Care Home: Castle View House

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What the care home does well Castle View House provides a therapeutic environment for up to 8 people who have mental health problems. The aim of the service is to enable people to develop greater levels of independence. Staff work with residents in a positive and enabling manner promoting individual choice and decision-making. The Provider, who manages the home on a day-to-day basis, is very well qualified and experienced and takes a hands- on role in the home. She has developed a detailed assessment process combining Care Programme Approach documentation with the home`s own pre-admission assessment forms. The assessment is an inclusive process involving the service user at the heart of decision-making. The environment is suitable for the needs of the residents providing a comfortable, well-maintained and homely environment. Staff receive all required training and this is supported by in-house training addressing mental health issues conducted by the Providers. Residents can choose how to spend their time and reported that the atmosphere is relaxed and the food good. Service users are supported to manage their own healthcare needs, but staff provide support in this area where needed. The home seeks feedback about the service through both formal and informal means. Regular 1:1 sessions are held with residents and house meetings take place frequently. What has improved since the last inspection? The Providers work in the home on a daily basis. There is evidence that all aspects of the service are being critically reviewed including updating care planning and risk assessment records to on-going maintenance and redecoration. Feedback about the service is gathered in formal and informal ways to aid the development and improvement of the home. No requirements or recommendations were made at the previous inspection. CARE HOME ADULTS 18-65 Castle View House 9 Castle View Strood Rochester Kent ME2 3PP Lead Inspector Joseph Harris Unannounced Inspection 27th June 2008 10:30 Castle View House DS0000029021.V365290.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 View House DS0000029021.V365290.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 View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle View House Address 9 Castle View Strood Rochester Kent ME2 3PP 01634 721107 01634 312665 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) Mr Peeryduthsing Ramburuth Mrs Indira Ramburuth Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That two service users over the age of 65 years on admission commensurate with the category of Mental Disorder, excluding learning disability or dementia (MD) may be accommodated. 9th October 2006 Date of last inspection Brief Description of the Service: Castle View House offers accommodation over two floors; the home is situated in a residential area within walking distance of Strood Town Centre, which offers a range of shopping and other community facilities. Mr & Mrs Ranbruth, the providers, manage the home on a day-to-day basis. A small staff team is employed with whom the Proprietors closely work. Both proprietors hold professional qualifications which relate to the client group cared for in the home and have many years experience of caring for people with a mental health condition. Weekly fees for the home are: £471.48. The statement of purpose and service user guide are both kept in the quiet lounge and are accessible to all service users and their representatives. Castle View House DS0000029021.V365290.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 the people who use this service experience good quality outcomes. This key unannounced inspection process culminated in a site visit to the home on 27th June 2008. The site visit commenced at approximately 10.30am and concluded at 3.30pm, lasting for around 5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the owner/manager, staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: Castle View House provides a therapeutic environment for up to 8 people who have mental health problems. The aim of the service is to enable people to develop greater levels of independence. Staff work with residents in a positive and enabling manner promoting individual choice and decision-making. The Provider, who manages the home on a day-to-day basis, is very well qualified and experienced and takes a hands- on role in the home. She has developed a detailed assessment process combining Care Programme Approach documentation with the home’s own pre-admission assessment forms. The assessment is an inclusive process involving the service user at the heart of decision-making. The environment is suitable for the needs of the residents providing a comfortable, well-maintained and homely environment. Staff receive all required training and this is supported by in-house training addressing mental health issues conducted by the Providers. Residents can choose how to spend their time and reported that the atmosphere is relaxed and the food good. Service users are supported to manage their own healthcare needs, but staff provide support in this area where needed. The home seeks feedback about the service through both formal and informal means. Regular 1:1 sessions are held with residents and house meetings take place frequently. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 7 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 View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 8 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. Quality in this outcome area is excellent. The needs and aspirations of prospective service users are assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two individual service user files were examined through the course of the inspection site visit. One individual file related to a service user who has recently moved into the home. In both cases full and informative assessments had been completed prior to the person moving in. This information includes Care Programme Approach (CPA) documentation including care plans and risk assessments. The registered manager has also developed clear and detailed pre-admission assessments that are completed throughout the referral process. These assessments cover physical, mental and social health and provide the basis of subsequently developed care plans and risk assessments. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 9 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. Quality in this outcome area is excellent. The needs and perceived risks for service users are reflected in the individual plans. Residents are supported in the decision-making process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two individual service user plans were examined. In both circumstances support plans were sufficiently detailed providing guidance on needs, actions to meet the assessed needs and outcomes. The plans are reviewed at least every 6 months, but more frequently should the needs of any individual change. Residents are involved in the care planning process as fully as possible. The philosophy of the home is to promote personal responsibility and encourage people who use the service to become more independent. To this end service users are supported and encouraged to take decision affecting their lives on a daily basis. Service users are supported to manage their own Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 10 finances, attend medical consultations and manage their time as independently as possible. However the Providers and staff are available to support and guide people where required. The AQAA states that staff are trained to work with individual residents and their associated needs applying the values and philosophy of the home. There is a positive outlook towards managing risk and service users are enabled to take responsible risks and consider the impact decisions can make on their lives. Residents have regular 1:1 sessions with the registered manager and senior staff to discuss issues and problems and how to overcome them. Risk assessments are completed using a format developed by the home loosely based on CPA documentation. These include a comprehensive preliminary assessment that rates risks depending on probability and severity. Where a risk is assessed as medium or high within this rating scale a detailed risk management plan is developed providing clear guidance to enable staff and the service user to minimise the perceived risk. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is good. Service user’s rights and responsibilities are respected and they have a lifestyle that suits individual and collective needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users contribute to a relaxed and friendly atmosphere in the home. People who use the service are encouraged to plan and organise their own time as far as possible. Many of the residents prefer to spend time in their own company in and out of the home. Discussions were held with a number of residents who confirmed that life in the home is enjoyable and relaxed. One resident said, “This is a nice place to live. The staff are good and I can pretty much do what I want.” Another person said, “I haven’t lived here long, but I’ve settled in well, I really like it.” Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 12 The home does not arrange organised activities in the home on a regular basis, but some service users do attend groups and day centres in the local community. The AQAA provides confirmation that residents enjoy a range of activities depending on their interests. One service user has recently received a ‘passport to leisure’ and another person is attending a college computer course. Staff in the home encourage residents to take part in the daily running of the service through household chores, cooking and other aspects of daily life. Residents confirmed that they can choose how they spend their time and are able to plan their routines accordingly. Visitors are welcomed into the home at all reasonable times and residents confirmed that their visitors are treated respectfully and made welcome by the home. The home maintains menu records and offers a choice at all meal times. Residents are encouraged, where possible to assist with the planning and preparation of food. There is a good-sized dining room adjacent to the kitchen and meals are taken in a relaxed atmosphere and that the quality of the food is good. Any specialist dietary and nutritional needs are considered and referred as appropriate. Cultural and religious diets and needs are catered for. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is good. The personal care and healthcare needs of service users are met. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of people who use the service are fully self-caring requiring only encouragement to meet their own personal care needs in some circumstances. Three service users have greater needs in this area and staff assist with dressing, bathing and other aspects of personal care. The preferences, needs and level of support are clearly indicated in individual service user plans. Residents confirmed that staff are sensitive to their needs and take into account their wishes and preferences when supported in personal care issues. The home retains clear healthcare records keeping copies of appointment letters and outcomes of reviews. Some service users have relatively complex physical healthcare needs, but the home has suitably addressed these ensuring conditions are monitored and issues referred to appropriate practitioners. The Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 14 AQAA provides evidence that one service user is being supported to manage her own healthcare needs and, due to the potential for relapse, is being monitored closely by the home whilst supporting the individual’s right to choose. All residents are registered with general practitioners and are supported to attend appointments when required. Service users have access to community mental health teams and it was reported that good support is received in this respect. Complimentary healthcare issues such as dentist and opticians are arranged as required. The home has suitable storage facilities with regard to medication, although consideration should be given to purchasing a separate lockable drugs fridge. Refer to recommendation 1. Medication administration records are well maintained and up to date with no gaps apparent. The home keeps leaflets and information about medications and associated conditions. A blister pack system has recently been introduced into the service and it was reported that this has improved the ease of administration and ordering of medications. Adequate policies and procedures are in place relating to medication issues and the Provider is a qualified first level nurse with a comprehensive knowledge base in the area of medication. A community pharmacist periodically visits the home to assess and provide guidance on medication issues. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is good. Service user’s views are listened to and acted upon. People who use the service are protected from forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints process in place that is displayed and provided to all new service users at the point of referral. The Providers stated that the home always aims to address any concerns or issues in an informal manner in the first instance, but a formal process is available should this prove unsuitable. Residents stated that they feel comfortable raising any issues with staff or the proprietors. There have been no formal complaints made to the home or the Commission for Social Care Inspection in the past 12 months. Adult protection protocols are in place and policies and procedures relating to the awareness, reporting and recording of abuse. Staff demonstrated a good working knowledge underlying the principles of adult protection issues. All staff have completed training covering adult protection issues and updates have been booked for the coming year. The Providers were advised to investigate training opportunities covering the Mental Capacity Act 2005, which she agreed to do. There have been no adult protection alerts raised in relation to the home since the last inspection process. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 16 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 and 30. Quality in this outcome area is good. The home environment is suitable for the individual and collective needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was conducted. The home is well decorated and furnished commensurate to the needs of the service users. The house is set in a relatively quiet residential area of Strood approximately half a mile from the town centre with local shops and facilities closer to hand. The accommodation is set out over two floors with the communal areas on the ground floor and majority of bedrooms on the first floor. There is a good-sized garden to the rear of the home with some parking space available. There are three main communal areas including a smoking room lounge, a non-smoking lounge and a large dining room. There are toilets, baths and showers located Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 17 conveniently throughout the building. 4 of the bedrooms are single occupancy with two double rooms. At the current time all of the residents sharing rooms are happy to do so. The kitchen is well appointed and domestic in scale and there is a small domestic laundry area suitable for the needs of the home. A number of residents spoken to stated that they liked the house and that their rooms were comfortable and met their needs. It was reported that the home meets the requirements of the fire and environmental health departments. Universal control of infection precautions are in place. The house was clean, hygienic and free from offensive odours. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 18 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 and 35. Quality in this outcome area is good. There is a well-trained and competent staff team supporting the people who use the service. Recruitment processes ensure the safety and protection of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the staff working the home have achieved a National Vocational Qualification in care at level 2 or above. One member of the care team is currently considering doing her NVQ 4. In discussion with staff on duty it was evident that there is a good understanding of the needs of the service users and issues relating to mental health. The home’s training matrix was examined, which demonstrates that all staff receive mandatory training within the first 6 months of employment. Staff are also required to work through an induction process covering the key aims of the service. The home tends to source the majority of training from one training provider that arranges a wide range of courses pertinent to the needs of the home. One of the Providers holds a current RMN qualification and has Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 19 extensive knowledge of mental health issues. A number of in-house training events are organised and/or staff are guided and supported by the Providers when required. Two staff personnel files were examined that demonstrated staff have been recruited following receipt of the majority of pertinent information. In one file for a relatively new staff member it was noted that there was not a current CRB check, but an existing CRB disclosure from the individual’s last place of work. CRB checks are not legally transferable from one place of work to another and a new disclosure must be sought. This was discussed with the provider, who agreed to ensure that a new CRB disclosure would be gained. The home must confirm the receipt of this CRB in writing to the Commission for Social Care Inspection at the earliest opportunity. The use of POVAfirst register checks was also discussed. Refer to recommendation 2. The AQAA states that a recruitment policy and procedure is in place, however it is essential that this is adhered to. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is good. Service users benefit from a well-run home with appropriate quality assurance systems. The health, safety and welfare of service users is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Provider of the home is a Registered Mental Nurse with many years of experience in the field of health and social care. She has attained the necessary management qualifications and has continually updated her own knowledge and skill base having qualified as a psychotherapist and Cognitive- Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 21 Behavioural Therapy counsellor. Staff and service users stated that the home is well managed and an open and relaxed atmosphere has been created. A quality assurance process is in place. Service users have the opportunity to feedback about the home in both formal and informal ways. 1:1 meetings are held with service users and resident’s meetings take place regularly. Additionally residents and relatives are surveyed annually regarding their opinions of the home and service. The responses are collated and suggestions/comments addressed. Both owners take a hands on role in the home and maintenance issues are addressed as required. There is evidence that improvements to all aspects of the service are monitored. All documentation relating to health, safety and welfare is up to date and in place. Fire safety logs are maintained and a fire risk assessment completed. Certificates relating to service checks such as gas installations and electrical wiring are in date and satisfactory. Policies and procedures are present covering safe working practices and staff receive the necessary training and instruction. The AQAA provides evidence that equipment and service maintenance has been completed within appropriate timescales. Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 4 3 X 4 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X Castle View House DS0000029021.V365290.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA20 YA34 Good Practice Recommendations To purchase a lockable drugs fridge. To ensure all pre-recruitment checks are completed prior to a new staff member commencing employment. Provide the Commission for Social Care Inspection with written confirmation that outstanding CRB checks have been obtained. 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