Care Home: Castle View Nursing Home

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What the care home does well The new providers have performed a full assessment of the services and home environment. They have taken prompt action to ensure that the heating and hot water systems have been improved and that access is improved for people living in the home with a disability. They have provided a wide range of new equipment to improve service provision, this includes among others, new hoists to assist manual handling, new pressure relieving equipment, new bed linen, new water jugs and cups and CD player to support activities. The providers have introduced their own improved records keeping systems and have trained staff in their use. They have improved activities provision, increasing the hours of the activities coordinator. They have reviewed meals provision, revised menus and improved the quality of the ingredients used. They have performed a full review of staff training and have put an action plan in place to address deficits. Residents and their relatives reported on their appreciation of the service provided. One person reported "I`m fine here", another "I`m fortunate to be here", another "I enjoy it well enough", another you "join in with what you feel like" and a relative reported that they were "very happy with care". People also commented on the staff. One person reported "the girls here are lovely" and another described staff as "so kind". One person described the activities person as "kind of friendly, a very very nice person" and another person described the acting manager as "lovely". Staff commented on their roles. One person reported "I love working here" and another on how much they enjoyed being a carer, as they could get "really close" to the residents. What has improved since the last inspection? This is the first inspection since the home was purchased by the new providers. What the care home could do better: At this inspection, seven requirements and ten good practice recommendations were advised. The home needs to improve certain aspect of documentation relating to people who are assessed as being at risk of pressure ulceration, to ensure that they can provide evidence that people are having their position changed in accordance with care plans. Some of the records also need more clarity in descriptions of care provided. Where residents have care needs such as a risk of falls or a medical condition such as diabetes, there need to be care plans to direct staff on how risk is to be reduced and medical care needs met. Some aspects of medicines management need attention. Where a person is receiving regular administration of a medicine by injection, there needs to be evidence that the injection site is rotated, to prevent tissue damage if the same site is used too often. The home needs to ensure that all staff complywith their policies when medicines are omitted. Residents would benefit from care plans relating to medicines which can affect their daily lives, such as painkillers or mood altering drugs, to ensure that the effect of the drug on the resident can be evaluated. Records relating to prescribed lotions and supplements should be put in place so that the home can demonstrate that the person has received their prescribed treatments. Some aspects of documentation should improve. Where a person is having their fluid intake assessed, the record should be totalled every 24 hours, to assist in assessments for risk of dehydration. Where medicines administration direction are completed by hand, there should be evidence that these have been checked and counter checked. If residents have brought up matters or observations are made of issues raised by residents, there should be a record made, so that management can be aware of the situation and take appropriate action to address needs. Any such records should be signed. Where a resident had an accident, a follow up record should be made to assess the effect on the resident. Some improvements are needed to fully ensure that risks of spread of infection are reduced. This includes training for all staff in the area and improvements to cleanliness in the laundry and use of equipment for management of used linen. Improved systems are needed when bed rails are needed, including risk assessments, plans for their use and ensuring that such equipment is used in a manner, to reduce risk of injury to residents. CARE HOMES FOR OLDER PEOPLE Castle View Nursing Home 8 Old Castle Road Salisbury Wiltshire SP1 3SF Lead Inspector Susie Stratton Unannounced Inspection 8:40am 23 & 27 January 2009 rd th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castle View Nursing Home Address 8 Old Castle Road Salisbury Wiltshire SP1 3SF 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) 01722 328315 Wessex Care Ltd Vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 25. - Date of last inspection Brief Description of the Service: Castle View Nursing Home is registered to provide nursing care for 25 older people. The accommodation is provided over three floors with passenger lift in between. All the bedrooms are single, most are not en-suite. There is a small, separate 4 bedroom unit at the back of the home, called the bungalow. There is a garden to the rear of the home and parking provided at the front. There is also a bus stop close by with regular busses into the centre of Salisbury. The home is in an elevated position on the outskirts of the city of Salisbury with pleasant views of Old Sarum. The home is owned by Wessex Care, a local provider of care homes for the elderly. There is currently no registered manager, but suitable management arrangements have been put in by the provider. The fee range is £624 – £670, with additional charged for such items as hairdressing and chiropody. The service users’ guide is readily available. Castle View Nursing Home DS0000072699.V373426.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 stars. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of this inspection, the provider submitted an annual quality assurance assessment. This was their own assessment of how they are performing. It gave us information about what has happened during the last year. We also reviewed the service’s file. We looked at the quality assurance assessment and reviewed all the other information that we have received about the agency since the providers purchased the home. This helped us to decide what we should focus on during the inspection. We performed two site visits, the first one to review care provision within the home and the second one to review systems for recruitment of staff and perform a feedback to the providers at their main offices, which are situated at another home that they own. The first site visit took place on Friday 23rd January 2009 between 8:40am and 4:20pm. It was unannounced. The second site visit took place on Tuesday 27th January 2009 between 8:50am and 10:30am. One regulatory inspector performed the inspection but this person is referred to as “we” throughout the report, as the report is made on behalf of the Commission for Social Care Inspection (CSCI). During the site visits, we met with seven residents, four visitors and observed care for five residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day. We reviewed care provision and documentation in detail for four residents across all parts of the home and also considered certain specific records for a further four residents. As well as meeting with residents, we met with two registered nurses, four carers, the activities coordinator and the chef. We observed a lunch-time meal and activities taking place in the sitting room. We reviewed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records and complaints records. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: At this inspection, seven requirements and ten good practice recommendations were advised. The home needs to improve certain aspect of documentation relating to people who are assessed as being at risk of pressure ulceration, to ensure that they can provide evidence that people are having their position changed in accordance with care plans. Some of the records also need more clarity in descriptions of care provided. Where residents have care needs such as a risk of falls or a medical condition such as diabetes, there need to be care plans to direct staff on how risk is to be reduced and medical care needs met. Some aspects of medicines management need attention. Where a person is receiving regular administration of a medicine by injection, there needs to be evidence that the injection site is rotated, to prevent tissue damage if the same site is used too often. The home needs to ensure that all staff comply Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 7 with their policies when medicines are omitted. Residents would benefit from care plans relating to medicines which can affect their daily lives, such as painkillers or mood altering drugs, to ensure that the effect of the drug on the resident can be evaluated. Records relating to prescribed lotions and supplements should be put in place so that the home can demonstrate that the person has received their prescribed treatments. Some aspects of documentation should improve. Where a person is having their fluid intake assessed, the record should be totalled every 24 hours, to assist in assessments for risk of dehydration. Where medicines administration direction are completed by hand, there should be evidence that these have been checked and counter checked. If residents have brought up matters or observations are made of issues raised by residents, there should be a record made, so that management can be aware of the situation and take appropriate action to address needs. Any such records should be signed. Where a resident had an accident, a follow up record should be made to assess the effect on the resident. Some improvements are needed to fully ensure that risks of spread of infection are reduced. This includes training for all staff in the area and improvements to cleanliness in the laundry and use of equipment for management of used linen. Improved systems are needed when bed rails are needed, including risk assessments, plans for their use and ensuring that such equipment is used in a manner, to reduce risk of injury to residents. 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 Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents who are admitted to Castle View will be assured that their needs can be met. EVIDENCE: All residents have a full assessment of need, prior to admission. These assessments are performed by a senior member of the management team who is a registered nurse. The acting manager is not involved in these assessments, although she reported that she would be able to discuss if her home could meet the prospective resident’s needs with the senior manager performing the assessment, prior to admission and that her opinion would be listened to. Assessments were clear and completed in detail. We observed care for one very recently admitted person. Staff were observed to not rush the person, letting them take time to get up and dressed, Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 10 appreciating that the person would feel tired by the admission process and could have difficulty in adapting to different surroundings. Documentation relating to the person’s immediate care needs, such as a manual handling assessment and a risk assessment for pressure ulcers had been completed within 24 hours of the person being admitted. The acting manager confirmed that other documentation would be completed as the staff got to know the person. The person had a daily record completed. We discussed the admissions process with the activities coordinator, who reported that they were very much involved in the admissions process and that as part of their role, they ensured that the person’s room was properly prepared for their admission and that homely details were attended to such as putting flowers in the person’s room. The chef reported that they tried to see the person as soon as possible after admission, so that they knew what the person liked to eat. They reported that they had met the person who had been newly admitted, who had told them the way they liked their food cooking and that she had adapted the lunchtime meal to meet the person’s preferences. