Care Home: Castleford Home for the Elderly

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What the care home does well The assessment process aptly placed people who used the service. Suitable entertainment was provided to keep people who used the service occupied. Staff delivered personal care in a professional manner to ensure people who used the service retained their dignity. The food served at the home met the nutritional needs and tastes of people who used the service. People who used the service were offered choice within the homes routines to help them retain some independence. Visiting was open and friendly to help social integration. The recruitment procedures were robust and helped keep people who used the service safe. The decor and furnishings of the care home were of a good standard and provided a homely atmosphere. The good amount of staff training ensured staff kept up to date with best practices. The induction process ensured new staff were comfortable with their role. The health and safety policy, training and maintaining the equipment helped keep staff and people who used the service safe. The system used to hold residents monies protected them from possible financial abuse. What has improved since the last inspection? The people who used the service were engaged in community events and could join in activities to help fulfill their lives. The daily recording made by staff about people who used the service was respectful to help preserve their dignity. The registered manager held recorded meetings with staff to gain their views. What the care home could do better: Plans of care should, were possible, be developed with the assistance of people who used the service to ensure their views are included. Plans of care must be reviewed to supply staff with updated information about people who used the service.The administration of medication was generally safe although two staff must sign hand written prescriptions and information about as required medication is is included by the pharmacist on the medication records. The health care needs such as tissue viability, nutrition and falls risk assessment must be reviewed on a regular basis to ensure up to date advice and treatment can be offered. The needs of residents should be reviewed and staffing adjusted accordingly to give staff the time to complete paperwork and socialise to provide a better service to people who used the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Castleford Home for the Elderly Queens Road Clitheroe Lancashire BB7 1AR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Graham Oldham     Date: 1 0 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Castleford Home for the Elderly Queens Road Clitheroe Lancashire BB7 1AR 01200426355 01772562304 ian.taylor@careservices.lancscc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lancashire County Care Services Name of registered manager (if applicable) Ian Raymond Taylor Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service only: Care home only - code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP (maximum number of places: 16). Dementia - code DE (maximum number of places 23). Physical Disability - code PD (maximum number of places 6). The maximum number of people who can be accommodated is: 45. Date of last inspection Brief description of the care home Castleford HFE is part of Lancashire County Care Services and is registered with the CSCI to provide personal care and accommodation for up to 45 older people. There are 4 separate living units that have different functions and provide different levels of care. Building and refurbishment work has created a homely and cosy environment for Care Homes for Older People Page 4 of 27 care home 45 Over 65 0 16 0 23 0 6 Brief description of the care home service users to live in. A conservatory provides the residents with a spacious dining area. Many bedrooms are en suite and there are assisted bathrooms, shower rooms and toilets for residents throughout the home. The service operates a rehabilitation unit for 6 people and this is separately staffed. Castleford is located on Queens Road and is close to local shops, supermarkets, train station and other amenities in the town centre of Clitheroe. The home is situated on a main bus route that offers transport to all towns in the Ribble Valley area. Prospective residents receive a copy of the homes service user guide and have access to the Statement of Purpose. The RCO (Residential Care Officer) on duty at the time of the inspection stated that the current fees payable to live at Castleford were £332 to £374 depending on the degree of support required. The fee for people who are self funding is £392. People pay extra for daily newspapers, private chiropody, toiletries and individual personal items such as clothing. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted on the 10 December 2008. Much of the information gained was obtained from talking to residents and staff members. The views of residents were obtained on a variety of topics. Three residents were case tracked. Case tracking gave the inspector an overall view of the specific care for the individual resident by checking the plans of care, other documentation and talking to staff and the people who used the service. Only one Care Homes for Older People Page 6 of 27 person was able to participate due to the debilitating conditions of most of the residents. Two staff members were questioned about the care of the residents case tracked. Some of the views have been reported collectively with specific comments contained within the body of the report. Staff were directly and indirectly observed carrying out their tasks and interacting with residents. Paperwork examined included plans of care, assessment documentation, policies and procedures or documents relevant to each standard. A tour of the building was conducted. The service returned an AQAA. This is a document which the service provides to us with key information on how they feel they have progressed since the last key inspection and on how they can improve their service. What the care home does well: What has improved since the last inspection? What they could do better: Plans of care should, were possible, be developed with the assistance of people who used the service to ensure their views are included. Plans of care must be reviewed to supply staff with updated information about people who used the service. Care Homes for Older People Page 8 of 27 The administration of medication was generally safe although two staff must