Inspection on 18/01/10 for Langford Park Care Home

This inspection was carried out on 18th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Langford Park Care Home Langford Road Newton St Cyres Exeter Devon EX5 5AG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Oliver     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 45 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 45 Information about the care home Name of care home: Address: Langford Park Care Home Langford Road Newton St Cyres Exeter Devon EX5 5AG Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Vision UK Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 34. The registered person may provide the following category of care only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) - maximum number of places 24. Physical disability (Code PD) - maximum number of places 10. The registered person must ensure that additional communal space which is suitable to meet the needs of people whose primary care needs on admission relate to their physical disability is in place and available for use by those service users within six months of this registration. Date of last inspection 0 10 Over 65 24 0 Care Homes for Older People Page 4 of 45 Brief description of the care home Langford Park Nursing Home is situated off the main Exeter to Crediton Road, near the village of Langford, in a rural setting. There are ample parking facilities, but limited access by public transport. Most people living at the home have nursing needs on both the 10-bed wing for Younger Adults with Physical Disabilities and the floors, above, for older service users. The service has a shaft lift to enable people to access all floors, as well as external level access to the first floor. Only one bedroom is registered for double occupancy. Younger and older residents presently share lounge and dining areas. The cost of care ranges between £520-£750 per week for older people requiring residential or nursing care and £600- £1400 for younger adults at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing, some activities and outings and personal items such as toiletries and newspapers. Current information about the service, including CQC reports, is available to people living at the home and to those considering making Langford Park their home. Care Homes for Older People Page 5 of 45 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This inspection was undertaken over 12 hours in one day by one inspector. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 10 people living at the home, 5 staff and 5 health care professionals. Six surveys were completed and returned to us from people living at the home, 5 from staff and 4 from health care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. To help us understand the experiences of people living at this home we looked closely Care Homes for Older People Page 6 of 45 at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and 7 people were spoken with in depth to hear about their experience of living at the home. We also spoke with 6 staff, including the manager, deputy manager and accountant, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Currently fees charged at the service range from: PD from £600 - £1400 Nursing from £520 - £750 General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Copies of the inspection report are available from the office. Care Homes for Older People Page 7 of 45 What the care home does well: The service has produced comprehensive information that is made available to people who are considering making Langford Park their home. Trial visits to the service are encouraged and a senior member of staff from the home will usually carry out an assessment of individuals health and social care needs before anyone is admitted to the home to ensure their needs can be met.[ please refer to what the service could do better] Not all people spoken to during this inspection were able to recall their admission to the home but all expressed satisfaction with the outcome. All people living at Langford Park have individual care plans, risk assessments have also been completed identifying potential health risks and care staff [ please refer to what the service could do better]complete daily reports to give a picture of how people are cared for and how they lead their lives. Medications are stored safely and only experienced, trained staff carries out the administration. Evidence was obtained in various ways through this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. We saw staff assisting people in a friendly, caring and respectful manner throughout this inspection. The home provides activities and has its own transport. Good arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. The home provides a varied menu which people generally enjoy. The home has a range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home are confident that if they have complaints or concerns, they will be taken seriously and action taken to address them. Good recruitment practices ensure people are safeguarded from abuse. In response to surveys sent before this inspection staff told us the service provides pretty good service to service users, provides activities and care as well, creates a warm caring friendly environment, weve got very caring staff. Very good manager and they provide to the residents the best care that they can give. They also promote the independence of each resident and they assist them to socialise with others. In response to the question what does the home do well people living at the home told us, friendly and very helpful. Responses from health care professional In response to the question what does the home do well included high standards in my experience of, care, liaison, support to Care Homes for Older People Page 8 of 45 relatives and prompt actioning of plans, caring staff especially ancillary staff with basic nursing needs being met and communication with all parties. Relatives reported friendly efficient staff. What has improved since the last inspection? What they could do better: One requirement was made as a result of this inspection. Twenty recommendations for good practice were made. The registered person must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of all people living at the service. The service does not consistently assess peoples health and social care needs before they move into the home. Assessments are not consistently undertaken by people trained to do so. People living at the service are not consistently involved in the initial drawing up of their individual care plans, and in regular reviews or kept informed of any revision to the plan. The psychological health of some people living at the home has not been monitored regularly. Care staff have not consistently maintained the personal and oral hygiene of a person living at the home. Care plans do not set out in detail the actions that need to be undertaken by care staff to ensure that all aspects of the health, personal and social care needs of people living at the home are met. Assessments should be undertake to assess the potential risks presented to people from bedrails before they are used. Although the service has a homely remedy policy it has not ensured that homely remedies are agreed by individuals doctor, to ensure they are safe to be given. When creams are prescribed a record is not consistently kept of their application. Plans to improve activities provided at the service should continue to be developed. People should receive a diet which is suited to individual assessed and recorded requirements. The complaints procedure is not be clear and accessible to all people living