Inspection on 22/02/06 for 34-36 Langstone Road

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

34-36 Langstone Road 22/02/08

34-36 Langstone Road 11/09/07

34-36 Langstone Road 14/11/06

34-36 Langstone Road 17/08/05

34-36 Langstone Road 17/02/05

34-36 Langstone Road 03/09/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 34/36 Langstone Road Russells Hall Estate Dudley West Midlands DY1 2NJ Lead Inspector Jayne Fisher Unannounced Inspection 22nd February 2006 09:30 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 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 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 34/36 Langstone Road Address Russells Hall Estate Dudley West Midlands DY1 2NJ 01384 234510 01384 357752 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) Langstone Society Mrs Patricia Joan Brookes Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17 August 2005 Brief Description of the Service: Langstone Road is a residential care home registered for eight people with a learning disability. Originally two semi-detached properties It maintains a similar appearance to other residential properties in the area and is situated close to local shops and public transport links. The Registered Provider is Langstone Society which is a Registered Charity who rent the premises from the Churches Housing Association of Dudley District Limited (CHADD). Facilities include 6 single and 1 double bedroom, kitchen, dining room, 2 sitting rooms, and sufficient numbers of bathrooms and toilets. Car parking is available at the front of the property with gardens at the rear. The home’s aim is to provide a homely and stimulating environment, ensuring that each person exercises maximum choice and control over their own life and maintains independence. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted between the hours of 9.30 a.m. and 6.30 p.m. The inspector was aided by two senior support staff and the Chief Executive who was present for the latter part of the day. The purpose of the inspection was to assess progress towards meeting the national minimum standards and towards addressing items identified at previous inspection visits, and following the investigation of a complaint in November 2005. A range of inspection methods were used to make judgements and obtain evidence which included: case tracking, interviews with four members of staff and a tour of the premises. Three residents were at home during the day. They were happy to participate and showed the inspector their bedrooms. The remaining five residents returned from their day centres later in the afternoon. Formal interviews were not appropriate therefore the inspector relied upon brief chats and observations of interaction between staff and service users. A number of records and documents were examined. Other information was gathered prior to the inspection from reports of visits undertaken by the Responsible Individual and an action plan submitted by the manager following the last inspection. This was an encouraging inspection with good progress made towards meeting previously required improvements and evidence gathered to confirm that good standards of support continue to be provided. A number of standards were examined at the last inspection and this report should therefore be read in conjunction with the previous inspection report to give a comprehensive overview. What the service does well: There is a welcoming atmosphere within the home and service users said they are happy. Daily routines are flexible and are tailored to meet residents’ individual wishes and needs. For example on arrival at 9.30 a.m. only one resident was up and had eaten breakfast. The remaining residents were either bathing or had chosen to have a lie in. Staff respect residents’ rights to privacy and do not restrict their freedom of movement around the home. Residents wandered into the manager’s office at their leisure and listened or joined in the inspection process. They chatted about their favourite hobbies and outings. Staff continue to fully encourage and support residents to maintain links with their family. The general health care needs of residents are carefully monitored by staff who are swift to ensure that any potential complications are treated by relevant health care professionals. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 6 All parts of the home are exceptionally clean and tidy. Communal areas are comfortably furnished and decorated to a good standard providing residents with an attractive place to live. Bedrooms are decorated and furnished to suit individual tastes. They contain lots of personal possessions and equipment and feel homely. There is ongoing training for staff. Residents are supported by a dedicated and caring staff group. The service provider remains committed to making improvements where necessary and respond quickly to any serious issues raised through inspections or complaints. What has improved since the last inspection? What they could do better: Although care plans and risk assessments are of a good standard, some require updating and expansion to reflect residents’ changing needs. Not all staff are familiar with the content of residents’ care plans and therefore some aspects of support and care are not being provided. There are still a number of staff vacancies which does have an impact upon residents’ activities and community outings. Following a recent complaint the service provider devised an action plan to address any items requiring improvement. This has yet to be fully introduced. There are still a number of issues relating to food and the lack of choice provided to residents. This remains a source of conflict between staff and the manager. There is a lot of emphasis on low fat and low sugar products however the majority of residents are not overweight and in addition may need more energy and protein rich foods. On the whole residents need to be offered more support in exercising control and choice over their diet. Concerns were also raised with regard to one service user and the failure to consistently offer nutritional supplements, closely monitor food intake, poor record keeping and lack of proactive action. A lack of clear care planning and nutritional screening has lead to confusion amongst staff. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 7 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. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Overall there are good care plans and risk assessments in place, however expansion and updating in certain aspects would provide staff with more useful guidance in delivery of support and care provided to residents. Residents are supported to make decisions about their lives with assistance given as needed. EVIDENCE: A sample of care plans were examined. In some cases although there is a summary sheet identifying regular six monthly reviews had been undertaken, it was not possible on further reading to discern what parts of the care plans had been reviewed. It is clear that sections of care plans have been added to, but as there were no dates or staff signatures, it was not possible to confirm when these amendments had been made. Confusingly the ‘individual care plan goals’ were still dated as 2004 for some residents, making it unclear as to whether these had been reviewed. During interviews some staff were not aware of the contents of care plans, therefore this may explain why some behavioural strategies were not being 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 11 followed (see further comment in standard 17). One key worker admitted that they had not read the care plans for ‘some time’. There is a new signature sheet in place to confirm that staff have read the care plans; this was incomplete. In some cases care plans give conflicting advice particularly with regard to nutrition and the administration of oral nutritional supplements. For example, a nutritional care plan states that one resident is to be given Fortisip if she misses two meals and also states that her weight never varies. This is inaccurate according to discussions with staff and examination of monthly weight checks. It is also gives the lowest weight and highest weight recorded but this is obviously in relation to checks undertaken in 2004. The administration of nutritional supplements does not comply with instructions detailed in management of behavioural guidelines (dated 2002), and also instructions given by the community learning disability nurse in the priority health screening tool. The care plan makes no reference to the fact that the resident is below her ideal body weight. Interviews with staff and examination of food records demonstrate that there is an inconsistent approach as to how and when staff offer Fortisip to the resident. There are minutes from this resident’s last review meeting in June 2005. During the meeting staff stated that her weight is stable which is inaccurate given that she had lost a total of 6 lb from January 2005 to June 2006. One resident has a care plan entitled ‘special instructions’ which states that 2 hourly night checks are to be undertaken due to incontinence however there is no specific care plan in relation to continence management. There is a nutritional care plan which states that plenty of fluids are required because of a catheter in situ, however this was removed in July 2005. As with care plans, it is unclear if risk assessments which were introduced in 2004 have received review (this must take place at least annually, or more frequently if a higher risk is identified). One resident’s risk assessment with regard to travelling independently is dated 2003 and makes no reference to walking aids which are in place to assist mobility. Whilst there are risk assessments in place with regard to use of the bath seat (and this now includes how many staff assist in transfers), there are no details regarding service or maintenance checks. One resident had an incident of challenging behaviour during the inspection, whilst there are comprehensive guidelines in place regarding management strategies there was no corresponding risk assessment in place. There are detailed communication packages contained within care plans which demonstrate how residents are supported to make decisions. All residents are able to express opinions or make their preferences known. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 12 There are care plans in place with regard to financial assistance however these need expanding as they give no details as to how the individual resident is supported to manage their finances other than to state ‘Langstone Society new procedures in place – October 2005’. As well as having a general procedure, care plans must be devised with regard to the specific needs of the resident, money recognition skills and support given by staff. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Daily routines are flexible and promote residents’ rights. The home has made limited progress to enable residents to exercise choice and control over their diet. There are serious concerns relating to how and if the special dietary and nutritional needs of some service users are being met. EVIDENCE: Progress was monitored at this visit towards outstanding requirements. In respect of providing more opportunities for community based activities there has been some improvement, but according to staff outings are still restricted as a result of staff vacancies. This was confirmed on examination of activity records. For example, during January 2006, one resident had participated in going to the Cresta Club (once), going to the cinema and taking a walk in a local park. At present staff state that there are a total of around 147 hours vacant per week. As a result staff are unable to forward plan monthly activity programmes, these are completed as and when activities/outings have taken place. