CARE HOMES FOR OLDER PEOPLE
Langdale House Care Home Grove Avenue Nottingham NG7 4BP Lead Inspector
Lee West Key Unannounced Inspection 18th April 2007 10:30 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 House Care Home DS0000002296.V334298.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 House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 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 F/P 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.V334298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the total number of residents accommodated, 1 may be within the registration category MD(E) 19th April 2006 Date of last inspection Brief Description of the Service: Langdale House Care Home is an adapted detached house on a private road, situated close to the shops and other amenities in Hyson Green and near to the tram route to Nottingham city centre, Bulwell and Hucknall. The home provides care for an all male group of people, who have a varied range of care needs. The accommodation is on two floors. Three bedrooms are on the ground floor with one shared bathroom. There is a lift to these rooms. The remaining bedrooms and a shower room are on the first floor. There is a small courtyard at the front of the building, with a garden to the rear. 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 current scale of charges is £298.21 per week, which does not include the cost of haircuts, trips or new clothing. The range of facilities provided, service user’s rights and complaints procedures are set out in the service user’s handbook. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, including a visit over 5 hours. The method used was Case Tracking, where a number of staff and service users were spoken with about their experiences and expectations of living, or working, at the home. A tour of the premises was also undertaken to see the rooms used by service users case tracked and the facilities available to them and other service users. Their care plans and other records, including a pre-inspection questionnaire, prepared and made available by the manager, were analysed, together with the responses from the service user and relatives surveys received. This, with information already in the Commission’s records helped develop the judgements and evidence set out in the report. What the service does well: What has improved since the last inspection?
The Manager’s excessive hours have now been reduced, and staffing levels are still maintained to meet the needs of the service users. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 6 The home was clean and hygienic, “its not a palace, but I like it,” said one service user. The shower areas were clean, hygienic and free now from used equipment in the shower trays. Care planning and service user files have been improved since the last inspection, with information in individual service user files, making it much easier to find information. Notification of events as required in Regulation 37 are now being received by the Commission. What they could do better:
The home’s statement of purpose, service user handbook and updated policies and procedures should be available at all times, so that even if the manager is not present, potential service users, or their representatives, have access to the information needed to make a decision about staying at the home. The home’s policy on alcohol consumption should be clarified, and all service users given the opportunity to consent to any restrictions, with any consent signed and recorded in the individual care plans. As the current policy is not clear, with one section saying “alcohol is forbidden,” and another “service users will make their own arrangements.” This leads to confusion for the service users and their visitors, who may wish to have a drink of alcohol in their rooms. Service users’ personal and medical histories, together with their preferences and wishes should be included into their individual care plans and this information can then be used to develop a programme of suitable activities available for all service users who wish to carry them out would improve their mental stimulation. “We don’t have a sports room, or anything like that here,” “There’s never much to do in the home, that’s why I spend so much time outside,” commented some service users. Staff supervision, personal development and appraisal should be carried out regularly and formally recorded in the staff files. This would help to monitor staff competence to care for the service users and have their own development needs identified. A system should be set up to collate and deal with the information from service user questionnaires to help monitor the quality of service and ensure their equality and diversity issues are addressed.
Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 7 The service user and staff meetings should be started again to help the service users to share their preferences and expectations of the home, which should include activities to improve the quality of time spent in the home and also the service users’ views on the standards of care. 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 House Care Home DS0000002296.V334298.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 House Care Home DS0000002296.V334298.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): 1, 3, 6, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information to make an informed choice has been produced, but was not available at this time, making it difficult for anyone to find information. EVIDENCE: Staff on duty were unable to find copies of the service user guides, statement of purpose, or previous inspection report, which would have provided potential service users with information needed to decide if the home could meet their personal needs. However, a copy of the statement of purpose and service user guide formed part of the records held by the Commission, and used in this inspection. Service users spoken with said they were aware of the “handbook” and had seen a copy. They had not seen a copy of the home’s Inspection Report and this was not available either at the time of inspection. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care needs are identified within the individual care plans, but more information on personal history and preferences is required to develop individualised care for the service users. EVIDENCE: Care plans set out the service user’s needs, but there was no information seen, in the care plans, about medical history, personal history or personal preferences, to provide personalised, individual care. There was evidence of care plan reviews, but this did not address the issues around mental stimulation, or personal preferences, reducing the opportunities to improve the state of mind of service users. Service users spoken with though said they were happy that their care needs were met. Staff spoken with also confirmed they felt they met the care needs.
Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 11 However, it was noted a number of the service users had not been shaved for some time, but on discussing this with them, they all assured me that they preferred to have facial hair, but this was not identified within their care plans. The staff were observed treating the service users with respect and maintaining their privacy, and those spoken with confimed that staff treated them with respect. One said, “they always knock before coming into my room.” The Medicines Administration Records (MAR sheets) were inspected, during the lunchtime administration of medication, and found to be completed accurately and the medication stored appropriately. Service users spoken with said they preferred the staff to give them their medicines, but the home’s policy for self medication was seen and staff explained their role in this, that they should ensure the medication was being taken properly, recorded and stored safely by the service user. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The daily activities within the home are limited. Meals are varied and substantial and provided when service users want them. EVIDENCE: Service user surveys contained comments, which included, “We don’t have a sports room, or anything like that here,” “There’s never much to do in the home, that’s why I spend so much time outside.” “The days are very long.” Service users spoken with also said they would like more interactions between themselves and staff, “ it would be nice to have a long conversation with someone,” said one service user. Staff said they tried to spend time with service users and the rapport between them was observed during the inspection to be positive and supportive, with them sharing jokes.
Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 13 “The food is very good, not top class but really ok.” “I go out when I want to, and they save my lunch until I get back,” said one service user. This was observed as he arrived for his lunch over two hours after everyone else had eaten, and his meal was presented hot in the dining areas, with staff cheerfully asking how his morning had been. The lunchtime meal was observed to be nutritious, with good-sized portions. The menu was varied and choices offered. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and dealt with, although the home’s procedures are not always followed, which could lead to the complainant being dissatisfied with the process and to further complaints. EVIDENCE: Responses to recent complaints were seen. These addressed the issues raised, but the home’s procedures for complaints were not being followed. The timescales, investigations, outcomes and conclusions were not always clear, Service user surveys though, all showed they would discuss any complaints with the owner and that they were satisfied their complaints were listened to. Staff interviewed were able to demonstrate, verbally, their role in safeguarding the service users and how they would protect them from any abuse, to ensure the safety of service users. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23, 26, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The environment suits the needs of the service users, and is clean and hygienic. EVIDENCE: The environment was clean and hygienic, in all areas inspected. The bedrooms were clean and, as one service user said, “suit me fine, thanks.” They were able to have their own possessions around them and the communal areas were also clean. The shower and toilet on the ground floor were also used by the staff, but, there were no facilities in this room for washing and drying hands. This could have led to possible cross infections, as neither service users nor staff could wash or dry their hands. However, this was corrected, during the inspection, with liquid soap and towels being made available.
Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 16 The dining room had been painted and the lighting had been improved and was brighter, to provide sufficient light for reading, or eating. There were areas that required routine maintenace, particularly to the individual televisions and in individual bedrooms, although some work on the décor and carpetting in the communal and individual rooms had been carried out, to provide a good standard of surroundings for the service users. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staffing levels have been re-organised, reducing the manager’s excessive hours, and maintaining suitable levels to meet care needs. EVIDENCE: There are 8 service users at present and staffing levels had been organised to meet their needs. There were two staff on duty and responses in the service user surveys said, “they were satisfied with the level of care and staff are always around if help is needed.” Staff spoken with also said they felt there were sufficient on duty per shift, even though they are responsible for cooking the meals and the domestic work as well. Staff records all contained Criminal Records Bureau checks, two references and evidence of training undertaken to support protection of service users with competent staff. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Information was much easier to track in the reorganised service user files, but quality audits are still not being collated and policies require clarification to avoid misunderstanding of the home’s policies. EVIDENCE: Chief Ogbakaeko, the proprietor and registered manager of the home, has now reduced his number of hours of work and leaves the premises. Service user surveys identified the home did not deal with any of their finances and this was confirmed by service users, when they were spoken with. Staff records showed supervision had not been carried out for some time and a staff member interviewed had not had any supervision. Discussion with the
Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 19 staff member highlighted gaps in training, which should be addressed within supervision and she said, “supervision, I’ve never had any.” Other staff members had training records which were up to date and included the mandatory training of First Aid, Basic Food Hygiene, Moving and Handling and Infection Control. Records provided by the proprietor, supplied evidence that mandatory health and safety checks were regularly carried out and recorded to support the health and safety of the staff and service users. The home’s policies and procedures had not been updated for a considerable time and were not easily available. When found, the policy on alcohol within the home and within the contracted terms and conditions for service users were contradictory. One said no alcohol and another said “service users will make their own arrangements.” This leads to confusion amongst the service users and staff and possible distress for those who wish to have an alcoholic drink. However, Service user surveys returned reflected their satisfaction at the way the home is run and said “Bernard is always approachable and he looks after us.” Another quoted, “couldn’t be better, even if it were Butlins.” Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 20 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 1 X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 x 2 x 3 x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 2 Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6(a) Requirement Timescale for action 25/06/07 2. OP12 16(n) 3. OP36 18(2) 4. OP38 241(b) The statement of purpose and service user guide must be reviewed and the policy about alcohol within the home must state the home’s position on consumption of alcohol clearly to enable prospective service users to make an informed choice of the suitability of the home to meet this and other needs. A programme of activities to be 25/06/07 developed, suitable for each service user, which takes into account their personal preferences and interests to provide a mentally stimulating environment and improve the wellbeing of service users. Staff must be regularly 18/07/07 supervised and this supervision to be formally recorded in their individual staff file, to support staff development and competence and promote safety of service users. Develop a system to monitor the 18/07/07 quality of care provided at the home which uses the information gathered from the service user
DS0000002296.V334298.R01.S.doc Version 5.2 Langdale House Care Home Page 22 questionnaires and the service user and staff meetings. This will provide a pathway for service users to have input into the quality of the care provided and identify any areas of strength, or weakness in the care standards provided. 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 OP16 Good Practice Recommendations The complaints procedure would be improved by including the timescales, investigations and outcomes in the complaints records and the information used in the quality auditing of the service. Langdale House Care Home DS0000002296.V334298.R01.S.doc Version 5.2 Page 23 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
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