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents’ personal and healthcare needs will largely be met. Some attention is needed to certain specific areas in documentation, so that the home can ensure that all residents’ needs are being met. EVIDENCE: Castle View has recently been purchased by new providers. The new providers manage other similar homes in the area. They have their own set of documentation systems. The acting manager reported that they had gradually introduced these documentation systems into the home. As part of the process, they had reviewed residents’ nursing and care needs, involving the resident, their relatives and staff. They reported that people had enjoyed and learnt from this process. In order to ensure that people are consulted about care plans, all care plans are now available in residents’ rooms. During the inspection, we met with a range of residents and their relatives as well as observing care and discussing residents’ needs with staff. One resident Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 12 reported, “they do come and see to me” and another “they come and sort me out”. We observed one resident who clearly experienced confusional states, who was relaxed and able to walk about if they wished to. We also observed staff using effective communication systems with a person who had multiple disabilities, including visual and auditory loss. Care plans were completed in detail. Where people had particular needs in relation to personal care, this was documented and we observed that staff knew about their needs and followed care plans. Care plans relating to manual handling were particularly clear, detailing precisely how a person was to be moved. Where a person needed supports with eating and drinking, assessments were carried out and care plans put in place. We discussed one person who needed thickening agent, to be able to swallow safely with two members of staff, both people knew how thick the person’s fluids needed to be and this was fully documented in their care plans. People who needed supports to eat and drink had monitoring charts in place. These were completed at the time the drink or meal was given. Charts also documented if a person had declined a drink. Charts were not totalled every 24 hours, and this is advised, so that people at risk of dehydration can be identified. People who were frail and unable to change their positions had assessments for risk of pressure ulceration and care plans and equipment provided to direct how risks were to be reduced. The acting manager reported that the new providers had invested in equipment to meet the needs of people are risk of pressure ulceration. They also reported that when they had taken over the home, several people had previously sustained pressure ulceration. This had now improved and all of the people had responded to treatment. This was reflected in the wound care records. There was also evidence that the tissue viability nurse had been asked to advise on treatment of these ulcers. Care plans documented how often a person needed to have their position changed. Some attention is needed to how such charts are completed, as some charts stated wording such as “repos” or “pac” without defining what these words meant or describing the actual care given. Several charts did not provide evidence that the resident had had their positions changed at the frequency directed in their care plan. For example, one person whose care plan stated they were to have their position moved every three to four hours had records which did not document that their position had been changed between 23:00 on 22/1/09 and 06:00 on 23/1/09. Another person’s monitoring chart did not show that their position had been changed between 5:00am and 12:00 and they were observed to be in the same position when first visited at 8:45 as they were just before 12:00. Another person’s chart indicated that while they had been attended to four hourly, that on both occasions they had been left in the same position. The National Institute for Clinical Excellence (NICE) guidelines, the European Pressure Ulcer Advisory Panel (EPUAP) and local guidelines all state where a person is assessed as being at risk of pressure ulcers, that as well as providing pressure relieving Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 13 aids, in order to prevent risk of pressure ulcers, people at risk also need to have their positions changed at least four hourly and for those people at higher risk, they need their positions changing two hourly. The home completes a range of assessments to reduce risk to residents. Where a resident was not able to use the call bell system, risk assessments and care plans were consistently completed, to direct how a person’s safety was to be maintained. These were individual in tone. For example one person could use the call bell system at some times but not at others. The person’s care plan documented this and how the persons’ safety was to be maintained at times when they were not able to use the call bell. One person who was not able to use the call bell reported “if I need help, someone turns up” and another “they pop in to see to me”. Where residents were assessed as being at risk of falls, there were clear risk assessments about this. However care plans were not drawn up to direct staff on how risk of falls was to be reduced. This was indicated for one resident who had a history of falling and particular circumstances relating to their physical and mental health needs, which would need consideration, to ensure that their risk of falling could be reduced. Residents had care plans about their medical needs and staff reported on effective working relationships with local GPs and other health care professionals, such as the speech and language therapist. Where a resident needed a urinary catheter, there was evidence of consultation with relevant healthcare professionals and full records about the management of the catheter. Wessex Care has standard care plans relating to