at and visiting the service and does not include contact details of the Care Quality Commission. Care Homes for Older People Page 9 of 45 Complaints have not consistently been responded to within the procedures timescales. The home should ensure that hygiene is well managed at the home to ensure that the home is always clean, pleasant and hygienic. Not all radiators are guarded or have guaranteed low temperature surfaces. Not all people living at the home are able to control the temperature of radiators in their rooms as the controls are not easily accessible. People should be provided with a means of calling for staff when they are in communal areas, and not depend on more able people to do so for them. There should always be sufficient staff on duty to meet the assessed needs of people living at the home. The service should develop a quality assurance monitoring system, the outcomes of which should be made available to people living at the home and other interested parties, including the Care Quality Commission. A record of any accident affecting a person in the home, or any other incident in the home which is detrimental to the health or welfare of the person should be maintained at the home. 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 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 Older People Page 10 of 45 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 45 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Information gathered prior to admissions to the home would benefit from being more comprehensive and consistent. The home does not admit people who require intermediate care. Evidence: During this inspection we looked at the admission records of two people who had recently moved into the home. We talked to several people about how they chose the home, about the information that was shared, and about the discussions and agreements that were reached on the care they need. Not all were able to remember their admission clearly and generally their admission had organised by relatives or Social Services. We were told that the policy and procedures at the service was that when an enquiry is made by individuals who may want to make Langford Park their home, an Care Homes for Older People Page 12 of 45 Evidence: assessment of their individual health and social care needs is undertaken by an appropriately qualified member of staff. Undertaking an assessment means that before people are admitted to the Home they can be assured that the home is able, in relation to staffing, staff knowledge and environment, to meet their health and social care needs. We looked at the care files for two people who were recently admitted to the home. We noted that no assessment of health and social care needs had been undertaken for one person prior to their recent admission to the home. We were told this was due to the fact that the admission was undertaken quickly as the persons needs could no longer be met at their home. Due to the bad weather a member of staff was not able to visit them at home. Some information had been taken during a telephone conversation with relatives; however this was not undertaken by an appropriately trained member of staff. An assessment of the persons needs was undertaken when they were admitted to the home. Not undertaking a pre admission assessment prior to admission potentially puts people at risk of the health and social care needs not being able to be met at the service. We looked at a pre admission assessment for another person recently admitted to the service. The format used to gather information meets the National Minimum Standards but the actual information gathered was not comprehensive. Also, information gathered detailed the persons needs with no mention of any strengths the person may have. This potentially puts people at risk of losing whatever degree of independence they may have. All prospective residents and, or, their family or representatives are encouraged to visit the home, meet other residents and have a meal if they choose before the decision is made to make it their home. The manager told us that brochures, which provide comprehensive information about the Home, are sent out on request. Displayed in the entrance hall are the Homes Statement of Purpose and the most recent inspection report for visitors and people living at the home to refer to if they wish. All people living at the home who we spoke to, who were able to communicate, confirmed that the home had provided ample information about Langford Park before they decided to make it their home and the home had lived up to their expectations. We sent questionnaires to 10 people living at the home and received responses from 6. All responses confirmed that people received enough information about Langford Care Homes for Older People Page 13 of 45 Evidence: Park before they moved in so they could decide if it was the right place for them. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to : Ensure a copy of the statement of purpose, service user guide, and information relating to individuals named nurse and key worker to be available in all rooms. A statement of purpose and service user guide to be sent out with the offer letter. More communication with families of service uses. To have an updated Service User guide. Retention of staff. To achieve an excellent rating. Update our care plans for a more user friendly and individualised approach. Updated staff training records to be available at all times. The home does not offer intermediate care. Care Homes for Older People Page 14 of 45 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Care plans include basic information necessary to deliver the residents care. Improvement in care planning would support person centred care. Evidence: All people living at the home, who responded to questionnaires, felt confident that the home always(5) or usually (1) met their needs. One person wrote Friendly and very helpful, nursing care is excellent. Nurses are very well informed and keep me informed, regular reviews take place within the home and with outside agencies, the care care manager and another nursing care good. Comments received from a health care professional, in relation to what the service could improve, included improve continuity of care. Prior to this inspection we were contacted by a person who wished to remain anonymous , about several issues of concern, which we inspected during this visit. One issue was that staff are not provided with enough information about people Care Homes for Older People Page 15 of 45 Evidence: before they are admitted to the home, Depends if you are in the right place at the right time. In response to the question Are you given up to date info about the needs of people you support or care for? 4 staff responding to surveys that they were always and 1 usually given information. Staff felt that the service provide to the residents the best care that they can give. Staff we spoke to during this visit did agree that they are not always given information when they are admitted. However, they said that they will spend time with individuals and get to know them and their needs.We were also told that there is a staff handover for each shift when information is provided. All people living at Langford Park have individual files that include information relating to the admission, assessments of their health and social care needs, assessments of risks and care plans. Care plans are the end point of the assessment of the persons health and social care needs and should show what care must be delivered in accordance with the service user plan for that individual. The plan becomes the yardstick for judging