, staff supported and the environment checked to ensure it was safe. Evidence: The registered manager has been a qualified nurse since 1984 and has been the manager of Castle Rise for the last three years. She keeps her skills and nursing registration up to date with relevant training courses. Residents and relatives spoken with knew the managers name, which told us she was able to get out and about around the home rather than remaining in the office. Staff members told us the manager was very supportive and would sort out any problems quickly. They also said that the home had a good atmosphere, communication worked well between staff and that team work was very important. The deputy manager won the national, Nurse of the Year award last year and is to be commended. There is stiff competition for this award and it is an excellent Care Homes for Older People Page 25 of 29 Evidence: achievement. There was a staff supervision system and all care staff received formal, one to one supervision with their line manager every two months. Staff told us that supervision covered discussions about their key worker role, any problems they may have and training needs. The supervision records examined could have more detail about the topics discussed and any actions the staff member needs to take. The company had a quality assurance system that included monthly audits and a range of questionnaires to people. The audits are sent to separate directors within the company, action plans are completed to address any shortfalls and these are checked by the directors to ensure they have been met. Questionnaires are sent to residents, relatives, staff and visiting professionals. Results are published on the notice board and each relative receives the information in a letter. We saw the results of a catering survey and the changes that were made as a result of comments. The home had gained a, A in the local authority food safety assessment - scores on the doors and had been awarded a, healthy heartbeat award for the last fifteen years for ensuring a healthy option on the menu. We had a discussion with the administrator regarding the management of residents finances. Families mainly manage the residents finances although some residents manage their own and two people are supported by the local authority. Individual records are maintained on a computerised system and invoices sent to relatives regarding any expenditure. Receipts are obtained for any purchases such as chiropody and hairdressing. Bedrooms have lockable facilities for people to store personal items. There is a residents fund although the administrator advised that most things are provided by the company. The home was a safe place for the residents. Fire alarm checks and drills were carried out and equipment was serviced. Environmental audits took place daily and any shortfalls addressed straight away. All water outlets accessible to residents had thermostatic controls to prevent the risk of scalds. Staff completed mandatory training and were aware of how to safeguard people from abuse. The manager advised that all residents requiring bed rails had them integrated with the bed to help prevent injuries and the risk assessments seen took account of health and safety guidance. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 All handwritten entries onto the MAR should have a witness signature to avoid mistakes being made and a protocol should be in place to guide staff when to administer specific when required medication to a particular resident. Privacy locks should be installed to bedroom doors as standard when bedrooms become vacant. The staff supervision record should include more detail about the topics discussed and any actions the staff members need to take. 2 3 24 36 Care Homes for Older People Page 28 of 29 Helpline: 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. 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. 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