Inspection on 17/02/09 for Langdown House

This inspection was carried out on 17th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Langdown House 20/02/08

Langdown House 07/09/06

Langdown House 08/11/05

Langdown House 07/06/05

Langdown House 07/10/04

Langdown House 22/07/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Langdown House 1-4 Yeend Close West Molesey Surrey KT8 2NY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia Collins     Date: 2 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Langdown House 1-4 Yeend Close West Molesey Surrey KT8 2NY 02089794561 02089798901 jane.gupta@surreycc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kingston & Wimbledon YMCA care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 28. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Langdown House is a care home providing personal care and accommodation for up to 28 adults of either gender whose primary care needs on admission are learning disability or mental disorder, excluding dementia. The home is operated and managed by Kingston & Wimbledon YMCA, with staff under contract to Surrey County Council. Langdown House is located in the centre of the local Molesey community and benefits Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 0 28 28 Brief description of the care home from good access to transport, shops, banks and other community facilities. It comprises of four detached, purpose built two-storey houses, designed to provide small group living environments in which people using services can enjoy maximum independence. These have spacious communal living and dining accommodation, kitchen and utility facilities on the ground floor. Bedrooms are all single occupancy and arranged on both floors, also bathrooms and toilets. There are no lift facilities to the first floor. Houses have secluded, enclosed gardens and car parking spaces. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The weekly fee is 765 pounds 25 pence per person per week. Additional charges include some transport costs for holidays and for holiday escorts, toiletries, hairdressing and clothing.There is also an annual charge of 5.00 pounds for television licences. The unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. The inspection visit was undertaken by one inspector over two days. The report will say what we found as it is written on behalf of the Commission for Social Care Inspection (CSCI). The inspection process included discussions with the person designated by the responsible individual to manage the home, also an acting team manager. We consulted some people using the homes services and had discussions with a number of Care Homes for Adults (18-65 years) Page 6 of 36 staff. All available information has been taken into account in making judgements about how well the home is meeting the National Minimum Standards for Adults (NMS). This includes the cumulative assessment, knowledge and experience of the home since its last key inspection. The inspection process involved sampling records and tour of all four houses and gardens.We also considered information in surveys completed with staff support by seven people who use the homes services, also two completed by staff members and one from a health professional. Each year, providers registered with the Commission for Social Care Inspection (CSCI) must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CSCI. It provides quantitative information about their service. It requires assessment of the service against the NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time and its content was clear and validated by evidence. This information was also also used to inform judgements about the home. We wish to thank all of the people using the homes services, its management and staff for their time, hospitality and assistance throughout the inspection visits. What the care home does well: What has improved since the last inspection? The two requirements made at the time of the last inspection have been met. This has improved odour control in the one bedroom that was not free from malodour when last inspected; also reduced risk of skin breakdown for two individuals. The management team has been strengthened by arrangements for an acting team manager. Managers roles and responsibilities have also been refined. The AQAA states that communication has been enhanced by regular site and team meetings. The development of individualised support and shift planners has further empowered people using services to have control over their lives and their routines, for example cooking and cleaning and in budgeting and managing their own finances. Individuals have been supported in forming new friendships outside of the home and one individual enabled to get back in contact with an old friend. Another individual has been successful in gaining employment. Further training and development of procedures has improved medication practice generally and increased staffs Care Homes for Adults (18-65 years) Page 8 of 36 confidence when supporting people with health care needs. The home has worked in close partnership with health colleagues to be able to manage the complex health needs of one individual, substantially enhancing her quality of life. Some improvement in the environment has been noted. Communal areas have benefited from redecoration and some furniture and appliances have been replaced. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have information to choose a home that will meet their needs. They can be assured their needs can be met on the basis of comprehensive needs assessments carried out before admission. Evidence: An equality impact assessment has been carried out at the home to ensure services address all strands of diversity and promote equality and non-discriminatory practice. There is a clear position statement in the homes service user guide from the YMCA organisation which owns and manages the home. This states clearly that as a Christian movement the organisation welcomes into its fellowship people of other religious faiths and those of none. It affirms a commitment to equality of opportunities for people using services and of staff. This means both will be treated fairly, regardless of their race, colour, age, gender, disability or sexual orientation. Observations confirmed equality of access to the homes services and management and staffs understanding of the key issues for diverse groups of people using this service. Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: Services provision is purchased by Surrey County Council. Discussions with management during the inspection confirmed a change in the homes admission criteria, specifically that short-term placements are no longer offered. The referral and admissions policy needs to be updated to reflect this change. Due to a decision to sell Langdown House and the other two care homes within this group, no admissions have taken place in over two years. At the time of previous inspections comprehensive needs assessments were undertaken prior to admission, to be assured the home could meet individual needs. Prospective users of this service were involved in decisions regarding the homes suitability. The home had worked in close partnership with care managers to ensure care plans and essential lifestyle agreements were in place before admission. The admission process had followed a best practice, with a planned transition including visits and overnight stays before admission. We were informed by a person using the homes service, I came and looked at the home and said it was nice, I stayed for tea. Records viewed confirmed an ongoing assessment process after admission over a twelve week period, with a review after six weeks so that adjustment can be made to care plans, if necessary. The homes management understands the importance of having sufficient information when choosing a care home. A combined statement of purpose and service users guide has been produced for this purpose. This sets out the homes aims and objectives, care philosophy, services and facilities and states who the home is for. It was suggested this be produced in other formats to meet the range of communication needs of people for whom the home is intended. The document is dated October 2007 and is in need of updating. Specifically details of interim management arrangements, the change of address of the organisations head office and of the CSCI and current information about staff qualifications. A copy of this document had been supplied to people using services. The shorter version of this document in leaflet form also needs updating. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are actively involved in planning their care and support and their independence is promoted. Some care plans need to be further developed and the scope of risk assessments extended. Evidence: Since the last inspection staff rotas had been developed to enhance individualised support practice. New shift planning activities have further promoted and enabled choice in their lives. Two people have been successfully supported to move on to other settings, affording increased opportunity for independence and control in their lives. Individuals living at the home have benefited from further opportunities to form friendships outside the home. The care records of three people using services were randomly selected for inspection. These were detailed and mostly comprehensive, the approach to care planning placing the individual at the centre of service delivery. It was positive to noted individuals had signed their care plans and monthly care summary. It is suggested for care plans and Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: the care summary to be produced in accessible formats to meet individuals communication needs. It is acknowledged the essential lifestyle plan uses pictorial symbols. A record of things people using services like to do on their home days, that is, days when they do not attend day services, had been compiled with each individual. In one of the files the list read, go to church, swimming, shopping, cinema, watch football matches, clean room, prepare evening meal, go to Hampton Court and the coast some days. This individuals care records evidenced he makes choices in his everyday life. He was noted to have had a lie in bed on a recent home day, getting up around 11 am and after breakfast he had tidied his room. He later went to church and enjoyed doing puzzles on his return. On other home days he went shopping with staff, enjoyed film nights at Burview Hall, went out for a meal to celebrate the birthday of another person living in the home and spent Christmas with his family. Routines are reasonably flexible, including times people go to bed and get up which is determined by pre-arranged day services or appointments. There is choice of meals and in how people spend their days, a choice of what to wear and of hairstyles. We were told by people using services they decide what they spend their money on and which social and leisure activities they take part in. They choose their friends and people they form relationships with. They are consulted in planning their care and in setting and reviewing goals. The care plans and guidelines viewed mostly established individualised procedures for meeting needs, the management of behaviours and for keeping people safe. Though shortfalls in risk assessments at the time of the last inspection had been addressed and a multi-disciplinary approach to risk assessment evident for some individuals, a number of potential hazards had not been assessed. The need to further extend the scope of personal risk assessments was discussed with management, to ensure the safety of vulnerable people. These included their access to a pond in one of the gardens, access to toiletries in bedrooms and bathrooms and to washing up liquid in kitchens. In one house where people with a dual diagnosis of a learning disability and dementia were accommodated, dish washer tablets, cleaning liquid and a substance for disinfecting the specialist bath were found stored in an unlocked cupboard under the kitchen sink. A risk management plan for one person in this house was not being adhered to by