CARE HOMES FOR OLDER PEOPLE
Langdale House Care Home Grove Avenue Nottingham NG7 4BP Lead Inspector
Lee West Unannounced Inspection 19th April 2006 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.V289645.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 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.V289645.R01.S.doc Version 5.1 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.V289645.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the total number of residents accommodated, 1 may be within the registration category MD(E) 12th October 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.V289645.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a period of 6 hours. During the inspection the provider and manager, Chief Bernard Ogbakaeko was available and assisted with the relevant records. Two other members of staff were on duty and assisted. There are only 7 service users at present and four were spoken with. Case tracking was the method used, where Service users were asked about their experiences and expectations of living at the home, a tour of the home undertaken, 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; together with analysis of available records. Since the last inspection there has been 1 new admission and there remain 5 vacancies. All service users within this home are male. All judgements within this report have been made using the available evidence, including the visit to the service. What the service does well: What has improved since the last inspection?
The lighting in the dining area has been improved and this has brightened this area considerably. Two new members of staff were on duty during the inspection. These are replacement staff so do not increase the staff compliment. However, there are now only 7 service users and staffing level did appear to be appropriate to meet the needs of the service users. Generally the home is clean, and the rooms are mostly clean and hygienic. There remain some bedrooms with an
Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 Page 6 odour and there was evidence seen during the inspection that these rooms are being thoroughly cleaned and carpets shampooed to try to remove the odour. The Care plans have been reviewed and updated, although further development is still required. What they could do better:
During the tour of the premises clean and soiled items were observed in both shower areas. The practice of storing items in the shower trays could lead to spread of infection within the home. Care planning has been improved since the last inspection. However, the numerous books and folders are creating some confusion in finding records when required and rationalisation of the system into one file for each service user, each with a photograph and all records would provide an easier system of work. The risk assessments require improvement to include personalised risks, including risk of falls, risk of going out alone and any other individual risk. Some of the Medicines Administration Records sheets do not have a photograph of the service user. A service user does self medicate, however, the staff of the home do not follow their published procedure for checking that this medication has been taken. This should be checked each day and carried out as the procedure sets out, and all records completed. The home has a number of maintenance problems, which are outstanding. There are no organised activities, trips or entertainments arranged for the service users, lack of appropriate activities can lead to an institutionalised attitude and setting. A structured plan of introducing entertainments, trips and activities to the service users’ and appropriate for their likes and dislikes is required to improve quality of days within the home. The care staff carry out the cleaning and cooking, reducing the amount of time available for therapeutic interactions between staff and service users. The duty rota also shows that the Manager appears to be working excessive hours which must be addressed. Since the last inspection, there has been a death of a service user, also a service user being admitted to hospital, neither of which were notified to the Commission as required in Regulation 37. All notifiable events, death, injury, illness must be notified to the Commission on the appropriate forms. The Complaints procedure which is explained within the service users’ guide and statement of purpose, is not being followed and all complaints, timescales and outcomes require dealing with and recording.
Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 Page 7 There are service user and visitor questionnaires, which were seen in service user files. These, though, should be kept together in one file and their contents analysed to monitor the standards of care and to deal with any issues the questionnaires may highlight. There is no other formal quality audit within the home at present. 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.V289645.R01.S.doc Version 5.1 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.V289645.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 Quality in this outcome area is adequate Service users have access to information to make an informed choice. EVIDENCE: There has been one admission since the last inspection. Service user guides and statement of purpose are available. Service user records case tracked contained a written contract with the terms and conditions set out. There was also an assessment carried out by the social services within the records. Relatives of a service user said that they did have the opportunity to look around the home. There are no service users receiving intermediate care at present. Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is adequate. Care plans address the needs of the service users. Service users have the opportunity to be responsible for their own medication. The care plans identify the wishes at time of death. EVIDENCE: The individual care plans set out the service user’s needs, evidenced in the care plans case tracked. The records also showed evidence of regular reviews of care plans. There were also risk assessments within the records, but these require further development to address individual risks. The staff working during the time of the inspection, treated the service users with respect and maintained privacy. They were observed to knock on the door when requiring entry to private rooms. The service users spoken with all said they were satisfied with the staff and that they are treated with dignity and given the chance to make decisions.
Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 Page 11 There is a policy in place to enable service users to be responsible for their own medication. There was evidence seen that service users are being encouraged to do this. However, the monitoring of this requires improvement as the staff are not following the procedure to ensure the service user is taking medication correctly. Service users spoken with though prefer to have their medication dispensed for them. The other medicines are kept locked in a trolley, and these were observed to be kept appropriately, and given in the proper manner. Service user records did reflect the service users’ wishes at time of death. Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. There are no structured activities or outings Family and friends are encouraged and the service users are helped to make choices. The meals are varied and appreciated by service users in the adequate dining area. EVIDENCE: Five of the service users were spoken with during the inspection. Some said that they spend time outside the home, but others expressed their wish to go out, but are unable to because of poor mobility. Some said they would like to go on “outings” to the seaside or countryside. There is no activities programme within the home to provide opportunities for mental stimulation, nor trips or holidays arranged. Service users spoken with also said that they “just do my own thing”. During the inspection, following lunch, all the service users disappeared to their individual rooms, and did not emerge again until the time for the next meal. There is a television set in the lounge and some service users have their own in their rooms, however the picture reception on these televisions was poor, with “snow” interference.
Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 Page 13 Service users said they were satisfied with the food. The daily menu is displayed on a chalkboard in the dining room. The staff member responsible for cooking does ask the service users for their choices. The meals book gave clear evidence that choices are being given when a service user wishes. Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is adequate The complaints procedure is displayed in the entrance hall of the home, but complaints are not dealt with according to the procedures set out. Service users are encouraged to vote and to exercise their legal rights. Procedures are in place to protect service users from abuse. EVIDENCE: There is a complaints procedure in place, however, these are not followed and although recorded the timescales, investigations and outcomes are not recorded. Blank forms were seen to meet these, but there was no evidence seen that any had been used. Service users said they would talk to the manager if there was anything to complain about. The staff also explained their processes for dealing with any complaints from service users, or visitors. Staff spoken with are aware of their role within the Safeguarding adults processes and explained this during the inspection. The Nottinghamshire policy documents are kept within the home. Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. The environment is adequate, but requires some routine maintenance. There are sufficient toilet and washing facilities and the service users’ rooms suit their needs. The home is generally clean, hygienic and adequate, however, there are two bedrooms which have an odour. EVIDENCE: The communal areas in the home were clean and adequately furnished. The service users spoken with said they were satisfied with their own rooms, that they were able to have their own possessions around them. The home, observed during a tour of the building, is generally safe, clean and hygienic, but there are some areas with an odour, which the inspector observed was being dealt with by shampooing the carpets to try to reduce this. There are sufficient toilet facilities for the service users, but, used catheter bags were seen in the shower tray of the upper bathroom, with clean commode bowls being stored in the downstairs shower tray. The toilet cistern
Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 Page 16 in the downstairs bathroom has a large crack. Bed linen in one of the service user’s bedrooms was soiled and required changing. There was a gas fire in the lounge, which had been labelled as “unsafe to use” and this was due to a problem within the “flue”. It was noted during the inspection though that quotes for this repair had been requested. The vertical lift was in working order and there were records of regular maintenance. Mobility equipment was seen to be in serviceable condition, the hoist in the downstairs bathroom had records of regular maintenance. Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. The staff numbers meet service users needs at present, but the manager’s hours are excessive. The recruitment practices are followed to protect service users and they are in safe hands with appropriately competent staff. EVIDENCE: There are now only 7 service users and none, at present, with complex needs. Therefore the two care staff on duty, together with the Manager, appears appropriate for the needs of these 7 service users. However, the care staff are required to do the cooking and the cleaning, which could leave the service users vulnerable. The Manager, according to the duty rota, is working excessive hours to maintain the staffing levels. Service users spoken with said they are always helped whenever they need it. They said the staff do arrive quickly when sent for. They also said they are satisfied with the care the staff do provide for them. Staff records inspected all contained two references, Criminal Records Bureau checks and evidence of induction training. Other training records were also seen. Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 Quality in this outcome area is adequate. The proprietor, Chief Ogbakaeko, also the manager, registered with the Commission, is approachable who tries to benefit the service users and maintain their rights and welfare. Some monitoring of quality of service takes place. EVIDENCE: The proprietor/manager is present in the home most days of the week, and the home’s policies and procedures are in place to safeguard service users. The record keeping, although thorough, does appear chaotic, with service users having two files, there are also numerous books recording different aspects of care. This all makes it difficult to track information quickly and efficiently. Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 Page 19 Service user and visitor questionnaires are completed, but these are put into the service user’s records and not collated to identify any areas requiring improvement or change. Since the last inspection there has been a death and another service user admitted to hospital, neither of which were notified to the Commission as is required. The home does not deal with any of the service users’ money, they are encouraged to be independent with this and have lockable facilities within their rooms to make sure their money and possessions are secure. Staff interviewed said they had received supervision and the staff files case tracked confirmed this is carried out regularly. There was evidence of staff being trained in First Aid, Basic Food Hygiene, Moving and Handling and Infection Control. Records inspected showed regular maintenance of lift, hoists and electrical appliances. Fire alarms are regularly tested and records for this were seen. Service users spoken with said they felt the home was run satisfactorily and that “Bernard is approachable”. Staff were interviewed and they said that they felt the home was run in the best interest of the service users and that they tried to make sure this happened by the way they approached the service users. Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 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 3 3 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 2 2 3 3 3 3 2 STAFFING Standard No Score 27 2 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 2 3 Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 Page 21 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. Standard OP9 Regulation 12(3) Requirement Ensure that procedures for service users’ who take responsibility for their own medication, are followed to monitor health and welfare of the service user taking such medication and that appropriate risk assessments are in place in the service user’s care plan to address this. Consult service users about their social interests and make arrangements for them to engage in local, social and community activities Consult service users and develop a programme of activities arranged by or on behalf of the home, and provide facilities for opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities. Carry out the repairs to the toilet cistern, the gas fire flue and the television sets within the home to ensure the home is kept in a
DS0000002296.V289645.R01.S.doc Timescale for action 19/05/06 2. OP12 16(2)m 20/06/06 3. OP12 16(2)n 20/06/06 4. OP19 23(2) 20/06/06 Langdale House Care Home Version 5.1 Page 22 5 OP26 13(3) 6 OP31 9(2)ii 7 OP38 37(1) good state of repair. Ensure policies are followed to prevent infection, toxic conditions and the spread of infection within the care home and ensure that used catheter bags are not left in the communal shower areas, to stop the practice of storing commode bowls in the downstairs bathroom and to ensure that all bedlinen is free from any soiling. The Registered Manager must ensure that he is physically fit to manage the care home by ensuring hours of work on the duty rota are not excessive. Avoiding working during the day and working the waking night shift concurrently. All accidents, injuries, incidents of illness or communicable disease and death of any service user to be recorded and reported to the Commission 24/04/06 06/05/06 24/04/06 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 3 4 Refer to Standard OP7 OP9 OP33 OP37 Good Practice Recommendations Ensure risk assessments address individual service user’s risks. Ensure photographic identification of service users on Care Planning documentation and Medicines Administration Records. To establish a process of collating the questionnaires from service users and visitors for the purpose of monitoring the quality of service provided by the home. To rationalise the construction of service user records in accordance with statutory requirements to ensure information is easily accessible, but kept secure.
DS0000002296.V289645.R01.S.doc Version 5.1 Page 23 Langdale House Care Home Langdale House Care Home DS0000002296.V289645.R01.S.doc Version 5.1 Page 24 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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