whether appropriate care is delivered to the individual and will reflect changes as regular assessment of the person shows changing needs. Information received anonymously prior to this inspection indicated that Care plans are diabolical, too much information but not easy for staff to really find out individual needs We looked, in detail, at the care plans for 3 people living at Langford Park during this inspection. The format/ paperwork the service has for recording information about all people who live at Langford Park is well laid out and prompts comprehensive information to be recorded. However, the files we looked at had not been comprehensively completed. For example the format provides for an observation period to be undertaken by all staff for 3 days following individuals admission to the home. We looked at one file and this had been carried out for only two days. Some aspects of peoples care plans, such as their physical needs, were more detailed than other areas, such as psychological or social needs. For example people who may Care Homes for Older People Page 16 of 45 Evidence: need emotional support or those who may be depressed do not have plans of how these needs will be met. We looked at one care plan that stated the persons general mood continues to be low. No plan of what action was being undertaken to address this or how this need was to be met or monitored had been completed. A risk assessment for a person indicated that staff should report to a doctor if regular tests undertaken by staff, did not fall within the acceptable range However there was no indication of what the acceptable range is. This means that this person may be at risk of this need not being met or monitored. Although information had been included in care plans indicating that some people required bed rails to prevent the risk of them falling there were no assessments of the risks presented by the rails. People told us they always or usually receive the medical attention they needed. However, one care plan we looked at indicated that a person had presented with signs and symptoms of an acute condition which no care plan had been actioned to provide staff with information of how the condition was managed, monitored or reviewed. People we spoke to during this inspection were not aware of having care plans. They could not recall being involved in regular reviews or in the initial drawing up of the plans. This means people may be at risk of not being involved in how care is delivered or in making decisions about how the live their lives. Care files showed that people have access to outside professionals such as G.P, specialist consultants, chiropodist and optician in order to ensure their health care needs are met. Peoples personal care is generally well attended to. People were well dressed and groomed, and attention to their personal care was good. Many female residents were wearing make up and jewelry, one told the inspector, I see the hairdresser regularly. Male residents were smartly dressed and well shaved. Staff spoken with and observed demonstrated a good understanding of the peoples needs and preferences. We saw one person who we were concerned about however. We saw them early in the day, before they had been assisted to wash and dress and noted their mouth was very dry, their lips cracked and their nails dirty. A call bell had been placed on the bed but was not within reach. Care Homes for Older People Page 17 of 45 Evidence: We looked at this persons personal file in detail. We noted that staff had recorded that the person could use the call bell with difficulty but no further information relating to how the person could call for assistance had been recorded. An assessment relating to the risk of the person developing pressure sores had been undertaken and the outcome was that the person was at high risk, but no record of actions to be taken to minimize this risk had been undertaken, although the service had provided a pressure relieving mattress to minimize this risk. A care plan had been completed in relation to management of wounds and included details of actions to be taken including referral to a skin specialist nurse. However, there was nothing to confirm this had been undertaken, as recorded on a wound care assessment dated 5 days later it was recorded ? Referral to skin specialist nurse. Another assessment indicated that the person was at risk of weight loss but no nutritional care plan for meeting, monitoring and reviewing this need had been undertaken. Information recorded at the time of the persons admission indicated that they experienced pain but no plan for monitoring this had been recorded. We returned to this persons room close to lunch time. They had been washed and dressed and were sat out in a recliner chair. Their mouth was still dry and looked dirty. Their lips were dry and cracked. Their finger nails had not been cleaned. We looked at a record of care provided by staff, which is kept in individuals rooms. We noted that they had had a wash, and that nail or mouth care had not been attended to. We saw no fluids or glass in the room. We noted that staff had been asked to ensure that all rooms had jugs of drink and glasses in their rooms, refreshed daily or when needed. When we were in the persons room a member of staff was asked to recline their chair so they didnt fall as they had fallen the previous day. When we checked the record of accidents a report had not been completed for this accident. We were then told that the person didnt actually fall but slipped to the floor from the chair, hence the need to recline it further. We discussed that by reclining the chair the person was at risk of being restrained. No assessment of risks presented by restraining the person had been undertaken. A Registered nurse at the service takes responsible for the management of medication at Langford Park. They order the medications and check them in when delivered to the home. There has been a recent change in the health centre and pharmacy used by the Care Homes for Older People Page 18 of 45 Evidence: service. We were told that since this change the management of medication has improved. The homes medication storage and records were looked at. The fridge used to store medicines is lockable and is stored in a clinical room that is locked when not being used. Other storage was satisfactory, including the arrangements for storing of controlled medicines. Suitable arrangements are in place for the safe disposal of unwanted medication. Medicine Administration Records (MAR) were looked at; where hand written entries had been made, two signatures had been obtained to ensure accuracy, this is good practice. Where variable doses of medication are needed, accurate records were available with the actual dose given. On several occasions, codes were not used where medicine had not been given. Some people are prescribed creams to be applied daily. Records were not completed indicating that this may not be happening. When we spoke to staff we were told that creams are applied but not recorded. Medication with a limited shelf life once open had not been dated to ensure they were used within the timescale suggested by the manufacturer. The home has a homely remedy policy indicating non prescibed medicines that the service uses. This list includes medication that can be bought over the counter such as pain relievers, cough linctus and gastric remedies, and includes timescales they may be given for before contacting a doctor if the problem is not resolved. This list has not been agreed by a doctor, to ensure that they agree with the medications and that they do not interact with prescibed medication. We