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 14 Daily routines are flexible as observed during the inspection and upon interviews with residents and staff. For example, on arrival at 9.30 a.m. three residents were at home, one resident was up and dressed and had had breakfast, another was taking a bath and a third was still in bed. There are details contained within care plans as to whether residents wish to hold bedroom door keys and consent to staff opening their mail on their behalf. Staff were seen to respect residents’ privacy and knock on their bedroom doors before entering. It was pleasing to see that when a relative telephoned to enquire as to the progress of their family member, that staff asked if the resident would like to speak on the phone to their family. Despite requirements made at the last inspection and an action plan following a recent complaint, interviews with staff and examination of documentation confirms that food is still very much a contentious issue between staff and the manager. This is particularly with regard to the what constitutes a normal healthy diet but at the same time allows residents to exercise control and choice. The action plan introduced by the service provider following the complaint investigation has only been partly introduced. For example, the weekly menu plan does not consistently include a choice for supper and when it does, records are not completed of what residents have chosen. Frozen homemade meals as an alternative to the meals on the menu plan have not been introduced. Staff have not started on a healthy eating course in January 2006. At a staff meeting following the complaint it was suggested that one service user be encouraged to help, prepare and cook meals. However this is not taking place on a regular basis and is only happening spontaneously. Another residents’ behavioural guidelines state that she should be encouraged to prepare her own tea but this is not occurring. Care plans needs to be devised to help staff in encouraging residents with planning, preparing and cooking meals, snacks or drinks as part of independent living skills tasks. As already stated in this report there are serious concerns regarding one resident who has known eating problems and low body weight. Advice is conflicting within care plans and staff are unsure as to when to offer extra oral nutritional supplements, nor are they following all of the strategies devised by psychologists. A nutritional screening was undertaken by the community learning disability nurse in 2004 which stated that the resident was underweight for her height using the body mass index calculation at 5 st 8lb. This has not been reviewed and updated. The manager must obtain a suitable nutritional screening tool and carry out regular reassessments (at least annually) or more frequently if a high risk is identified. This resident now weighs 5 st. yet the only concession to providing more energy and protein rich foods appears to be whole milk (long life cartons). On examination of the menu plans there is a lot of emphasis on low fat and low sugar foods but the majority of residents are neither overweight or diabetic, or have health complications which would necessitate specialist diets. There are no records to 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 15 demonstrate that residents have chosen these type of foods and products and no corresponding care plans or risk assessments as to why this sort of diet is necessary. Staff on duty reported that if the resident with eating problems refused any meals that they would give a Fortisip supplement and that this would be recorded in the menu book and daily reports. It was disappointing to see that the resident is frequently refusing meals but there are no records in either reporting systems to confirm that Fortisip is given on a consistent basis. It was very concerning that reports in daily records as to what this resident had eaten on a daily basis frequently conflicted with records in the menu book. For example, on 16 February 2006, the menu book stated that the resident had eaten an evening meal of faggots but the daily report stated that she had refused her evening meal. There were no records to demonstrate that Fortisip had been given. Although the resident has been seen very recently by the doctor with regard to other health complications, urgent advice must be sought from the doctor, community dietician and/or psychologists with regard to this resident’s weight loss, nutrition and eating problems. In the first instance, it is essential that correct advice is sought and followed with regard to the provision of oral nutritional supplements and introduction of energy and protein rich foods. It is still unclear as to how residents are actively encouraged to participate in menu planning or choosing from the daily menu. Staff report that on a weekly basis they will plan the weekly menu with the residents and their initials are later used to denote they have chosen a particular meal on the menu. However these records are not consistently maintained for all meals. There is no lunch identified during the week on the menu plan as it is stated that residents attend day centres, however not all residents attend their centres on a daily basis. Two meals must be identified. On the day of the inspection three residents had the same meal but there was no evidence of consultation. In addition, the same meal was planned for later in the week. On occasions there is only one meal offered on the menu plan for the evening meal. On the evening of the inspection the tea time meal consisted of either ham or corned beef cobs, there was no hot meal option. Staff stated that they are instructed to plan lighter meals in the evenings as residents will have the option of a hot meal at their day centres, but they were concerned that this may be insufficient, as they were not convinced that residents would always choose a hot meal for their lunch. Further issues as discussed during this inspection are contained within the Requirements section of this report. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Residents receive personal support according to their preferences and requirements in most aspects of care, but further improvements are needed. Service users’ physical and emotional health needs are generally very well met but progress is needed with regard to health care screening to enhance current practice. The systems for administration of medication improvement in order to provide greater protection. EVIDENCE: It is pleasing to see that care plans contain residents’ preferences with regard to getting up, going to bed and bath times. There is a designated key worker system to ensure consistency of support. Interviews with staff confirmed that they were aware of individual residents’ likes and dislikes. Residents’ care plans state that they require either two or three hourly checks during the nighttime. Apart from a resident who requires incontinence checks there are no care plans or risk assessments to demonstrate why this level of monitoring is required. Examination of records completed by nighttime staff reveals inconsistent recording as to the frequency of nighttime checks (or in one resident’s case change of incontinence pads). During interviews staff 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 17 are good but require reported that they checked on residents during the night by going into their bedrooms to check if they were still ‘breathing’, had not been ‘sick’ and were sleeping ‘well’. As discussed, any monitoring at night time must be based on clinical good practice as to whether there is a justified medical reason for this level of monitoring, (and recorded in the care plan and risk assessment). This is due to the fact that increased monitoring at nighttime can disturb residents’ sleeping patterns and compromises dignity. Discussions with staff and examination of excellent records demonstrates that good practice continues to be maintained with regard to ensuring that health care needs are met. For example, there are monthly recorded weight checks, regular chiropody appointments and dental check ups. Staff proactively deal with any health care issues they identify. For example, one resident was noted to be unwell and on the following day was taken to see the doctor. Staff discussed how they are unhappy with current continence products and were seeking further advice. There are only a couple of issues which require further attention. The priority for health screening tool was introduced in 2004 and although contains reference to screening conducted in that year, this must receive on-going attention on an annual basis by staff. It was stated in 2005 that residents would be attending well person clinics following completion of the tool but there is no evidence that this has taken place. It is required that care plans are introduced for all health care screening such as breast, testicular and cervical screening. If a resident does not consent to screening (or there are issues over capacity to consent), this must discussed with the relevant professionals such as the doctor and social worker (at review meetings), with outcomes recorded in the residents’ care plan. All residents must receive annual ophthalmic tests (and again if they refuse, this must be discussed within a multi-disciplinary forum). A full evaluation of the control and administration of medication practice was undertaken. There are some good procedures in place for example with regard to ordering and receipt of medication. There is no overstocking of medication although a couple of bottles of skin preparations were found to be out of date and were removed. Since the last inspection household remedy policies have been amended and include information regarding maximum dosage. Good progress is being made with obtaining maximum dosage instructions from the prescriber with regard to ‘as and when’ required (PRN) medication, although not all residents have these fully in place. Medication administration record (MAR) sheets contained up to date information regarding PRN medication. A risk assessment has been carried out with regard to staff not holding the drugs keys on their person, however this requires expansion as it does not identify sufficient hazards or control measures. There were some new items identified at this inspection which require action. For example, Fucidin 5 mg. was supposed to be administered to one resident 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 18 three times a day, however for over twenty day period staff had only been administering this twice daily. There were a couple of gaps in the MAR sheet records where staff had failed to sign to confirm administration had taken place. As observed during this inspection, staff failed to follow appropriate procedures with regard to administration of medication. MAR sheets had been signed before drugs had been administered. On the whole staff are obtaining copies of prescriptions as previously requested although one resident had recently commenced on a short course of antibiotics but a copy of the prescription had not been obtained and the medication profile was not up to date. Any other items discussed during this inspection are contained within the Requirements section of this report. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected at this visit. EVIDENCE: Progress was monitored towards some of the outstanding requirements in relation to these standards. It was pleasing to see that some staff have received training in vulnerable adult abuse. As requested risk assessments have been completed with regard to how residents will be protected from financial abuse in respect of the current financial procedures. These need further expansion to identify more control measures with regard to security of personal identification (PIN) numbers. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The standard of the environment is good providing service users with an attractive and comfortable place to live. EVIDENCE: A tour of all communal areas was undertaken and with their consent and invitation, the inspector also visited some residents’ bedrooms Very good standards are maintained. The communal areas are bright and airy with comfortable and homely furnishings. All bedrooms are decorated and furnished to a good standard and individualised with personal possessions and photographs. It is pleasing to see that colour schemes, décor and furnishings reflect service users’ individual tastes. Since the last inspection some residents have had new bedroom furniture and staff stated that some residents will be having their rooms redecorated. It was pleasing to hear that residents would be offered opportunities to participate in choosing colours. The provision of equipment in bedrooms does not meet National Minimum Standards 26.2 in totality. As previously required staff have negotiated any shortcomings with service users and/or their families. Such as the nonprovision of two armchairs. Outcomes are included in individual service user plans. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 21 On the day of the visit there was a problem with the heating. This was rectified by contractors and in addition the Chief Executive brought some portable heaters as a contingency plan. Good progress has been made towards improving infection control measures. The laundry now contains appropriate procedures with regard to washing laundry and information relating to the control of substances hazardous to health (COSHH). There is no lock on the laundry door and a small container of COSHH was found unsecured. Staff reported that service users need supervision in the laundry area at all times and feel that a suitable lock would offer greater safety. Any additional items discussed are contained within the Requirements section of this report. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 The systems for recruitment and selection of new staff have been improved and as a result, are more robust, and offer greater safeguards to residents from abuse. EVIDENCE: It was pleasing to see that staff have now received training in epilepsy awareness. As recommended the manager has updated the central training programme. A number of staff have undertaken training in challenging behaviour however not all, and in addition some training is more than three years old. Further training should be arranged. Since the last inspection a new ‘sessional’ worker has been recruited. The relevant personnel file was brought from the organisation’s head office. Examination revealed that good procedures are now in place in respect of recruitment and selection. It was also reassuring to find that agency staff who are employed to cover the shortfalls in the duty rota, have also received a recent criminal record bureau (CRB) and Protection of Vulnerable Adult (POVA) check. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 The manager is supported well by her senior staff although a more open and positive approach would enable an inclusive atmosphere for staff and service users to effect the delivery of the service. EVIDENCE: Mrs. Brooke has been Registered Manager at Langstone Road for the past four years, and has worked at the Home for the last eleven years. She has already obtained an NVQ in management and care and is also an NVQ assessor. Mrs. Brooke was not present for this inspection and therefore was unable to be afforded an opportunity to respond to some of the issues raised by staff. Four staff were interviewed who raised concerns over food and the lack of choice for residents. They gave examples of where suggestions made to vary the diet had been overruled. Three out of the four staff felt that they were not listened to and were not able to influence service delivery in relation to this aspect of care. Apart from this, all other areas seem to operate very well with residents benefiting from a competent and skilled manager and staff team who are dedicated to providing the best possible care. During the inspection staff were 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 24 receptive to advice and were eager to actively participate. For example, one senior member of staff whose shift ended at 2.45 p.m. elected to stay until the end of the visit to support the staff team. Progress was monitored towards some of the outstanding items and outcomes are detailed in the Requirements section of this report. For example, there is good health and safety practice with only a small number of items still requiring attention. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 x 2 X X X X X X 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 26 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(b) Requirement To review the contract/licence agreement to include all information contained within Standard 5.2 of the National Minimum Standards for Younger People. (Previous timescale of 1/1/04 is not met). Timescale for action 01/06/06 2. YA6 15(1) 3. YA8 12(3) To undertake a documented liaison with the Local Authority Commissioning Department to establish the exact nature of what the basic contract fee covers in terms of service users expenditure on activities and the nature of the central activity fund and how this is to be disseminated. (Not able to be assessed at this visit). To update and review care 01/06/06 plans to reflect changing needs of service users. For example with regard to nutrition, finances and continence management. To offer more opportunities 01/06/06 for service users to