Care Home: Castleford House Nursing Home

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What the care home does well What has improved since the last inspection? Improvement to the environment is an ongoing process but the work already completed particularly to the communal areas, residents rooms, and the kitchen and corridors has made the home a light bright, attractive and comfortable place to live and work. It was also confirmed by a relative spoken with that the refurbishment programme was carried out without too much disruption to the resident`s lives. Through staff training, the change in registration to accommodate both those with physical and mental needs appears to be working well and staff now appear confident in meeting all the residents needs. CARE HOMES FOR OLDER PEOPLE Castleford House Nursing Home Castleford Hill Tutshill Nr Chepstow Glos NP16 7LE Lead Inspector Mrs Janet Griffiths Unannounced Inspection 10:00 17 March 2008 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 Castleford House Nursing Home DS0000016398.V360633.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. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castleford House Nursing Home Address Castleford Hill Tutshill Nr Chepstow Glos NP16 7LE 01291 629929 F/P 01291 629929 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) Milkwood Care Limited Mrs Madeleine Frances Parsons Care Home 45 Category(ies) of Dementia (25), Old age, not falling within any registration, with number other category (20), Physical disability (20) of places Castleford House Nursing Home DS0000016398.V360633.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 providing nursing or personal care only - Code N to service users of either gender 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 of 20 places Physical Disability (Code PD) - maximum of 20 places Dementia (Code DE) - maximum of 25 places The maximum number of service users who may be accommodated is 45. 30th July 2007 2. Date of last inspection Brief Description of the Service: Castleford House is situated on the Gloucestershire/ Gwent border overlooking the town of Chepstow and the River Severn. The house is a large red brick building providing accommodation on three floors, which also have mezzanine levels on these floors. There is a shaft lift and three stair lifts providing access to all levels. The accommodation is spacious with large landing areas on each floor. There is a large reception, which is favoured as a seating area for many of the residents, plus a lounge, a dining room and a library. Bedroom accommodation consists of thirty-seven single and four double rooms, with fourteen rooms offering en suite facilities. Two assisted bathrooms are situated on the ground floor, one assisted and one not assisted on the first floor and one not assisted on the top floor. There are also assisted toilets on both the ground and the first floor. There is level access to a patio at the rear of the building and a spacious walled garden and well-laid flowerbeds. Information about the service to include CSCI reports is made available by the provider to prospective service users through the homes’ Statement of Purpose and Service Users Guide. At the time of inspection the fees are £650. These are figures that may be adjusted on an individual basis. Additional charges are made for hairdressing, chiropody and newspapers. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 5 People funded through the Local Authority have a financial assessment carried out in accordance with fair access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms can be accessed from the Office of fair trading web site at www.oft.govuk http:/www.oft.gov.uk Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced key inspection site visit took place over ten hours on two days in March 2008. During this time the inspector spoke to a number of residents, one relative, staff working in the home, the manager and the area manager of the home. A tour of the premises was also carried out. Five residents’ care files were examined in detail to include their medication records. Other records examined included staff recruitment and training records, accident, quality assurance and maintenance/servicing records. In addition to this, as a result of some concerns raised care records of another resident, who had received respite care at the home and has since been discharged home, were closely examined. Survey forms were issued to the residents/relatives and staff prior to the inspection, to complete and return to CSCI if they wished. The results of these surveys will be collated and included in this or the next inspection report. Eleven relative surveys and one staff survey had been returned at the time of this report. Also an Annual Quality Assurance Assessment (AQAA) is being completed and its contents used as part of the inspection process and report writing. What the service does well: Has a committed team of care staff, led by a strong management team. The staff enjoy their work and are motivated to training and development. They generally meet the needs of the residents well. Provides a pleasant environment in which to live and work. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 7 Provides a warm and friendly welcome to visitors to the home. When asked what the home does well, relatives comments in the surveys received included the following: • ‘The entertainment of the residents is very well looked after as it is always a varied programme according to the time of year. The entertainment lady in charge does a good job to keep the residents happy’. • ‘ General care and attention’. • ‘Improvements in ,diet,activities,newsletters and staff always attentive’. • ‘It is left clean and tidy and the staff are always visible and paying attention’. • ‘Caring staff;always answer queries/requests; very clean and no bad odours; treat people well’. • ‘ The care home always maintains a very happy atmosphere’. • ‘Fulfils my mothers requirements. Very pleased with the care provided’. What has improved since the last inspection? What they could do better: More consistency in record keeping is required to ensure that all residents whether admitted for short or long term care are assessed on admission and have appropriate care plans and risk assessments completed to ensure that no omissions in care put a service user at risk of harm. Please contact the provider for advice of actions taken in response to this Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 8 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. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 9 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 Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 10 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): 1,2 and 3. Standard 6 not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families have most of the information they should have to make an informed choice regarding placement at the home, and pre-admission visits take place to carry out an assessment and ensure that needs can be met. Residents normally move in on a long-term basis therefore Std. 6 was not assessed. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Statement of Purpose and Service Users guide for the home are currently under review and amendments need to be made to reflect the new registration for the home in which they are now able to admit up to 25 people with dementia. It was also stated that they do not currently provide each service user with a copy of the service users guide in accordance with regulation 5(2) but make them aware by a notice on the board, that a copy is accessible for them. This is to be addressed. However, from a recent survey completed by 18 out of 38 residents/relatives it stated that ‘most replied they had enough information prior to admission and everyone was very helpful’. When asked how they heard about Castleford, most replied ‘social services/lived locally or recommended’. One lady spoken with had moved from London to be closer to her daughter. Several residents who had been admitted since the last inspection were spoken with at inspection and all confirmed that they were happy with the care provided and the facilities offered. One man commented on the lovely view from their room and one relative stated that she was very satisfied with the care her mother received and she and her sister were always kept informed of any changes in their mother’s condition. Most of the relative surveys received also confirmed that they received enough information. One pre admission assessment was seen and was completed in brief. It was discussed that it is not always appropriate to be writing at length when carrying out a first assessment, but brief notes taken then should be completed in full after this meeting to demonstrate that the home is able to meet the needs of each prospective resident. It was also discussed that the current pre-admission assessment is to be altered to allow different methods of recording for social and nursing care admissions. Copies of contracts were seen in place and signed. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 12 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. These judgements have been made using available evidence including a visit to this service by the key inspector. People who live in this home generally have their health care needs met through individually planned care. This clearly sets out needs and how they are met, to include healthcare referrals and interventions where required. They are also generally protected by the medication administration procedures that the home has in place and are treated with respect; their privacy and dignity are protected. EVIDENCE: A total of six care files to include some of those most recently admitted service users, one who had received respite care and others with high dependency nursing and dementia care needs were examined and a number of residents were spoken with. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 13 All had assessments completed and evidence that these had been updated with the exception of the one who had been on respite care. However, the form used does not clearly indicate a space for the nurse completing the assessment to sign and date this, which needs to be addressed. The amount of information included was generally very informative. Included in these assessments were a number of risk assessments to include moving and handling, pressure sore, falls, and nutritional risk assessments. Again, all of these, with the exception of the one on respite care had been reviewed regularly. As a result of the investigation carried out through concerns being raised it was established that despite good record keeping in general the staff had been remiss on this one occasion in completing either a pressure sore risk assessment or care plan and there was no evidence of the previous assessment being updated. It was therefore not possible to confirm or otherwise that someone in their care had received appropriate care and had not been put at risk or neglected by omission of appropriate care during their short stay. Care plans were in place for all of the permanent residents and these were detailed, reflected the current needs and were reviewed regularly but not signed by the resident or their representative. However, there must be consistency to ensure that all residents for short or long term care receive the same attention. Core care plans had been used for a number of problems to include dementia, vulnerable sacrum and where use of bed rails had been deemed necessary. These had all been individualised. Included in the paperwork were records of professional visits from the doctor, district nurse, community psychiatric nurse, chiropodist and other professionals such as speech and language therapist, all indicating liaison with other health professionals where appropriate. One doctors’ practice also makes weekly routine visits to the home and makes their own records which are held on file. Most relatives surveys received stated that they felt their relative’s needs were met by the home and that they were kept informed. One stated that ‘their husband was very happy and thinks he is in a good hotel’. However one did state that it does take a long time to get her husbands’ hair cut. Medication records were examined during the inspection, with particular reference to those of the residents whose care files had been examined. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 14 Most were quite well maintained, with just one or two gaps noted and being followed up, but there were a number of hand written entries which had been made with no date, signatures of two members of staff or record of who had prescribed the medication. In one instance it was also noted that ‘homely remedy-Paracetemol 6 hourly prn’ was recorded, which is not acceptable on the homely remedies policy. There were also a number of handwritten entries for paracetemol tablets but none found for those service users in the drug trolley or cupboards used to store medications. One medication-nitroglycerina patches did not have a residents name on and one resident was found to have an excessive quantity of eye drops in stock. This was all fed back to the manager and deputy manager to be followed up. An audit of the controlled medications held in the home was completed and found to be correct. All medication was stored correctly. The manager carries out her own regular audits of the medication and feeds back the results to the qualified nurses to be actioned where necessary. Four qualified staff identified on the training records had recently attended a medication update. Residents spoken with and observed confirmed that their privacy and dignity is respected and staff were observed knocking on doors and addressing residents by their preferred name. There are currently four rooms being shared, one by a married couple. Those currently sharing are reportedly doing so from choice. Portable screens between beds offers a degree of privacy when personal care is given. Fourteen rooms have en suite facilities. Castleford House Nursing Home DS0000016398.V360633.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 a visit to this service. People who live in the home are supported to realise their own preferences and expectations, both in the home and in the community and are able to maintain contact with friends and family. They also receive a wholesome, appealing and balanced diet in pleasant and comfortable surroundings. EVIDENCE: The home employs an activities co-ordinator for approximately 14 hours a week and she plans a weekly programme of activities, displaying a notice in the reception area of the home for residents to note and to take part if they wish. Her aim is to provide some social interaction/stimulation to all residents whatever their ability; discussions are currently underway to see how best this can be managed with the number of residents, lay-out of the building and varying degrees of dependency. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 16 The manager is just completing a course on ‘the provision of activities in the care setting’ and has introduced individual care plans for activity provisions based on capabilities and interests, and the current activities programme is under review to establish how many residents take part in each organised activity and how successful each one is. Relatives are also invited at admission to complete a ‘lifestyle and interests form and some of these seen were very informative. One aim is to involve all members of staff in the home, within their field, to become involved in the provision of a stimulating atmosphere for the residents and to ensure that each one receives regular social interaction. On the second afternoon, of the inspection, the administrator was giving facials to some of the residents and one seen appeared very happy to have just had her face made up. She had also organised a very successful Valentines tea dance, inviting a local school band, and many of the residents had got up and danced. The programme for March includes individual chats, sing songs, reminiscing, dominoes, quiz, carpet bowls, musical movement and craft to make Easter bonnets. On the first morning of the inspection the organiser was involved in decorating a tree with Easter eggs in the main foyer, which appeared to be the most stimulating atmosphere, with people chatting and reading their newspapers, and doing the crosswords, but unfortunately there were still a large number of residents asleep in the other lounges. Staff do however, whenever possible, spend time sitting and chatting to residents which they greatly enjoy. Several of the relatives and the one staff survey received commented on the activities with the following statements; • They often arrange events for the residents e.g.a tea dance, Easter bonnet parade. At Christmas there were many events all of which were excellent. • I dont think they could do much more but in the summer perhaps they could sit outside in their wheelchairs. • ‘ A bit more organised events. a lot of people are sitting around all day- I know how difficut this must be to arrange though’. • ‘A recent suggestion by a relative that volunteer visitors might be an idea appealed to me. My mother is fine in this respect but some residets never have anyone to visit them. If this could be implemented I thnk it would be excellent’. Residents spoken with confirmed that they are able to exercise choice and control over their lives as far as possible, by choosing how and where they spend each day. Most relative’s surveys completed also confirmed this with the following comment made: • ‘She has the freedom to wander the home with restrictions as to her safety’, another saying, Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 17 • ‘ This is a difficult question to answer, bearing in mind the need for constraints to be in place e.g.safety’. • Visitors are made welcome at any time of the day or evening and residents have access to privacy when having visitors. One visitor was spoken with on this occasion (see comments above). Links with the community are maintained. Since the last inspection there have been many changes within the communal areas, to include total refurbishment and conversion of the large lounge to a dining room. This is now a spacious and attractive area that accommodates any of the residents who choose to dine in the dining room, and allows plenty of space for staff to sit besides, and offer assistance to some residents where required. Breakfast and lunch on both days of the inspection were observed and found to be calm and sociable occasions. The new chef has produced a five-week menuplan; printed and displayed on the tables each day and residents were observed thoroughly enjoying the steak and ale pie and beef stroganoff served on the two occasions seen. Special dietary needs are also well catered for, to include soft and pureed diets where required. Themed meals for special occasions such as Valentine’s Day, and green iced cakes for St. Patrick’s Day are also being provided. Castleford House Nursing Home DS0000016398.V360633.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 a visit to this service. People in the home are protected by the systems in place. EVIDENCE: The home has a complaints procedure included in the service users guide, provided with the contract and on display in the home. This has been amended to reflect the new address of the Commission for Social Care Inspection. A record is kept of any complaints received (one since the last inspection) and this was seen and demonstrated that complaints are investigated in accordance with their policy. One concern raised by Social Services on behalf of the relative of a former service user was followed up as part of this inspection and the findings added to this report. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 19 The home has policies on adult protection and disclosure of abuse and bad practice (whistle blowing). Staff have received training on Protection of Vulnerable Adults, the manager and deputy attending enhanced training. Training records seen and staff spoken with confirmed this. Castleford House Nursing Home DS0000016398.V360633.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, clean and hygienic throughout. Equipment is provided to aid mobility and promote independence. Individual bedrooms are decorated and equipped to meet the needs of their occupants. EVIDENCE: During a walk around the building every room was looked at and all were found to be clean and mostly in good decorative order, with evidence that each person had had the opportunity to personalise their rooms with photographs, items of their own furniture and other treasured possessions. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 21 A great deal of refurbishment has been carried out since the last inspection with all communal areas on the ground floor redecorated, refurnished and with new carpet and curtains fitted, creating a variety of light, bright and comfortable areas for residents to spend their days. In the foyer/reception, a popular seating area for many residents, four twoseater leather settees have been positioned. There was doubt as to the practicality/suitability of this furniture, both from a moving and handling point of view and for resident’s independence and ‘personal space’ but those who use them are independent and apparently have no problem getting out of them, and confirmed that they find them very comfortable. They also appear to encourage more social contact when two residents sit side by side and one relative spoken with stated that her mother seemed quite comforted by the presence of another resident sitting close to her. New carpeting has been fitted along the corridors on each floor again greatly improving these areas. Several areas noted requiring attention were already on the maintenance list to be addressed as soon as possible. The home was in the process of appointing a new maintenance man during the inspection but was using the services of the gardener, who works between two homes belonging to the Company. Work has also been completed in the kitchen following a visit from the Environmental Health Officer and the food storage area has been totally refurbished and greatly improved. The two ground floor bathrooms and the laundry were the next major areas to be addressed, with one of these assisted bathrooms being converted to a ‘wet room’. Attention to the ground floor assisted toilet and a vanity unit in one shared bedroom were pointed out as requiring attention. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their needs met by sufficient skilled staff who are able to meet the needs of the current number of people living at the home. They are also protected by the homes’ recruitment system. Staff are supported to undertake regular and relevant training. EVIDENCE: There were thirty-seven residents accommodated during the site visit. There were six carers, two qualified nurses and the manager on during the morning, five carers, two nurses and the manager during the afternoon and five carers and two nurses during the evening. There is one qualified nurse and three carers during the night. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 23 In addition to care staff, there was a chef and two kitchen assistants, two cleaners and the housekeeper, the administrator, gardener and the activities co-ordinator. Staff observed during the inspection appeared to be carrying on with their work in a professional and organised manner and all of the residents and one relative spoken with were very happy with the care provided. No one gave any indication that they felt the home was short-staffed, or that they had been kept waiting for attention at any time. No call bells were heard constantly ringing. Feed back from the homes’ own quality assurance surveys stated that all found the staff helpful. Two staff files were examined of staff appointed since the last inspection. Both had applications completed and all the records and checks required. Both gave a full career history, and one also provided a curriculum vitae (CV). Both had a medical questionnaire completed confirming mental and physical fitness. Both had documents of identification but did not yet have a photograph on file. Both had two written references, although one did not have one from the last employer as required and both had POVA First confirmation but one was still waiting for CRB disclosure to be returned. This new member of staff was spoken with and confirmed that she worked under the supervision of a senior carer who was NVQ trained and was not allowed to work unsupervised or to carry out any moving and handling procedures until her training, which was booked, had been completed. An interview checklist was seen but a record of interviews was not, although it was later reported that they had been completed and had been located. Induction records were also seen based on Skills for Care. The home is very committed to training and staff confirmed that wherever possible they were able to attend any training felt to be useful to them. Staff training records confirmed that they undertake regular training and updates, to include moving and handling, fire training, dementia training and POVA. All training is entered onto the computer and a print out was provided. Further training on dementia and challenging behaviour as well as an awareness of the mental capacity act is planned. Staff spoke very enthusiastically about the dementia training, and the deputy manager said how useful training on malnutrition and dietary awareness, just attended, had been. Seven staff have NVQ level 2 or above and others are working towards this. The home has three NVQ assessors. The deputy manager is currently undertaking NVQ 4. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 24 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): 31,32, 33,35, 36, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their best interests met by the manager and staff who are committed to their responsibilities. They and the staff are generally protected by the health and safety systems in place in the home. EVIDENCE: The registered manager has been in post since 1999 and is a registered general nurse and a registered mental nurse. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 25 The deputy manager is currently completing NVQ 4 and ably supports the manager as does the area manager and providers who also have a high profile in the home and foster good staff relations. Both the manager and deputy have recently attended a number of both clinical and managerial training courses, to include enhanced protection of vulnerable adult training, dementia and activities provision and awareness of malnutrition and dietary needs. Several staff were spoken with during the inspection to include the new chef, the gardener, the housekeeper, the administrator and qualified nurses and care staff and morale in the home currently appears quite high, particularly related to training and development and the improved environment. The gardener stated that he is really happy coming to work and one of the qualified nurses spoken with who previously had worked in a number of hospitals was apprehensive initially but now loves it. The company recently sent out staff surveys and a large number of staff completed them. The results are currently being collated and were seen at inspection. The home does have formal meetings, the last carers meeting being in December 2007 and the last qualified nurse meeting in February 2008. There are plans to hold more regular care staff meetings. However, there is an ‘open door’ policy and staff can speak with the manger or her deputy whenever they are on duty and all staff are seen regularly on an individual basis in their supervision sessions. Records of regular supervisions were seen and staff appraisals for the year are currently being arranged. Daily records are being kept and these are full and informative and generally demonstrate action taken when a problem has been identified. The one exception to this was the service user on respite care. Accident records are kept and audited and generally actioned where appropriate. However, one resident seen to have had at least 31 recorded accidents within the last 6 months did not have a fall risks assessment or care plan to identify that this was a problem although it was reported that action such as referral to the Dr to review medication has taken place. This was addressed immediately. The Commission is kept informed of any serious accidents and other notifiable incidents. Satisfaction surveys have been carried out by the home this year and were seen at inspection. Resident/relative surveys have been collated and a copy of the report provided at inspection. Some of the suggestions made have already been accepted and acted upon to include refurbishment of the conservatory to create a quiet room and provision for storage and maintenance of wheelchairs, which is much improved. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 26 Other audits are carried out within the home to include care plan and medication audits and the proprietors and general manager carry out a full monthly audit on a wide range of things within the home. Residents’ finances are generally their own or their families responsibility and the home does not act as appointee to any resident. They do keep personal expenditure for residents who wish them to do so. This is held in a bank account until required and records of any financial transaction undertaken are kept and were seen. These records are also available for the family’s inspection on request. Records were also seen to confirm that regular maintenance and servicing of equipment is carried out, to include portable appliance test and services to the lift, hoists, fire safety equipment and gas. The only health and safety issues noted were that one bathroom window on the first floor was not restricted and several other rooms on that floor had restrictors that did not appear to follow health and safety guidelines of restriction to 100 mm. The majority of radiators were also guarded but one large radiator on the top floor was unguarded. These are to be addressed. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 27 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 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4(1)(c) Timescale for action Amend the Statement of Purpose 30/04/08 to indicate the range of needs the care home is intended to meet. A copy of the service users guide 30/04/08 to be provided to each service user. A written plan of care must be 30/04/08 completed for each service user and kept under review. Ensure that any risks to the 30/04/08 health or safety of a service user are identified and so far as possible eliminated. This is in relation to risks of pressure sores and falling. Hand written entries on 30/04/08 medication administration charts should be checked and countersigned by two staff and the date of commencement entered; use of homely remedies must be reviewed to ensure that over use is avoided and no resident should be given any medication that has not been prescribed for them by a doctor. This is to ensure that arrangements for the recording, DS0000016398.V360633.R01.S.doc Version 5.2 Page 29 Requirement 2. 3. 4. OP1 OP7 OP8 5(2) 15 13(4)(c) 5. OP9 13(2) Castleford House Nursing Home 6. OP29 19 7. OP38 13(4)(a) safe handling, safe- keeping, safe administration and disposal of medicines received into the care home are in place. All relevant checks and records are completed and satisfactory prior to the appointment of a new member of staff. This is relevant to a reference from the last employer and a photograph as part of identification, to ensure that residents are protected by the homes’ recruitment process. Timescale of 31/10/07 not met in full. Ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards for their safety. This is in relation to an unguarded radiator and unrestricted windows 30/04/08 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Service users should be assessed to identify those who are at risk of or who have developed pressure sores and appropriate intervention is recorded in the plan of care. Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 30 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 Castleford House Nursing Home DS0000016398.V360633.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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