CARE HOMES FOR OLDER PEOPLE
Langholme Arwenack Avenue Falmouth Cornwall TR11 3JP Lead Inspector
Paul Freeman Unannounced Inspection 18th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Langholme Address Arwenack Avenue Falmouth Cornwall TR11 3JP 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) 01326 314512 01326 317577 home.fal@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Care Home 39 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (33) of places Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 33 adults of old age (OP) Service users to include up to 6 adults aged over 65 years with a Mental Disorder (MD E) Total number of service users not to exceed a maximum of 39 Date of last inspection 5th December 2005 Brief Description of the Service: Langholme Residential Home is registered to provide accommodation and care for a maximum of 39 service users. This includes a respite facility for up to four service users who experience confusion for a period of rehabilitation before returning to their home in the community. This service will be withdrawn in July 2006 given funding will not withdrawn by the Commissioners of the service. The home is purpose built and provides accommodation on two floors. There is a large lounge on the first floor and dining room on the ground floor. The home is suitable for a resident who requires a wheelchair, and two lifts provide access to the first floor. An attractive garden is located at the rear of the home and this is also wheelchair accessible. The home and grounds are maintained to a good standard. Langholme is situated a short walking distance from the town centre of Falmouth and the Maritime Museum. All the facilities the town has to offer are within easy reach of the Home. Car parking is available for visitors to the home. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned unannounced inspection took place on 18th and 19th May 2006. The purpose of the inspection was to consider the work that had been undertaken on the requirements and recommendations set at the last inspection on 5th and 6th December 2005 and to inspect the key standards. Therefore some of the key standards that were considered include assessment and care planning, health and safety and staff recruitment. The manager, residents and staff were consulted about the services and facilities provided. The environment, records and documents were also considered. What the service does well:
The Providers have established a satisfactory statement of purpose and service users guide that details the services and facilities provided. Residents’ health needs are well met and medical assistance is promptly accessed when required. Residents said they had confidence in the manner in which the staff took care of their health needs. The evidence indicates that medical practitioners regularly visit the home and that good multi disciplinary working occurs. Residents said they were treated with dignity and were pleased with the manner in which staff undertook their duties. Residents also commented they felt in control of their lives and felt able to direct the care and support provided. The Providers have established satisfactory arrangements to deal with any complaints or concerns raised by residents or their representatives or relatives. The evidence indicates that complaints are dealt with promptly and efficiently and wherever possible a satisfactory resolution is reached. Residents said there were no barriers to raising any issues with the management and staff of the home and were confidant that any matters would be dealt with in a satisfactory manner. Appropriate arrangements are also in place to protect residents from abuse and any concerns are reported to the statutory authorities for investigation. Residents are very satisfied with standard of the environment and the facilities provided. The home is decorated and maintained to a good standard and presents as welcoming and homely. Residents stated they were pleased with Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 6 their bedrooms and the majority of rooms have been personalised by the occupants. Five bedrooms have also recently been redecorated. Some of the bedrooms also have ensuite facilities and a number of bathrooms and toilets are distributed throughout the care home. These facilities are within a reasonable distance from communal areas and residents bedrooms. Speaclist disability equipment is available to residents throughout the home in order to promote and maintain each residents independence and individual residents are provided with appropriate equipment when this is required. The home is clean and hygienic and residents confirmed that a good standard is maintained at all times. The Providers have established robust arrangements for the induction of new staff that occurs over the first six months that staff is in post. Staff recently appointed said they had been well supported and suitable records are maintained. The staff also receives regular training to make sure their knowledge, skills are abilities are up to date. The Providers are committed to treating residents and staff with dignity and respect and in a manner that reflects the residents’ individual needs and preferences. They have established a number of policies and procedures to achieve this outcome and to make sure that everyone is treated in an equal manner. Residents and staff said they had confidence that their treatment was fair and there were no barriers to raising any issues. The residents were also confidant that any issues would be dealt with in a positive manner. A range of measures has also been put in place to assess the quality of the services and facilities provided. Residents are therefore regularly consulted to make sure that every reasonable effort is made to meet individual need and provide a good quality service. The Providers will assist residents to manage their personal allowances where require and there is no other third party available. There are also apparently no concerns about the financial viability of the care home. There are some positive arrangements in place to promote safe working practices for the staff and residents. A detailed health and safety audit has also been completed for the environment that is regularly reviewed. The equipment and services at the home are also appropriately maintained and serviced. The Providers have also established policies and procedures to promote the health and welfare of residents and staff. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 7 Suitable arrangements for fire prevention and fire safety have been put in place to make sure that residents and staff are safeguarded. What has improved since the last inspection?
