CARE HOMES FOR OLDER PEOPLE
Langley Court 9 Langley Avenue Surbiton Surrey KT6 6QH
Lead Inspector Diane Thackrah Announced 24th May 2005 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. Langley Court Version 1.10 Page 3 SERVICE INFORMATION
Name of service Langley Court Address 9 Langley Avenue, Surbiton, Surrey, KT6 6QH 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) 020 8399 6766 020 83992183 Mr Dinesh Ambalal Patel Mrs Gita Dinesh Patel Care Home 28 Category(ies) of Dementia - over 65 years of age (3), Old Age, registration, with number not falling within any other category (25) of places Langley Court Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9 November 2004 Brief Description of the Service: Langley Court is a residential home providing care for up to twenty eight people over the age of sixty five, three of who may be mentally frail. The home is a large detached house situated in a quite suburb of Surbiton. The home has twenty two single bedrooms (three with en suite facilities) and three twin bedrooms. There is one large communal lounge and a communal dining area. There is an additional smaller sitting area, a hairdressing room, and a conservetory. Langley Court Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection that took place between 09.30 – 17.30. A partial tour of the premises took place and care records were examined. The Registered Provider, acting manager, care and domestic staff, visitors and service users were spoken with. The majority of feedback received about the home was positive. The home has addressed many of the Requirements set at the last inspection. However, an immediate Requirement was made following this inspection as a result of the Registered Providers continual failure to ensure that all staff members are vetted in line with the National Minimum Standards and Care Homes Regulations. What the service does well:
The home was able to demonstrate that the care needs of service users are appropriately assessed and met. Service users and their relatives spoke highly of the care and support that they received from the staff team. Some care plans set out well the individual needs of the service user and how staff members should meet these needs. Care plans are drawn up, and reviewed regularly with the full involvement of the service user, and their relatives were appropriate. Service users’ health needs are well monitored and addressed. The home liaises with a range of health care professionals in meeting service user’s health needs. The home has developed good links with a local GP surgery. Service users are provided with a varied range of social and recreational activities and are fully involved in selecting these activities. Family members are actively encouraged to maintain contact with service users. The home facilitates access to the local community. The home has an accessible complaints procedure and no complaints have been made recently. Service user’s bedrooms are, in general, safe and comfortable and reflect service users personal identities. All areas of the home are clean, homely and very well decorated and maintained. Langley Court Version 1.10 Page 6 What has improved since the last inspection? What they could do better:
The Statement of Purpose must be further developed to ensure that it provides all information required by Regulation. Care plans for some service users do not fully detail their needs, or how staff members should address needs. These care plans must be developed further. Also, care plans are currently not stored securely. Whilst in general medication is handled safely, there was one instance were a service user’s medication had not been obtained by the home in line with the service user’s prescription. Medication must be available to service users, as prescribe by the GP. There must be a detailed risk assessment in place in relation to fire safety. Also, safety tests must occur in relation to Portable Appliances, gas and hoists. The home has been without a Registered Manager for over ten months. Whilst there has been an acting manager in place, who has provided good guidance and support to staff and service users, there must be a suitably qualified manager in place who is registered with the Commission for Social Care Inspection. The absence of a Registered Manager has meant that some staff members have not received formal supervision on a regular basis. A system must be implemented were by all staff members receive regular formal supervision.
