Inspection on 20/02/08 for Langdown House

This inspection was carried out on 20th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Langdown House 17/02/09

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Langdown House Langdown House 1-4 Yeend Close Off High Street West Molesey Surrey KT8 2NY Lead Inspector Damian Griffiths Unannounced Inspection 20 February 2008 09:00 th Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 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 Langdown House DS0000060463.V347682.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 Adults 18-65. 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. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langdown House Address 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) Langdown House 1-4 Yeend Close Off High Street West Molesey Surrey KT8 2NY 020 8979 4561 020 8979 8901 jane.gupta@surreycc.gov.uk Kingston & Wimbledon YMCA Position vacant Care Home 28 Category(ies) of Learning disability (24), Learning disability over registration, with number 65 years of age (4), Mental disorder, excluding of places learning disability or dementia (2), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1) Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Of the 24 service users within the category LD (Learning Disabilities), 2 may also fall within the category MD (Mental Disorder) Of the 4 service users within the category LD (E) (Learning Disabilities - over 65), 1 may also fall within the category MD (E) (Mental Disorder - over Of the 4 service users within the category LD (E) (Learning Disabilities - over 65), 1 may also fall within the category MD (E) (Mental Disorder - over 65) The age / age range of those to be accommodated will be: 24 residents aged 32 - 64 years, 4 residents currently over the age of 65 years 7th September 2006 3. Date of last inspection Brief Description of the Service: Langdown House is operated and managed by Kingston & Wimbledon YMCA, with staff under contract to Surrey County Council. Langdown is located in the centre of the local Molesey community and benefits from good access to transport, shops, banks and other local facilities. Langdown House consists of four, seven bed roomed detached houses, purposely built and designed with specific attention to the service users. In addition all 4 house benefits from individual private gardens. Service users have single bedroom accommodation and each room is linked to an emergency call system. Specialist equipment can be made available if required. Costs £765.per week. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection of Langdown House took seven and a half hours beginning at 09.00 and ending at 16:30. Two houses, including Langdown House, were inspected out of the four at the Langdown house site. Kingston and Wimbledon YMCA the registered owners of the care homes in conjunction with Surrey County Council are in the process of selling the Langdon house complex. CSCI had been informed by the owners that it is hoped to conclude the sale of the homes by the end of May 2008. Mr. Damian Griffiths Regulation Inspector completed the visit. The homes registered managers post was vacant; therefore, the registered manager of Langdown’s sister-home, located nearby, was also managing the home with the support of senior care staff. This key inspection report takes into account information from the Annual Quality Assurance Assessment (AQAA) provided by the previous manager in November 2007, samples from a number of service user files, staff personnel files, staff supervision records, staff training, medication administration and daily records. Observation of staff practice, equality and diversity issues and feedback from fifteen, CSCI survey’s completed by service users, relatives and social and health care practitioners have also been included in this report. The inspector would like to thank service users, their friends and relatives and staff at Langdown House for their time, assistance and hospitality. Comments taken from CSCI surveys, received from October last year, comments received during the inspection and ‘Annual Quality Assurance Assessment’ are in italics and some words have been changed in respect of confidentiality and are featured within (brackets). What the service does well: Service users and residents received helpful information about the home and new service users could expect a care needs assessment prior to moving into the home to ensure there care needs were met. Service users relatives completing CSCI survey commented that; (Langdown hse) always aware of the difficultys residents have. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 6 Service users benefited from individual care planning ensuring care staff were informed about how to support their independent life skills, choices and personal care support. The AQAA completed by the previous registered manager stated that; Both the Kingston and Wimbledon YMCA and Surrey County Council have robust policies and procedures in place to ensure that we approach equality and diversity measures effectively within our establishment. The service users received support to participate in the lifestyle of their choice ensuring that their individual care needs and independence was respected. A previous complainant had written to complement the home had made the following comment: for more than two years Ive been complaining and complaining and it gives me great pleasure now to praise you. Service users benefited from care staff and management team committed to implementing the national minimum care standards consistently with the resources available to minimise the potential disruption facing the home. What has improved since the last inspection? What they could do better: The home received to requirements to ensure that the national minimum standards were met. The home must ensure that all service users have appropriate risk assessments and ensure that all areas are regularly cleaned and free from malodour. Five practice recommendations were made, they included: • That all appropriate care plan documentation be amalgamated into one care plan folder for ease of use and to increase information potential. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 7 • That the pharmacist uses the pharmacy stamp to show a clearer record that the unused medication has been collected by an authorised service when completing the drugs return book. That a national service user advocacy group the care be contacted to ensure service users received independent advocacy advice and group support during the transitionary-ownership period currently facing the homes. That the homes ensure that any agency care staff are suitably trained and qualified to work with service users. That a fire safety officer carries out a new fire safety assessment as soon as possible. • • • 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. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2 were inspected. Quality in this outcome area was good. Service users and residents received helpful information about the home and new service users could expect a care needs assessment prior to moving into the home to ensure there care needs were met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection the YMCA was negotiating the sale of the Langdon house residential complex, therefore, information about the progress being made available to service users and their relatives was inspected. There was evidence in place to show that the home had made available information it had received from the head office. Meetings arranged on the day of inspection for the manager to attend indicated that further information would become available and be distributed to service users and their families. Four service users files were inspected for information relating to care needs assessments are required to be completed prior to service users moving into the home. There had been no new service users to Langdown since the last inspection. All care plans inspected had the necessary care needs assessments in place. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9 were inspected. Quality in this outcome area is good. Service users benefited from individual care planning ensuring care staff were informed about how to support service users independent life skills, choices and personal care support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four service user care plans were inspected and compared with care needs assessments. The care plan folders included an ‘Essential Lifestyle Plan’ (ELA) had been completed in a style familiar to the service users who were able to confirm that they were fully involved in the process during the inspection. The Essential Lifestyle Plan captured some of the individual personality of each individual starting off with a good photo of the service user and it was completed in a style including diagrammatic details to assist the service users understanding, prompt memory and was enjoyable to read. Details found in ELA’s and care plan folder include a specific detail that required care support as identified in the care assessment. Most documentation inspected had been reviewed regularly and were up-to-date however an older service users care plan was in need of review. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 11 Staff were observed responding to service users needs and to their requests. The service users were consulted about food choices and were involved in shopping and daily decision-making including holidays. Six service users had, with the help of care staff, completed CSCI surveys the majority had agreed; that they could do what they wanted to do during the day, evening and weekend. Risk assessments supporting service users with independent pursuits/past times including employment, shopping and smoking could be found in the care plan folders. These included details of individual need, such as: checking that ID was being carried. There was one service user at risk of skin breakdown who had not received risk assessment from the four files inspected. Please see the requirements section of this report. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. The service users received support to participate in the lifestyle of their choice ensuring that their individual care needs and independence was respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence was in place to show that service users were able to access local facilities such as the bank and local shops, regular employment and made full use of day-care, drop-in centres and religious facilities indicating that the home supports the service users diverse and cultural needs. Service users were encouraged and supported with independent living tasks relating to daily housekeeping tasks, employment and food preparation. The home had completed an Annual Quality Assurance Assessment (AQAA) that all homes are required to complete. The AQAA stated; Service Users have regular visits planned to meet and stay with family. Service Users recently had their relationship celebrated through a blessing conducted at the local church. And service users also confirmed that they had been involved with holiday planning as well as planned leisure activities and trips out: Memphis, Euro Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 13 Disney and the New Forest were some of the destinations reached. It was not clear however whether anything had been planed for this year. Other areas of staff supporting service users with independence issues and reflecting the current housing situation were in evidence, for example service users housing applications had been completed and were in place in care plan folders. Social care practitioner completed the CSCI survey confirmed; holidays, trips