were told that a doctor is due to visit the home to undertake reviews of peoples medications and they will be asked to look at this policy and to sign to agree to it. People spoken with told us that staff respect their privacy and dignity and during our visit, staff were polite and friendly when delivering care. We saw staff knocking on peoples bedroom doors, waiting to be asked to come in and addressing them in a respectful way. It was evident that staff had established a good rapport with people. Care Homes for Older People Page 19 of 45 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People living at Langford Park are given choices about the way they choose to live their lives. Improving activities provided at the home would further increase the choices people have. The home currently provides meals that people living at Langford Park enjoy. Evidence: Information provided to us prior to this inspection, by a person who wishes to remain anonymous, include an allegation that night staff had to get a certain number of people , who were unable to make a choice, out of bed,washed and dressed in the mornings, starting as early as 5am. We arrived at the service at 5:30 am. We asked staff whether they had assisted people to get out of bed, wash and dress at this time. We were told that they had washed one person who was unable to express their wishes or to communicate at all but this was part of the planned ongoing care for this person who received total care. We visited the person who lacked communication skills and noted that they were comfortable and looked well cared for. Staff were also assisting another person who, we were told, wanted to get up at 5:30am routinely.We spoke to this person who told us they wanted to be assisted early and were grateful to staff for helping me. Care Homes for Older People Page 20 of 45 Evidence: We asked staff whether they were told they had been told to get people up in the mornings, who could not express their wishes or make a choice, they confirmed that they had not. They said several people needed assistance with some personal care early in the morning, but when this was completed and people were made comfortable, they remained in bed and were assisted to wash and dress when they chose. When we arrived at the home one person was dressed and sitting in the dining room having a drink. We were told that the person was independent, got themselves up and was assisted to have a shower later, when the person chose. We were also told that it was not unusual for this person to return to bed later in the morning. We later saw that this was the case. Another person came to the dining room at about 6am and they confirmed that they were also independent and chose to do what they wanted when they wanted. During this inspection we spoke to several people who told us the routine at the home was fairly flexible, one person told us I am free to get up and go to bed when I choose. Prior to this inspection we also received allegations that activities provided at the service are limited. One person returning a survey told us that there were always activities at the home they could take part in, two people felt the service usually and three sometimes provided activities they could take part in. The home employs an activities organiser who divides their time between Langford Park and another service owned by the Company, Vision UK. Langford Park has purchased a mini bus with a tail lift and facilities for people who used wheelchairs. The service has a notice board in the entrance to the service to enable visitors to know the number and designation of staff employed at the home and this is updated daily. According to the information provided for the day of this inspection, an activity organiser was due to be at Langford Park between 10am-6pm. However, the organiser did not come to the home. We spoke to the manager about this and were told that the activities person was at the home only on Tuesday/Wednesday and Friday. Throughout this inspection we did not see staff engaging people in activities, although a person who had previously been very involved in church organ playing, provided us with an impromptu recital, which was enjoyed by all. We were told that when one of Care Homes for Older People Page 21 of 45 Evidence: the Directors had been chatting with the person about what they liked to do before moving to Langford Park found they had had this interest and as a result brought a keyboard to the home. The person told us they got great enjoyment from the keyboard. During the inspection several people stayed in their rooms listening to music, watching TV or reading. People who spent time in the lounge watched a film on television. In response to What could the home do better in surveys people told us, Activities, trips out, entertainment within the home, one to one time when staff sit and talk with my relative and the only improvement that could be made is the activities. We spoke to a member of staff who told us that they were taking a group of people out the following day for a trip in the services mini bus. We looked in the daily reports for a person who told us that they used to go out more and misses not going and would like to go out more and to visit a friend. They said that a carer had told them they would take them to visit their friend but this had not happened. Records indicated the person had gone out twice in October, November and December and had taken part in two activities arranged at the home during that time. Information recorded about this person indicated they were interested in music and football, but no indication of their interest in horses, which they spoke to us about with great enthusiasm. There were no records of the person pursuing their interests in football or music. Two people told us that they are not offered the choice of going out during the eveinings. Staff confirmed that this had not ever been considered. A record of activities undertaken by people living at the home is maintained. Activities provided at the home include board games, crafts, exercise classes, visiting entertainers, outings, skittles and darts. Comments made in surveys returned from staff in response to what does the service do well included They also promote the independence of each resident and they assist them to socialise with others. In response to what could the service improve comments included Need more activities in the afternoon. Comments made by staff during this inspection included that they encourage people to partake in activities and to go out another we do not have time to just spend time with people and talk to them. Care Homes for Older People Page 22 of 45 Evidence: Comments received from a health care professional, in relation to what the service could improve, included Provide more socail interactions and emotional stimulation to some of the more needy residents. There is no restriction on visiting times at Langford Park and throughout the day visitors came to the home and were made to feel welcome. Relatives told us that they could visit at any time and that they felt welcome at the home. Five people responding with surveys felt that staff always listened and acted on what they said and one said this was usually the case. We saw people were given choice throughout the day, for example what they wanted to eat and drink, where they sat, what clothes they wore and people said that they were able to choose when they got up or went to bed. An allegation, made anonymously prior to this inspection, suggesting that food was abysmal, some people would like a cooked breakfast but they only get slops, cook does their best and poor quality food. We were told