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Inspection on 05/03/07 for Langdale Residential Home

Also see our care home review for Langdale Residential Home for more information

This inspection was carried out on 5th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users said that staff were in general friendly and helpful towards them, they said that staff welcome visitors (which was confirmed by both visitors), and they thought that the food provided to them was generally good. Staff were observed to be friendly towards service users. Service user needs are covered regarding medical authorities being involved where necessary following illness or injury. Service users generally spoke positively about the activities arranged by staff, which provided interest and stimulation for them. Staff thought they were valued in their performance of their jobs, which helps to motivate staff to meet service users needs.The Registered Provider has a positive attitude in seeking to improve the care standards in the service and was receptive to ideas as how to improve the service for service users.

What has improved since the last inspection?

Care Plans have been updated to include important issues relating to service users care. The buildings work to the premises has been largely completed, with minor works to be finished to create a garden/patio area outside by summer this year, according to the Registered Provider.

What the care home could do better:

The Registered Provider needs to ensure that the welfare of service users is protected at all times, as there were staff without statutory Criminal Records Bureau and reference checks, which meant service users were exposed to staff who may have posed a risk to them if they had criminal convictions or cautions. The Commission for Social Care Inspection issued an Immediate Requirement Notice for the Registered Provider to rectify this situation. Staff must always be aware of service users care needs; this would include ensuring a full assessment of needs on admission, Care Plans need to have full details of the care requirements of service users regarding Risk Assessments so that the proper care is always given. Care Plans need to contain clear information regarding service users current needs and staff need to read all of them to ensure that know how to properly care for service users individual needs. It would assist if Care Plans contained a detailed past life history of service users if service users/their representatives agree to supply this information. This helps staff see service users as people with a valued past and assists in talking with them. Staff must be observant to service users hygiene needs and for plans to be in place to deal with the continence needs of service users so as to maintain their dignity and comfort. Providing more signs to facilities would assist service users who have dementia, in that they can identify facilities clearly. Staffing levels need to be reviewed as there are only three care staff available for service users care in afternoon/ evening periods which may not provide essential supervision and care needed for service users with high dependency needs. Domestic cover is needed for seven days a week to ensure the homemaintains standards of cleanliness. Staff need to receive training on all essential care and health and safety issues to ensure that service users needs are always met. Staff always need to have a full understanding of the Vulnerable Adults procedure to ensure they know how to act to report to outside agencies if needed, therefore ensuring the protection of service users welfare. A review of fire precautionary arrangements are needed to ensure that all systems are regularly tested, that there is a detailed fire risk assessment in place, that staff are fully aware of the fire procedure and that fire doors are not propped open, unless supported by a proper Risk Assessment. This will then protect the welfare of all persons in the home from fire risks.

CARE HOMES FOR OLDER PEOPLE Langdale Residential Home 6 Church Street Sapcote Leicestershire LE9 4FG Lead Inspector Keith Charlton Unannounced Inspection 5th March 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Langdale Residential Home DS0000061086.V329294.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 Residential Home DS0000061086.V329294.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 Vacant 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) Langdale Residential Home DS0000061086.V329294.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. 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. 2nd June 2006 Date of last inspection 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 has a chair lift 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. An extension has nearly been complete so as to increase numbers by two residents, with a change of lounge set up, to make the lounge by the office much bigger. The weekly fees range from £311 to £400 per week - this information was provided on the inspection day. There are additional costs for expenditure such as hairdressing, private chiropody, toiletries, newspapers, etc. Langdale Residential Home DS0000061086.V329294.