Langley Court Version 1.10 Page 7 There have been ongoing concerns regarding the lack of safe recruitment practices. The home has continually failed to meet Requirements made about the need to obtain Criminal Records Bureau and Protection of Vulnerable Adults list checks prior to staff members commencing work in the home. In some cases, the home has also failed to obtain written references in relation to staff members. This practice leaves service users at risk. 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. Langley Court Version 1.10 Page 8 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 Langley Court Version 1.10 Page 9 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, 2, 3, 4 and 5. In general, service users and their family members have the information they require about the home prior to admission. Service user’s needs are generally met as a full assessment of needs is carried out prior to service users moving into the home and staff members are made aware of these needs. EVIDENCE: There is a clear Statement of Purpose and Service User Guide which is made available to service users and their families. These documents, in general, are in line with National Minimum Standards, however, there was no information regarding room sizes in the home, or regarding the fire precautions and associated emergency procedures in the home. All service users are provided with a statement of terms and conditions at the point of moving in the home. One family member confirmed this. Individual records are kept for each service user. Inspection of records for the three most recent admissions detailed that a full assessment of needs had been carried out. Staff members spoken with were aware of the individual
Langley Court Version 1.10 Page 10 needs of service users. One relative said that they had been given good opportunities for viewing the home and said “they asked all about mums needs before she moved in” Comments were received from a number of service users and visitors about the high level of care they received from staff members. These included “The staff are very polite and caring” “The staff are marvellous, first class” “All staff members are kind” Comments were also raised about some staff members not fully understanding service users because of a language barrier. Steps have been taken by the home to reduce any problems caused by some staff members not speaking fluent English. However, this issue should be monitored by the Registered Provider to ensure that service users assessed needs are fully meet. Langley Court Version 1.10 Page 11 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, 8, 9, 10 and 11. Although there has been some progress in improving the arrangements for ensuring that service user’s needs are identified and met, there are still some shortfalls in this area that have a potential to place some service users at risk. Service users are consulted with regarding care plans allowing them to make decisions about their lives. There are good systems in place for ensuring that service users’ dignity is upheld. In general, medication is handled safely; this ensures that service users are protected. EVIDENCE: Each service user has an individual plan of care that details aspects of health, personal and social care needs. There is detailed information in some of these plans about how staff members should address needs, however, some care plans do not fully detail the arrangements for care provision. Care plans examined had been reviewed on a monthly basis. Service users and their relatives are involved in this process. Records are maintained of significant events in the home. These include daily observations of service users and any action taken regarding changes in need.
Langley Court Version 1.10 Page 12 Care plans are currently stored unlocked in the staff room. This practice has potential for breaching service users’ right to confidentiality. Health records detail that the home liaises with health care professionals on behalf of service users. Visits from a GP were recorded in one service user’s records. Staff members were aware of the outcomes of this visit. One family member said, “Staff members make sure that mum sees the GP, dentist and chiropodist” Risk assessments were in place, including arrangements for moving and handling. Staff members spoken with confirmed that they had received training in how to handle service users safely. All service users are registered with a GP. There are policies and procedures in place regarding the safe handling of medication. Staff members demonstrated that they were knowledgeable about safe practices. However, some policies and procedures had not been reviewed recently. This issue should be addressed to ensure that service users benefit from any changes in legislation or good practice advice. Arrangements are in place that allows those service users who wish to self medicate, to continue to do so. Medication Administration Records are maintained appropriately and in general, medication receipt, storage, handling and administration is dealt with safely by staff members. However, one item of medication, which had been prescribed for one service user, was not available in the home. Staff members were observed to engage in respectful interactions with service users. One family member reported that staff members “always make sure mum looks smart” A number of service users have a telephone in their bedroom. The home liaises with health care professionals in meeting the needs of service users who are dying. Families are supported during this time and given opportunities to remain with their relative. Langley Court Version 1.10 Page 13 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. Social activities are well managed and take into account the service users cultural and religious needs as well as the individual abilities. This enables service users to experience a lifestyle that matches their preferences. EVIDENCE: Feedback from one visitor was that “outings provided are stimulating and activities are available for those who want them” A number of service users spoken with said that they enjoyed taking part in quizzes and sing-alongs. Records available detailed that a variety of activities are provided on a daily basis. Regular outings occur. A dedicated activities worker is employed in the home and staff member’s duties involve attending to the social needs of service users. There is a hairdresser’s room and a mobile library visits the home monthly. One service user said that a staff member help them to write letters, another said that there are not always enough staff members to take them out. A number of service users were observed to be spending time in their bedrooms, which were very comfortable and homely in appearance.