that the full time cook has recently unwell and staff have been filling in undertaking the preparation of meals. The cook returned to work on the day of this inspection. Surveys showed that 4 people always and 2 usually enjoyed the food served at the home and the majority of people we spoke with during this inspection said they usually enjoyed the meals they were served. They described the choices available and were full of praise for the regular cook. In response to What does the home do well? in surveys comments included Meals, good variety, well presented, Food is good, my (relative) requested cooked breakfast and this was arranged, and chef asks what they would like, if my relative wants odd things the chef will prepare this for them. People can choose where to have their meals and several people choose to eat in the dining room. We saw several people who came to the dining room for breakfast. Tables were not laid and cereal bowls were simply put onto the table with a drink. This looked basic and did not create a comfortable atmosphere. One person came to the dining room and was asked by the cook what they would like for breakfast and were offered a choice. However, the atmosphere in the dining room at lunchtime was convivial; tables were Care Homes for Older People Page 23 of 45 Evidence: laid with table cloths, flowers, cutlery and napkins but none had condiments. We noted people asking for sauce etc, which were provided. Staff were available to assist people in a discreet manner where needed. We saw that people were provided with appropriate aids to enable them to retain their independence. One person told us that they generally liked the meals but they did not like the instant mash, which is served and cant see any reason we cant have proper potatoes mashed with butter. The instant always has an awful taste to it. We visited the kitchen during the preparation of lunch and saw that instant mash had been prepared. We asked why fresh potatoes werent used and were told that the instant had been prepared using cream and milk to ensure that it was tasty. However, a person who was diabetic and whose care plans indicated should have a diabetic diet was served this, which would not form part of a well controlled diabetic diet. The meal served at lunch time consisted of fried egg, vacuum packed wafer thin ham, instant potato, tinned mushrooms, frozen peas, or smoked haddock with fresh cauliflower and broccoli in a cheese sauce. When people are admitted to Langford Park, staff let the cook know their individual likes and dislikes, and this is recorded in a diary kept in the kitchen for this purpose. We checked this and found that details relating to a recently admitted person had been recorded. The cook told us they always visit people when they are admitted to the home to find out what meals they prefer. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends : To ask service users to compile a wish list and then endeavour where possible to carry out these requests. Implement a more social and varied activities calendar. The newly appointed activity staff are working hard to build links with the local community to increase our activity calendar. To purchase a computer and provide training for all our service users to access the internet. To continue to support our service user in booking their annual holiday and extend this Care Homes for Older People Page 24 of 45 Evidence: activity to other service users if required. Care Homes for Older People Page 25 of 45 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 living at Langford Park benefit from the homes complaints procedure and can be confident that any issues they may have are taken seriously and acted upon. Improvement to the presentation of the Complaints procedure and the inclusion of contact details for the Commission will further enable staff to be fully informed of the procedure. People are kept safe and protected from harm or from the risk of harm. Evidence: The home has a complaints procedure, which includes timescales for investigating complaints, is prominently displayed for all those living at the Home and visitors to see and is included in the homes statement of purpose. However, the displayed procedure is not user friendly. The size of print is small and difficult to read and details need to be updated to include contact details for the CQC. The complaints procedure included in the services service user guide, a copy of which, we were told, is given to all people when they move to the home, does not include contact details for the CQC. Details suggest that people look at a copy of the CQC reports in the entrance to the home if they need contact details. Care Homes for Older People Page 26 of 45 Evidence: Information received prior to this inspection indicated that no complaints had been received since Horizon UK took over the service in June 2009-September 2009. During this inspection we were told that two complaints have been made to the service since September 2009. We were not able to assess whether appropriate actions were taken to comply with the services complaints procedure as no records were available to the service. The manager told us that all the paperwork was at the Companys head office as one of the Directors was dealing with the complaints. We saw a letter from a complainant, however, which was querying why the manager had not responded to their complaint. We were told that a meeting is due to be held where this complaint will be discussed. All staff who responded to surveys confirmed they knew what to do if anyone was unhappy about anything at the home. Information received prior to this inspection indicated that a person had been distressed at the general lack of care their relative received because they presented with food in their beard and a stained jumper. We were told a member of staff reassured the person and reported the complaint to the manager. It is alleged that there was no feedback to this complaint from the manager. Five of the 6 people living at the home who responded to surveys agreed that the always know who to speak to if unhappy or wanted to make a complaint, one stated that they did not know how to make a complaint and werent sure if there was anyone they could speak to if they were unhappy. People living at Langford Park who we spoke to during this inspection said that if they were unhappy about anything they would not hesitate to raise any matter at any time and were sure that it would be dealt with to their satisfaction. Staff said that if anyone made a complaint they would report it to either the manager or deputy. People spoken to said that staff were very helpful, respectful and that nothing was ever too much trouble for them. A procedure for responding to abuse is available and staff spoken to were aware of this and the procedures to be followed in the event of an allegation. They were able to describe differing types of abuse and gave good details of what they would do if they suspected abuse was occurring. They were aware of the homes Whistle-blowing policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised concerns about bad practice. Care Homes for Older People Page 27 of 45 Evidence: People spoken to during this inspection praised staff for their kindness and described staff as kind, caring, polite and friendly. They also confirmed that they felt well cared for and safe living at the home. Care Homes for Older People Page 28 of 45 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, 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. 