Inspection on 04/09/07 for Langdale Heights

This inspection was carried out on 4th September 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Langdale Heights 27/08/08

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Langdale Heights Langdale Heights 352 Burton Road Derby DE23 6AF Lead Inspector Steve Smith Unannounced Inspection 4th September 2007 09:30 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 Langdale Heights DS0000070079.V347526.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. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langdale Heights Address Langdale Heights 352 Burton Road Derby DE23 6AF 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) 07956846324 Neemat Kassam Yasmin Kassam Connie Christine Hudson 01332 367429 Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability (3) of places Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following categories of service only: Care Home only - PC To services of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Old Age, not falling within any other category Code OP, maximum number of places: 31 Physical Disability - Code PD, maximum number of places: 3 The maximum number of service users who can be accommodated is: 31 New service 2. Date of last inspection Brief Description of the Service: Langdale Heights Care Home can accommodate 31 Older People and is situated close to the centre of Derby. The property was originally a private dwelling, which has been converted and extended into a nursing home. Residents’ rooms are located over three floors, and all floors are accessed via a passenger shaft lift or staircase. One shared room and two single rooms have ensuite facilities. Bedrooms are attractively decorated and personalised. Support services are in place with a choice of General Practitioner and visiting Chiropodist, Dentist and Optician. Community Psychiatric Nurses, Occupational Therapists, Physiotherapists and Dieticians are accessed as required. Staff are provided with appropriate training to meet the needs of residents. The charges made for a room at Langdale Heights Care Home range from £331.00 a week to £460.00 a week, dependent on the bedroom provided and the needs of the particular Resident. A copy of the Commission’s inspection report is available from within the Home. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in just under 8 hours. Discussion was held with two Residents, and the records of three Residents were ‘case tracked’. Discussion was also held with the Manager of the Home, and with one member of the care staff. A number of records were examined, and all bedrooms and public areas in the Home were looked at. The Commission’s pre-inspection questionnaire, sent to the Manager, was examined. The Commission’s Residents questionnaire was also sent to a selection of Residents, however, none had been returned at the time of this visit to the Home. What the service does well: What has improved since the last inspection? This home was only purchased by the Registered Providers in May of 2007. Therefore, there has not been a previous inspection of the Home under their ownership. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 6 What they could do better: A statement of purpose was needed that addressed the issues required by the new Registered Providers. The Residents Guide also needed to be updated to ensure it addressed all of the issues listed in Regulation 5, as amended in September 2006. The Residents plans of care needed additional items addressing to ensure they met appropriate standards, and the records of the administration of medication also needed considerable attention. The Registered Providers and Manager were recommended to improve the activities provided in the Home. Staff also needed to be encouraged to knock on Residents doors and wait to be invited in by those Residents considered capable of doing this. The Registered Providers were encouraged to provide a choice at the main meal each day. Staff were also recommended to improve the way in which they assisted Residents with their main meal. The Manager needed to ensure that all concerns and complaints were fully recorded. Staff should be informed that they cannot benefit from Residents wills, and this, together with other issue, should be included in a staff handbook. Work was also needed on the fabric and condition of the Home to ensure it met legal and recommended requirements. The Registered Providers needed to ensure that at least 50 of care staff held an NVQ level 2 in Care at all times. The Registered Providers needed to begin to formally ‘inspect’ the Home on at least a monthly basis, reporting their findings to the Manager. The Registered Providers and Manager needed to ensure that a complete Quality Assurance programme was in place. The Manager needed to ensure that Residents saving, held be the Home, was always correctly maintained. The supervision requirements of care staff also needed to be entirely put into practice. Mandatory training was required by a number of staff, and risk assessments were also needed to safeguard all staff while carrying out their duties. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 & 6. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. The statement of purpose and Residents Guide did not provided appropriate information to ensure that Residents were adequately informed about the Home prior to admission. EVIDENCE: The Registered Providers had provided a statement of purpose for the Home, together with a Resident’s Guide, which was available in each Residents bedroom. However, the Manager said that the statement of purpose was that provided for the Home before the new Registered Providers took over, and as a result the new Registered Providers were in the process of updating it. The Residents Guide was well completed, but did not include the new issues listed in the Regulations that came into force in September 2006. The Residents Guide also did not contain the opinions of Residents on what life was like in the Home. However, the Guide did contained information on how contact could be Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 10 made with the Commission and the local Social Services Dept, but not how contact could be made with the local Health Authority. The records of three Residents were examined during this inspection and a complete copy of the statement of terms and conditions of residency or a contract, if purchasing their care privately, was available. When new Residents were admitted to the Home, the Manager was provided with a summary of the needs of each person, completed by the Social Services Dept Care Manager supporting each Resident, copies of which were seen. The Manager also assessed all Residents sponsored by Social Services Depts. If the Residents were self-funding from the outset, the Manager completed her own summary of needs, which were also seen during the inspection. Standard 6 does not apply to this Home. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 & 11. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Residents’ health and personal care needs were being met, as demonstrated within care plans, although attention was needed to the administration and distribution of medication to meet Residents needs. EVIDENCE: To help assess Standard 7, the Resident’s Plan of Care, the records of three Residents were examined, for the purpose of case tracking. Most of the basic information, concerning each Resident, was found to be in the files examined. That was, their name and date of birth, their preferred name, their next of kin, their GP, and their date of entry to the Home. However, none of the files examined showed details of who the Social Services Dept Care Manager was or who the designated keyworker was for each of the Residents. Records of the Manager’s initial assessment of each Resident were found in each file, together with completed Individual Plans of care for each Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 12 Resident, which were mostly found to be up to date. Records of the risk assessment on each Resident were also available. However, the Manager had not provided appropriate records for the Resident suffering with dementia, as there were no records of the Resident’s possible limitations of choice, freedom and decision making ability. The Manager was also not holding formal 6 monthly reviews of care of each Resident. The Resident, their relatives or formal representative, should all be invited to these formal reviews. However, it was found that the local Social Services Depts undertook formal reviews of care on an annual basis. All of the files were easy to read and satisfactory entries had been made by the nursing staff. The Manager said that she reviewed the records of each Resident at regular intervals, but she had not signed the records to indicate that this had taken place. The files were well organised, with different sections, although a confidential records section was not found in any of the files examined. In one of the Residents files a member of staff had asked other staff to ‘Please observe’ the Resident, concerning a particular problem for the Resident. However, no entry whatsoever had been made following this request, even though the entry had been made in February 2007. Staff were appropriately maintaining the records of Residents health needs. All medication and the method of distributing it to Residents was examined, and a good system was found to be in use. However, the following issues needed to be addressed: The medication provided for at least two Residents was found on a trolley in one of the bathrooms of the Home. This medication should have been locked away in the medication room. Creams were prescribed for a number of Residents on the Medication Administration Record (MAR) sheets, but these entries on the sheets were not being completed by staff, therefore there was no record as to whether the Residents creams were being applied. In various places on the MAR sheets staff had written an ‘O’. The printed MAR sheet indicated that an ‘O’ indicated ‘Other’. However, ‘Other’ was not defined on the MAR sheet and no place was provided on the MAR sheet for a definition. This needed to be taken up by the Manager with the Pharmacist to clarify the matter. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 13 Throughout the MAR sheets two staff signed every entry made. However, only two signatures were needed when Controlled Drugs were dispensed, on all other occasions only one signature was needed. Discussion was held with Residents about life in the Home. They said that staff were very good at listening to their views on how they liked to be cared for and staff would carry out their wishes. They also said that their care needs were always met with dignity and respect. As a result, they felt very safe in the Home, and appeared to have a strong sense and appearance of well being – ‘Staff do things my way, and that is all the staff.’ - ‘Yes, staff usually do what I ask for. I can say what I want to wear and usually they get it, staff find it in the wardrobe for me.’ Discussion was also held with Staff, and very positive ways were described of assisting Residents within the Home. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14 & 15. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Residents preferred lifestyles were respected by the Home, although attention was needed to the activities provided. Residents were given a wholesome and appealing diet in pleasant surroundings, although improvements were needed to ensure that Residents well-being was appropriately supported. EVIDENCE: Residents were asked about the activities provided in the Home. Those spoken with said that apart from card games, dominoes, TV and reading, nothing else is provided. Staff were asked about this and they confirmed that only the activities already listed were provided, with the addition of music. The Manager also confirmed that this was all the activities that were provided. One Resident said that she decided when she got up and went to bed – ‘I stay up till about 9.30 each night, and I can stay in bed and get up when I want. Staff ask me what time I want to get up, because I need their help.’ Another Residents said that ‘I am bed-fast, but staff make sure I am comfortable in bed, they don’t leave the room until I am comfortable’. Residents said that they had one bath a week, and the Manager said that more than one bath a week could be provided if Residents requested this. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 15 Relatives and friends of Residents were able to visit at any time, and could always be seen in private - ‘I always see my visitors in private in my bedroom.’ The staff spoken with also said that relatives could visit at anytime. It was said that Residents could chose where they wanted to see their relatives, in the lounge, the dining room or in their bedrooms. Residents spoken with said that there was a mixed response when asked how staff entered their bedrooms. They said that some staff knocked and waited to be invited in, while others simply knocked and walked in. Residents said that the Home provided a choice of meals, but that this was only at breakfast time, and teatime. At dinner time a fixed meal was provided, and the choice was offered only if the meal was actively disliked by the Resident. Staff confirmed this. At breakfast time, cereals, a cooked meal and toast was offered. At teatime, a small cooked meal was offered or a choice of sandwiches was provided. Staff also said that drinks and snacks were always provided between meals for Residents. Staff said that when Residents needed to be fed by the staff, that, for example, all of these Residents were fed with their dinner, and then all Residents would be feed with their sweet/pudding. The result of this was a long period of time between each part of the meal. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 16 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): Standards 16 & 18. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. Written Complaints made to the Registered Providers or Manager were addressed to meet Residents needs, however, attention was needed to verbal complaints. The protection policies and procedures provided meant that Residents were well protected. EVIDENCE: One Resident said that she had complained about the quality of the chairs provided with the Home, when the new owners took over, and new chairs were provided. Another Residents said that if she had a complaint to make she would tell one of the nurses, who would tell the Manager. She said that she had to do this once, and she was happy that it was dealt with well. The Commission had received two notices of complaint, in August 2007, since the present Registered Providers bought the Home, in May 2007. The complaints were passed to the Registered Providers to investigate, and at the time of writing this report they had not replied to the Commission with the results of their enquiries. Aside from the above complaint notices passed on by the Commission, the Manager said that she had not received any other notice of complaint or concern since the new Registered Providers took over the Home. However, the Manager said that she did not normally record issues of concern or complaint Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 17 passed on to her verbally by relatives. She said she would investigate the issue and report back to the complainant directly. So, no record was made. The Registered Providers had a Safeguarding Adults procedure that included a ‘Whistle Blowing’ policy. The Manager said that a copy of the Public Interest Disclosure Act of 1998, and of the Dept of Health’s policy called ‘No Secrets’ were available in the Home. The Manager also confirmed that all allegations and incidents of abuse would be promptly followed up and that all actions taken would be recorded. The policies and practices laid down by the Registered Provider ensured that all staff understood physical and verbal aggression by Residents. The Manager said that a policy was available to staff stating that they could not benefit from Residents wills, but a staff member asked about this was unable to confirm this as the case. This would seem to be the result of the Registered Providers not providing staff with a staff handbook. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 18 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): Standards 19, 20, 21, 22, 23, 24, 25 & 26. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. The Home was well maintained throughout, although some attention was needed, providing all Residents with a safe, comfortable environment in which to live. EVIDENCE: A tour was made of the Home, which included all of the bedrooms of the Residents. The Home was pleasantly decorated throughout, and the lounge and dining room were pleasant to sit in, and were provided with the appropriate items for the Residents. The bedrooms provided satisfactory space and provision for each Resident. The Registered Providers had provided most of the required furnishings in all locations seen during this visit to the Home. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 19 Toilets were available to all Residents, were clearly marked, and were provided with handrails where necessary. A call system was available throughout the Home. Laundry was found to be washed at appropriate temperatures. However, the following items needed addressing within the Home: In bedroom 19, there was no light switch available at the door; the light could only be turned on and off elsewhere in the bedroom. The Manager said that this was due to a fault, possibly damp, in the space above the bedroom. A working light switch must be provided at the door to the bedroom. This must be addressed by 31 October 2007. In bedroom 3, the height of the bed was very high and was fixed at this level. Access to the bed could only be provided with a hoist. An adjustable height bed must be provided. This must be addressed by 31 October 2007. Bedroom 7, was found to have three beds in it. The Manager said that all three beds were used for a short period just before the current Registered Providers took over the Home. One bed must be removed from the bedroom. This must be addressed by 31 October 2007. In the two toilets near to the dining room and one on the first floor, the toilets themselves are situated on the edge of small step. As a result the toilets were very high, making it very difficult for many older people to access them. The step on which the toilets are set must be removed. This must be addressed by 30 November 2007. An outside area for Residents was provided with seating and tables. However, this area led immediately on to the Home’s car park area and access away from the Home. To protect Residents with dementia the Manager has placed seating across the access to the car park. However, the seating could be easily pushed to one side allowing Residents with dementia to leave the Home. Fencing and a lockable gate must be provided to protect Residents from the dangers of inappropriately leaving the safe areas of the Home. This must be addressed by 31 December 2007. In all bedrooms only one comfortable seat per Resident was provided, and not the two comfortable seats recommended by National Minimum Standard 24.2. In one bathroom a medic-bath was provided, but was not used. This should be removed and an appropriate bath or shower be provided. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 20 Hoists used throughout the Home were found to be of an old style, and should be reviewed and more modern hoists provided should the original ones be found to be inappropriate in any way. The overalls worn by kitchen staff were seen to be badly stained and marked. The marks suggested that the overalls had not been changed for a number of days. Clean, unstained overalls should always be worn by kitchen staff. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 & 30. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Care staffing was provided to meet the needs of Residents, and appropriate recruitment practices were always followed when recruiting new staff, so that Residents welfare was always safeguarded. EVIDENCE: A good level of staffing was found to be provided in the Home to meet the needs of Residents. At the time of this visit to the Home it was found that under 50 of care staff had a qualification of at least NVQ level 2 in Care: 0 out of a total of 9 care staff. However, the Manager was able to say that 6 staff had just enrolled to begin an NVQ level 2 course, and it was anticipated that they would have completed their courses with passes by August 2008. The records of two new staff employed during the past 12 months were examined to see whether the Manager had obtained all relevant information about them. All relevant information had been obtained. The Manager said that new staff would be provided with induction and foundation training, which was confirmed by staff. She also said that all care staff would be provided with at least three paid days training a year, by the Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 22 new Registered Providers. All staff also had an individual training and development assessment and profile. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35, 36 & 38. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. Management arrangements at the Home were not sufficiently robust to ensure that residential care was maintained at a positive standard. EVIDENCE: The Manager was appropriately qualified to manage the Home, having an NVQ level 4 qualification in Management and a Nursing qualification. However, the Manager said that although the Registered Providers regularly visited the Home, they had not as yet carried out the monthly unannounced ‘inspections’ of the Home, or provided the written report on these ‘inspections’ to the Manager, as required by Regulation 26. The Manager was aware of many of the issues required to address the Quality Assurance information needed in the Home, and indeed had started work on Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 24 some of them. However, none had been completed or published at the time of this visit to the Home. The Manager was able to show that the personal money of Residents, held by the Home, was appropriately maintained, although one Resident’s saving had to much actual money in it when compared with the written record. While reviewing Residents personal money a number were found to need revising to a more suitable amount to be kept in the Home. Staff were asked about the regularity of supervision in the Home, and the staff said that this was not provided. This was later confirmed by the Manager. The training required by the Regulations was examined. This showed that Fire Safety training had been provided for all staff. However, Moving and Handling training was still needed by 2 staff, and First Aid training was still required by 4 staff. Food Hygiene training had been provided for all catering staff, but was still needed by 2 care staff. The Manager said that Infection Control training was still required by 3 staff. A staff member spoken with confirmed this need for training. The Manager also said that additional training had been provided for staff on Advocacy, Blind/Deaf Awareness, Feeding Awareness, PEG Feeding, Strokes, and Arthritis Training. From copies of the Home’s maintenance schedule, forwarded to the Commission prior to the inspection, it was found that all necessary maintenance and repairs were being appropriately addressed. The Registered Providers had complied with all necessary legislation, such as the Health and Safety at Work Act 1974, and the Manual Handling legislation of 1992. The Manager was not able to show that she had provided risk assessments on all safe working practices of staff; that is for care staff, catering staff and domestic staff. Nor had she provided a written statement of the policy, organisation and arrangements for maintaining those safe working practices. Finally, the Manager was able to show that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. With the assistance of the Fire Service, fire safety notices were also posted in relevant places around the Home. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 2 2 2 2 3 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 2 X 1 X 3 2 X 2 Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? This is a newly registered home. 