CARE HOMES FOR OLDER PEOPLE
Langholme Arwenack Avenue Falmouth Cornwall TR11 3JP Lead Inspector
Paul Freeman Unannounced 6 June 2005 09.30 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 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 D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Langholme Address Arwenack Avenue Falmouth Cornwall TR11 3JP 01326 314512 01326 313577 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Methodist Homes for the Aged Mrs Susan Kings Care Home 39 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (5), Old age, of places not falling within any other category (33) Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 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 1 February 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 four service users who experince 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 service user in 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 D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over eleven hours. The Inspector looked over the building and at a number of records and documents. Ten of the residents, six of the staff and the registered manager were spoken to. The Inspector found the requirements and recommendations set at the last inspection had been worked upon. What the service does well: What has improved since the last inspection?
The statement of purpose continues to be improved but does not comprehensively describe the service and facilities offered. Each prospective resident is assessed to find out about their needs and the best way to meet them. The information recorded in assessments needs to be more detailed to make sure that a clear picture of the persons needs, preferences and choices is provided.
Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 6 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. Daily records are kept about the events that happen to each resident. The records continue to be developed so that a summary of events is provided for each day. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 8 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 standard(s) 1, 3 and 5 The statement of purpose requires improvement to comply with the regulations and reflect the services and facilities provided by the home. Prospective residents are given the opportunity to visit the home to help them make an informed decision. Each prospective resident is assessed but the arrangements need to be improved. This will provide the staff with a clear picture of the person’s needs and best ways to meet the needs. EVIDENCE: The statement of purpose has been improved since the last inspection but does not contain all the information detailed in schedule 1 of the Care Homes Regulations 2001. The current document does not comprehensively reflect the services and facilities provided at the home. The service users guide was not considered on this occasion. Each prospective resident is assessed before moving to the home to make sure the home are able to meet their individual needs and the staff have a clear picture of each persons requirements, preferences and choices. One of the managers of the home has a lead role in completing the assessments which
Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 9 also take account of any assessments that have been completed by the Social Services Department or Health Service. The assessments arrangements continue to improve but require further information to provide a comprehensive picture of the personas needs. New residents are provided with the opportunity to visit the home to help them make an informed decision about their future plans. The visiting arrangements are flexible. New residents said they were warmly welcomed by the staff and were given satisfactory information about the home before and after their arrival. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 10 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 standard(s) 7 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 are well looked after and staff treat them in a respectful and dignified manner. EVIDENCE: The care plans continue to improve but need to provide more information to direct, guide and inform the staff about the most appropriate way to meet the persons needs. This is particularly important for residents who are not able to direct their own care to make sure the care and support provided meets all needs and reflects the person’s choices and preferences. Each care plan is reviewed on a regular basis but the records of the review should be more detailed. This will make sure that staff are fully aware of any changes and that any agreements reached between the home and the person or their representatives are recoded. Observation during the inspection showed that staff have a good awareness of how to treat residents in a dignified manner that respects their privacy. Staff
Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 11 were seen to ask residents what they wanted, knock on doors and spoke to people in a respectful manner. Residents said they were very satisfied and confidant about the way in which staff undertook their duties and found the staff to be reliable and approachable. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 12 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 standard(s) 12 Resident experience a stimulating and varied lifestyle and a wide range of activities are provided. The records about the activities require improvement. This will help with the planning, coordination and development of the activity programme. EVIDENCE: The home provides a wide range of activities each day that reflect the collective and individual interests and hobbies of the residents. Residents are regularly consulted about their social activities to make sure that each person’s wishes and chosen lifestyle are catered for. The home have appointed an activities coordinator to help with the organisation and further develop the opportunities available. Activities occur in the home and in the summer they are supplemented by trips out which many residents said was a great source of pleasure. The home also makes best use of the local facilities and amenities available. The records in the care plans about activities need to be improved to make sure that residents wishes are catered for and to help with the planning and coordination of the programme provided. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 13 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 standard(s) 16 Positive arrangements are in place to deal with any concerns raised by residents or their visitors. EVIDENCE: No complaints have been received by the home or CSCI since the last inspection in September 2004. A robust policy and procedure have been established and residents are aware of the arrangements. Residents commented about their confidence in the management and staff to positively deal with any issues of concern they have. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 14 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 standard(s) Not Assessed A comfortable and well maintained standard of accommodation is provided. EVIDENCE: The environment is maintained to a high standard and a refurbishment plan has been established for areas that are tired. A second passenger lift between the two floors has been installed. This is user friendly and popular with residents. Residents very satisfied with the facilities provided. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Sufficient numbers of staff are on duty each day to meet the needs of residents. Robust recruitment arrangements are in place and new staff completes an induction programme. A varied training programme is in place for the staff group. The records about induction and training need to be improved. EVIDENCE: The home comprises of three units Harbour View, Cherry Tree and The Avenue and each unit has a nominated manager to coordinate the services and facilities provided. Each of the managers has supervisory responsibility for named staff members. The staffing levels at the home meet the minimum standards and residents said they were very well looked after. The recruitment arrangements for new staff are robust and satisfactory records are maintained. Each new staff member undertakes a positive programme of induction but records of the induction programme were incomplete in some instances. A varied programme of staff training is provided and a suitable training plan for the staff group is in place. The records of the training completed by each staff member were also incomplete. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 38 The daily records about residents require further improvement and the arrangements to manage risks to individual residents and staff need to be improved. EVIDENCE: There are no concerns regarding financial viability of the home and appropriate insurance cover is in place. The daily records kept about service users have improved following the last inspection and there are examples of quality record keeping but some of the records need to be improved. Positive policies and procedures are in place to promote safe working practices. The current arrangements to manage individual risks to services users are not satisfactory. The reports about accidents and incidents are also not sufficiently detailed to adequately complete a satisfactory risk assessment and make plans to minimise unreasonable risks. The home must ensure that all records comply with the DATA Protection Act.
Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 17 Equipment at the home is regularly monitored and maintained to a satisfactory standard. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x 2 2 Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 19 no 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 1 Regulation 4 Requirement Amendments to the statement of purpose must be undertaken to ensure that it adheres to all criteria as set in Schedule 1 of the National Minimum standards. In addition it must include all service provision that the home provides. Service Users assessments of need must comprehensively detail the needs and where appropriate the most appropriate means of meeting the needs. 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. The records about induction and staff training must be complete. The personal records maintained on service users must deatial the events that have occured, any issues of concern, the action taken by staff and the outcome. Risk assessments must be completed on each occassion an accidents or incident occurs or service users needs change.
D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Timescale for action 30.9.05 2. 3 14 30.8.05 3. 15 7 30.11.05 4. 5. 30 37 18 17 30.10.05 30.10.05 6. 38 13 30.8.05 Langholme Version 1.20 Page 20 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 7 12 37 Good Practice Recommendations The content and decsions of service users reviews should be fully recorded. A record of the activites should be maintained in a manner that complies with the DATA Protection Act. records maintianed at the care home must comply with the DATA Protection Act. Langholme D52-D04 S9108 Langholme V224220 060605 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection 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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