CARE HOMES FOR OLDER PEOPLE
Langley Court 9 Langley Avenue Surbiton Surrey KT6 6QH Lead Inspector
Diane Thackrah Unannounced Inspection 3rd November 2005 11:45 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 Langley Court DS0000013390.V263862.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. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Langley Court Address 9 Langley Avenue Surbiton Surrey KT6 6QH 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) 020 8399 6766 02083992183 Mr Dinesh Ambalal Patel Mrs Gita Dinesh Patel Mrs Lorraine Margaret Taylor 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 DS0000013390.V263862.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th May 2005. 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 conservatory. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 11.45 and 15.00 on 3rd November 2005. A partial tour of the premises took place and care records were examined. The Registered Provider, Acting Manager, Care and Domestic staff were spoken with. A number of service users and four visitors also provided feedback about the home. What the service does well: What has improved since the last inspection?
There have been some environmental improvements since the last inspection. A service user said that they were happy with the redecoration of their bedroom, and that they had been consulted with about the décor. Some health and safety issues identified as areas of concern at the last inspection of
Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 6 the home have now been addressed. There have been improvements with the care planning process, and care plans seen provided good detail about the health, personal and social care needs of service users. There has been an ongoing staff training programme, and the acting manager has achieved the NVQ Level 4 in Manager Award. What they could do better: 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.
Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 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 the following standard(s): 1, 3 and 4. A Service User Guide is available so that service users and their families have most of the information that they need about the home. This requires amending to ensure that all information needed is provided. There are effective procedures in place for gathering information about the needs of prospective service users, which ensure that the needs of service users are met. EVIDENCE: A Requirement made at the last inspection of the home regarding the need to amend the Service User Guide has not been addressed. A repeat Requirement is made that the Service User Guide must include information about room sizes in the home, and about the fire precautions and associated emergency procedures. The home ensures that the needs of all new service users are assessed prior to them moving in. There was a detailed initial needs assessment in place for the most recent admission to the home. This had been obtained from the local
Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 9 Health and Social Care Team. A service user and their relative confirmed that they were consulted with about the service user’s needs prior to moving into the home. All service users spoken with throughout this inspection spoke highly of the care that they received. One service user confirmed that staff members consulted with them about their care, and about daily living. One service user said “We are very well looked after” another said “It is very good here, the staff members are very good workers” Four visitors were spoken with, all confirmed that thy felt that the home provided good care to service users and was able to meet their needs. One visitor said, “I have no complaints whatsoever” At the last inspection of the home, comments were raised about some staff members not fully understanding service users because of a language barrier. This issue was not highlighted as an area of concern during this inspection. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 10. There have been improvements to the care planning process; good arrangements are in place for ensuring that the health, personal and social care needs of service users are met. EVIDENCE: The home uses the ‘Standex’ format for care planning. There have been improvements to the care planning process since the last inspection. Two care plans were examined. There was good detail in care plans of the action needed to be taken by staff members to ensure that all aspects of the health, personal and social care needs of service users are met. Risk assessments were in place detailing risks in relation to moving and handling. Daily observation notes detailed that needs described in care plans were being addressed. There were records indicating that care plans are reviewed at least monthly and updated to reflect changing needs. There was a six-week review of care, involving a service user and two of their relatives occurring at the time of this inspection. Care plans had been signed by the service users, indicating that they had been involved in the planning for their care. One service user confirmed that staff members provided care in line with their wishes. There
Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 11 continues to be a need for care plans to be stored securely and a Requirement made at the last inspection of the home is reiterated. Each service user is registered with a GP as part of the admissions process. Files examined contained contact details of their GP. Multi-Disciplinary sections in care plans detailed that GP’s are contacted, and visit service users in the home at regular intervals. The home liaises with a number of health and social care professionals in order to promote and maintain the health of service users. Examination of one service user’s records highlighted that within the past year they had been seen in the home by a dentist, social worker, dietician, optician, GP chiropodist and community eye nurse. There are policies and procedures in place for ensuring that medication is handled safely. Medication Administration Records examined were accurate and up to date. In-house audits of medication handling occur on a regular basis. One staff member confirmed that they had received training in the safe handling of medication. All medication was noted to be stored securely at the time of this inspection and medication prescribed to service users was available. Staff members were noted to share positive relationships with service users at the time of this inspection. Staff members knocked on service user’s bedroom doors, and waited for a response before entering. Some service users have a private telephone line in their bedroom. Feedback received from service users was that staff members treated them with respect. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 and 15. Varied activities and wholesome and enjoyable meals are provided; therefore differing expectations and lifestyles are well catered for. EVIDENCE: Service users have good opportunities for social and recreational activities. Staff members are proactive in finding out how service users want to spend their time, and arranging activities in line with their views. There was an activities programme displayed in the lounge. This detailed activities such as quizzes, arts and crafts, crosswords, exercise and bingo. One service user said that they enjoyed quizzes and crosswords provided by ‘Activities Anne’ another service user said they had enjoyed a number of bus trips with the home recently, including trips to the seaside and a barge trip. Some service users have been on a recent visit to a local community centre for a ‘Reminiscence session’ one-service user said that they enjoyed this. Some service users said that they are sometimes supported by staff members to go on walks. Others said that their priests, or their hairdresser visited them in the home. A number of service users use the mobile library that visits the home on a monthly basis. There were minutes of a recent service user meeting, which detailed that service users had been consulted with about daily living in the home. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 13 Visiting times are flexible. All visitors spoken with said that they were always made to feel welcome when visiting, and that there were places to meet in private. There was a weekly menu available that detailed that meals provided are varied, and that a choice is always available. Fresh, wholesome and nutritious food was available in the kitchen. Tables in the dining room were set attractively and a choice of condiments was available. Staff members were available throughout lunchtime and provided appropriate support, including to those who required to be fed. There were instructions about service user’s preferences, and specific dietary needs in the kitchen and a visitor confirmed that the home had been “really good” about ensure that their relative was provided with appropriate and enjoyable food. Hot and cold drinks are provided throughout the day, and on request. All service users spoken with said that meals in the home are enjoyable and of good quality. One service user said, “They come and ask you what you want to eat” Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 14 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): None of these Standards were assessed during this inspection. EVIDENCE: Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 15 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, 22, 25 and 26. There have been environmental improvements in the home since the last inspection. The home is decorated and furnished to a good standard and facilities are clean. This ensures that service users live in a pleasant, homely and comfortable environment. EVIDENCE: A service user said that their bedroom had been redecorated since the last inspection. This service user said that they were happy with the new décor, and had been consulted with regarding the decorating. The home and grounds were maintained in good order at the time of this inspection. The premises meet the Requirements of the local fire service, and a risk assessment in relation to fire was available, in line with a Requirement made at the last inspection. The home is decorated and furnished well. There is a homely atmosphere and one service user said, “I’m very cosy here” There is one communal lounge,
Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 16 with a dining area, and a conservatory. There is a small garden to the rear of the property, which is used by those who wish to smoke. The home has been assessed by an occupational therapist. Ramps, hoists, grab rails, call bells, assisted baths and raised toilet seats are provided. There was a rucked carpet in one service user’s bedroom at the time of the last inspection that was a potential trip hazard. This problem has now been rectified. Bedrooms are naturally ventilated with windows conforming to recognise standards. There is central heating throughout the home, and radiators can be adjusted in individual bedrooms. Pipe work and radiators are covered and lighting is domestic in nature. Thermostatic valves are fitted on all hot water outlets in bedrooms, communal toilets and bathrooms. Water distributed from a random sample of outlets throughout the home was found to be at a temperature close to 43 degrees, including water in room 32, were this was not the case at the last inspection. There were records detailing that water temperatures are checked to reduce any risk of scalding. Emergency lighting is provided throughout the home, and there were records detailing that this is tested regularly. There were also records that detailed that key workers carry out monthly quality checks of service user’s bedrooms. The home was found to be clean and free from offensive odours. The laundry is appropriate, there is a contract for the collection of clinical waste and the washing machine has a sluice facility. Policies and procedures are in place to deal with the safe handling of clinical waste and staff members receive infection control training. Service users spoken with confirmed that they were satisfied with hygiene standards in the home. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 17 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, 29 and 30. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. There is a staff training and development programme that provides staff members with skills necessary for meeting the needs of service users. EVIDENCE: Staffing levels, evidenced in staff rotas, and in numbers on shift at the time of this inspection were found to be appropriate and safe, in accordance with the care and social needs of the service users. There was a skills mix of staff on shift, including the manager, four care staff, a cleaner, a laundry worker, a kitchen assistant and a cook. All service users spoken with spoke very highly about staff members. One service user said that staff members are “very helpful and work hard” and there was feedback from four family members detailing that they were very satisfied with the level of care afforded to their relative, by staff members. There has been a continuous failure by the Registered Provider to ensure that new staff members have a new Criminal Records Bureau and Protection of vulnerable adults check, prior to them working in the home. This practice does not ensure that service users are fully protected from abuse. The Registered Provider must carry out a Criminal Records Bureau check, and a Protection of
Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 18 Vulnerable Adults list check for each new staff member, and be satisfied with the outcome of these, prior to any new staff member working in the home. Currently, there is one staff member employed in the home, which the Registered Provider has not checked against the Criminal Records Bureau and Protection of Vulnerable Adults lists. There were records, however, detailing that all other pre recruitment checks have been made regarding this staff member, and that they have undergone induction training. The Registered Provider is aware of the need to make an application for a Criminal Records Bureau and Protection of vulnerable adults list check regarding this employee without delay. The Registered Provider is also aware of the need to supply the Commission for Social Care Inspection with a action plan, detailing the arrangements for ensuring that this staff member does not work unsupervised with service users, until the time that satisfactory Criminal Records Bureau and Protection of vulnerable adults checks are in place. Staff members confirmed that they had good opportunities for training and there were a number of certificates available detailing that training has been ongoing since the last inspection. A new staff member said that they had been through induction and that the manager had provided them with good support through this. Records were available to back this up. This staff member said that they ‘shadowed’ another staff member during their first week of employment. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 19 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, 36 and 38. Staff members receive good support and guidance, ensuring that the home is run in the best interests of the service users. EVIDENCE: An acting manager has managed the home for fifteen months. There has been no application to the Commission for Social Care Inspection to register a manager, despite this being made a Requirement at the last inspection of the home. This Requirement is repeated. The acting manager has worked in this home for a number of years; she has proved to be competent and skilled in managing the home. There is an atmosphere of openness and respect, with service users, their visitors and staff members feeling valued. The acting manager has achieved qualifications at NVQ Level 4 in Care, and in Management and has expressed her intentions to
Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 20 make an application to the Commission for Social Care Inspection to register as manager. Three staff members spoken with said that they felt supported by the manager and received regular, formal supervision. Supervision records were available to back this up. There are currently no arrangements for providing supervision to the acting manager. It is recommended that arrangements be made which would allow her to receive regular, formal supervision. One staff member said that the acting manager was “excellent” A number of service users spoke highly of the acting manager, one said, “She’s very good” Visitors also confirmed that they had found the acting manager to be supportive, approachable and helpful. One visitor said, “She keeps me informed” about her relative. 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 continues to be no records available detailing that portable appliance testing has occurred. A Requirement regarding this issue is repeated. There was a Landlords Gas Safety Certificate, dated 20/06/06, detailing that the gas supply to the home had been serviced, in line with a Requirement made at the last inspection. Records were also available detailing that the lift, and hoists used in the home had been serviced recently. Records indicate that there are weekly fire alarm tests, regular fire drills and testing of emergency lighting, and staff training in fire safety. Documentation detailing bacteriological analysis results indicates that there is no risk from legionella in the home. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X 3 X X 3 3 STAFFING Standard No Score 27 3 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 3 X 2 Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 22 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 OP1 Regulation 4(1)(C) 1 Requirement The Registered Provider must ensure that the Service User Guide 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. (Repeat Requirment. Timescale of 01/08/05 unmet) The Registered Provider must ensure that all persoanl records in relation to service users, including care plans, are stored securley in a locked facility. (Repeat Requirment. Timescale of 01/08/05 unmet) The Registered Provider must be in reciept of a satisfactory Criminal Records Bureau and Protection of Vulnerable Adults list check for all staff members prior to them commencing work in the home. (Repeat Requirment.
DS0000013390.V263862.R01.S.doc Timescale for action 01/02/06 2 OP7 12(1)&(4) 17(1)(b) 01/01/06 3 OP29 19 (1) 2 03/11/05 Langley Court Version 5.0 Page 23 Timescales of 01/07/04, 01/01/05 and 24/05/05 unmet) 4 OP29 12 (1)(a) The Registered Provider must 08/11/05 supply the Commission for Social Care Inspection with a action plan, detailing the arrangements for ensuring that one staff member, who has not undergone necessary recruitment checks, does not work unsupervised with service users, until the time that satisfactory Criminal Records Bureau and Protection of vulnerable adults checks are in place. The Registered Provider must 01/01/06 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. (Repeat Requirment. Timescale of 01/08/05 unmet) 01/01/06 The Registered Provider must ensure that all portal appliances in the home are tested regularly. A Record of these tests must be made available for inspection. (Repeat Requirment. Timescale of 01/08/05 unmet) 5 OP31 24 (1)(2)(3) 6 OP38 12 (1)(a) 13 (4)(a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 24 1 OP31 The Registered Provider should ensure that the acting manager receives regular, formal supervision. Langley Court DS0000013390.V263862.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 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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