CARE HOMES FOR OLDER PEOPLE
Langholme Arwenack Avenue Falmouth Cornwall TR11 3JP Lead Inspector
Paul Freeman Announced Inspection 5th December 2005 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.V258820.R01.S.doc Version 5.0 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.V258820.R01.S.doc Version 5.0 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 313577 Methodist Homes for the Aged Mrs Susan Kings 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.V258820.R01.S.doc Version 5.0 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 6th June 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. 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.V258820.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned announced inspection took place on 5th and 6th December 2005 and lasted for twelve hours. The Inspector looked over the building and at a number of records and documents. Seven of the residents, seven of the staff and the acting Manager were spoken to. Before the inspection the Providers had sent written information about the services and facilities provided by the care home. Some progress towards compliance had been made on certain requirements and set at the last inspection. Limited or no progress had been made on other requirements that were set. What the service does well:
Residents that had recently been admitted to the home said the staff had warmly and positively greeted them. 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. 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 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. 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
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 6 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 for abuse and any concerns are reported to the statutory authorities for investigation. Residents stated that staff made every reasonable effort to be flexible, responsive and to meet needs according to their individual choice and preference. The evidence indicates the Provides and staff make efforts to provide care and support in a manner that promoted the residents independence and gives each person control over their lives. The Providers have also established reasonable arrangements to measure the quality of the services and facilities provided and this includes consultations with residents and their visitors. The staff stated they are well supported at the home and advice, guidance and assistance is readily available when required. The staff said there is a good team spirit and commented they work well as a team in a mutually supportive manner. The Providers have established satisfactory policies and procedures to promote safe working practices for residents and the staff. Good arrangements are in place to make sure the environment is safe and any unreasonable risks are minimised. What has improved since the last inspection?
The Providers have established a satisfactory statement of purpose and service users guide. The statement of purpose summarises the services and facilities provided at the home and details the staffing and management arrangements as well as the philosophy of care. The service users guide is given to all prospective residents and this provides the individual with appropriate information about the services and facilities provided. 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 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
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 7 the areas considered, any agreements that were reached and any action that is required. 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 their bedrooms and the majority of rooms have been personalised by the occupant. 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 records at the home continue to improve but further development is required. This is illustrated by some of the residents and staffs documentation that were found to be incomplete. 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. What they could do better:
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 are 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 and there was no evidence the Providers had consulted with any 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
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 8 operates alongside the other care provided and does not have dedicated staff or any alternative management arrangements. Some of the staff said they did not feel appropriately trained to provide the care or support required. Other staff did not feel sufficient time or resources were available to provide the rehabilitation required. The arrangements are in need of review by the Provider. The arrangements regarding the storage and administration of medication require urgent attention. A number of shortfalls were identified regarding the storage of medication, the disposal arrangements and the records. An Immediate requirement was set for the shortfalls to be improved by 13 December 2005. In addition it is recommended that staff administering medication receive accredited training. The kitchen is in need of redecoration to make sure that a safe and healthy environment is provided. In addition the kitchen flooring is showing signs of wear and tear and requires attention. Residents generally said they felt in control of their lives and the care and support provided. However some of the residents commented they found it difficult to communicate effectively with certain staff members and this is an area that requires further consideration and action by the Providers. Where a compliant is made the Providers need to make a suitable record of the complaint and any action that is taken. 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 reviewing with a view to improving the experience for the diners concerned. Storage of equipment and other items also needs to be considered. There appears to have been an increase in the number of items stored in communal corridors following the last inspection. This created an impression of untidiness and could potentially place residents at risk. There is a minimum of four staff on duty during waking hours and waking night staff are employed each night. Additional staff is allocated to work during peak times each morning but the available hours are utilised over three days. The Providers have also made provision to appoint an Activities Coordinators but the post is currently vacant. The Manger said the rostered staff were supporting the programme in the interim but there was no evidence that additional staff had been employed to met the shortfall. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 9 In addition there are some concerns if sufficient numbers of staff are employed to meet the needs of the residents that experience confusion or mental health issues. Recently the Providers have recruited six workers from the European Community. Residents and staff commented that some of the staff although keen to provide the care and support required experienced communication difficulties. The staffing arrangements therefore need to be urgently reviewed to make sure that residents’ needs and safety are not compromised. In addition the Induction arrangements for new staff require urgent attention. The Providers have established a suitable format for a comprehensive induction to take place over the first six months of employment. However the records sampled were incomplete and therefore indicate that new staff had not been comprehensively introduced to their roles and responsibilities. There was also no evidence that staff from other European countries had been offered any additional assistance to make sure they could communicate effectively with residents. There appear to have been some limitations in the temporary management arrangements that were established following the departure of the Registered Manager. It now appears that appropriate steps have been taken to make sure that reliable arrangements are in place. The Providers will assist residents to manage their personal allowances or pocket monies where required and no third party is available. The record keeping arrangements are not satisfactory and need to be more detailed. 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.V258820.R01.S.doc Version 5.0 Page 10 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.V258820.R01.S.doc Version 5.0 Page 11 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 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 urgent review to make sure sufficient resources are provided and a robust and user lead service is in place. EVIDENCE: The statement of purpose and service users guide have been reviewed and developed following the last inspection and now meet with the national minimum standards. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 12 The statement of purpose summarises the services and facilities provided at the home and details the staffing and management arrangements as well as the philosophy of care. The acting manager stated that the service users guide is given to all prospective residents and this provides the individual with appropriate information about the services and facilities provided. Prospective residents are assessed by the Provider to determine their needs, preferences and choices. The assessment should also enables 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 many of the assessments were incomplete. In addition the information provided in the assessment was insufficient in scope and detail to clearly outline the persons needs or clearly satisfy the Provider the service could 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 no evidence to indicate that any consultations had occurred with speaclist workers or that a copy of their assessment had been obtained. It is of concern that the recent improvements in the assessment arrangements at the home have not been sustained. 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 the Social Services Department and a satisfactory contact has been established about this speaclist service. This service is not managed differently to the other care provide at the home and there are no dedicated staff to work with the residents concerned. In addition some of the staff commented they did not have the required skills or appropriate training to meet the needs of the residents concerned or to work in the rehabilitative manner required. Other staff did not feel that sufficient time was allocated or available for residents to receive an appropriate package of rehabilitation. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 13 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.V258820.R01.S.doc Version 5.0 Page 14 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 and 9. 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 systems for the administration of medication are poor and potentially place residents at risk. EVIDENCE: Each resident has a care plan that details their needs, preferences and choices regarding the care and support they require. The information in the care plans has improved 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 has developed a good rapport with residents and have a good understanding of the residents support needs.
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 15 Residents said they were 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. 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. When it is safe to do so residents are able to manage their medication but staff also assist where required. Medicines are stored in secure facilities but the storage arrangements would benefit from improvement. In one area the disposed medication and the nighttime medication are stored in open boxes next to each other and more secure arrangements are required. Next to these medications was a number of Pharmacy bags that contained prescribed medication for users of the Domiciliary Care Service that also operates from the care home. The medicines were not stored in any container and the Inspector established there is no formal record of Providers receiving or distributing the medication concerned. The arrangements to dispose of medicines that are no longer required needs further improvement given the records of the medicines for disposal were incomplete, inaccurate and did not reflect the actual medicine that had been placed in the nominated box. A secure fridge is also provided for medicines and preparations that need to be refrigerated. The temperature of the fridge is regularly monitored and medicines stored in the fridge are appropriately dated to make sure their shelf life is not compromised. The records about the administration of medication (MAR sheets) are not always completed as required. The records about the administration of control drugs were in good order and the medicines are stored securely. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 16 All staff that administers medication has been trained by a Pharmacist and an appropriate Pharmacy agreement is in place. It is recommended the Providers consider more detailed training in the storage and administration of medication. An Immediate requirement was set at the Inspection for the storage, administration and disposal arrangements to be improved. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 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): 13, 14 and 15. Positive and flexible visiting arrangements are in place to enable residents to maintain contact with family and friends. Residents are encouraged to have control over their lives but there are potential limitations given certain communication difficulties. 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 would benefit from improvement to make sure that residents’ health and safety are not potentially compromised. EVIDENCE: 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. Residents said they were generally satisfied with the care and support provided by the staff. Residents stated the staff were willing to provide the assistance required and were generally available to respond to their needs. In certain
