CARE HOMES FOR OLDER PEOPLE
Langdale Residential Home 6 Church Street Sapcote Leicestershire LE9 4FG Lead Inspector
Keith Williamson Unannounced Inspection 2nd June 2006 09:00 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 DS0000061086.V296580.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. DS0000061086.V296580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Langdale Residential Home Address 6 Church Street Sapcote Leicestershire LE9 4FG 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) 01455 274544 01455 274544 Mrs Yasmin Nazir Kassam Miss Neemat Kassam Mrs Debbie March Care Home 27 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (27), Physical disability over 65 years of age (7) DS0000061086.V296580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No person in category PD(E) to be admitted to the home when there are 7 persons of that category already accommodated within the home. Service User Categories MD(E) or DE(E) No person to be admitted to the home in categories MD(E) or DE(E) when 5 persons in total of these categories/combined categories are already accommodated in the home. Date of last inspection 23rd November 2005 Brief Description of the Service: Langdale Residential Home offers accommodation for 27 Older Persons, and is situated close to the centre of Sapcote, which offers local shops including a Post Office and local supermarket. Views from part of the home overlook the local Church and countryside. Langdale Residential Home offers two lounges and one dining area to the ground floor, with bedrooms being sited on the ground and first floor. Access to the first floor is via stairs, which have two chair lifts and a passenger lift. The majority of bedrooms have en-suite facilities, which consist of a wash hand basin and toilet. Bathroom and showering facilities are located on both floors. A proposed extension is planned, with building work planned to take place shortly after the publication of this report. DS0000061086.V296580.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting clients and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation. The inspection took place over one day, commenced at 9.00 am and was completed in six and one half hours by one Inspector. An opportunity was taken to view the care plans and other records in detail. Four residents were spoken with on this visit; comments made are enclosed within this report. The manager and deputy manager assisted in the inspection process. The current fees charged are £319 to £379 per week. What the service does well:
The service does Service users privacy and dignity was seen to be upheld, with staff communicating appropriately with service users, knocking and waiting for answers before entering rooms with a closed door. The programme of activities offered to service users, includes visits and time away from the home as well as in house activities such as hand and nail care which was being offered at the time of the inspection. Service users religious preferences are dealt with on an individual basis, service users bedrooms viewed were personalised accordingly. The menu system continues to offer a well-balanced dietary choice, also offering suitable provision for special diets. The complaints procedure is publicly displayed in the foyer of the home, as well as being entered in the Statement of Purpose. Detailed examination of the adult protection policy indicated that sufficient information is contained in the document for staff members’ guidance on how to prevent elder abuse in the home. Evidence of advocates and advocacy information is publicly displayed on a notice board in the foyer of the home. A comfortable and clean standard of accommodation is provided for service users. Staff showed a good awareness of cross contamination, cross infection and infection control.
DS0000061086.V296580.R01.S.doc Version 5.2 Page 6 Trained and qualified staff are employed in sufficient numbers to meet the care needs of service users. What has improved since the last inspection? 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. DS0000061086.V296580.R01.S.doc Version 5.2 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 DS0000061086.V296580.R01.S.doc Version 5.2 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): 1, 2, 3 & 6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The accuracy and availability of information does not protect service users in the home. EVIDENCE: The homes’ Statement of Purpose was viewed and though given to prospective service users considering admission to the home, this is lacking some vital information. On viewing the files of the case tracked service users, it was apparent that not all information is kept in one file. No information could be viewed on the contract between the service user and the home, as this and a number of assessments were locked in a separate filing system in the office. This is inappropriate, as the inspector must have access to this information on a continual basis. DS0000061086.V296580.R01.S.doc Version 5.2 Page 9 Of the service user assessment seen on the day, this was comprehensive and covered the areas to enable a plan of care to be formulated. The home does not provide an intermediate care service. DS0000061086.V296580.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not looked after well in respect of their health, medication and personal care needs, resulting in residents being placed at risk in the home. EVIDENCE: Care plans were viewed in the inspection process, these were reviewed on a regular basis; one plan in particular had a number of changes, from the original and to give an accurate reflection of the service users current needs would have been better being totally re-written, giving staff the accurate reflection of the service user. Other plans seen lacked specific details on moving and handling information, hearing, communication, sight, behavioural and social care information. Of the health care information recorded, this was not clear and left the inspector (as with any new member of staff) with unanswered questions. DS0000061086.V296580.R01.S.doc Version 5.2 Page 11 Medication is poorly managed, though the staff administering medication on the day followed the procedure appropriately. An immediate requirement was left, for improvements to the system. Service users privacy and dignity was seen to be upheld, with staff communicating appropriately with service users, knocking and waiting for answers before entering rooms with a closed door. DS0000061086.V296580.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 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 good. This judgement has been made using available evidence including a visit to this service. Service users can influence the choices in their daily lifestyle. EVIDENCE: A programme of activities is offered to service users, this includes visits and time away from the home. On the day of the inspection hand and nail care was being offered to the service users, staff were observed to communicate appropriately at this time. Personal choice is offered throughout the home, and evidence is in place to suggest that practices are flexible, promoting resident’s individuality and independence. Service users religious preferences are dealt with on an individual basis, service users bedrooms viewed were personalised accordingly. The menu system continues to offer a well-balanced dietary choice. Comments from the service users indicated that “I have a special diet, my foods always tasty”, “if there is something on the menu I don’t like, I have