abroad had been arranged and are very successful. Four CSCI surveys were completed by the service users relative’s. Comments, such as: (the home has) taken over my (relatives) needs and care as is professionally possible and another commented when completing the section: Does the care service for people to live the life they choose? to always be aware of the difficulties residents have. The inspector who was able to talk to various service users conducted a tour of the premises. A service user, for the sake of confidentiality shall be known as Mr X, confirmed that the care staff had helped him in the number of different areas, and it was evident that he was quite independent, however, after talking to him briefly about his hobby it soon became apparent that care staff could be taking more of an active interest to assist/supervise with; contacting relevant clubs, local exhibitions and purchase relevant periodicals. Service users helped prepare their own food and dietician advice was available if needed. The AQAA completed by Langdown house stated that; The Service Users have a choice of meals and regular takeaway meals, bowls of fruit were in evidence in each house inspected. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, & 20 were inspected and the quality in this outcome area was adequate. Most service users benefited by receiving their assessed care needs in the way they preferred, enabling them to be more independent. Service users may be put at risk due to lack of assessed care need updates that could affect their health. Service users requiring help with their prescribed medication also benefited by the support of care staff to enable them more independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users Essential Lifestyle Plan contained details of how they preferred to receive the care support, as assessed and as described in the previous section. There was evidence in place to show the service users were in contact with health and social care practitioners as required. The majority of the files inspected contained Health Care Plans that detailed service users immediate protocols, health care needs and details of health care practitioners involved in their care. An older service user, however, did not have a health care plan and had not received a risk assessment, relating to the Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 15 risk of skin breakdown and other aspects of recorded information were in need of updating. The home is required to ensure that the health care needs of all service users are regularly assessed, properly recorded and actions taken to ensure the health and safety of service users. The health action plans were not part of the care plan folder so it was recommended after discussions with care staff and the manager who determined that all appropriate care plan documentation should be amalgamated into one care plan folder for ease of use at information potential, especially for new/agency staff joining the home. There had been several instances of medication errors recorded since the last inspection and in one instance, a safeguarding meeting was arranged between the home and the local social care team. Service users, who are able to, were encouraged and supported to take regular control of self-administration of their prescribed medication. Appropriate risk assessments and signed agreements between the service user and care staff had been completed. Medication Administration Records (MAR) were examined for irregularities; loose tablets contained in packets, medication being returned, storage and recording were all in place and correct. Unused medication was stored in a secure area and recorded in a drugs return book waiting for the local pharmacy to collect. The drug returns recorded did not show a clear signature or pharmacy stamp, therefore, It was recommended that the home request that the pharmacist stamps the drugs return book to make it clear that the pharmacy has control of all drug returns. Two CSCI surveys completed by health care practitioners agreed that service users medication was appropriately managed in the home. Please see the requirements and recommendation section of this report. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 were inspected. Quality in this outcome area is good. The homes complaints system was accessible and understood the service users and the relatives and safeguarding procedures were respected and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had received several complaints since the last inspection from service users and relatives and the majority had achieved a satisfactory outcome, one complaint was still outstanding and at stage two of the home’s complaints process. The four CSCI surveys completed by relatives of the service users confirmed that they knew how to make complaint if they needed to and all service users completing the CSCI survey in a format that supported their care needs agreed that they knew who to speak to if they were not happy. Service users were observed to be relaxed, well dressed and ease with staff and confidence talking to Inspector about making a complaint if needed. Service users who are not so forthcoming or confidence about making complaints had the support of individual advocates. A previous complainant had written to complement the home and had made the following comment: the more than two years Ive been complaining and complaining and it gives me great pleasure now to praise you. It was recommended however that a national service user advocacy group should be contacted to ensure service users received independent advocacy Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 17 advice as a group during the transitionary-ownership period currently facing the homes. The home and care staff were aware of safeguarding vulnerable adults issues and Langdown and there had been two