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 18 instances the residents felt there were some communication issues with certain staff employed at the home and this is addressed further later in the report. Overall the residents who are able to direct their own care said they felt in control of their lives and were able to exercise choice. For residents who are unable to direct their own care the arrangements in place are less transparent but it was noted that staff do conduct themselves in a compassionate and helpful manner. 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. The kitchen is appropriately staffed and the staff concerned is trained to the required standard. Appropriate equipment that is regularly serviced and maintained is provided and in good working order. There was evidence that appropriate health and safety practices are in operation but the decor and flooring require improvement. The decor is looking tired and in certain areas the paint on the ceiling is flaking. The flooring is also showing signs of wear and tear and could potentially be a risk. The evidence indicates that kitchen staff regularly consult with residents about the food and menu provided. Residents said they had confidence in the kitchen staff who made every effort to meet their individual preferences and choices. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 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. The records regarding complaints must be maintained and available for scrutiny to evidence that issues raised with the Providers have been dealt with satisfactorily. EVIDENCE: The Providers have established a satisfactory complaints policy and procedure and have received one complaint following the last inspection. The Manager stated the complaint had been dealt with according to the procedures and a satisfactory resolution had been reached with the complainant. Unfortunately the records about the complaint were not available. 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 and 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.V258820.R01.S.doc Version 5.0 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 good and provides residents with a homely setting. The storage arrangements and one area of the dining room would benefit from improvement. EVIDENCE: The care home is a two storey building that has bedrooms and communal areas that are located in the middle 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 good standard and an ongoing programme of maintenance and redecoration is in place. Car parking is provided at the front and one end of the building and there are attractive accessible gardens to the rear. 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.
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 21 The sitting room is attractively laid out and furnished to a good standard. Wherever possible domestic furniture and fittings are provided and the facilities are welcoming and homely. 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 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. It is recommended this area be 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. 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. There were a number of items of furniture and other equipment found to be stored in communal corridors. The number of items appears to have increased following the last inspection and in certain areas gave the impression of being untidy and cluttered. The storage arrangements therefore need to be considered to determine what improvements can be made. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 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 and 30. The staffing arrangements need to be urgently reviewed to make sure that sufficient numbers of staff with the appropriate skills are on duty at all times. The arrangements for the induction of staff are not satisfactory and do not make sure that staff have a clear understanding of their roles and responsibilities. EVIDENCE: The Manager stated that staffing levels have been determined as a minimum of four staff on duty during waking hours. Each morning a further staff member is scheduled to work at peak times. This represents an additional staff member for half the morning. However the additional hours are utilised over three mornings. This means that on three days a week five care staff are on duty. This arrangement must be reviewed to make sure that residents’ needs are not compromised. The Providers have also allocated additional hours to employ an Activities Coordinators but the post is currently vacant. The Manager stated that the rostered care staff were providing the planned programme of activities in the interim. There appeared to be no evidence that additional staff had been employed to meet the shortfall. This arrangement must be reviewed to make sure that resident’s needs are not compromised. Sufficient numbers of waking night are on duty each night and a senior officer is also on call to provide advice guidance and assistance where required.
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 23 Generally residents found the staff to be flexible, caring and made every reasonable effort to provide the care and support they require. However six of the staff has recently been appointed from other European countries. Some of the residents and staff commented that certain staff appeared to have some difficulties in communication. It is also of concern the records indicate that induction arrangements for new staff were incomplete. The Providers have established a suitable format for a comprehensive induction to take place over the first six months of employment. It is also of concern there was no evidence to indicate that staff from other European countries hade been provided with any additional assistance to assist with communication or use of English. The Manager acknowledged the shortfall in the induction arrangements and stated that steps were in place to address the situation. Given the conclusion reached in standard six and the issues regarding staffing an urgent review of the staffing arrangements must occur at the earliest opportunity. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 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, 33, 35, 36, 37 and 38. Temporary management arrangements continue to be established to make sure the services and facilities meet the needs of the residents. The Providers have established reliable quality assurance measures to make sure the home is run in the best interests of the residents. The Providers will assist residents to manage their personal allowances but the records are not satisfactory. 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. EVIDENCE: There appears to have been some frailty in the management arrangements following the departure of the Registered Manager. Although a temporary Manager was appointed they were unable to take responsibility for the management role for three of the first four weeks. In addition staff reported the on call arrangements had not been reliable for this period. The situation