Each prospective residents needs are assessed by the Providers to make sure the services and facilities are able to meet the needs, preferences and choices of the person concerned. The assessments have improved but continue to be insufficient in scope and detail to provide a suitable picture of the needs of the prospective resident or for the Providers to reach an informed decision if the setting is suitable. In addition some of the residents that had recently been admitted indicated there assessment had not been completed until after they had moved to the care home. The assessments examined were not always complete but there was some evidence the Providers had consulted with speaclist workers that were involved with the prospective resident at the time of their admission. The home also offers a speaclist rehabilitation service for people who experience confusion or mental health issues and require a period of rehabilitation before they are able to return to the community. The service operates alongside the other care provided and has a dedicated coordinator and staff. The staff was appointed following the last inspection and have improved the service and support provided. The Providers recognise that further development is necessary to meet the required standard. Each resident has a care plan but the information provided needs to be more informative to better reflect the actual standard of care provided. Improved care plans will also provide the staff with better guidance and direction about the best ways to meet the needs of the residents. The Providers have established robust arrangements for the storage and administration of medicines and the staff administering medication are all suitably trained. Residents are also able to administer their own medicines when it is safe to do so. Flexible visiting arrangements have been established to enable residents to maintain relationships with their families and friends. There are regular visitors to the home and residents said that the staff always positively welcome all visitors. Residents are able to decide where they meet with their visitors and staff will support residents if they do not wish to see a visitor. Residents’ stated the meals at the home were “very good” and a nutritional and varied menu is provided. Residents have a choice of what they eat at each
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 8 mealtime and residents stated that every reasonable effort was made to meet their personal preferences. The kitchen is appropriately equipped and the kitchen staff is suitably trained. The equipment in the kitchen is regularly maintained and serviced and generally the health and safety practises are satisfactory. Recreational and leisure opportunities are improving at the home and the recent appointment of an Activities Coordinator has assisted the development of opportunities for residents. A programme of activities is in place that reflects the residents’ choice but some residents commented that this area could be further developed. Other residents said they prefer to manage their own leisure time. The manager said they are establishing regular occasions for residents to be consulted about the recreational and leisure opportunities available. The environment was less cluttered and the manager is developing plans to improve the storage facilities. There is a minimum of five staff is on duty during waking hours and waking night staff are employed each night. Additional staff is also employed where required to meet the individual needs of residents. Given the concerns at the last inspection that sufficient numbers of staff were employed the position has been improved and the managers continues to review the arrangements to make sure that residents needs are not compromised. The new manager has also improved the recruitment selection and vetting arrangements to make sure they comply with the Provider’s detailed policy and procedure. The records of staff that have recently been recruited indicated a robust procedure but some of the records required by regulation were not in place. The Induction arrangements for new staff have also improved. The Providers have established a suitable format for a comprehensive induction to take place over the first six months of employment. The records about induction were also found to be up to date. A new substantive manager was appointed by the Providers to manage the facilities and services and the manager commenced duties in February 2006. The manager has a wide range of experiences in the social care sector and has applied to the Commission to be the registered manager of the care home. The application is currently under consideration. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 9 Residents and staff at the home said the manager had made a positive impact on the services and facilities provided and were confidant that any issues or concerns would be dealt with in a positive manner. The Providers have improved the records that are kept about any assistance they provide to residents to mange their personal allowances. This makes sure that a detailed record of all transaction is in place that is regularly audited. Records at the home have improved but in certain instances the improvements are at an early stage. The risk management and risk assessments arrangements have also improved but there continues to be occasions where risks are not appropriately taken into account. In addition some of the guidance to staff about positively managing risks an individual resident experiences need to be more detailed. The Fire safety and fire prevention measures need to improve given the records about the maintenance and review of certain equipment were incomplete. In addition there was limited evidence that regular fire drills occur. What they could do better:
The statement of purpose and service users guide will required review and revision during the summer given the planned changes to the service. These include the appointment of a new manager and the planned withdrawal of rehabilitation services for older people who experience confusion. The indication are that care plans are regularly reviewed with the residents but the records of the review are limited and would benefit from more detail about the areas considered, any agreements that were reached and any action that is required. Records about the visits of medical practitioners also need to be improved and provide clear guidance and information about the conclusions of the visits and any action the staff is required to take. The alcove in the dining room is a multi purpose area where some residents eat and it also contains a sink, kitchen units and acts as a storage area. This part of the facilities should be improved. The manager said that plans were being established to bring this area up to the standard of the main dining area. Three of the communal bathrooms do not meet the required standard and need to be improved given they are in a poor condition and state of decoration. The records regarding recruitment selection and vetting require improvements to make sure the Providers comply with the regulations. In addition the staff
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 10 are not provided with individual training plans for the year ahead and there is no annual training programme in place for the care home. An annual report needs to be written for residents and interested parties that summarises the finding of the quality assurance review. The report also needs to state any actions the Providers are taking to address any individual needs or shortfalls in the service. Some of the records about the management of residents’ personal allowances need further improvement in order to meet the required standard. A number of records at the home were found to be incomplete, insufficiently detailed or were not in place. 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. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 12 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. The homes statement of purpose and service users guide provides residents and prospective residents with details about the service and facilities provided. The documents require further revision given the panned changes to the service. The arrangements to assess prospective residents are not satisfactory and do not provide sufficient information about the needs of the person concerned. The speaclist rehabilitation service for residents that experience confusion or mental health issues require further improvement to make sure a robust and user lead service is in place. EVIDENCE: The statement of purpose and service users guide has been reviewed over the last year and reflects the current services and facilities provided. A further revision will need to take place given the withdrawal from July 2006 of funding by the commissioners of the dedicated rehabilitation service. In addition the
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 13 document also needs to accurately reflect the management arrangements at the home. Prospective residents are assessed by the Provider to determine their needs, preferences and choices. The assessments also enable the Provider to determine if the care home is able to meet the needs of the person concerned. The Providers have established a format for recording the assessments and it was found that some of the assessments were incomplete. In addition the information provided in assessments was in a number of instances insufficient in scope and detail. This limits the Providers ability to be satisfied the services and facilities are suitable to meet the needs of the person concerned. The records indicated that a number of the people assessed were also in regular contact with speaclist workers including social workers and nurses. There was some evidence to indicate the opinions of speaclist workers had been taken into account. Therefore there has been some improvement in the assessment arrangements but further developments are required to meet the required standard. Residents that have recently moved to the home confirmed they were consulted about their needs but on certain occasions this only appears to have occurred after the person had been admitted. The residents said they had been well received at the home when they were admitted and were positive about the manner in which the staff provided the care and support they require. The home provides a dedicated rehabilitation service for residents that experience confusion and act as a bridge to help them return to the community. This is a commissioned service by Cornwall County Council and a satisfactory contract has been established about this speaclist service. The service has been improved following the last inspection. An experienced senior staff member and two core members of the care team have been put in place to take the lead roles in the service provided. Consequently there was evidence that assessment and care planning arrangements had been strengthened. The manager and staff said they were aware that further improvements could be made. Other forms of intermediate care or rehabilitation services are not provided at the home. The Providers are however committed to maximising residents’ independence as part of the care and support they provide to the residents. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 14 Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 15 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Further attention needs to be given to developing care plans so they provide a rounded picture of the care required to meet the assessed needs. The care plans are regularly review but the records of the review should be improved. Residents’ health needs are well met and there is evidence of good multi disciplinary working. The records about visits by health professional are not satisfactory and do not provide staff with adequate guidance about the care and support required. Satisfactory arrangements are in place to administer medicines in a manner that promotes residents health. EVIDENCE: Each resident has a care plan, which is designed to detail their needs, preferences, and choices regarding the care and support they require. The information in the care plans has continued to improve in certain areas but in other areas does not provide sufficient information, direction or guidance to staff about the care and support required. The plans do not always indicate where a resident is able to direct their own care or if staff need to anticipate or be aware of a residents needs and safety. It is evident that experienced staff
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 16 has developed a good rapport with residents and have a good understanding of the residents support needs. Residents said they were generally satisfied with the manner in which the staff meet their needs and provided the care and support required. The evidence indicates that care plans are reviewed with residents but in certain situation the frequency was unclear. Most residents were aware they were consulted about the care and support provided but were unclear what action was taken if they raised any issues. To assist arrangements the manager is in the process of establishing a named key worker for each resident. The staff commented the care plans had improved and provided reliable information about the care and support required. The records of reviews are limited and do not always detail what was discussed, any agreement that was reached or if additional action is required. Residents said they had confidence in the manner in which their health needs are met and commented that medical services were accessed promptly when required. The evidence indicates that General Practitioners and nurses regularly visit the home. On the days of the inspection two District Nurses attended to different residents and other health professionals also visited the home. However some of the records did not clearly indicate when visits had taken place or record any conclusion or the medical guidance provided. When it is safe to do so residents are able to manage their medication but staff also assist where required. The Providers have significantly improved the arrangement for the storage and administration of medicines that now meet the standard required. Medicines are kept in secure faculties in good order and suitable records are maintained. The staff administering medicines is all trained and a good relationship is in place with a Pharmacist. Medicines that are no longer required are disposed of safely and a suitable policy and procedure is in place to guide, direct and inform the staff. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Residents are encouraged to have control over their lives but there are potential limitations for certain residents given their communication difficulties. The opportunities to participate in valued social and recreational activities continue to improve to make sure that residents’ needs and preferences are met. Dietary needs of residents are well catered for with a balanced and varied selection of food available the meet residents tastes and choices. EVIDENCE: Residents said the routines of daily life were flexible and met with their expectations. Flexible visiting arrangements are in place and residents said that the staff always positively welcomed visitors. Residents are able to decide where they meet with visitors and the staff will support the resident if they decide not to have any contact with a visitor. The Providers have established a range of activities at the home and in the local community that reflect the interests and pastimes of residents. Most of the residents were pleased with the arrangements in place but others thought
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 18 the programme could expand further. Some of the residents choose not to participate in the activities provided and prefer to manage their own recreational opportunities. The care plans in place generally do not address the social and recreational needs of resident adequately and in some instances no records have been made. However the Providers have recently recruited an activities coordinator and therefore the opportunities and service provided is developing. The residents were very positive about the food provided at the home. A varied nutritional menu is in operation and residents have a good choice at each mealtime. The kitchen also provides a ‘meals on wheels’ service to around thirty local people each day. Dietary needs of residents are well catered for with a balanced and varied selection of food available the meet residents tastes and choices. The kitchen facilities have also been improved to make sure that residents’ health and safety are not potentially compromised. Further attention needs to be given to the kitchen floor given it contains a number of cracks that could be potentially hazardous to the residents and staff health and safety. The kitchen is appropriately staffed and the staff concerned is trained to the required standard. Appropriate equipment is in place that is regularly serviced or replaced when required. There was also evidence that appropriate health and safety practices are in operation. Regular opportunities are also in place to consult with the residents about the meals provided. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Satisfactory arrangements are in place for dealing with any concerns, complaints or allegations of abuse. This makes sure that residents are protected and are able to raise any issues of concern. EVIDENCE: The Providers have established a satisfactory complaints policy and procedure. The Provider or Commission following the last inspection has received no complaints. Residents said there were no barriers to raising any issues or concerns with the managers of the home. The residents were confidant that any issues would be dealt with promptly. A satisfactory policy and procedure has been established by the Providers for also dealing with any concerns or allegations of abuse. Any issues of concern are reported to the statutory authorities for investigation to make sure that every reasonable step is taken to protect residents. A whistle blowing policy is also in place. This enables staff to report any concerns to a third party if they feel unable to directly raise the issue with the Providers. This provides residents with further measures of protection. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. The standard of the environment is satisfactory and provides residents with a homely setting. The three communal bathrooms, the storage arrangements and one area of the dining room require improvement. EVIDENCE: The care home is a two-storey building that has bedrooms and communal areas that are located in the centre of the home on both floors. The home is located near to the centre of Falmouth and therefore a wide range of facilities is within easy access. The care home is maintained and decorated to a satisfactory standard. The manger has recently reviewed the facilities and made arrangements to improve certain areas. This includes the dinning room, redecoration of bedrooms and the replacement of the carpets in certain communal corridors. At the time of the inspection an annual plan of redecoration and refurbishment had not been established. Car parking is provided at the front and one end of the building and there are attractive accessible gardens to the rear.
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 21 The dining room is situated on the ground floor and the sitting room on the first floor. Two lifts are provided to ensure residents have easy access to both areas. A large dining room is located next to the kitchen and overlooks the garden on two aspects. The room is principally a large oblong room with a small alcove next to the internal entrance. Apart from the alcove the dinning room is carpeted and provides a positive setting for residents to take their meals. The alcove is not carpeted and also is a multi purpose area that has a sink and kitchen units as well as a storage area for other items. The manager stated this area is being reviewed in order to mirror the standard provided in the main dining area. The bedrooms are situated at the two ends of the home and the corridors are painted different colours to assist residents’ orientation. A number of bedrooms are provided with ensuite facilities and there are adequate toilets and bathrooms located throughout the home. These facilities are within a reasonable distance of the communal areas and residents bedrooms. Three of the bathrooms are very tired and require redecoration and improvement at the earliest opportunity. This will also make sure that residents’ health and safety are not potentially compromised. It is evident that a wide rage of disability equipment is provided throughout the care home to assist residents to maintain their independence. In addition residents are individually provided with equipment when this is required following the completion of a speaclist assessment. Residents said they were very satisfied with the facilities provided and the majority have clearly personalised their own rooms. The home is clean and hygienic and no offensive odours were evident. Residents stated that good standard of hygiene and cleanliness was maintained at all times. Storage at the home continues to be a challenge but the environment was relatively tidy and had improved from the last inspection. The manager said they were continuing to consider how the storage arrangements could be improved. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The care staff arrangements have been reviewed and refined so that sufficient numbers of staff are on duty to provide the care and support required. The domestic staffing arrangements require improvement to make sure sufficient staff are employed to provide a healthy and hygienic setting. The recruitment and selection arrangements have also been improved but the records do meet the required standards. New staff undergoes a period of induction to make sure they are able to provide the care and support required. The staff group are also appropriately trained in order that their skills and knowledge are up to date. However the Providers have not established an annual training programme for the staff group or individual training plans for the year ahead. EVIDENCE: The staffing arrangements have been reviewed following the last inspection and five care staff is on duty for waking hours. In addition the deployment of waking care staff has been reviewed and adjusted and this has also provided some additional hours for direct care. Two waking care staff are employed each night to provide the care required and reliable “on call” arrangements are in place if any emergencies occur. The manager said that staffing levels continued to be reviewed and monitored and additional staff was employed when required by residents needs.