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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, 17 and 18. There is an accessible complaints procedure that ensures that service users and their relatives know that their concerns will be listed to and acted upon. Service users have their legal rights protected. There are procedures in place for ensuring a proper response to any suspicion or allegation of abuse. However, no progress has been made in ensuring that recruitment practices are safe which thus would ensure the safety and protection of service users. EVIDENCE: The home has a detailed complaints procedure which is made accessible to service users. There have been no new complaints since the last inspection of the home. Arrangements were made for service users who wished to vote at the recent elections. Staff members spoken with were aware of their responsibilities regarding service user confidentiality. There is a procedure for responding to allegations of abuse. Records of staff training detailed that all staff members have undergone training in abuse awareness. The manager said that refresher training is also provided in team meetings. There have been serious shortfalls in the home’s staff recruitment procedures. This practice does not ensure proper protection and place service users at risk. This issue is addressed in Standard 29 of this report.
Langley Court Version 1.10 Page 16 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) 19, 20,21, 22, 23, 24 and 25. There have been improvements made to the décor ensuring that service users live in a very pleasant, homely and comfortable environment. However the home does not fully comply with the requirements of the local fire service, therefore not fully ensure service users safety. Special equipment is provided allowing service users to maximise their independence. Bedrooms are individualised, and in general safe, however, problems with the water supply must be addressed to ensure that service users live in a safe environment. EVIDENCE: Since the last inspection, the home has continued their redecoration programme. All areas viewed were decorated to a high standard. Fire safety equipment is provided throughout the home, however, records from a recent visit to the home by the local fire service detail that the building does not fully comply with their requirements. Communal space is comfortable and a new conservatory has recently been added to the building.
Langley Court Version 1.10 Page 17 Toilets are clean, accessible and provided in sufficient numbers. Three bedrooms have en suite facilities. Since the last inspection the home has been assessed by an occupational therapist. The majority of recommendations made during this assessment have been addressed by the home. However, this report highlighted that the carpet in bedroom 1B is rucked in places and has raised areas that were a tripping hazard. Ramps, hoists, grab rails, call bells and assisted baths are provided. Service users spoken with all said that they were happy with their bedrooms. Bedrooms viewed were comfortable, homely and decorated and furnished to a high standard. Screening is provided in shared bedrooms. Bedrooms do not have a lock, however, the Service User Guide details that a lock can be provided if this is the wish of the service user. There are records detailing that current service users have been given the option of having a key to their bedroom. Bedrooms currently do not have a lockable storage space, however, the Registered Provider reported that the home is currently in the process of providing each room with this facility. Arrangements have been made for ensuring service user’s safety and comfort in bedrooms including the provision of radiator covers, window restrictors, adjustable heating and thermostatic valves on water outlets. Records are in place detailing that water temperatures are monitored to prevent the risk of scalding and in general, water temperatures in bedrooms and bathrooms were safe. However, water was distributed at 52 degrees from the sink in bedroom 32. This has the potential for placing service users at risk. Langley Court Version 1.10 Page 18 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) 28, 29 and 30. The procedures for the recruitment of staff are not robust, with newly appointed staff not having criminal record bureau checks applied for. This therefore does not provide the safeguards to offer protection to people living in the home. There is staff training and development programme that provides staff members with the skills necessary for meeting the needs of service users. EVIDENCE: The staff files of three staff members employed since the last inspection of the home indicated that the home has not undertaken all the necessary recruitment checks to ensure the protection of service users. Criminal Records Bureau and Protection of Vulnerable Adults list checks had not been obtained for these staff members. There were no written references in one of these files. Requirements regarding this issue have been made at the previous two inspections of the home and have remained unaddressed. This practice does not ensure protection for service users. There were records detailing that staff members undergo induction and foundation training that is in line with ‘Skills for Care’ specifications. Certificates were in place detailing that staff members have completed training at NVQ Level 2 in Care. Over 50 of the staff team have this qualification.