participate in the day to day DS0000024966.V284459.R01.S.doc Version 5.1 Page 27 34/36 Langstone Road 4. YA9 13(4)(c) 5. YA13 16(2)(m) 6. YA14 16(2)(n) running of the Home through joining staff meetings, representation in management structures, recruitment and selection of staff. (Previous timescale of 1/1/05 is partly met). To review and expand risk 01/06/06 assessments. For example with regard to continence management, challenging behaviour. All risk assessments must be reviewed at least annually (or sooner depending upon level of risk). To provide more 01/06/06 opportunities for service users to undertake community based activities on an individual and group basis based on their individual preferences and needs. (Previous timescale of 1/12/05 is partly met). Service users should be given 01/06/06 the option to have a minimum seven-day annual holiday, outside of the home, as part of the basic contract price. (Previous timescale of 1/1/04 is not met). Service users should not be expected to pay towards staff expenses incurred whilst involved in activities, day trips, outings, holidays etc. (Previous timescale of 1/1/04 is not met). To improve recording systems for daily and/or weekly activity planning and evaluation. All refusals to participate in activities such as community outings must be clearly recorded. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 28 7. YA17 (Previous timescale of 1/12/05 is not met). 16(2)(i)12(1)(a) To ensure more consistent 01/05/06 recording of service users chosen options from the daily menu. (Previous timescale of 1/11/05 is not met). To review and expand the written menu plan. For example to ensure that there are at least two options available lunch and dinner. (Previous timescale of 1/11/05 is not met). To establish written guidelines for staff with regard to menu planning and strategies for supporting service users in making choices. (Previous timescale of 1/11/05 is partly met). To seek clarification with the General Practitioner or community dietician with regard to the frequency of administration of extra oral food nutrition supplements (Fortisip) for the service user with identified eating problems and recent weight loss. The outcomes must be fully recorded in the care plan by 3 March 2006. To seek further advice from suitably qualified persons (such as the community dietician or behavioural psychologists) with regard management strategies for this resident’s fluctuating weight and eating problems. This must include dietary advice on the use of energy and protein rich foods. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 29 Outcomes to be recorded in the relevant care plan. To carry out reviews of nutritional assessments (using a suitable tool such as one recommended by the community dietician). The assessments must demonstrate whether the there is a high, medium or low risk and must identify the ideal weight for the service user using the body mass index. To improve monitoring systems for service users with weight loss or other nutritional problems, for example using food intake charts which also record sizes of food portions. To ensure more consistent recording of the provision snacks, desserts and suppers on the menu. To ensure that service users are offered opportunities to plan, shop, prepare and serve meals. Care plans and risk assessments must be completed. To review the practice of 01/06/06 three hourly checks undertaken during the night on all service users. Outcomes and guidelines for staff to be documented in individual care plans. To establish care plans with 01/06/06 regard to specific health care screening in respect of breast, testicular and cervical cancer. All refusals and consent issues must be DS0000024966.V284459.R01.S.doc Version 5.1 Page 30 8. YA18 12(1)(a) 9. YA19 12(1)(a) 34/36 Langstone Road discussed within a multidisciplinary forum including the General Practitioner. To ensure that all service users have access to annual ophthalmic tests. To make the following improvements to the control and administration of medication: 1) To review and expand the medication policy to include all areas of the control and administration of medication and to follow good practice guidelines issued by the Royal Pharmaceutical Society. (To forward to CSCI). (Previous timescale of 1/1/05 is partly met). 2) To ensure drugs keys are either held by the sole person in charge or to identify a more secure location for the holding of keys. To carry out a written risk assessment if keys are not held by the person in charge. (Previous timescale of 1/1/05 is partly met). 3) To ensure that guidelines are established in individual care plans for the administration of P.R.N. medication. (Previous timescale of 1/1/05 is partly met). 4) To ensure that all household remedies administered are ratified by the General Practitioner including Aloe Vera and Almond and Lavender oil 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 31 10. YA20 13(2) 01/05/06 (and any other essential oils). (Previous timescale of 1/5/05 is not met). 5) To obtain copies of original prescriptions. (Previous timescale of 1/5/05 is partly met). 6) To pursue plans to ensure that all staff receive training in the safe handling of medication from an accredited trainer. (Previous timescale of 1/11/05 is partly met). 7) To obtain written consent from service users with regard to the administration of medication and record in care plan. 8) To ensure that care plans contain up to date medication profiles for all service users. 9) To improve medication administration record (MAR) sheet recording – all gaps to be fully explored with explanations recorded on the back of the MAR sheet. 10) To ensure that staff fully adhere to the dosage instructions for administration of medication as specified by the prescriber. For example administration of Fucidin. 