safeguarding meetings arranged within the last 12 months. Langdown house was committed to Surreys multi -agency safeguarding process and works closely with the local authorities Social Care Team. Regulation 37 notifications are sent to CSCI that records all such notifications of significant harm to service users. Relatives completing the CSCI surveys confirmed that the home usually responds to their concerns. The Annual Quality Assurance Assessment completed by the home stated; Service Users are encouraged to make disclosures and consequently participate in Safeguarding forums where appropriate. The CSCI surveys completed by a health and social care practitioners did showed some concern; when asked to confirm whether care staff responded appropriately to care concerns raised they answered: sometimes, when it impossible to overcome deep-seated objections and usually, staff have listened to any recommendations (made). Please see the recommendation section of this report. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 were inspected. Quality in this outcome area is adequate. Service users benefited from living in comfortable and a homely environment that was close to local amenities but attention to daily routines/maintenance had been neglected and threatened to impinge on health and safety requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two of the four houses, Langdown house and Mallards, and the surrounding area were inspected. Issues relating to the security of the back gardens had not been addressed as required in the last inspection report. Care staff did not feel that the lack of individual locks/bolts affixed to individual gardens was necessary as a bolted gate at the end of a small passageway secured the entrance to the gardens. We (the commission) feel that care staff had considered the security needs of the service users in this instance and would not pursue any further changes. Langdown, the first house and hub of the housing complex was fresh and clean however the decorative state of each house had suffered the wear and tear of Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 19 everyday living and was in need of an ongoing decoration program. Mallards, the second home inspected was in need of good cleaning blitz. It was grubby throughout with dust and dirty services in evidence. The bedroom of a service user, apparently with incontinence needs smelled of urine, the home had arranged for new flooring to be fitted however malodour in service users bedrooms is unacceptable. Service users had access to laundry facilities and were, generally, supported to initiate their own laundry care needs. The commission acknowledges that there is a limit to the extent of home maintenance that can be reasonably expected to be achieved during the transitory ownership period experienced by Langdown and the other homes. Please see the requirements section of this report. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 & 35 were inspected. Quality in this outcome area is good. Care staff were aware of service users care needs and had received good range of training that promoted the health and welfare on the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to the transition of ownership that the homes were undergoing there had been regular staff vacancies occurring. Agency care staff currently employed were familiar with service users as some had been working at the homes for a number of years but it was not clear what level of experience a new agency care worker would bring to the home. Three staff files were examined for evidence of good recruitment procedure all staff had: application forms to written references, and receive regular supervision. Social and health care practitioners completing CSCI survey warned that; use of bank/agency staff means that sometimes important support information is lost. More training in regards to conflict resolution would be useful to staff and their CSCI survey completed by a health care practitioner commented; staff turnover can cause problems. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 21 The AQAA completed by the previous registered manager stated that: Service Users are involved in the recruitment of new staff. Service Users have shown candiates around Langdown and have been involved in the interview and selection process. There were no new employees, possibly due to the transitional nature of the current employment needs of the care home and staff. Agency care staff had received a criminal record check as confirmed by their particular agency on the day the inspection. Care staff files of those on duty throughout the day and night were inspected the information relating to the suitability and train experience received by care staff. A good selection of training was in evidence including: first aid basic food hygiene, safe manual handling, makaton, administration of medication and safeguarding this ensured that service users care needs could be met by the staff on duty over pay 24 hours period. Health and social care practitioners completing the section of the CSCI survey entitled; does the care service respond to the different needs of individual people? Commented: dementia issues are not always responded to appropriately and a comment received from a relative completing the CSCI survey was as follows; We are pleased with the support given regards mental stimulation and employments of those capable to prevent them becoming institutionalised. It is recommended that the homes ensure that any agency care staff used should have evidence training and shown above before they are allowed to work with service users. Please see the recommendation section of this report. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 were inspected. Quality in this outcome area is good. Service users benefited from care staff and management team committed to implementing the national minimum standards consistently with the resources available to minimise the potential disruption facing the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Langdowns sister home situated nearby, was managing Langdown House, the registered manager left in September 2007. The acting manager was very experienced and commanded respect and co-operation from the care staff. Operating an open-door policy care staff, service users and relatives were confident that their concerns, questions and practice issues would be supported by the management team at Langdown. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 23 A recent letter received from a previous complainant who had written to complement the home: I must tell you that you are much liked. The manager was able to support senior care staff from the two care homes due to the close proximity of both homes. The manager was aware of the increased stresses and problems brought on by the sale of the homes and the transition of ownership, was committed to keeping service users, their families and care workers fully informed of any progress. Despite the increase of staff turnover related to the transition of ownership, the manager had ensured that agency staff known to the service users and familiar with their care needs were used whenever possible. Manager and care staff agreed that care plan harmonisation was needed in order for care staff/agency staff to have access to easy-to-read and precise records of service users care needs. Despite the good management and the current level of care support service users received there was evidence that reflected the stress that the service was currently undergoing. Continuity of care was not in evidence in the case of one of the older service users; the home had not implemented a health action plan, a risk assessment relating to potential skin breakdown and general continence care within the home environment. There was no evidence to suggest that the care staff had been able to assist a service user with a relatively simple piece of work. It must also be noted that an opportunity to arrange for service users to receive support of a nationwide independent advocacy group had not been taken at the beginning of negotiations the sale of the home in June 2007. Service users were involved in the majority of decision-making including assistance with new staff selection. The AQAA completed stated that; Regular Service User reviews facilitated by Care Managers inform us that assessed needs are met, and; Weekly Service User meetings take place in each of the houses. A relative completing the CSCI survey in the section entitled; How can the home improve? Expressed concern; Relaying messages to other members of staff when at changeover time. Service users were regularly consulted at weekly meetings and everyday interactions. Care staff were keeping the service users informed about developments being undertaken in relation to the sale of the homes. Care staff acknowledged that the service users were well supported by their families and individual advocates; however, due to the impact of the changes, it was recommended that an independent national advocacy group be involved to represent the service users and offer additional support. There were some health and safety issues such as the matter of the security of the rear gardens, the decorative state of the homes, housecleaning and potential fire hazards. The manager agreed to ensure that all stairwells would be cleared of obstruction for example; the empty cabinet and folders that were observed at the bottom of the staircase at Langdown house. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 24 It was recommended that a fire safety officer carry out a new fire safety assessment as soon as possible. We (the commission) are concerned about the interim arrangements in place covering the transitionary ownership phase of the home; the increase of staff turnover and obvious lack of a full-time manager, the quality rating reflects this concern and relates to key lines of regulatory assessment (KLORA). Please refer to the recommendation and requirement section of this report. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 2 X Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? 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. 2. Standard YA9 YA30 Regulation 13 (4)(c) (2) (b) 16 (2) (j)(K) Requirement The home must ensure that all service users have appropriate risk assessments. The home must ensure that all areas are regularly cleaned and free from malodour. Timescale for action 20/04/08 20/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA18 Good Practice Recommendations It was recommended after a discussion with care staff and the manager determined that all appropriate care plan documentation should be amalgamated into one care plan folder for ease of use and to increase information potential for new/agency care staff. It was recommended that the home request that the pharmacist signs/stamps the drugs return book to make it clear that the pharmacy have control of all drug returns. It was recommended however that a national service user advocacy group should be contacted to ensure service users received independent advocacy advice as a group during the transitionary-ownership period currently facing the homes. DS0000060463.V347682.R01.S.doc Version 5.2 Page 27 2. 3. YA20 YA22 Langdown House 4. 5. YA35 YA42 It is recommended that the homes ensure that any agency care staff are suitably trained and qualified to work with service users. It was recommended that a fire safety officer carry out a new fire safety assessment as soon as possible. Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Langdown House DS0000060463.V347682.R01.S.doc Version 5.2 Page 29 - 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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