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 23 Domestic staff is also employed at the home each day and this includes staff that are employed in the laundry. The roster indicated that due to annual leave and sickness there has recently been a reduction in the number of domestic hours. Maintenance staff is also employed and the residents said that any repairs were dealt with efficiently and competently. Staff that have been recently recruited have undertaken a comprehensive induction programme to make sure they are able to provide the care and support required. Staff is also provided with training opportunities and the Providers are committed to staff undertaking NVQ training. In addition other core training occurs to make sure that staff have the information, knowledge and skills and abilities to provide a good quality of care in a manner that does compromise safety. However the Providers have not established an annual training programme for the staff group or individual training plans for the year ahead. The new manager has also improved the recruitment selection and vetting arrangements to make sure they comply with the Provider’s detailed policy and procedure. The records of staff that have recently been recruited indicated a robust procedure but some of the records required by regulation were not in place. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38. An experienced manger has bee appointed who has applied to the commission to be the registered manager. This has improved the management arrangements and there are positive indications for the services and facilities in the future. The Providers have established reliable quality assurance measures to make sure the home is run in the best interests of the residents. The providers are committed to treating residents and staff in a manner that promotes equity and diversity. The Providers will assist residents to manage their personal allowances but the records require further improvement to make sure there is clear evidence of the manner in which the monies have been managed. . The Health and safety practices and the records at the home continue to improve but further development is required. This will make sure that residents safely receive the care and support they require.
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Providers appointed a new substantive manager who took up the post in February 2006. The Manager has applied to the Commission to become the Registered Manager and the application is currently being determined. In addition the manager has also applied to the Commission to be the registered manager for the Domiciliary Care Service that operates from the care home. The manager has extensive experience in the field of social care and is currently completing the Registered managers Award. It is evident the new manager has improved the management arrangements and provided a clear structure for operational staff. This has included reviewing the roles and responsibilities of senior staff. The staff group were positive about the impact of the new manager and had confidence in their skills and abilities. A senior member of staff is also on duty for all waking hours make sure that the staff is suitably supported. Residents said they had been satisfied with the manner in which the new manager had introduced herself and commented they had made a positive initial impact. The manager stated that senior staff of the organisation regularly undertakes regulation 26 visits to the care home to make sure the services and facilities meet the required standards. No reports of the visits are being received by the Commission as required by regulation. The Providers are committed meeting good standards of practice in relation to all aspects of equity and diversity. To achieve this a wide range of policy and procedures have been established that provide clear direction to managers ands staff at the home. In addition the individually focused approaches that are taken wit residents make sure that individual needs, choices and preferences are accommodated as far as possible. The Providers have also established a range of measures to review the quality of the services and facilities provided. The measures inclued regular opportunities to consult with residents and during the inspection three staff were consulting with residents and staff about different elements of the care
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 26 and support provided. In addition the manager had met with residents to consider the best arrangements for consultations to occur and further meetings were planned. The manager said that quality assurance was also considered at each resident’s monthly review and any issues or concerns were highlighted. The manager plans to develop more quality assurance measures that are user friendly to make sure that comprehensive arrangements are in place. In addition an annual report will be produced by the end of the year for residents and interested parties that details the finding and any action that is planned. The Providers will assist residents to manage their personal allowances where there is no third person available to offer assistance. A record is made of each transaction and the records have improved following the last inspection but one of the records sampled was found to be incomplete. The Providers also complete an annual financial “health check” that was recently undertaken and concluded that satisfactory arrangements are in place. However it is the stated intention that where assistance is given to residents to manage their personal allowances the records will be audited each month. There was only limited evidence this occurs on a regular basis. The records at the home are continuing to improve but as detailed in this report a number records do not meet the required standard. There are some positive arrangements in place to promote safe working practices for the staff and residents. A detailed health and safety audit has also been completed for the environment that is regularly reviewed. The equipment and services at the home are also appropriately maintained and serviced. The Providers have also established policies and procedures to promote the health and welfare of residents and staff. The Providers have also established robust policies for fire prevention and fire safety. However the records did not confirm that the fire equipment was regularly checked and there was little evidence that regular fire practices occur. The manager said they were aware of the current shortfalls and plans were being put in place to make sure robust and reliable arrangements occur. The risk assessment and risk management arrangements are good for the environment but continue not to be satisfactory for residents and staff. Although the arrangements have improved there still continues to be occasions where risk assessment are not always completed when a situation arises that could potentially compromise the health, safety or well being of the individuals concerned. In addition some of the risk assessments that had been completed did not provide staff with sufficient information, direction or guidance. Where assessments had been completed there was some evidence of improvement.
Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 3 X 3 2 3 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 2 X 2 2 Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 28 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. Standard OP1 Regulation 4(1)(a-c) 5(1)(a-f) Requirement The statement of purpose and service users guide must be reviewed and revised. Timescale for action 30/07/06 2. OP3 14(1)(a-c) Service Users assessments of 30/09/06 need must comprehensively detail the needs and where appropriate the most appropriate means of meeting the needs. 15(1)(a) Service users care plans must be developed to ensure that all care needs are identified and appropriate interventions and actions to meet these needs are available to all care staff. Service Users social and recreational opportunities must be develop to reflect their choices ans preferences. The flooring of the kitchen area must be improved. The fabric, decoration and furnishings and floor coverings must meet the required standard.
DS0000009108.V295982.R01.S.doc 3. OP7 30/08/06 4. OP12 16(2) (m-n) 30/08/06 5. 6. OP15 OP19 16(2)(g) 23(1)(a) (2)(b)(d) 30/08/06 30/09/06 Langholme Version 5.2 Page 29 7. OP21 23(1)(a) 2(j) Three of the communal bathrooms must be redecorated and refurbished to the required standard. Sufficient storage space must be provided. Sufficient numbers of domestic staff must be on duty at all times. Records required by regulation for the recruitment, selection and vetting of staff must be in place. An annual training programme for the staff group and individual training programmes for each staff member must be in place. A registered manager must be appointed who holds or is in the process of obtaining the registered managers award. Monthly visits as required by regulation must occur and a report of the findings must be sent to the Commission each month. A report of the findings and any action plan regarding the Quality assurance audit must be sent to the Commission each year. Accurate records must be maintained of the personal monies the Providers assist service users to manage. 30/07/06 8. 9. OP25 OP27 23(2)(l) 18(1)(a) 30/10/06 30/06/06 10. OP29 19(1)(b) sch 2 30/07/06 11. OP30 18(1)(c) 30/09/06 12 OP31 8(1)(a) 18(1)(a) 30/09/06 13. OP31 26(2) (5)(a) 30/06/06 14. OP33 24(1)(2) 30/11/06 15. OP35 17(2)Sch 4 (9) 30/07/06 16. OP37 17 The records required by 30/08/06 regulation must be maintained to the required standard. Risk assessments must be
DS0000009108.V295982.R01.S.doc 17. OP38 13 30/06/06
Version 5.2 Page 30 Langholme completed on each occasion an accidents or incident occurs or there are any concerns about the safety of service users or staff. . (Previous timescale of 30 August 2005 not met). 18. OP38 23(4)(a) (c)(e) Robust fire safety and fire protection measures must be in place. 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP8 OP19 OP20 Good Practice Recommendations The content and decisions of service users reviews should be fully recorded. A record should be kept of any visits undertaken by a health professional that detail the conclusions and any directions about the acre and support required. A written annual plan of redecoration and refurbishment should be in place. The alcove in the dining room should be reviewed to improve the facilities provided. Langholme DS0000009108.V295982.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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