DS0000061086.V296580.R01.S.doc Version 5.2 Page 13 something else”, and “there are crumpets for tea tonight, I like them”. “The meals here are definitely better than my last home”. An alternative personal menu for a resident with specific dietary needs is in place; this is seen as very good practice and is congratulated as a positive step in the individual attention residents receive in the home. DS0000061086.V296580.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected from abuse, neglect and self-harm. EVIDENCE: The complaints procedure is publicly displayed in the foyer of the home, as well as being entered in the Statement of Purpose, which makes clear the process of making a complaint. Detailed examination of the adult protection policy indicated that sufficient information is contained in the document for staff members’ guidance on how to prevent elder abuse in the home. The majority of the staff have undertaken an extended instruction course on dealing with abuse in the home. Two staff members spoken to displayed good verbal knowledge concerning the protection of vulnerable adults in their care. Evidence of advocates and advocacy information is publicly displayed on a notice board in the foyer of the home. Service users spoken with on the day stated, “ if I had a problem, I could speak to xxxx (member of staff), if they couldn’t help I would ring my son”, and “the staff are very polite, I understand them and they understand me”. DS0000061086.V296580.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comfortable and clean standard of accommodation is provided for service users. EVIDENCE: Service users spoke positively of their environment. A comfortable and clean standard of accommodation is provided for service users, though one commented that their bedroom “could do with a good dust now and again”. Staff spoken with showed a good understanding of the Control of Substances Hazardous to Health (COSHH) and cross infection issues. Three bedrooms were viewed by the Inspector and found to be in good decorative order, and were furnished to meet the needs of the individual and reflected their individual style, including provision of furniture and personal items provided by the service user themselves. One service user commented that there was a lack of water pressure at times.
DS0000061086.V296580.R01.S.doc Version 5.2 Page 16 Equipment is available to assist service users and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Staff showed a good awareness of cross contamination, cross infection and infection control. DS0000061086.V296580.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Trained and qualified staff are employed in sufficient numbers to meet the care needs of service users. EVIDENCE: Four members of care staff support service users in the morning and three care staff in the afternoon/evening, in addition there can be a member of the management team on duty. Two members of care staff support Service users during the night. A service user spoken with felt that staffing numbers were not always sufficient and this could impact on effective care. The inspector observed there was opportunity for care staff to interact with service users. The inspector could not view any staff recruitment records, and therefore could not confirm that the necessary pre-employment checks were in place for the four new staff employed since the last report. Access to this and other vital information has been dealt with previously in this report. Staff spoken with confirmed they received an annual development review, the frequency of supervisions was variable, one member of staff stating they have a supervision session “every two to three months”, with another indicating that supervision was “not regular”.
DS0000061086.V296580.R01.S.doc Version 5.2 Page 18 Langdale employs seventeen members of permanent care staff, of which seven members of staff have completed a National Vocational Qualification in Care at level 2 or above, this represents 42 of the care staff team. Training records were again, not viewed due to being locked away. A senior care worker indicated that the staff are currently undertaking training in Dementia Care other courses she had recently completed were the National Vocational Qualification level 3, accredited medication course, safe handling of medication, food hygiene and infection control. DS0000061086.V296580.R01.S.doc Version 5.2 Page 19 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, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Managerial improvements need to be made to ensure an effective management team within the home. EVIDENCE: The current manager is qualified to run a residential care home, gaining her National Vocational Qualification level 4 award. The manager has knowledge of a quality assurance framework; though no formal means of communication with service users or their representatives currently exists in the home. A copy of a blank questionnaire exists in the Statement of Purpose, but no evidence exists of any dialogue being entered into, or any completed questionnaires being returned to the home. Quality assurance needs to be developed, to formalise the process of gaining service
DS0000061086.V296580.R01.S.doc Version 5.2 Page 20 users and relatives’ views. Through this the home will be able to review its practices, to ensure its ability to continue to improve both the care and quality of life for its service users. Service users monies are currently held within the establishment, though no records were available for inspection on the visit day; all resident bedrooms viewed had the appropriate locking facilities. Fire records were viewed, few were completed appropriately, and no consistent evidence of regular fire drills and tests was offered to the inspector. A fire risk assessment was in place, though has yet to be reviewed. Additional health and safety checks include the monitoring of hot water temperatures, on a periodic basis, again this was not confirmable that these were up to date. The accident and incident book was viewed; service user records demonstrated good correlation with the accident book. DS0000061086.V296580.R01.S.doc Version 5.2 Page 21 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 DS0000061086.V296580.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No. 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 13 Requirement The registered person must ensure that suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Timescale for action 02/06/06 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. 5. Refer to Standard OP1 OP3 OP7 OP7 OP32 Good Practice Recommendations It is recommended that the Statement of Purpose is updated with the information and findings of the resident questionnaire circulated recently. It is recommended that all residents have their assessments of need updated periodically. It is recommended that all residents care plans are rewritten periodically. It is recommended that the healthcare monitoring in plans of care is accurate, and encompasses all the service users’ needs. It is recommended that senior staff have access to records
DS0000061086.V296580.R01.S.doc Version 5.2 Page 23 6. OP33 to enable an inspection to take place. It is recommended that individual receipts are made out for resident’s expenditure within the home, and copies kept on file. DS0000061086.V296580.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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