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 benefit from living in a well maintained, comfortable home that is generally clean, fresh. Improvement to some hygiene procedures need to be undertaken. Evidence: Langford Park is well maintained and provides comfortable accommodation including single rooms, some with en-suites, and a lounge/ dining room. Outdoor areas are attractive, with easy access at the front of the home for wheelchair users. We have been told that the service has plans to make front lawn area into sensory garden accessible for wheelchairs with walkways and undercover seating areas and for gardens to be made accessible and appropriate for people living at Langford Park. In response to surveys comments in relation to improvements that could be made at the home included Double glazing, thicker curtains and Need white lines in the car park and separate car park for people working at the home. Prior to this inspection we received information alleging heating at the home is turned Care Homes for Older People Page 29 of 45 Evidence: off at night, some rooms are warm and some are freezing. We arrived at the home at 5:30 am and at that time the home was warm and all rooms we visited were warm and people agreed they were happy with the heating. We spoke to night staff who confirmed that the heating was not turned off between 1am5am, but that if the building was cold, or a person complained of being cold, this can be addressed by resetting the timer. We went in to an unoccupied room which was cold, although a radiator was turned on. This room was being refurbished at the time and windows had been opened. We noted that the temperature control on the radiator was not easily accessible which means that the temperature could not be controlled in the room. We also noted that several radiators had not been covered to reduce the risk of burns to people. We were told that this will be done during the refurbishment programme currently underway. All of the people we spoke to during this inspection told us the biulding was always comfortable and warm. The home is furnished with good quality furnishing and fittings and has a passenger lift which gives access to all the floors. The home has the necessary equipment to assist people and meet their needs including aids, hoists, and assisted toilets and baths which are capable of meeting peoples individual needs. A call bell system and an emergency call bell system is accessible for people to use in their bedrooms. However, there is only one nurse call bell in the dining room/lounge, and this was tied up and not easily accessible to the majority of people in the room. this means that people depend on more able people calling for assistance for them if the need a carer. During this visit one person asked us if we could call for a carer to assist them as they were sat at a dining table and were unable to make their way back to their room without assistance. People living at the home are encouraged to make their rooms personal to them and to be able to maintain a comfortable environment. Several individual bedrooms were visited, with peoples permission, during this inspection, and all were comfortable and personalised with sentimental items, photographs and small pieces of furniture. After recent discussion with people living at Langford Park wall mounted digital plasma screen televisions are now available in every bedroom. Care Homes for Older People Page 30 of 45 Evidence: The home has a programme for redecoration and improvement to ensure that people enjoy a good standard of accommodation. Rooms are refurbished regularly and all rooms seen during this inspection were well decorated and maintained. The upper floor has been refurbished and the service has started to admit people onto this level. The service has a dedicated maintenance team who are at Langford Park on a daily basis and there is a maintenance book where staff communicate any problems. The service also has a dedicated company which deals with all health, safety and fire aspects and are present at Langford on a weekly basis. They also provide the training for staff in these areas. We were told that plans to maintain this continued improvement include building a large lounge/conservatory, replacing dining room chairs, continuing phased replacement of lounge chairs, continue phased replacement of occasional tables, re decorate bathrooms, continue to purchase more profiling beds, continue to redecorate bedrooms and to provide bedspreads that are aesthetically pleasing. The provision of additional lounges will address the need for extra communal areas for younger people living at the home. In response to the question is the home fresh and clean, in surveys received prior to this inspection 4 confirmed it always is and 2 usually. At the time of this inspection the home was clean and free from offensive odours throughout. We had a full tour of the building during this inspection and all, but one, areas were extremely clean and fresh. Hand washing facilities are provided in all rooms and bathrooms to ensure good hygiene practice at the home. Prior to this inspection we received information that gloves and aprons are locked away. During this inspection we noted that hand washing facilities are provided in all rooms and bathrooms to ensure good hygiene practice at the home. Staff are provided with the necessary protective equipment, such as gloves and aprons and we saw supplies of these throughout the home. There is liquid soap and disposable towels in toilets and bathrooms to promote good standards. Prior to this inspection we also received information that 2 cats live at Langford Park. Both of the cats have the freedom of the home, which includes visiting peoples rooms. We were told that one cat is incontinent and staff have to clean this up, although the cleaner sometimes comes behind with a spray.We were told that when Care Homes for Older People Page 31 of 45 Evidence: this is done by care staff a disinfectant or cleaner is not always used. During this inspection, when we were speaking to a person in their room, we saw evidence of the cat being incontinent and also saw a member of staff who was not following the homes infection control procedures when cleaning up. We did discuss this with the manager at the time. One person living at the home told us that although they enjoyed having cats at the home one was frequently incontinent in the dining room, and staff have to clear this up, which isnt their job. The laundry is well equipped; necessary equipment is available, and a red bag system is used for any soiled laundry ensuring staff are protected. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. Care Homes for Older People Page 32 of 45 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Staff employed are competent in their roles to ensure that people living at Langford Park are safe and well cared for. Recruitment practices ensures that they are also protected from potentially unsuitable staff. An Evidence: We received information prior to this inspection that indicated that staff at the home consisted of a registered nurse and 4/5 carers during the day. As part of this inspection we looked at the staff rota maintained at the home and noted that the service aims to have the following number of staff on duty at the home: The manager is on duty Monday - Friday 9am - 5 pm. There is always a registered nurse on duty at the home 24 hours a day. Care Homes for Older People Page 33 of 45 Evidence: An activities coordinator is on duty at the home on Tues/Weds/ Fri from 10am -6pm In addition to the above, between 8am - 2pm, 6 carers, a housekeeper, 2 domestics, a chef, a kitchen assistant, and an administrator are on duty at the home. Between 2pm--8pm this changes to 5 carers and a kitchen assistant who