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)(a) to (c) 5 Requirement A new up to date statement of purpose must be provided as soon as possible. The Residents Guide must contain all the information outlined in the up dated Regulation 5 provided in the legal amendment made in September 2006. Residents files must contain the name of the designated Care Manager and the Social Services Dept who arranged the admission of the Resident. The Manager needs to ensure that each Resident suffering with dementia, or their representative, has had the opportunity to discuss their rights of choice, freedom and decision-making while staying in the Home. The outcome needs to be recorded in each Resident’s records, as they deteriorate, at least on a 6 monthly basis. Residents medication must be DS0000070079.V347526.R01.S.doc Timescale for action 30/11/07 2. OP7 17(1)(a) and Sch 3, 3(c) & (h) 17 & Sch 3, 3(q) 30/10/07 3. OP9 13(2) 30/10/07 Page 27 Langdale Heights Version 5.2 locked away in the medication room after use. It must not be left in bathrooms or elsewhere in the Home. When creams are prescribed for Residents, the Medication Administration Record (MAR) sheets must be completed each time the creams are applied to Residents. An ‘O’ on the MAR sheet indicated ‘Other’, but this was not defined on the MAR sheet, and nor was a place provided for staff to define what the use of ‘O’ meant. The Manager must take this up with the Pharmacist and ensure that the form provides a place for a definition to be provided, i.e. ‘O’ Other, please define ………… 4. OP16 22 All verbal and written complaints must be recorded and acted upon and a report of the outcome made to the complainant, within the time frame listed within the Home’s procedures. A number of Requirements must be addressed in and around the Home, details of which are including in the section headed Environment Standards 19 – 26. Time schedules for this items are also provided in the above section of the report. The Registered Providers must ensure that the Home is inspected on an unannounced basis, at least once each month in line with the requirements listed in Regulation 26. 30/10/07 5. OP19 to OP26 12, 13 & 23 31/10/07 6. OP31 26 30/10/07 Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 28 7. OP33 24 The Registered Providers and Manager must address and complete the Quality Assurance issues listed within Standard 33.1 to 33.7. Supervision must be provided for all care staff. Mandatory training must be provide for the 2 staff requiring Moving and Handling training, the 4 member of staff requiring First Aid training, the 2 staff requiring Food Hygiene training and the 3 staff requiring Infection Control training. 31/12/07 8. 9. OP36 OP38 18(2) 18(1)(c) (i) 30/10/07 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP1 No. 1. Good Practice Recommendations The Residents Guide should contain information obtained from Residents (or their relatives) on what the Home is like to live in. The Residents Guide should also contain information on how contact can be made with the local Health Authority. 2. OP7 Formal reviews of care should be undertaken at 6 monthly intervals. Those taking part should at least include staff from the Home, the Resident and their relatives, particularly the ‘personal representative’. The review of care should be shown to the Resident (or representative) for signature. One of these reviews, each year, could be conducted by the Social Services Dept, although the Manager should provide formal written input to the review of the welfare and care provide to the Resident. When the Manager has reviewed a Resident’s file, she Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 29 could indicate that this has been done by signing the record with a red or green pen. Each Resident’s file should contain a ‘confidential’ section. This section should be used for records made by staff that the Resident should not see and for information passed to the Home by professionals to which the Resident had not been made party. When staff use the Resident’s record of events to ask other staff to carry out tasks, such as ‘Please observe’, the task should be addressed on each entry following until the staff member requesting the task signs it off as no longer needed. 3. OP9 Two staff only need to sign the Medication Administration Record sheets when Controlled Drugs are dispensed. On all other occasions only one signature is required. Additional activities should be provided within the Home. This could be arranged by an Activities Coordinator across three or four days or part-days each week, with group and individual activities offered. Staff should be made aware of those Residents who should be encouraged, following staff knocking on their bedroom door, to invite staff into their bedrooms and those Residents who can no longer do this. 5. OP15 A choice of meal should be provided at all meals offered within the Home, including the main lunchtime meal. Residents who needed assistance with eating should, for example, be given both their dinner and sweet/pudding together, to avoid a long period of time elapsing between each part of the meal. Residents waiting to be assisted with their meal should be left in the lounge, until staff could assist them with all their meal. Where these Residents were slow to eat, the meal should be reheated at least twice before accepting that the Resident does not want to complete the meal. 6. OP18 All staff should be provided with a staff handbook that summaries all issues relevant to staff, such as staff not being allowed to benefit from or assist residents in the making of their wills. A number of Recommendations should be addressed in DS0000070079.V347526.R01.S.doc Version 5.2 Page 30 4. OP12 7. OP19 to Langdale Heights OP26 and around the Home, details of which are including in the section headed Environment Standards 19 – 26. At least 50 of care staff must hold an NVQ level 2 in Care by the end of August 2008. 50 of care staff must hold this qualification at all times the Home is in operation. Residents personal allowance money held by the Home should always tally with the record kept. The amounts of Residents personal allowance kept within the Home should be reduced to the amounts suggested during the visit made by the Inspector. 8. OP28 9. OP35 10. 11. OP36 OP38 The Manager should arrange for all care staff to receive supervision at least 6 times a year. The Manager should provide risk assessments, for all staff, on all working practice topics in order to ensure that significant findings are recorded and acted upon. A written statement should also be provided on the policy, organisation and arrangements for maintaining safe working practices in the Home. Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Langdale Heights DS0000070079.V347526.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!