meeting diabetic care needs, however they have not yet been introduced for this home. This was indicated as two of the people met with had diabetic conditions and records showed that one person’s diabetic condition was unstable. This person therefore needed a care plan to ensure that their diabetic condition could be managed effectively as possible. We observed two medicines administration rounds during the inspection. Both rounds were correctly completed in accordance with the provider’s procedures and Nursing and Midwifery Council (NMC) guidelines. There were safe systems for storage of medication, including Controlled Drugs and items needing to be stored in a fridge. There were full records of medicines received into the home, given to residents and disposed of from the home. The home has changed medicines suppliers and reported on how much more responsive the new suppliers were. The acting manager reported that once all the old medicines providers’ equipment has been moved, the medicines room will be up-graded, including new cupboards and storage systems. The home has clear information about the action of drugs and the acting manager showed a detailed knowledge of the actions of a range of prescribed medication. The medicines administration records were largely fully completed to show that a resident had been given their prescribed medication. However on one occasion, a medicine prescribed to be given regularly was being given on an Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 14 “as required” basis. This meant that at times records for this drug were not completed. There was also no evidence that staff had approached the person’s GP to have this medication reviewed. Another person was having a certain drug omitted for a period of time for a specific reason. Their chart had not been completed using the provider’s coding system to indicate why this was. Medicines records need to be accurately completed to ensure that a person is being administered their medication as required. Records must be completed in line with the medicines policy, so that all registered nurses giving out medication can be fully appraised of the situation for the resident. This is particularly important for the home as they are currently using agency nurses, who will not be as familiar with situations as permanently employed staff. One person was prescribed a medication which needed to be given regularly by injection. Where this is the case, there is a risk of tissue damage if the same site is used. The person who was prescribed this treatment was not able to reliably remember where they were last injected so as to inform staff. The home needs to ensure that staff complete a record, to document where the person was injected, to ensure that injection sites are rotated and tissue damage prevented. Several residents were prescribed medications which could affect their daily lives such as aperients, painkillers or mood altering drugs. Information on these drugs was usually listed in their records, including some of their side effects, however care plans were not developed to inform and direct staff on the indicators for their use. One person who was prescribed sleeping tablets was not given them, staff knew why this was but this was not assessed or recorded. Care plans relating to such medicines are advised as this will assist staff in informing GPs of the effectiveness of such medicines treatments. Some residents were prescribed topical applications and supplements. A documentary systems should be developed so that the home can provide evidence that residents have been given these treatments and supplements. Most medicines administration directions were printed by the pharmacist from the GPs prescription, however a few were not. Some had been checked and countersigned but not all had been and this is recommended to reduce risk of transcription error. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will be supported in choosing how they live their daily lives and engage in recreational activities. Mealtimes are seen as an important area for residents in their daily lives. EVIDENCE: The new providers have increased the hours devoted to activities. The activities coordinator is able to work flexibly to meet need. For example on the site visit, she came in later in the day, so that she could run a Burns night in the evening for the residents. The activities coordinator has links with local transport providers, so that she can take residents out of the home and reports that staff and relatives are happy to support such trips out. She has an activities programme, this includes large group, small group and 1:1 activities. She reports that she regularly visits people who do not wish to or are unable to leave their rooms to take divisional activities to them. External people also come into the home. Pictures of a pantomime group were displayed in the main entrance area and a PAT dog was visiting the home with their owner on the day of the site visit. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 16 Several residents commented on the activities. One person reported “I go to the television room and do all sorts of things”, another “I go downstairs & we do singing” and another “There’s quite a group of us” about the people who attend activities. One member of staff described how much the recent cooking activities had supported one resident who had complex disabilities, including visual and auditory disability, as they had been able to smell the food and taste it during the activity. The provider has introduced their documentation systems for activities and the activities coordinator reported that they had been supported in introducing this documentation. They also reported that now the home was part of a group, she benefited from meeting other coordinators across the group to exchange ideas. Residents and their relatives reported that they could choose how they spent their days and that visitor were encouraged. One person reported, “I do what I want”, another “basically you can chose when you get up and go to bed” and another “they do what I ask them to do”. At the start of the site visit, we