is on duty until 6:30 pm to assist care staff with evening meals. From 8pm - 8am 3 carers are on duty. At the time of this inspection the level of staffing met with the aims of the service. We were told that the service is currently recruiting a registered nurse to join the staff team, to work between 24-36 hours a week. In response to the question Is there usually enough staff to meet the individual needs of all people who use the service and are staff available when you want them 4 people who responded to surveys felt there always were and 1 usually enough staff available to meet their needs. In response to surveys all 5 staff thought there was usually enough staff available to meet the individual needs of people living at Langford Park. Throughout this inspection we noted that staff were busy but met peoples needs in an unhurried manner and were kind and respectful at all times. Staff spoken to during this inspection expressed concern about the staffing levels between 2pm-8am. During this time five care staff and a registered nurse are responsible for people living at the home who have rooms over 3 levels. We were told that 2 staff worked on the ground floor, 3 on the 1st floor and none on the top floor between 2pm-8pm and staff also have to assist with serving meals and currently assist at least 5 people with their meals. People also ask to be assist with care needs and to be assisted to bed and staff feel there are not enough staff to enable this to be done in a timely fashion and are concerned. Comments received from a health care professional included I have been concerned with the recent change of management. There was a sudden large change in staff particularly senior staff. Too many agency staff leading to poor communication of correct information. while the new manager and deputy are hard working and caring I do believe them to be under qualified and overworked and improve continuity of Care Homes for Older People Page 34 of 45 Evidence: care with more permanent qualified and experienced nursing staff. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to undertake assessments indicating dependency levels of the residents to ascertain the staffing levels. All staff agreed they are given training that is relevant to their role, helps them understand and meet the individual needs of people, keeps them up to date with new ways of working and provides them with enough knowledge about health care and medication. One member of staff felt they were not given enough information about health care and medication. We were told that staff received training in the management of medication in June/ July 2009 when the service changed its medication supplier. Staff are also due to undertake a national recognised award (NVQ) at level 2 in medication management. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to ensure that all trained staff undertake a medication administration course and to ensure that all care staff who counter sign for controlled drugs have an insight into what the role involves. All newly employed staff undergoes a period of training when they start working at the home to enable them to get to know the residents, the homes philosophy of care, safety procedure, care procedures, and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. Training is a priority at Langford Park and the deputy manager told us that they have taken a particular interest in coordinating training provided for all staff at the home. Improvements include a new computerised training matrix being developed which includes mandatory training and in addition to this training in management of dementia. All care staff at Langford Park have achieved or are undertaking an NVQ at level 2 or 3. Records of training undertaken are kept for all staff. We saw evidence that after the 21/01/10 all staff will be up to date with manual handling training. Some staff have also undertaken infection control training and all staff have had training in safe management of potentially harmful substances. Training planned included dementia and Parkinsons awareness. Care Homes for Older People Page 35 of 45 Evidence: We received information prior to this inspection that indicated that a member of staff had been employed at the home for 2 months and had not received fire training induction and could not silence the fire panel when a small fire occurred at the home. We discussed this with the manager and directors and looked at records of induction training. We were told that all staff are given fire training as part of their induction training. Also, 6 monthly fire training is provided at the home, but many staff fail to attend. The incident involving the fire panel was also discussed; we were told that following the incident it was found that the fire panel was faulty, an engineer was called out and the home has been inspected since this event and no requirements were made. We looked at three recently employed staff files. All included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, training certificates, health declarations evidence of identity, police checks and references. Staff files are stored in locked cabinets and are only accessible to management staff. This procedure means that people living at the home are protected by the homes recruitment procedure. Care Homes for Older People Page 36 of 45 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 home is generally well managed and run in the best interest of those living there. Attention is needed to ensure that some records are accurate and up to date. Evidence: The manager of Langford Park at the time of this inspection is an experienced Registered Nurse who is supported by a deputy manager, an administrator and the Directors of the Company. The current computer system for recording all training undertaken by staff does not capture up to date details. We spoke to the deputy manager about this and plans are being undertaken to ensure that training records reflect an accurate up to date record of training undertaken by all staff, including dates for refresher training. Care Homes for Older People Page 37 of 45 Evidence: One carer we spoke to clearly described good infection control procedures and they had received recent updates in the procedures. Vision UK became the registered providers for Langford Park in July 2009. Since July a number of improvements in the environment have taken place and plans to further improve the environment and communal space are being undertaken. People living at the home and staff told us that they were aware of planned changes and were kept informed, involved and were happy with this. The Directors of the Company visit the home often and during their visits spend time talking to people living there and staff. It is during these conversations that people are encouraged to let them know their views and wishes. A formal Quality Assurance audit has not been undertaken since the Company took over ownership. One of the directors told us one is planned to be undertaken, which will mean that the views of people living at the home, in relation to the running of, and the quality of life experienced at, the home, will be gathered. Regular relatives and residents meetings are held at the home and minutes, including actions taken to address any issues raised, are kept. Information provided to us prior to this inspection included allegations of bills not being paid, of bailiffs visiting to the home, of an employment agency not being paid and consequently refusing to supply staff and a chiropodist not being paid. We discussed these allegations with the manager, company accountant and Directors. We were told that all invoices are sent directly