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 involved selecting three service users and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced Inspection. The Acting Manager was on holiday so it was conducted with one of the Registered Providers, Miss Kassam. Planning for the Inspection included reading the notifications of significant events sent to the Commission for Social Care Inspection, the last Inspection Report, and two complaints that have been made regarding the home’s services since the last inspection. The Inspection took place between 9.30 and 16.00 and included a selected tour of the home, inspection of records and indirect observation of care practices. The Inspector spoke with ten service users (though this was limited for some owing to the difficulty with communicating with service users with a high level of mental frailty) three staff members, and two visitors. Four Comment Cards were received from service users and three were received from relatives/friends. All were generally satisfied with the care the service provides. Reference is made where relevant in this Inspection Report. The Inspection was concluded on 6/3/07 with the Registered Provider. What the service does well: Service users said that staff were in general friendly and helpful towards them, they said that staff welcome visitors (which was confirmed by both visitors), and they thought that the food provided to them was generally good. Staff were observed to be friendly towards service users. Service user needs are covered regarding medical authorities being involved where necessary following illness or injury. Service users generally spoke positively about the activities arranged by staff, which provided interest and stimulation for them. Staff thought they were valued in their performance of their jobs, which helps to motivate staff to meet service users needs. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 6 The Registered Provider has a positive attitude in seeking to improve the care standards in the service and was receptive to ideas as how to improve the service for service users. What has improved since the last inspection? What they could do better: The Registered Provider needs to ensure that the welfare of service users is protected at all times, as there were staff without statutory Criminal Records Bureau and reference checks, which meant service users were exposed to staff who may have posed a risk to them if they had criminal convictions or cautions. The Commission for Social Care Inspection issued an Immediate Requirement Notice for the Registered Provider to rectify this situation. Staff must always be aware of service users care needs; this would include ensuring a full assessment of needs on admission, Care Plans need to have full details of the care requirements of service users regarding Risk Assessments so that the proper care is always given. Care Plans need to contain clear information regarding service users current needs and staff need to read all of them to ensure that know how to properly care for service users individual needs. It would assist if Care Plans contained a detailed past life history of service users if service users/their representatives agree to supply this information. This helps staff see service users as people with a valued past and assists in talking with them. Staff must be observant to service users hygiene needs and for plans to be in place to deal with the continence needs of service users so as to maintain their dignity and comfort. Providing more signs to facilities would assist service users who have dementia, in that they can identify facilities clearly. Staffing levels need to be reviewed as there are only three care staff available for service users care in afternoon/ evening periods which may not provide essential supervision and care needed for service users with high dependency needs. Domestic cover is needed for seven days a week to ensure the home Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 7 maintains standards of cleanliness. Staff need to receive training on all essential care and health and safety issues to ensure that service users needs are always met. Staff always need to have a full understanding of the Vulnerable Adults procedure to ensure they know how to act to report to outside agencies if needed, therefore ensuring the protection of service users welfare. A review of fire precautionary arrangements are needed to ensure that all systems are regularly tested, that there is a detailed fire risk assessment in place, that staff are fully aware of the fire procedure and that fire doors are not propped open, unless supported by a proper Risk Assessment. This will then protect the welfare of all persons in the home from fire risks. 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 Residential Home DS0000061086.V329294.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 Residential Home DS0000061086.V329294.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): 3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission process is managed so that service uses receive a satisfactory assessment, thereby ensuring that their main health and welfare needs are being met. EVIDENCE: No service users could remember anyone from the home coming to see them prior to admission to discuss their care needs, saying they could not remember that far back. The Registered Provider stated that prospective service users will be seen in their own setting prior to admission where possible and they can visit the home to see whether it suits their needs. This policy was reflected in the home’s Statement of Purpose. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 10 An assessment was inspected and whilst it contained relevant information as to service users needs it did not include all aspects of needs, as per the National Minimum Standard. The Registered Provider said the form would be reviewed to cover all care issues in this standard. There were also assessments on file from Social Service Departments available, which outlined service users needs. The home does not offer intermediate treatment facilities. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users are treated with respect and with their health needs though not always well looked after regarding their personal care. EVIDENCE: Service users said that staff would call the doctor if they were not well and medical appointments were made for their regular health checks. Service users care plans were inspected and included records of the service users care needs. However they were confusing in that the front sheets had information as to past needs, which had sometimes been superseded by changing needs upon review of need. The Registered Provider agreed that plans needed to be rewritten to ensure they were clear, and so ensure staff do not make mistakes giving the most up to date relevant care to service users. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 12 There was no written evidence that service users/their representatives were given the choice to be involved in the setting up and reviewing of the Care Plan, and plans only contained limited past life histories of service users if service users. More information would help staff see service users as people with a valued past and assist in talking with them. Risk assessments were kept and set out within a risk assessment framework though these were not detailed and need to be reviewed so that they state the specific risk and how it needs to be managed. Care Plans set out medical checks, e.g. dental needs as regards routine dental checks, chiropodist, etc though there was no information regarding daily living wishes. The Registered Provider said these issues would be followed up. There was a comment received that there were not enough wheelchairs and this appeared to be the case as service users were seen by the inspector to be moved by staff using a gliding chair, something that was not in the Risk Assessment section of the Care Plan for one service user. The Registered Provider said she would look into this and change this as necessary. Some accident records were viewed which showed that medical services were called if there had been injuries. Service users and information in most Comment Cards said staff were friendly in general though there was a comment that some staff ignored service users who were not seen as cooperative. The Registered Provider said she would follow up this remark to ensure that all service users were treated with dignity. The inspector observed that in general staff were friendly and respectful towards service users and observed their privacy and dignity by knocking on doors before entering bedrooms. The visitors who spoke with the inspector spoke with said they thought the staff were caring and friendly and did a good job. The inspector observed that there were a number of service users who had stained clothing/personal hygiene problems and who needed changing into clean clothes. This situation substantiates a recent complaint. The Registered Provider said that some service users resisted personal care programmes but this had not been recorded in the Care Plans or daily records seen by the inspector. The Registered Provider said this would be followed up. There was no specific information on Care Plans regarding whether service users with continence problems had been referred to medical authorities to assess this and to produce a plan to assist – frequency of needing to be helped to use the toilet etc. This is needed. One Comment Card stated that: ‘’not always the case that they (the staff) are proactive in toileting. This reinforces the need to take action on this issue. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 13 There was a remark in one Comment Card that ‘’staff sometimes forget what you have asked. Some of the staff need pulling together’’. A Senior Care Assistant confirmed that only senior staff issue medication and all have undertaken medication training. The Registered Provider confirmed this. Medication recording was good in general though there were some gaps in medication record sheets on the day of the inspection, which were then checked and rectified. Medication supplies were seen to be kept securely and staff confirmed that medication was issued directly to service users, not given to junior staff to take it to the service user, as this has been a recent allegation. The Registered Provider said that service users are able to self medicate where they have been Risk Assessed as safe to do so, which assists service users to maintain independence, as per the stated policy of the service. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 have the opportunity to lead full lifestyle and can generally exercise choice. The food supply is generally seen as tasty and varied. EVIDENCE: Some service users said there were not enough activities though the majority said that there were usually enough activities and they enjoyed them, though they would like more outings this summer. One Comment Card referred to the case that there are no relevant activities for the service user who completed this form. The Registered Provider said that there were always activities in the afternoon during the week – board games, bingo, exercise with bean bags etc though she agreed to set up and display an Activities Programme to demonstrate this and to inform service users that this was the case. Staff also confirmed that there were regular activities. It is recommended that service users are asked what activities they would like to be offered. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 15 No activities were observed to be on during the inspection apart from having the TV on. The Registered Provider said she would look into whether service users wanted the TV to be on most of the time or provide age appropriate music of service users choice instead. The Registered Provider said she would look into specific training to provide relevant activities for service users with dementia. It was also discussed that service users may benefit from having memory boxes filled with important items of interest and used to discuss events from the past, so as to provide more stimulation. The Registered Provider was asked to look into the provision of service user meetings so that service users and relatives are able to take part and feel involved in the running of the home. Both service users and relatives stated that visitors are always welcomed to the home by staff and no one reported any restrictions. Service users said that there were no rules – they said they could rise and retire when they wanted, could keep alcohol in their rooms, could stay in their rooms if they wanted, could request having more than one bath a week etc. There were a variety of views regarding the food in that service users said it was ‘very good’ to ‘ok’. Menus were inspected by the inspector and found to have a choice for the main meal. Food records were generally good but need more detail to include the vegetables served so this variety can be properly monitored. It is recommended that the cook attend service users meetings so that they can receive direct feedback from service users and answer any questions. It is also recommended, as part of the Quality Assurance Survey, that service users are asked on a one to one basis what meals they want and for menus to be provided based on their choices. The inspector tasted the food. It was of good flavour, there was a choice of main course and dessert and two fresh vegetables were served, therefore providing variety and the opportunity for healthy eating to service users. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for receiving and responding to complaints are not fully in place and staff training on the Adult Protection procedure is needed to ensure the full protection of service users from abuse. EVIDENCE: Service users generally said that they thought that if there were a problem then the Manager or Senior staff would sort it out. A Complaints Book is kept. The last recorded complaints were detailed and followed up. However visitors said that they had complained as to staff not getting their relative ready for a hospital appointment, in late 2006. This was not recorded in the Complaints Book. It also highlighted that information was not handed over from one staff shift to another, which caused this situation to occur. The Registered Provider said that this was a training issue and it would be followed up. The Complaints Procedure is generally satisfactory but does not give the complainant the opportunity to go to the Commission for Social Care Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 17 Inspection (or Social Service Department) at the initial stage, as per the National Minimum Standard. Care staff spoken with were unaware of the full procedure regarding which Agencies to contact if the in house arrangement failed. The Registered Provider said staff training would follow up these issues. It is recommended that a short procedural statement be drawn up and provided to help staff to follow the correct procedure. The service has had two complaints sent to the Commission for Social Care Inspection since the last inspection. The Registered Provider did not find evidence of any issues regarding the first complaint. Regarding the second complaint there were issues highlighted regarding personal care of service users, some medication not signed for and problems of some staff being understood by service users that need to be acted upon. The Registered Provider said these issues would be followed up. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Facilities are seen to be comfortable by service users. Odour control is generally good though needs improvement to some areas of the home. EVIDENCE: Service users said they were satisfied with their rooms, which the inspector observed to be personalised with items of resident’s furniture, pictures and photographs in them. The Registered Provider said that furniture to the new extended lounge was arriving that day so that this space would be available for service users to use, and that blinds would be installed to ensure service users privacy. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 19 The Registered Provider said that the area outside the lounge is to be completed within the next two months to provide a patio/sitting out area. The inspector recommended that the Registered Provider look into providing signing to the environment to assist service users with dementia, e.g. same colour doors for bathrooms, relevant pictures on bedroom doors to help identify facilities etc. She said that would be done. Radiators had the protection of having covers on them, which is needed as a number of service users have unpredictable behaviour and could be at risk from burning. Odour control was of a generally good standard. There was one bedroom, a first floor corridor area and the ground floor shower room where the flooring was odouress. The Registered Provider said these areas would be cleaned quickly and the shower room investigated as to source of the problem, with action to be taken to resolve this problem. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. Staffing levels may not be maintained to a level to meet service users needs. Recruitment procedures need to be in place to meet service users needs and properly protect them. Staff training systems need to be strenghthened to provide consistent training in all areas of service users needs. EVIDENCE: There were comments that there were not always enough staff to meet the needs of service users. The staffing rota demonstrated four care staff in the morning, though this reduced to three in the afternoon/evening. There are two care staff awake on night duty. The Registered Provider said that staffing levels would be reviewed especially as there has been an increase in registered numbers of service users and this would be especially relevant when those places were filled. Also there would be domestic cover for each day, as at present this is not in place on Sundays, to ensure standards of cleanliness. Staff said there had been training in the last twelve months. Records seen by the inspector that demonstrated this in part. There was also some evidence of induction training for new staff though this had not been completed for the Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 21 record seen by the inspector. The Registered Provider said this would be followed up for new staff. The Registered Provider was recommended to devise a Training Matrix to identify key issues that staff need training in (to quickly access who needs training in any relevant issues) – e.g. first aid, fire, adult protection, challenging behaviour, moving and handling, health and safety, medication, dementia, training on service users conditions – mental heath issues, diabetes, etc. Staff need to receive this training on all essential care and health and safety issues to ensure that service users needs