staff. A further risk was that a carer who had only worked a few shifts in the house and was being left briefly to work without other staff with this individual and two others, was unaware of the risk management plan. The need to ensure care plans address the communication needs of people using services was discussed. For people with dementia these need to be more specific and Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: consider the impact of the environment and support needs for maintaining skills and independence. Whilst recognising a multidisciplinary team approach to meting the needs of these individuals, observations suggest staff could do more to optimise their state of well - being by creating a positive dementia care environment. Staff working in this house had not all received dementia awareness training to ensure the necessary skills and competencies. Use of orientation aids, prompts and cues could be considered. It was good to note the intention to develop talking books for these individuals. On reviewing the file of another individual in the same house, Makaton signs he is familiar had been supplied by a therapist to support staff in meeting his communication needs. Staff were not observed to use Makaton however in their interaction with this individual. The staff training records confirmed only one of the staff deployed on this house had undertaken Makaton training and only four staff across the home. Discussions with the person designated responsible for managing the home confirmed a key worker system was not in operation. A file is held in each of the houses containing current risk assessments, care and support documents and guidelines. Each month staff produce a summary of all information recorded about each person using services. This provides an audit trail of their care, activities, health, mood, behaviours and significant incidents or events. This is then filed on the individuals personal files. The homes management has focused attention on improving staffs report writing skills since the last inspection. A system is in place for care records and summaries to be regularly audited. Observations confirmed that whilst record keeping was detailed, staff need to take care in dating records and risk assessment reviews. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are offered a healthy diet. They participate in age, peer and culturally appropriate activities and are part of their local community. They are able to make choices about their lifestyle and are supported in developing life skills. Evidence: A conversation with a person using services during the inspection demonstrated how well the home meets this group of standards. He began by saying how sad he was that his day centre was closing. He said how much he will miss it as he enjoys gardening when there. He added, I would love a part time job doing gardening but I know my age and unemployment in the area is against me. I usually like living here, its not too bad, I like the staff and when I get chance I give the garden here a tidy up. Most of the other residents are alright though they have their moments, but you can expect that. The food here is good, on a Sunday or Monday we all sit round the table and decide what we want to eat for the next week. This is written down by staff and Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: typed up. I can read the menu on the wall and those who cant read it ask staff what it says. We wash up after our meals and tidy up. Last year we went to Windsor Castle after saying we would like to go there at one of our meetings with staff. We asked if we can go to the Tower of London sometime. Survey feedback from people using services confirmed most made decisions about what they do each day, in the evening and at weekends. Two people clarified that they decide what they do if staff are available to support them. Comments in surveys included, I see my mum sometimes or go for walks and shopping with staff, today I am going to a Valentine disco, I like to lay in bed late on Saturdays and Sundays, I go to the cinema. The home is efficient at affording people opportunities for personal development, education and independence training. The individualised support provided by staff has empowered individuals to have more control over daily routines, for example, cooking, cleaning and their personal finances. A number of people are now supported in managing their own bank accounts and finances. Surrey County Council was stated to be working towards relinquishing corporate appointees responsibilities for individuals. A person using services told us she goes to the bank with staff to draw out her money and chooses what this is spent on. Her long - term goal is to go to the shops and bank independently, the same as two other people living in the same house. To prepare people for this level of independence there are robust risk assessments in place and a programme of training in road safety and stranger danger. The kitchens in all of the houses were clean and adequately equipped. Some kitchen units were showing signs of wear and tear however and in need of replacement or repair. The damaged floor covering in one kitchen also needs to be replaced. Each house has a catering budget and some people receive individualised catering budgets. They are supported in planning group and individual menus, shopping for food and in cooking meals. The menus displayed indicated people have a varied, healthy diet and special dietary needs and choices are met. It was suggested for consideration to be given to producing pictorial menus in houses where this would meet peoples communication needs. It is acknowledged that photographs of meals are used for menu planning. Early morning observations identified individuals making their own breakfasts with staff supervision. Effort is made to support people using services in following their chosen lifestyles and their independence is promoted. They are supported in keeping their rooms and homes clean and tidy and if able to do so, do their own laundry. They have high community presence and pursue individual interests