observed that whilst some people had finished their breakfast and were up and dressed, others were still eating breakfast and some people were still resting in bed, depending on how they preferred their morning routine to be. Visitors reported that they could visit when they wanted. One person reported “I can come and go when I want to”, another “they make me feel at home” and another “They listen to me about my [relative] and I know what [the person] likes”. During the inspection we met with the chef and observed a mealtime, as well as talking to residents. The menu is displayed in the main entrance area and the chef showed a very flexible approach to meals provision. She reported that she was happy to adapt menus to meet individual peoples’ preferences. For example of the site visit, she was providing three different meals, including fried fish and chips, boiled fish and soft potatoes and different vegetables from the main course for people who preferred it. Home-made soup and sandwiches were always available when people did not wish to have a large meal. She reported that the new providers had ensured that the quality of the foodstuffs had improved and she noticed that with better quality food, that residents were eating better. During the meal, she was observed to dish up meals individually and puree food at the time she was dishing up, so that the meal remained hot and the quality did not deteriorate with food being left in a hot trolley for a period of time. Residents and their relatives commented on the meals. One person reported “Food? Yes it’s good”, another “Foods very good, if I don’t fancy something, they’ll give me something else” and another the food “must be good, [my relative’s] not loosing weight and [my relative] would not eat it if [the person] didn’t like it”. The acting manager reported that she had worked on developing mealtimes since she came in post. Due to a range of factors, the mealtime took place later than usual on the site visit, however it was noted Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 17 that staff ensured that they did not rush people who needed assistance to eat, sitting with them supporting them and trying to make it a social occasion. Staff observed residents during the mealtime. One resident got into difficulties when eating, this was promptly observed by a carer who took action to support the person. Another person who was reported to have additional mental health needs, lost concentration and again a carer noted this and ensured that the resident was able to continue eating independently, whilst the food remained warm. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will have their complaints listened to and be safeguarded by the policies of the new providers. EVIDENCE: The new provider has introduced their own complaints policy to Castle View. One person described how supportive the new providers had been when they brought up an issue with them, which had been on-going from the previous providers. They also reported that the new provider had ensured that the issues that they had raised had been addressed in full. One resident reported, “you CAN talk to the manager”, another “Oh you can talk to the matron & the undermatrons” and another “you can talk to the staff & they’d do something”. One resident reported that they had raised a matter of concern to them which needed attention with the manager and “she’s done it”. We have not received any complaints about the home since the new providers took it over. The home keeps a record of complaints written to them, this includes correspondence and a short report of the issues raised. The short report is dated but it should be signed, to provide full evidence of investigation and actions taken. The home do not maintain records of issues raised verbally by residents or their relatives. This should take place, so that managers can be aware of all issues raised and actions taken by staff. During the inspection we met with Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 19 more than one person, who reported or were observed raising issues which concerned them. Some of these issues may not have happened as the person reported, if they were not fully able to understand or clearly remember what had occurred. When we spoke to staff, they generally knew about these situations. It is recommended that all concerns and reports raised by residents about quality of care, including personal comments made which could relate to racism to staff, be reported and documented, so that the manager is aware of matters raised. Such documentation will also assist in protecting people with mental health conditions, so that relevant healthcare professionals can be fully informed of circumstances relating to changes in their condition. The new providers are fully aware of the local systems for safeguarding vulnerable people and have ensured that since they took over the home, that all staff have been issued with a copy of the local procedure. No safeguarding referrals have been made about the home since the new providers took over management of the home. The acting manager reported that she identified that staff had not been trained regularly in safeguarding adults by the previous owner. She has ensured since she came in post that all staff have basic training and a training day was planned shortly by the provider to ensure that all staff are more fully informed of strategies for safeguarding adults and their responsibilities. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents will be supported by an environment where the provider is committed to make improvements to meet their needs. Some attention is needed in the laundry to ensure that the principals of cross infection are followed. EVIDENCE: Castle View is a 25 bedded care home. Accommodation is provided over ground, first and second floors and includes a separate 4 bedded bungalow to the rear of the building. There is a passenger lift in the main building and a chair lift to the bungalow at the rear of the building, with a separate external ramped way, which also provides access to the garden at the rear of the home. The new providers only took over the home recently but they have made substantial improvements to the home since they have purchased it and have Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 21 plans in place for further developments. Improvements include the full covering over of the main entrance way to the bungalow and an upgrade of the heating and hot water systems for the home. They have also invested in a wide range of equipment and services, including provision of pressure relieving mattresses to all beds and increased numbers of air mattresses, new variable height beds, new bedding, new commodes, new wash hand basins and new crockery. Some improvements were in progress and there were action plans in place to further improve facilities and equipment. The provider has a central maintenance department and during the inspection, we met with the maintenance manger. He reports that he attends the home daily. He also reported that he is planning to put shelving into the sluice room, to stop items being placed on the floor, develop improved storage systems for disposables such as continence aids and wipes and ensure that cleaning products can be stored separately from dry goods in the kitchen store. Castle View currently does not have a separate dining room. The new owners have fully up-graded the sitting room and provided a domestic style-dining table at one end of the sitting room. The providers reported on the plans they were developing to improve the building, to make it more disabled friendly, provide a dining room and make the most of the garden areas. They also reported that they are planning to up-grade and modernise the fire protection facilities when they do this, including removal of external fire escapes, which can present a risk to frail users of the service. During the inspection, we reviewed systems for hygiene and prevention of spread of infection. The domestic was observed to be very careful in his role, including cleaning underneath the dining table, as well as on top, cleaning the undersides of raised toilet seats and corners and angles in rooms. Staff were observed to use appropriate equipment, including blue plastic aprons at lunchtime and white aprons and gloves for personal care. One member of staff was observed to carefully wash their hands after attending to a resident. However some areas of practice need improvement. When we came into the home, the clinical waste bin in the sluice room was very full, with no liner visible and there were no plastic gloves or aprons in the room. This had been rectified by mid-morning but it should not have taken place. A person’s used continence pad was observed left on the floor of an assisted bathroom. One resident’s commode bucket, which they reported they had used overnight had not been emptied by 10:00am and another resident’s bucket showed deposits of brown matter throughout the inspection until 3:30, when it was shown to the acting manager. This indicates a lack of attention to some areas of hygiene and may relate to the fact that there was no evidence that staff had been trained in the principals of infection control by the previous provider for a period of time (see Standard 38 – Health and Safety below). The laundry is small and cramped. The providers are aware of this and have plans for its development, however until this takes place, the home needs to ensure that risk of cross infection to residents presented by the laundry, are Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 22 reduced. We noted throughout the inspection that dust and debris was visible behind and to the sides of the machines, this presents a risk of cross infection as micro-organisms can live in dust, particularly from dryers and then be transported round the home on staffs feet. On two occasions, used laundry was observed spilling out of containers on to the floor and on one occasion the items in the disposables bin was spilling on to the floor. This again presents a risk to cross infection. The home has laundry skips but one of them is the type which is attached to a trolley with clean items, including dressings, disposables and gloves on it. The attached skip contained used linen. This is not good practice, as clean items can easily become contaminated if they are stored in close proximity to used linen. The current system for used laundry is that it is re-sorted in the laundry room. Current good practice guidelines are that used laundry should be sorted at source i.e. in the resident’s room, to prevent risks of cross infection caused by re-sorting in the laundry. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Residents will be supported by a largely stable group of staff, although more permanent registered nurses need to be in post. There are safe systems for recruitment of staff. The new providers have identified that currently staff training needs attention and development. They have an action plan in place for this to be addressed, so that staff have been trained to meet residents’ needs. EVIDENCE: As noted above, the providers have only recently purchased this service and it is to their credit that there has not been a high turnover in staff when this happened, as can be observed in other services. Most of those people who have left the home, were leaving for planned reasons, such as retirement. The new providers have reviewed shift systems and introduced a shift which finishes at 10:00 at night and another one which starts at 7:00 in the morning, to ensure that night staff are more fully supported. People talked about staff availability. One resident reported that staff “just come in and help you”. One member of staff reported on how the staff team supported each other, saying “if I ring the bell for a second person, someone always comes” and another commented on how management expect residents to come first, reporting “we’ve been told not to rush them”, when caring for them. We observed Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 24 during the inspection, that residents did not have to wait for any extended period when they used their bell and no residents mentioned to us that they had any issues