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 25 has been further complicated because the Deputy Manger was not at work for the period of the temporary arrangements. The temporary Manager stated that they would now be at the care home for a minimum of four days a week and on call at other times any assistance is required. In addition a senior member of staff is on duty for all waking hours to coordinate the care and support provided and provide staff with support, guidance and supervision. The Providers have put in place satisfactory arrangements to monitor the quality of the services and facilities provided. The arrangements include consultations with residents and visitors to the care home and the results were favourable when the last review occurred in September 2005. 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 but the records would benefit from more detail and each transaction should be appropriately authorised. In addition it was of concern that the record did not balance with funds held on behalf of the residents in two of three accounts sampled. The arrangements to provide staff with formal supervision have been interrupted by the departure of the Registered Manager. The interim Manager has put arrangements in pace to make sure that staff is regularly supervised and that suitable records are made of each meeting. The staff said that informal advice guidance and assistance was readily available at the home when required. Some of the records at the home continue to require improvement but the daily records completed on each resident are satisfactory. There are some instances when these records could be more detailed and not only summarise events but also state the action taken and the outcome of the action. There are some positive arrangements in place to promote safe working practices for the staff and residents. A detailed health and safety audit has been completed for the environment. The equipment and services at the home are also regularly reviewed and serviced. The Providers have also established appropriate policies and procedures to promote the health and welfare of residents and staff. The risk assessment and risk management arrangements are good for the environment but not satisfactory for residents and staff. 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. There were also
Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 26 occasions when residents had experienced an accident but there was no evidence that a satisfactory risk assessment had been completed. Where assessments had been completed there was some evidence of improvement. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 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 3 X 1 X X 1 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 3 3 X 3 2 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 2 2 2 Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 28 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation Requirement Timescale for action 28/02/06 2. OP6 3. OP6 4. OP6 5. OP7 14(1)(a-c) Service Users assessments of need must comprehensively detail the needs and where appropriate the most appropriate means of meeting the needs. (Previous timescale of 30 August 2005 not met). 12(1)(aThe management arrangements b) of the speaclist rehabilitation service for service users who experience dementia must be reviewed and developed. 18(1)(a) The staffing arrangements for the speaclist rehabilitation service for service users who experience dementia must be reviewed 18(1)(a) Staff must be appropriately (c) trained to provide care and support to service users who experience confusion or mental health issues. 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. 30/03/06 30/03/06 30/03/06 30/04/06 Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 29 6. 7. 8. OP9 OP9 OP9 13(2) 13(2) 13(2) Medicines must be stored safely. Accurate and up to date records must be maintained about the administration of medication. Medicines that are no longer required must be disposed of safely and appropriate up to date records must be maintained. Suitable records must be maintained about any medication that is stored on behalf of the Domiciliary Service. The décor and flooring of the kitchen area must be upgraded. A record of all complaints and the action taken by the Providers must be maintained. Sufficient storage space must be provided. Sufficient numbers of staff with sufficient experience, skills and abilities must be on duty at all times. New staff must complete a satisfactory induction programme. Reliable management arrangements must be in place at all times. Accurate records must be maintained of the personal monies the Providers assist service users to manage. Staff must be regularly supervised and suitable records must be made of each meeting. The records required by regulation must be maintained to the required standard. 13/12/05 13/12/05 13/12/05 9. OP9 13(2) 13/12/05 10. 11. 12. 13. OP15 OP16 OP25 OP27 16(2)(g) 17(2) Sch(4) (11) 23(2)(l) 18(1)(a) 30/06/06 30/01/06 30/04/06 30/01/06 14. 15. 16. OP30 OP31 OP35 18(2)(b) 12(1)(ab) 17(2) Sch 4 (9) 18(2)(a) 17 30/01/06 30/01/06 30/01/06 17. 18. OP36 OP37 30/03/06 30/03/06 Langholme DS0000009108.V258820.R01.S.doc Version 5.0 Page 30 19. OP38 13 Risk assessments must be 30/01/06 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). 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. Refer to Standard OP7 OP9 OP20 Good Practice Recommendations The content and decisions of service users reviews should be fully recorded. Comprehensive accredited training should be provided to appropriate staff about the storage and administration of medication. The alcove in the dining room should be reviewed to improve the facilities provided. Langholme DS0000009108.V258820.R01.S.doc Version 5.0 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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