CARE HOMES FOR OLDER PEOPLE
Langdale House Care Home Grove Avenue Nottingham NG7 4BP Lead Inspector
Lee West Unannounced Inspection 12th October 2005 10:00 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 House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 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 House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Langdale House Care Home Address Grove Avenue Nottingham NG7 4BP 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) 0115 978 3822 0115 978 3822 Mrs Cordelia Nwafor Ogbakaeko Mr Bernard Okenwa Ogbakaeko Mr Bernard Okenwa Ogbakaeko Care Home 12 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (12) Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the total number of residents accommodated, 1 may be within the registration category MD(E) 24th June 2005 Date of last inspection Brief Description of the Service: Langdale House Care Home is an adapted detached house on a private road. There is a large garden and accommodation for service users is on two floors. Three bedrooms are on the ground floor with one shared bathroom. The remaining bedrooms and a shower room are on the first floor. There is a lift to these rooms. The home is not fully accessible for fulltime wheelchair users, but a portable ramp is available on request to provide access to the main entrance, which has four steps. The home is situated close to the shops and other amenities in Hyson Green and is near the tram route to Nottingham city centre. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and began at 10.45. Service users were spoken with about their experiences and expectations of living at the home, with analysis of the records and talking with members of staff to ensure that those living at the home have their needs met and their health and welfare maintained appropriately. This method is referred to as Case Tracking. The Manager and two members of staff were on duty during this inspection. The communal areas of the home were inspected and a selection of occupied and unoccupied bedrooms were also seen. The local shops and pub are used by the service users. All the current service users are male. There have been no new admissions since the last inspection and there are vacancies within the home. What the service does well: What has improved since the last inspection?
The floor covering in the laundry had been dealt with and was a nonpermeable covering. The staffing levels at nights have been addressed to meet the needs of the service users. Service users confirm that the staff do treat them with respect, but some still fail to knock on doors before entering. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 7 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 House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 There have been no admissions since the last inspection but service users have a written contract with the home. EVIDENCE: The service users’s notes case tracked, contain contracts with terms and conditions with the home. As there are no admissions the remaining standards have not been assessed during this inspection. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The individual care plans address the needs of the service users. The health care needs of some service users are not being met. Service users do not self medicate but this standard was not fully assessed during this inspection. The service users are occasionally not treated with respect, with their privacy upheld. The care plans identify the service users’ wishes at time of death. EVIDENCE: The individual care plans set out the service users’ needs. However, during this inspection, it was observed that the staff were not meeting the stated needs of some of the service users who have complex needs. The care plans case tracked also require review and updating, together with reviewed risk assessments. Service users spoken with stated that sometimes staff did not always maintain their dignity and privacy, some “don’t knock on the door”. The care plans identify the service user’s wishes upon death. The service users do not self medicate and medication was distributed and signed for appropriately, although this standard was not assessed fully at this inspection. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 The home encourages service users to maintain their independence and individual preferences are respected. They are helped to make choices and have control over their lives. Meals are varied and appreciated by service users. The dining room is poorly lit. EVIDENCE: Some service users said that they spend time during the day outside the home, having a drink in the local pub or shopping. One said he spends most of his time watching television and stays in his room to rest, coming into the communal rooms for eating and cigarettes. Staff also play cards and dominoes with the service users. All these activities are encouraged and service users are supported to make their choices. One of the care staff was responsible for the cooking and lunch looked substantial and service users said they “enjoyed the food and there were choices”. The day’s menu was displayed on a chalkboard in the dining room. The lighting in the dining room is poor. The low wattage bulbs and small central light do not give enough light in the room. On the day of inspection the dining room was dark during the day, even with the light on. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Policies and procedures are in place to protect service users from abuse. Complaints procedure is displayed in the entrance hall. EVIDENCE: There is a copy of the Nottinghamshire Committee for the Protection of Vulnerable Adults policy and procedure in the home. Staff spoken with are aware of their role within this procedure. Complaints procedures were in place and complaints had been recorded with outcomes. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 The home is generally suited to the purpose of a care home. There is still a need for minor maintenance and redecoration. The service users’ rooms suit their needs and they have their own possessions around them. The home is generally safe with homely surroundings. Some downstairs rooms do however have an odour and require fresh bedlinen. Lounge area is comfortable but the dining area is dimly lit. EVIDENCE: The communal areas were clean and comfortable and the majority of the individual rooms inspected were clean, hygienic and reasonably decorated. However, two rooms inspected downstairs required a change of bedlinen and both rooms had a strong odour of urine. The linen was changed before the end of the inspection and staff interviewed said the beds had not been changed as staff coming on duty were to carry out this task. The dining area, which is also used to house the records and medication, was very dimly lit and it was difficult to read documents, even though it was early afternoon and the light
Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 13 was on. One service user interviewed said he was very happy with his room which he said was “warm and comfortable. I’ve got my t.v. and a comfy chair and everything I need in my room.” There were sufficient, clean and hygienic toilet and bathroom facilities for the service users. The vertical lift maintenance is up to date. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The number of staff and skill mix do not meet the needs of the service users with complex needs. The manager hours are excessive and because of this the service users are not always in safe hands at all times. The home’s recruitment policy protects the service users and staff have received some training to do their jobs. EVIDENCE: There are 8 service users in the home at present with some with more complex needs. The current staffing rota shows two carers on duty, however, they are also responsible for the cooking, cleaning and laundry, which is leaving the service users vulnerable. The rota also shows Bernard Ogbakaeko working excessive hours. On the day of inspection he was on duty, commencing at 8.00am, for 31 hours out of 38 hours, before taking an overnight break, which, due to tiredness, could lead to service users not being in safe hands. Staff are recruited following the home’s procedures. Staff have Criminal Records Bureau checks and 2 references in place before starting work. Training records were seen in the staff files case tracked and care staff have been enrolled on National Vocational Qualification courses, but none have yet completed. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 The home is run by the owner, an experienced manager and his management approach tries to benefit the service users. Personal financial interests are safeguarded, together with service users rights by the home’s record keeping, policies and procedures. Health and safety in the environment is protected by trained staff and safety checks. EVIDENCE: The proprietor/manager is present in the home each day and the service users’ are safeguarded by the home’s policies and procedures. Some records are in need of review and updating and by case tracking from care plans to policy documents none recording of aggressive incidents was noted and this was confirmed to be the case by a staff member who said “its part of the job”. However, the records required to meet health, safety and welfare of service users were seen to be accurate and up to date. The personal financial records case tracked were in order.
Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 16 Staff interviewed confirmed that they receive regular supervision and this was again identified in staff records. Staff have received training in First Aid, Infection Control, Challenging Behaviour, Medication, Food Hygiene and Moving and Handling and are doing NVQs. Due to the care staff carrying out the cooking, cleaning and laundry, as well as care, the service users case tracked feel that they are not having their needs met properly and that their best interests are not being served. One service user said that he “needs more attention than they have time to give.” Another said he felt “the home was run for the staff’s convenience.” The majority of the service users case tracked said that they were happy with the help they are given and one said he was “content in this home.” Staff were interviewed and also felt they sometimes don’t have enough time to carry out the care required, but were generally happy working within the home. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 2 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 3 3 3 Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? None 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 2 3 4 Standard OP7 OP19 OP27 OP37 Regulation 15(1) 13(4) 18(1) 17(2)(3) Requirement Ensure care plans reviewed and risk assessments carried out. Ensure appropriate level of lighting in dining area Ensure appropriate staffing is provided to meet the care needs of all the service users Ensure all episodes of aggression or incidents are recorded and ensure all records kept are up to date Timescale for action 16/11/05 26/10/05 13/10/05 13/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP10 Good Practice Recommendations The manager to reinforce with staff the need for respect, privacy and dignity of service users to be maintained at all times. Langdale House Care Home DS0000002296.V256988.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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