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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) 31, 33, 34, 36, 37, and 38. In general, there is leadership and guidance to staff members, ensuring that service users receive consistency in care. However, not all staff members are appropriately supervised which has the potential of leaving service users at risk of not having their needs fully met. A quality assurance system is in place. Therefore, practice in general is in the best interests of service users. EVIDENCE: There has not been a Registered Manager in the home for ten months. There has been an acting manager during this time, but as yet, there has not been an application to register this manager with the Commission for Social Care Inspection. The acting manager has a qualification at NVQ Level 3 in Care, and is currently undertaking the NVQ Level 4 manager’s award. Staff members, visitors and service users spoken with spoke highly of the acting manager. Records
Langley Court Version 1.10 Page 21 indicate that there is good communication between shifts and staff members were clear about their roles. There are procedures in place for monitoring quality systems, including the use of questionnaires. Records indicate that regular service users meeting are held in the home and some service users said that they were regularly consulted about their views. It is evident that improvements have been made in the home since the last inspection including staff training and environmental improvements; a business plan was not available however. There were records detailing the financial viability of the home and up to date insurance. The lack of a Registered Manager has contributed to supervision not being provided in line with National Minimum Standards. Some staff members said that they did not receive formal supervision of a regular basis. Others said that they did receive some supervision. Records of this were maintained. In general, records required by Regulation are maintained in the home securely and in good order. Some, however, are not. These are detailed throughout this report. There were records detailing that routine safety checks are carried out in the home and that staff are trained in safe working practices. However, there were no records available detailing that the gas supply to the home had been serviced, Portable Appliance Testing has occurred and hoists are serviced. Langley Court Version 1.10 Page 22 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 3 3 2 3 3 2 x STAFFING Standard No Score 27 x 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x 3 3 x 2 2 2 Langley Court Version 1.10 Page 23 yes 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(1)(C) schedule 1 Requirement The Registered Provider must ensure that the Statement of Purpose includes details about: 1. The sizes of rooms in the home. 2. Details about the fire precautions and associated emergency procedures in the care home. The Registered Provider must ensure that each service user has a care plan which sets out in detail how health, personal and soacil care needs are to be addessed. The Registered Provider must ensure that all persoanl records in relation to service users, including care plans, are stored securley in a locked facility. The Registered Provider must ensure that any medication prescibed to a service user by a GP is available in the home. The Registered Provider must ensure that: 1. The home fully complies with the requiremnts of the local fire service. 2. There is a detailed risk assessment in place regarding fire risks in the home. The Registered Provider must
Version 1.10 Timescale for action 01.08.05 2. 7 15 (1) 01.08.05 3. 7 12 (1)(a) & (4)(a) 17 (1)(b) 13 (2) 01.08.05 4. 9 01.08.05 5. 19 12 (1)(a) 23 (4)(a) 01.08.05 6. 22 12 (1)(a) 01.08.05
Page 24 Langley Court 23 (1)(a) 7. 25 12 (1)(a) 23 (1)(a) 19 (1) Schedule 2 8. 29 9. 31 24 (1)(2)(3) 10. 36 18 (2) 11. 38 12 (1)(a) 13 (4)(a) ensure that the carpet in bedroom 1B is replaced or refitted to ensure that any rucks or raised areas are removed. The Registered Provider must ensure that water distributed from the tap in bedroom 32 is at a tempreture close to 43 degrees The Registered Provider must be in reciept of all documentation listed in Schedule 2 in regard of each staff member prior to them commencing work in the home. This includes a satisfactory Criminal Records Bureau and Protection of Vulnerable Adults list check. (Timescales of 01.07.04 and 01.001.05 not met) The Registered Provider must ensure that a suitably qualified person is recruited to the post of manager and that an application is made for this person to become registered with the Commission for Social Care Inspection. The Registered Provider must ensure that all care staff in the home are provided with formal supervision at least six times each year. All other staff members must be provided with regular supervision. Records of supervision sessions must be maintained. The Registered Provider must ensure that: 1. There is regular serviceing of the gas supply to the home. 2. All portal appliance in the home are tested regularly. 3. All hoists in the home are serviced regularly. 01.08.05 Immediate Requiremn et made. 01.06.05 01.08.05 01.08.05 01.08.05 Langley Court Version 1.10 Page 25 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 014 9 33 Good Practice Recommendations The Registered Provider should ensure that systems are in place for monitoring any problems which may arise as a result of staff members not speaking English fluently. The Registered Provider should ensure that policies and procedures in relation to medication are reviewed. The Registered Provider should develop a buisness plan for the home. Langley Court Version 1.10 Page 26 Commission for Social Care Inspection CSCI 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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