with response times when they used their call bell. Staff employment records are kept in the providers’ main offices in a separate care home. During the inspection, we reviewed records relating to three newly employed staff. All had been completed in accordance with the provider’s policies and procedures and our regulations. All files included a full employment history, police checks, two satisfactory references and a health declaration. All staff were interviewed and an assessment of their suitability for their role completed. Staff do not commence employment until the report from the protection of vulnerable adults register was satisfactorily returned. In accordance with our regulations, people may start work before their Criminal Records Bureau checks are returned so long as they are supervised. The providers reported that they had identified that records relating to providing evidence that such staff were supervised was not clear and that they were developing systems to ensure that there was clear documentation in place. Copies of records employment are not maintained at Castle View itself and it was agreed with the providers that baseline evidence of staff checks would be available at Castle View, with the main records being held centrally, so that evidence of staff suitability for employment could be available throughout the 24 hour period, in the home. When staff commence working at the Castle View, they receive an induction programme, which complies with current guidelines. New staff members always work supernumerary for at least three days and the acting manager reported that she has flexibility to extend this period when indicated and that she had done this recently with a new staff member who she had assessed as needing more support. New staff will receive formal supervision at set periods, after commencing employment. The home were using agency Registered Nurses, as there were only four registered nurses employed by the home, when it was inspected. The providers reported that they had successfully recruited more Registered Nurses, but they had not yet taken up post. They were also able to provide evidence that the nursing agency had been able to consistently supply the same two registered nurses, to ensure continuity of care. Records relating to Registered Nurses’ registration with the NMC are held centrally. It was discussed that, as for staff records, copies of confirmation of registration with the NMC for Registered Nurses would be held at Castle View, so that they were available for review, if needed, throughout the 24 hour period. The acting manager reported that when she had taken up her role, she had analysed the staff training files and found that training had not been kept up to date by the previous owners. She has developed an action plan to ensure that staff were trained in their roles. By the time of the inspection, she had ensured that all staff had been trained in fire safety, safe manual handling practice and Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 25 the basics of safeguarding adults. She reported that the providers are planning to develop their action plan during the next year, to ensure that all staff are trained to meet resident needs, in a planned manner. The providers reported that they were ensuring that all care staff were automatically put forward for training in National Vocational Qualifications, as part of their accepted role. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will be supported by the management systems introduced by the new owners of the home. Most areas relating to health and safety are up-held, but residents could be put at risk, as the home needs to modernise its approach to the use of bed rails and to ensure full training for staff in infection control EVIDENCE: The previous registered manager for the home retired in November 2008. the current person is acting into the role but is not planning to remain in post on a permanent basis. This was reported to relate to external factors, not the circumstances presented by the home or the new providers. A recruitment Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 27 process is underway to identify a new manager. The new providers have an experienced senior nurse and manager for the group, who will take over management of the home on an interim basis until a new manager has been recruited and confirmed in post. The new providers have put a range of supports into the home to more effectively manage the service. The current acting manager reported on the supportive weekly supervision systems to identify areas that needed addressing in the home and to develop action plans. She reported that she had identified that staff had had limited supervision previously. She had ensured that everyone had received one supervision since the new providers took over the home and that following this, the providers supervision systems would be introduced for all staff. The new providers regularly visit the home and make a report. They were not aware that we were on site during the inspection, but during the inspection they came into the home unannounced, to review certain matters, including discussions with the maintenance man. Several resident and visitors reported that they had met with the new providers and one visitor reported that they had “high praise for the new owners”. The providers have made a full assessment of issues presented by the home and, as can be seen in the rest of the report, have been progressing action plans to make improvements. As part of this inspection, they submitted a very detailed annual quality assurance assessment us and this provided evidence of the areas they were developing, to improve quality of care for residents. The new providers have developed systems to ensure the health and safety of people in the home. This has included making sure that all staff have been trained in fire safety and manual handling. They have also purchased new hoists and slings and ensured that all residents have a slide sheet in their room, to assist manual handling practice. Some areas still need development. As noted in Standard 26 above, staff have not