and hobbies, engaging in a wide Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: range of social and leisure activities. Individuals attend various day services and colleges, use gyms and swimming pools, enjoy horse riding and follow religious and spiritual beliefs. The Employability scheme has been accessed for finding employment opportunities, supporting individuals in gaining meaningful employment. The importance of encouraging people using services to develop and maintain personal and family relationships is recognised and encouraged by staff. Whilst there has not been an opportunity for people using services to go away for holidays since the last inspection, group and individual day excursions were stated by management to have taken place. It was stated in the AQAA that opportunities were being explored for small group holidays in the future. The home is conveniently located within walking distance of shops and other community amenities. People using services have free bus passes and access public transport as well as having access to a mini bus they share with another service. A staff member expressed the view that a mini bus for the homes sole use would benefit people living at the home; she commented, we used to take service users out for day trips and to the coast. It can prove very costly for them to use other means of transport. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and preferences. The assessment and management of risk must be improved to ensure the safety of people using services. Whilst medication practice is safe some shortfall in procedures were found. The principles of respect, dignity and privacy are put into practice. Evidence: People using services are registered with a general practitioner (GP) and have clear health action plans. They have access to their GP and NHS services including NHS dentistry, opthalmic and chiropody services. Individuals who need frequent chiropody also use a private chiropodist, which they pay for themselves. Staff support them in attending health care appointments and their health needs are closely monitored. The complex health needs of one individual were being managed with daily input from the district nursing service. Staff were facilitating this persons hospital visits three times a week for treatment and following best practice infection control procedures. Care plans, guidelines and protocols are in place for the management of various health conditions, including dementia, diabetes and epilepsy. The need to further develop Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: care plans for people with dementia was discussed with the acting assistant team manager. Risk assessments had been carried out for individuals with epilepsy and diabetes and action taken to minimise risk at night. The inspection visit however did identify significant risk in the night care of one individual who regularly gets up and comes down stairs during the night when on-call members of staff are sleeping. Though the risk assessment for this individual had identified potential hazards in respect of having access to electrical appliances in the kitchen without staff observation, inadequate measures had been put in place to minimise this risk. A discussion during the visit identified a recent incident in which this person had been at significant risk during the night yet action not taken to review the safety of night staffing levels. The staff member confirmed having verbally informed her line manager. An incident report had not been recorded or notification sent to the care manager or CSCI and an urgent care management review had not been requested. The homes managements response to this information during the inspection was robust to ensure effective risk management action taken. This included review of all risk assessments for this individual and short-term arrangements for waking night staff in this house. Notifications were then sent to the relevant agencies and arrangements made for an urgent review by care management. Observations confirmed staff encourage people using services to take pride in their personal appearance. The social model of disability is promoted in which staff see beyond individuals disabilities and provide self-directed support, respecting rights to dignity, equality, fairness, autonomy and respect. The homes management confirmed significant improvement in staffs report writing skills since the last inspection, in particular in monthly summaries of care. The need to ensure weight monitoring is consistently recorded and records including risk assessment reviews are dated was discussed. Shortfalls in risk assessments and risk management plans have already been detailed in the report in the outcome group Needs and Choices. The need for a personalised approach to the storage of toiletries was being reinforced by management, where practice had lapsed. Medication storage was observed to be satisfactory and no controlled drugs were prescribed at the time of the visit. There is an efficient medication policy supported by procedures and practice guidance, which most staff understand and follow. Observations of practice in one house where staff were not fully adhering to procedures for disposal of discontinued medication was discussed with managers. Systems for tablets to be counted each day as part of handover procedures were being diligently followed. It is policy for two staff to engage in medication Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: administration practice, both of whom must be trained in the homes medication procedures. Medication records were fully completed, containing required entries and signed by appropriate staff. Records of receipt, administration and disposal of medication were kept. The staff training programme for medication administration has a practice assessment element. The practice of secondary dispensing observed was noted to be due to exceptional circumstances when a person using services goes on leave with her family at short notice. The need for a robust risk assessment was discussed. The homes management has already issued staff with instructions how this to be managed and recorded. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people using services are listened to and acted upon and there is a clear and effective complaint procedure. Policies and procedures protect people using services from abuse and respect their rights. Evidence: We have not received any complaints about this home since the last inspection. The services complaints and protection procedures reflect the needs of people under the six strands of diversity. These are gender including gender identity, age, sexual orientation, race, religion or belief and disability. An easy read, pictorial complaint procedure is displayed in the entrance of each house. The homes complaints file included four complaints from people using services about one of their peers, relating to the same incident. Discussions with the acting manager confirmed their complaints had been taken seriously and acted on though a record not made of the action taken as required. 100 of the people using services who responded to our survey knew how to make a complaint and who to speak to if they were not happy. Most said the would speak with staff. One person commented, If I tell them someone upset me they write a complaint form for me. Staff consulted were also familiar with the complaint procedure and said they would inform a manager if they received a concern or complaint from people using services or their relatives/representatives. One complaint was made direct to the organisations responsible individual since the last inspection. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: This related to staffing, specifically the failure to recruit staff to replace those that had left since June 2007 when the intention to sell the home had been announced. The complaint procedure had been followed. 100 of people using services who completed our survey told us they felt safe in their home and staff treat them well. Policies and procedures for safeguarding adults are available at the home, incorporating clear and specific guidance to those using them. There is also a system for staff to report any concerns they may have about colleagues and managers. A copy of the latest edition of Surreys safeguarding procedure has been obtained. There have been two safeguarding referrals and investigations since the last inspection and the correct procedures were followed. Both are now closed. The staff training records viewed confirmed 45 of permanent staff had not received safeguarding training and of those who had, some had this many years ago. Of the eight care bank staff, the records indicate six have not attended safeguarding training since taking up post. The the two that had received this training undertook it eight years ago. The homes management is aware of the need for improvement in staff training. Robust policies and practices are in place for the protection of people using services for management of personal finances and vetting agency and care bank staff. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a comfortable environment that promotes independence. The homes management must ensure the environment is well maintained and safe at all times. Evidence: Langdown House is purpose built establishment comprising of four detached, twostorey houses. These have spacious communal living and dining accommodation, kitchen and utility facilities on the ground floor. Bedrooms are all single occupancy and are arranged on both floors, also bathrooms and toilets. Provision includes wheelchair accessible toilets. Specialist shower and bathing facilities are provided and aids and equipment to meet individual needs. First floor accommodation is accessible by two flights of stairs and includes office facilities. A bed for sleeping on-call night staff is provided in each staff office. Staff lockers are provided and en suite shower and toilet facilities. Each house has an emergency call system and pay phone. The houses are designed to provide small group living environments in which people using services can enjoy maximum independence. The inspection process incorporated a tour of all four houses, viewing all communal areas and sampling bedrooms by invitation of their occupants. Gardens were well maintained and set mainly to lawn, with patios, garden furniture and colourful shrubs. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: On day one of the inspection a significant amount of discarded furniture was in each of the gardens and on pathways at the side of the buildings.These included old beds and mattresses, a settee being replaced that day with a new one, armchairs, a commode, and a filing cabinet. By day two of the inspection a skip had been ordered and these items were awaiting collection. All of the houses are domestic in character and style. They are well lit, ventilated and heated, clean and tidy and odour is adequately managed. Staff work within the homes policy to reduce the risk of infection.Mostly the houses are well furnished and individuals had been issued with front door keys and keys to their bedrooms. There has been some redecoration in communal areas also replacement of showers, replenishment of furniture and equipment, since the last inspection. General observations however identified the need for further decoration and attention to cracks in walls, replacement of some carpets and floor coverings and kitchen units. Whilst the home does not have a designated person to carry out maintenance repairs, it was demonstrated that contractors promptly respond to requests for urgent visits. They visited the same day on the first inspection visit when immediate safety requirements were made. Care Homes for Adults (18-65 years) Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements do not always ensure the needs of people using services are safely met. Shortfalls in staff training have been identified. Evidence: Staff were observed to be friendly and supportive towards people using services. They are employed and managed by Surrey Adult and Community Services, in accordance with existing contract arrangements between Surrey County