11) To ensure that when any changes of medication are made on the MAR sheets by staff, such as the addition of new medication, two staff initials are obtained to 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 32 confirm accurate instructions have been recorded. 12) To ensure that administration of oral nutritional supplements are recorded on the MAR sheet. 13) To ensure that drugs requiring refrigeration are held in either a separate lockable container or a drugs fridge. 14) To ensure that staff only sign the MAR sheet once drugs have been administered. 11. YA23 13(6) 1) To provide all staff with training in vulnerable adult abuse. (Previous timescale of 1/1/05 is partly met). 2) To ensure that a written procedure is established with regard to service users financial contributions towards the use of a vehicle owned by one of the service users. To ensure that written consent is obtained with regard to the procedure and the use of this car. (Not assessed at this visit). 3) To obtain a copy of the Department of Health guidance on the Protection of Vulnerable Adults Scheme (POVA). (Previous timescale of 1/5/05 is not met). 4) To ensure that the vulnerable adult abuse policy includes procedures relating to the POVA scheme. (Previous timescale of 1/5/05 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 33 01/06/06 is partly met). 6) To review and expand the written procedure with regard to assisting service users with the withdrawal of personal monies. (Not assessed at this visit). 7) To carry out a written risk assessment for individual service users with regard to measures in place to prevent financial abuse. (Previous timescale of 1/12/05 is partly met). To ensure all wardrobes are securely fixed to bedroom walls. To replace stained headboard in resident’s bedroom (located adjacent to the communal bathroom). To improve infection control practice by: 1) To provide a separate wash hand basin in the laundry area or to carry out a written risk assessment is this is not feasible. (Previous timescale of 1/6/05 is not met). 2) To fit a suitable lock to the laundry area. 14. YA32 18(1)(c) To progress plans to ensure that 50 of the care staff team are qualified to NVQ II or above by 2005. (Previous timescale of 31/12/05 is not met). To provide all staff with training in understanding and 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 34 12. YA24 23(2)(b) 01/06/06 13. YA30 13(3) 01/12/05 01/06/06 15. YA33 18(1)(a) managing challenging behaviour. To ensure that the Manager is allocated and carries out dedicated supernumerary hours and to forward written proposals to the Commission for Social Care Inspection. (Previous timescale of 1/11/05 is not met). All staff must receive structured induction (within six weeks) and foundation training (within six months) to Sector Skills Council specification and provided by a LDAF (Learning Disability Award Framework) accredited trainer. (Not able to be assessed at this visit). 01/11/05 16. YA35 18(1)(c) 01/06/06 17. YA39 24 18. YA41 17(2) 19. YA42 18(1)(c) To ensure all staff complete training in equal opportunities and disability equality. (Previous timescale of 1/1/05 is not met). To develop an effective 01/06/06 quality assurance system to include feedback from service users, stakeholders in the community etc. (Not assessed at this visit). To obtain and hold 01/06/06 information and documents on the premises in respect of persons carrying on, managing or working at a care home as listed in Schedule 2 and 4 of the Care homes Regulations 2001. (Previous timescale of 1/1/05 is not met). To ensure all staff have up to 01/06/06 date training in: 1) first aid awareness. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 35 (Previous timescale of 1/1/05 is partly met). 2) infection control. (Previous timescale of 1/1/05 is partly met). 20. YA42 13(4)(c) To undertake the following improvements with regard to fire safety and health and safety: 1) To ensure that the water system has undergone chlorination and a bacterial analysis. (Not assessed at this visit). 2) To ensure that separate written risk assessments are undertaken for all substances used which are hazardous to health (COSHH). (Previous timescale of 1/6/05 is not met). 4) To carry out a written risk assessment with regard to the service user who has been identified as prone to falls. (Not assessed at this visit). 21. YA42 13(4)(c) To make the following improvements to food hygiene practice: 1) To ensure consistent checking and recording of cooked food temperatures. (Previous timescale of 1/5/05 is not met). 2) To ensure all foods frozen by the home are labelled with the date of freezing. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 36 01/06/06 01/06/06 (Previous timescale of 1/5/05 is not met). 4) To ensure all dried foods such as cereals are stored in pest proof containers once opened. (Previous timescale of 1/5/05 is partly met). 5) To comply with all of the requirements identified by the environmental officer food hygiene in report dated 1 February 2005. (Not assessed at this visit). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA17 Good Practice Recommendations To ensure that staff date and sign any additions that they make to care plans as part of the review process. To consider producing a pictorial menu plan and other strategies for assisting service users with menu planning and choosing daily food options. To pursue plans to provide all staff with training in healthy eating. To consider introducing an improved system for recording how individual residents choose the weekly menu and are enabled to make daily choices. 3 4 YA20 YA30 To consider obtaining a more suitable drugs cupboard. To cease storing the ironing board in the laundry area. 34/36 Langstone Road DS0000024966.V284459.R01.S.doc Version 5.1 Page 37 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 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. 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