to the Company Head Office and are dealt with by the accountant. The manager opens post when it is delivered to the home and is not aware of any demands for unpaid accounts. We were told that the Company has been taken to court due to a disagreement with a bill presented by an agency and was not paid by the company. This was done with no communication from the agency following the Companys initial query of the account. We were also told that due to ill health some of the tasks undertaken by an administrator were not completely up to date. Recently, a number of submitted accounts had been discovered and also a number of cheques made payable to the Company. The manager and Directors refuted the allegation that bailiffs had been to the home. Care Homes for Older People Page 38 of 45 Evidence: One of the services Directors visits the home and undertakes unannounced monitoring visits, a copy of which is given to the manager and to the Commission. The temperature of hot water in bathrooms is checked before a person is bathed to ensure they are protected from the risk of scalds. All first floor windows checked were fitted with window restrictors promoting safety within the home by reducing the risk of residents falling from them. Fridge and freezer temperatures are recorded which is good practice. Staff involved in food preparation confirmed that they had food hygiene qualifications. Not all radiators seen during this visit had been covered to promote the safety of people living at Langford Park, but we were told this will be undertaken as part of the refurbishment plans. Most people living at the home choose to have personal finances looked after by their family or legal representatives. The home will keep small amounts of money for people who receive services such as hairdressing, chiropody and other personal items that may be needed. Clear records and receipts are kept of all outgoings. All staff spoken to confirmed that they had all had up to date training in relation to Moving and Handling, although training records did not always reflect this. Risks to people living at Langford Park are individually assessed and documented with an agreed plan in place to minimise risks where possible. during this inspection we noted in a persons daily report that they had had a fall. We checked the homes record of accidents and this had not been recorded. Comments received from a health care professional, in relation to what the service could improve, included have a more rigorous internal significant event process. Information received before this inspection indicated that all equipment is well maintained regularly all of which contributes towards ensuring that Langford Park is a safe place for people to live. Comments made in the surveys returned from people living at the home included when I feel unhappy or uninformed, the staff listen and things happen. I am impressed with the care my (relative) receives. They are very happy at Langford Park. Care Homes for Older People Page 39 of 45 Evidence: The only improvement that could be made is the activities. Communication is good and works both ways. I feel happy and confident to approach anyone at Langford Park with any concern if I had any, another, X is satisfied with all aspects of their care and cannot think of anything that would improve their stay at Langford Park Comments from staff included from the brief time that Vision UK have owned Langford Park, their plans and ideas for the home seem realistic and very achievable, I have been with Langford Park for 21 years. This home has a friendly atmosphere. If I need to go to a nursing home I would like to be at this one and as a carer we are doing our best to take good care of our residents. We also received response to surveys sent to health care professionals and received responses from 4 of the 5 sent. All responses were generally positive and comments included high standards in my opinion of care, liaison, support to relatives and prompt actioning of plans, recent contact with new management has been positive and standards appear to be well maintained, caring staff, especially auxiliary staff with basic nursing needs being met and good communication with all parties. Relatives reported friendly efficient staff. Care Homes for Older People Page 40 of 45 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 Older People Page 41 of 45 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 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 8 12 The registered person must 15/03/2010 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of all people living at the service. To ensure that the health care needs are met at the service 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 1 3 New service users should only be admitted to the home on the basis of a full assessment undertaken by people trained to do so. No service users should move into the home without having their needs assessed and been assurred these can be met. Care plans should set out in detail the actions that need to be undertaken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Page 42 of 45 2 3 3 7 Care Homes for Older People 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 4 7 Assessments should be undertake to assess the potential risks presented to people from bedrails before they are used. Service users should be involved, where practicable, in the initial drawing up of their individual care plans, and in regular reviews or kept informed of ant revision to the plan. Care staff should maintain the personal and oral hygiene of each service user and, whenever possible support the service users own capacity for self care. Service users psychological health should be monitored regularly and preventative, restorative care provided. When creams are prescribed a record should be kept of their application. The service should ensure that homely remedies are agreed by individuals doctor, to ensure they are safe to be given. Plans to improve activities provided at the service should continue to be developed. People should receive a diet which is suited to individual assessed and recorded requirements. This relates to diabetic diets. 5 7 6 8 7 8 9 10 11 8 9 9 12 15 12 13 16 16 Complaints should be responded to within the procedures timescales. The complaints procedure should be clear and accessible to all people living at and visiting the service and should include contact details of the Care Quality Commission. People should be provided with a means of calling for staff when they are in communal areas, and not depend on more able people to do so for them. People living at the home should be able to control the temperature of radiators in their rooms. Radiators and pipework should be guarded or have guaranteed low temperature surfaces. The home should ensure that hygiene is well managed at the home to ensure that the home is always clean, pleasant and hygienic. 14 22 15 16 17 25 25 26 Care Homes for Older People Page 43 of 45 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 18 19 27 33 There should always be sufficient staff on duty to meet the assessed needs of people living at the home. The service should develop a quality assurance monitoring system, the outcomes of which should be made available to people living at the home and other interested parties, including the Care Quality Commission. A record of any accident affecting a person in the home, or any other incident in the home which is detrimental to the health or welfare of the person should be maintained at the home. 20 37 Care Homes for Older People Page 44 of 45 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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