Council and Kingston and Wimbledon YMCA. The home also has its own staff bank. There is an established,stable workforce. The staff team is depleted however since 2007 when a decision was made to sell the three homes within the group and not to replace staff who have left. A core group of staff have worked at the home for many years including agency and bank staff. Effort is made to use regular agency staff who know the home and the people who live there, to enable continuity of care and routines.Various strategies are in place to also promote service continuity.Though not ideal,on one house notices were displayed in the kitchen providing information and prompts for staff who may not be fully familiar with individual programme plans. This was aimed to ensure staff practice promotes and maintains the independent living skills of the people living in the home. Each house has a binder containing current duplicate risk assessments and other care records and guidelines for staff to use for Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: reference. Feedback from individual workers confirmed mostly these arrangements work well. However observations identified an agency worker about to be left to work by herself with three people using services and had not been made aware a risk management plan for one individual, to ensure her safety. Agency and bank staff are invited to attend house and team meetings to help them in keeping up to date with significant information about people using services and house decisions. Communication books on each house are also another good source of communication though observations identified the need for staff to be sometimes more selective in the way these are recorded. For example, in one house staff the communication book contained a record audit trail of behaviours challenging services that should more appropriately be recorded in an individuals care file. The sustained high use of agency staff can create difficulties, owing to procedures limiting and restricting their duties. These circumstances can adversely impact on areas of service provision. Discussions with management confirmed current staffing arrangements had been a barrier to offering people using services opportunity to go away for holidays. It was also noted the home is not always able to cover the shifts however staff are supportive and managers try their best. A complaint from a relative last year investigated under the organisations complaint procedure, raised concern about the homes staffing situation. It was stated that staff morale had been low and permanent staff felt under significant pressure to balance their responsibilities with continuously inducting and directing temporary staff. Observations during this inspection found most staff did not raise these issues. Those consulted were professional in their outlook about their future and that of the home and committed to allaying anxieties of people using services. A staff member did comment that sometimes it was difficult to manage administrative and care planning workloads. Staff rotas had been adjusted to provide individualised support for people using services on days they dont use day services and this is reflected in new shift planner records.Discussions with staff confirmed the view that mostly staffing levels were adequate during the day. Observation of records in one house and discussions with a staff member, as previously stated in the report, highlighted risks in the night care of an individual using services. Previous inspections confirmed good practice staff recruitment and vetting procedures followed by the home. No new staff had been employed for the past two years. Agency staff wear identity badges with photographs and are issued with a code of conduct by management. Assistant team managers check they have been vetted and trained and have all relevant employment documentation before they start work. A first day check list is in place for new agency and bank staff and they receive an Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: induction. A record is maintained of their Criminal Record Bureau disclosures (CRB) and of checks against the national register of people unsuitable to work with vulnerable adults (POVA). Discussions with managers confirmed they are aware of staff training shortfalls. The staff training records viewed confirmed four of the twelve permanent staff, excluding managers, had achieved National Vocational Qualifications (NVQ) in Health and Social Care at level 2 or equivalent. This is not compliant with the National Minimum Standards for Adult. Though positive to note in-house training had given staff increased confidence and skill in the management of health care needs, the staff training records viewed suggested the need for overall improvement in the area of staff training. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is management commitment to running the home in the best interest of people using services. Shortfalls were evident however in a number of areas of its management and operation. Evidence: The home has not had a registered manager since September 2007. The registered manager of another home within the group has assumed the management role at the home since then and has managed both homes. The manager has extensive relevant experience and suitable management qualifications including NVQ Level 4 and the Registered Managers Award. The management structure includes two assistant team manager posts. One of these posts is vacant and acting assistant team manager arrangements are in place. The acting team manager has NVQ Level 3 qualification and is an NVQ Assessor. The other post holder has extensive relevant experience and a long established relationship with people living at the home. The management team undertakes periodic training and development to update and maintain their knowledge, skills and competence, whilst managing the home.Staff consulted spoke positively about managers and stated they are very approachable. Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: The person in the management role and the acting assistant team manager were present for the duration of the inspection visits. They shared an office on one of the houses however during the course of this inspection, relocated this office base to another house in response to the inspection outcomes. The registration certificate and employers liability insurance certificate was displayed in this office. The AQAA contained clear, relevant information supported by a range of evidence. It let us know about the changes made at the home and where they still need to make improvements. The homes policies and procedures promote the rights and best interests of people using services and equality and diversity, however some need updating. Work is ongoing for continuous improvement and development of services. Minutes of staff meetings are a record of work that has taken place to improve staffs report writing skills. A combined health and safety and fire safety audit was undertaken by a specialist company during the course of the inspection visits. Though a record of the outcome was not available to view, action was taken for the safe storage of gas bottles used for barbecues and a notice displayed. A tour of the houses confirmed the practice of using door wedges to enhance supervision and on one house, for the safety of a person using services with mobility problems. The advice received during the fire audit was that door may be wedged open if staff are in the room. Observations suggest this may not always be practicable. It was suggested the Surrey Fire and Rescue Service be consulted about the possibility of using door guards in some houses. Staff were observed to be diligent in ensuring the security of the premises. Systems are in place for regular check on emergency call bleeps, bells and door alarms to ensure these are functioning and for monitoring hot water temperature. The homes management also keeps a central audit record. Observations highlighted some shortfalls in monitoring health and safety, specific to one house. Staff had recorded water temperature to a wash basin and a bath at an excessive high temperatures but no record found of this being reported to management or of remedial action taken. Noting also reference in a recently implemented hot water temperature monitoring form to mixer taps being set and locked at 45 degrees, attention was drawn to the National Minimum Standard for this to not exceed 43 degrees. A number of other environmental hazards were noted during the course of this inspection. The need for health and safety audits to be more robust and the scope of individual risk assessments extended was evident. Risk assessments should be carried out of access by people using services to a pond in one of the gardens and their use of remote controls to adjust beds and recliner chairs. It was suggested a risk assessment also be Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: carried out of a free standing plasma television in the bedroom of a person with dementia. This individual regularly gets up during the night and moves around her room and the wider environment of the home whilst staff are sleeping. In the same house staff were not activating the door alarm which was part of this individuals risk reduction plan and had not been testing the door alarm to notice it was not working. Also in the same house which accommodates three people with dementia, a broken window restrictor on the large window on the stairs went unnoticed by staff. Hazardous cleaning substances were found in the same house stored in unlocked cupboards in the kitchen and utility room. Also a staff member released a window restrictor in the upstairs bedroom of the same house whilst hoovering and failed to activate it afterwards. Monthly statutory visits are carried out by the responsible individual. Various system including regular house meetings enable the views of people using services to be sought as part of the homes quality monitoring systems. Systems enable and support people using services to budget their money and to choose how this is spent. The need for a planned maintenance and renewal programme for the maintenance and decoration of the houses was identified. The inspection also highlighted the need for improvement in staff training. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 To ensure close observation 20/02/2009 of a named individual to maintain individual safety until the alarm on the front door, which is part of an individual risk reduction plan, is repaired. To maintain this individuals safety. 2 9 13 For the door alarm to be repaired on the house identified. The door alarm is required to be activated at all times when this individual is at home to ensure her safety. 20/02/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 For the scope of risk assessments to be further extended; also for care plans to be further developed to ensure provision of a safe, quality care environment for people with dementia. 17/04/2009 Care Homes for Adults (18-65 years) Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure the service meets the current and changing needs of people using services. 2 24 23 For the home to have a planned maintenance, redecoration and renewal programme. This will ensure people using its services live in a homely, comfortable and safe environment. 3 33 18 To ensure a system in place for monitoring night staffing arrangements ensuring these meet the changing needs of people using services. This will ensure the safety and welfare of people using services. 4 35 18 To ensure all staff working in 16/06/2009 the home have received statutory training and other training specific to the needs of people using services. This will ensure the individual and joint needs of people using services are met by appropriately trained staff. 5 42 13 For health and safety audits to be more robust. 09/04/2009 01/04/2009 17/04/2009 Care Homes for Adults (18-65 years) Page 34 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure the health and welfare of people using services is promoted and protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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