sign hand written prescriptions and information about as required medication is is included by the pharmacist on the medication records. The health care needs such as tissue viability, nutrition and falls risk assessment must be reviewed on a regular basis to ensure up to date advice and treatment can be offered. The needs of residents should be reviewed and staffing adjusted accordingly to give staff the time to complete paperwork and socialise to provide a better service to people who used the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The suitable assessment of people ensured their needs could be met at this care service. Evidence: Three residents were case tracked during the inspection. Assessment documentation was examined. Three people who used the service had been assessed by a member of staff at the care home. Social services or the local hospital trust had supplied an assessment. The assessment of residents allowed staff to gain sufficient knowledge to develop a plan of care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Plans of care did not reflect the up to date needs of the residents to help staff deliver effective care. Plans of care had not been developed with the aid of people who used the service or their relatives to take account of their wishes. People who used the service had their needs reviewed but following deterioration were not best placed to meet their needs. The administration of medication was sufficiently safe to protect residents from possible errors. Risk assessments for nutrition, falls and tissue viability were not reviewed sufficiently to fully meet the needs of people who used the service. People who used the service were observed to be treated with dignity by caring staff. Evidence: Plans of care had been developed for two of the three people who used the service. The person who was accommodated on the rehabilitation unit had information supplied by hospital trust workers and social workers. The information supplied was aimed for when the person using the service was sent home. Staff need to be able to demonstrate they are up to date with the persons needs whilst they are in their care. Care Homes for Older People Page 12 of 27 Evidence: On the residential unit the residents mostly appeared to be suffering from dementia. Staff said one lady had a mental health problem. The registered manager said this person had been admitted for assessment for six weeks with a diagnosis of dementia but following assessment this was not the case. Staff said very few of the people who used the service were able to carry out tasks independently. The assessment of people who use the service must be ongoing and where the decline of a resident is such that they adversely affect other residents or would benefit from more specialised care this must be arranged. Plans had been reviewed on a spasmodic basis and did not transfer all the knowledge back to the plans of care leaving the possibility care may not be delivered effectively. The medication record sheets had been completed satisfactorily. There was a record for medication entering and leaving the home. Staff had access to their pharmacist for information and advice. Controlled drugs were stored and administered safely. All members of staff who administered medication had been appropriately trained. A trained person audited the system to check for errors. One written order had not been signed by any member of staff. Information regarding as required medications was available for staff in a separate form at the end of the recording folder. It would be good practice to ask the pharmacist to add the reason for as required medication to the prescription sheets. Policies and procedures for the administration were available for staff to follow. medication requiring to be kept cool was stored in a fridge and a record of the storage temperature was recorded. in general the administration of medication was safe for people who used the service. The first two and a half hours of the inspection was conducted from the dining room on the residential unit. Staff on this unit and subsequently the other units were observed to treat people who used the service in a professional and dignified manner. People who used the service were treated in a good way to help retain their dignity. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were suitable activities available to keep people who used the service occupied if they wished to be. Choice was offered within the routine to help retain peoples individuality. Visiting was encouraged to allow people who used the service to remain socially active. Meals and mealtimes met the nutritional needs of people who lived at the care home. Evidence: On the day of the inspection eleven residents were attending a function at the local college. Children from the local school and choirs were visiting the home to perform plays or sing. The registered manager said they held activities such as flower arranging and games on a regular basis. People who used the service were observed watching television, reading and socialising. Activities were provided to keep residents amused. Plans of care examined during case tracking listed residents preferences and choices. Staff were able to describe how they were able to offer choice to ensure residents were satisfied with the care they gave. Care Homes for Older People Page 14 of 27 Evidence: One visitor said visiting was open and unrestricted for them to socialise with their friends and families. There was a menu displayed to tell residents what was being served at mealtimes. The cook said she gained feedback from residents to ensure the food served was to peoples liking. The cook carried out necessary environmental health checks and recorded the meals served at the home. The meal served on the day of the inspection was hot, nutritious and tasty. The dining room was pleasant and people were able to season their food. People who needed feeding were attended to individually and discreetly. Special diets were catered for. The food served at the home was suitable to residents tastes. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was an accessible complaints procedure for people who used the service to voice their concerns. The robust adult protection policies and procedures helped safeguard the people who used the service. Evidence: There was a complaints procedure, which met current guidelines. There had not been any complaints raised to the Commission for Social Care Inspection since the last key inspection. The registered manager said any minor concerns had been dealt with satisfactorily for people who used the service. There were policies and procedures for staff to follow for the protection of vulnerable adults. Staff were aware of the complaints and whistle blowing policies and the safeguarding procedures to raise any concerns. Staff spoken to had been trained in safeguarding issues. There had not been any safeguarding issues raised since the last key inspection. The systems in place helped protect people who used the service. Care Homes for Older People Page 16 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The well decorated and furnished home provided a good environment for people who used the service to live in. Evidence: On the day of the inspection the home was warm, generally clean and well maintained. Outside space was accessible and the there was no intrusive camera coverage. There was a person who was available to carry out maintenance checks and this was recorded. Both reactive and planned maintenance was recorded. The home was in a good state of repair. Communal areas were well lit, well decorated and furnished with domestic type tables and chairs. All carpets and curtains were in good order. The communal areas provided people who used the services with space to socialise. Bedrooms visited had been personalised to help the transition into the home more acceptable. Equipment was provided to assist people with mobility or disability problems. The laundry contained sufficient equipment to launder the residents clothes. There Care Homes for Older People Page 17 of 27 Evidence: were policies and procedures about infection control for staff to follow safe practice.were on the laundry wall. There was a sluice on each unit and hand washing facilities were observed. Staff said they had attended infection control training. Infection control policies, procedures and staff training helped protect people who used the service from possible illness by cross contamination. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who used the service benefited from a well trained staff team. The recruitment procedure was good and protected people who used the service from possible abuse. Evidence: Staff survey forms and staff on duty did not feel there was sufficient staff on duty to meet the needs of people who used the service. This was described by staff as we do not have time to complete the paperwork and we do not have time to sit and socialise with residents as we would like to. The people who resided on the residential unit appeared to need a high level of care for mental health problems. The management of the care home must assess the needs of people who use the service and provide staff in sufficient numbers to fully meet their needs. Two staff files were examined during the inspection and contained sufficient documentation to demonstrate recruitment of staff was safe. Two staff said they were offered training on suitable topics on a regular basis to keep them up to date and provide good care. The induction process for two staff was observed and showed the care home provided a good introductory training system for new staff to gain confidence. Care Homes for Older People Page 19 of 27 Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager was suitably qualified and experienced to meet the requirements of the Commission for Social Care Inspection. The quality assurance systems gained the views and reacted to the aspirations of people who used the service. The financial monies of residents was held safely at the care home. Health and safety policies, staff training and servicing of equipment protected the welfare of staff and residents. Evidence: The registered manager was suitably qualified, experienced to and had updated his knowledge for the benefit of staff and residents. Residents or their families had been involved in supplying information for the management team to react and respond to the changing needs of people who used the service. Care Homes for Older People Page 21 of 27 Evidence: The financial system for handling residents pocket monies was observed and there were no discrepancies. Staff had to sign for any money used and provide receipts for any items purchased to ensure the finances of people who used the service was secure. There was a health and safety policy for staff to follow safe practice. The electrical installation and equipment had been serviced to ensure it functioned safely. The fire alarm system was serviced and fire drills and tests ensured the system was in good working order. Staff received training in mandatory subjects such as moving and handling to ensure they followed good practice. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure plans of care are reviewed on a regular basis. Both the plans of care were not up to date in key areas. Both residents had deteriorated and whilst the review document was very good not all the information was accurate in the plans of care. 30/01/2009 2 7 15 The registered person must, 30/01/2009 following review and assessment ensure residents are placed where their care is best provided. Several residents had deteriorated to a level where residential care was unsuitable. 3 7 15 The registered person must 27/02/2009 prepare a written plan with the needs of people who use the service taken into account. Care Homes for Older People Page 24 of 27 Three plans of care were examined and none had been developed with the resident or a family member. This was required at a previous inspection. 4 8 15 The registered person must ensure the risk assessments for tissue viability, nutrition and falls are reviewed on a regular basis to ensure staff are kept up to date. Although some residents had declined in health the risk assessments had not been undertaken on the basis of need. 5 27 18 The registered person must 29/01/2009 ensure that, having regard to the numbers and needs of people who use the service, provide at all times sufficient staff to meet the needs of people who reside at the care home. Staff said they felt unable to sit and talk to residents or complete care plans because they felt short of staff. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The registered person should ensure staff are aware to double sign any hand written prescriptions to help minimise errors. The registered person should ask the pharmacist to add the Page 25 of 27 2 9 Care Homes for Older People reason any as required medication is added to the medication administration sheets. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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