are always met. Staff said they were encouraged to undertake National Vocational Qualification level 2 training and the Registered Provider stated that the National Minimum Standard regarding of 50 of care staff with National Vocational Qualification level 2 had been met and another four care staff were in the middle of doing this course at present. Recruitment records were inspected and found in some areas to be poor with Criminal Records Bureau /Protection of Vulnerable Adults checks not in place when staff commenced employment, and some written references also not in place at this stage. An Immediate Requirements Notice was served for this to be quickly rectified by the Registered Provider. The Registered Provider said she now fully understood the proper procedure and would be immediately implementing this so as to protect service users from abuse. The most recent complaint made regarding the service stated that staff all took breaks together so were not around to meet service users needs, and that there was a problem in communication for staff whose first language was not English. The Registered Provider said there was no evidence that all staff took breaks together, and the inspector noted that service users all said staff were quick to answer call bells. The Registered Provider acknowledged there was some difficulty for some staff in their communication with service users and would be taking steps to address this. There are no service users meetings held at the moment. The Registered Provider said that she would be looking to organise these and also invite relatives so as to gain views of how to run the service to meet the needs of service users. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are not fully in place to protect the health and safety of service users. EVIDENCE: Service users said that they thought the Acting Manager ran the home well and that she was approachable if they had any problems they wanted to talk about. The Registered Provider said the Acting Manager was studying for the National Vocational Qualification level 4 Award at present. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 23 There was evidence on staff records that staff had been supervised and appraisals are also carried out, though supervision was limited to one practical task. The Registered Provider said that she would be looking into and implementing a fuller supervision system. Staff Meetings have been held and recorded, which helps to ensure practice issues are regularly discussed. A Quality Assurance system has been devised, and is in the Statement of Purpose but has not been carried out in the past year. The Registered Provider said this would be supplied to service users, relatives and other stakeholders, e.g. GPs, District Nurses etc. A summary of the outcome needs to be in place with an Action Plan to meet all issues identified and the results included in the Statement of Purpose. The service user monies records inspected were found to be properly kept with running balances, and two signatures recorded so that transactions are witnessed. Receipts are kept to provide evidence of spending. There is a Health and Safety folder with Risk Assessments for safe working practices. Radiators have covers to protect service users at risk from burning. Fire Precautions: A review of fire issues is needed to ensure that all systems are regularly tested (fire bells were only being tested on a monthly, not a weekly basis), that there is a detailed fire risk assessment in place, that staff are fully aware of the fire procedure and that fire doors are not propped open (there were three fire doors propped open in lounge/dining areas observed by the inspector). This will then protect the welfare of all persons in the home. Records are kept regarding hot water temperatures being checked to ensure that they are close to the National Minimum Standard is 43c, to protect service users from scalding water. However there was no evidence that any action was taken if temperatures were above the standard. The Registered Provider recognised this and said this would be put into place. Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 24 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 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 1 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 25 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 OP8 Regulation 12 Requirement The registered person must ensure that service users health and personal care needs are met at all times. All complaints need to be recorded and acted upon. Staff need to have Adult Protection Training to ensure they are aware of how to report incidents of suspected abuse. Statutory staffing checks must be in place before staff commence employment. The Registered Provider must ensure that staff receive training in all essential care and health and safety issues. The Health and Safety systems in the home must protect the welfare of service users from harm. This includes protection from fire. Timescale for action 05/03/07 2. 3. OP16 OP18 22 13 05/03/07 05/05/07 4. OP29 19 06/03/07 5. OP30 18 05/09/07 6. OP38 13 06/04/07 Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 26 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. Refer to Standard OP3 OP7 Good Practice Recommendations It is recommended that the assessment form conforms to the National Minimum Standard. It is recommended that all residents care plans are rewritten periodically to make them clearer to the reader so that care is always supplied that meets the needs of service users. Facilities need to be signed to help orientate service users with disabilities. Staffing levels need to be reviewed to ensure that service users needs are met. An effective Quality Assurance system, based on the needs of service users, needs to be put into place. 3. 4. 5. OP19 OP27 OP33 Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Langdale Residential Home DS0000061086.V329294.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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