been recently trained in principals of prevention spread of infection and this is indicated, as some observed practice indicated need for improvements in this area. The provider employs a company to advise them on health and safety and there a recent audit by this company had been performed about health and safety in the home. The providers reported that they were planning developments in the home to further improve principals of health and safety. During the inspection, we observed that many residents were provided with bed safety rails. The Health and Safety Executive regard the use of safety rails as a risk to vulnerable people and advise that, their use needs careful assessment, planning and monitoring. As good practice, if a person is assessed as being at risk of rolling out of bed, they should be cared for on a profiling bed which will go down to the floor with crash mat, rather than using safety rails. During the inspection, we observed that whilst one resident had a risk assessment about safety rails, three of the other people we considered in detail did not. None of the residents who had safety rails had care plans, which could be evaluated, about their use. Two of the people met with had a Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 28 significant gap between the mattress and safety rail, where a person’s limb could become entrapped, four peoples’ safety rails were loose in their fixings and one person’s air mattress meant that the height between the top of their safety rail and mattress was reduced, presenting a risk that they could go over the top of the safety rail. We gave the provider information on directives from the Health and Safety Executive during the feedback. They reported that they will ensure that practice at Castle View in relation to safety rails conforms to their polices and procedures. The home has clear records relating to accidents and incidents to residents, including documenting skin tears and unexplained bruising, as well as accidents involving falls. Notifications to us since the last inspection, did not indicate any unusual observations relating to residents falling and other accidents. We noted that whilst records were clear, that there were no written evidence of follow-ups to accidents after 24 and 48 hours, as is recommended as some injuries for elderly people may not become evident for a period after the accident. Castle View Nursing Home DS0000072699.V373426.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 2 Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 12(1)(a) Requirement There must be written evidence that all people who need their positions changing to prevent pressure ulceration have had their positions changed in accordance with their care plan and current guidelines. Where a resident has an identified risk or care need, such as risk of falls, or a medical condition such as diabetes, there must always be a care plan drawn up to direct staff on how risk is to be reduced and care needs met. Where a resident needs regular administration of a drug by injection, there must be a record available to show that injection sites have been rotated, so as to prevent tissue damage. Where a resident is prescribed a drugs regularly but it is not being given on that basis, the home’s policies and procedures must always be followed when documenting why the drug is not given and evidence that the prescriber had been contacted DS0000072699.V373426.R01.S.doc Timescale for action 28/02/09 2. OP7 15(a) 28/03/09 3. OP9 12(1)(a) 13/02/09 4. OP9 13(2) 28/03/09 Castle View Nursing Home Version 5.2 Page 31 5. OP26 13(3) 6. OP38 13(3) 7. OP38 13(4) about the situation. The laundry must be dust and debris free. Laundry and disposables must not be left in contact with the floor. Used laundry must not be placed in containers attached to units where clean items are stored. All staff must be trained in the principals of prevention of spread of infection and monitoring systems must be developed to ensure that staff comply with these principals. Where bed rails are used, a written risk assessment for their use must always be drawn up. Plans must be developed to ensure that they are used in the best interests of the resident. Bed rails must be maintained and used in a safe manner, in accordance with directives from the Health and Safety Executive. 28/02/09 31/05/09 28/02/09 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. 3. Refer to Standard OP7 OP7 OP9 Good Practice Recommendations All fluid charts should be totalled every 24 hours. Monitoring charts relating to changes of position should state the actual care provided. Where a resident is prescribed a drug which can affect their daily lives, such a painkiller, aperient or moodaltering drug, a care plan should be drawn up, so that the effectiveness of the medicines treatment can be assessed. Where instructions on medicines administration records are completed by hand, they should always be checked and countersigned. Where a resident is prescribed topical applications or DS0000072699.V373426.R01.S.doc Version 5.2 Page 32 4. 5. OP9 OP9 Castle View Nursing Home 6. 7. OP16 OP16 8. 9. 10. OP26 OP38 OP38 supplements, there should be written evidence that these have been applied/given in accordance with the prescriber’s instructions. All complaints records completed in the home should be signed by the person drawing up the record. A record should be maintained of all issues or observations of concern raised by residents and/or staff, to ensure that management is aware of and able to act on relevant matters. Equipment for managing used laundry should be provided so that used laundry can be separated at source. Where indicated, profiling beds which go down to the floor should be provided, to reduce the use of safety rails. Where a resident has an accident, a written system for 24 and 48 hour reviews of their condition should be put in place. Castle View Nursing Home DS0000072699.V373426.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 View Nursing Home DS0000072699.V373426.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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