CARE HOMES FOR OLDER PEOPLE
Langley Court 9 Langley Avenue Surbiton Surrey KT6 6QH Lead Inspector
Diane Thackrah Unannounced Inspection 9th May 2006 10:35 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.V287817.R01.S.doc Version 5.1 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.V287817.R01.S.doc Version 5.1 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.V287817.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd November 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 whom may be mentally frail. The home is a large detached house situated in a quite suburb of Surbiton. There is one large communal lounge and a communal dining area. There is an additional smaller sitting area, a hairdressing room, and a conservatory. A copy of the home’s Service User Guide and Statement of Purpose can be obtained on request from the Registered Provider, as can a copy of the most recent Commission for Social Care Inspection, inspection report. Fees for the home at the time of writing range between £400-650. There are no additional charges Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 10.35 and 15.00 on the 9th May 2006. 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 large number of service users and five visitors also provided feedback about the home. What the service does well:
All service users spoken with spoke very highly about the care that they received in the home and said that their needs were well met. One service user said of the acting manager “She can’t do enough for you” A visitor, who’s relative lives in the home said “I couldn’t be happier with the care provided here, the staff are wonderful” Another visitor said, “If I have a problem, the owner will sort it out immediately” One visitor said that they were “Very happy” with the arrangements for their relative’s health care. Another relative said “They arrange all the health appointments and transport” A service user said “I’ve been able to keep my own General Practitioner, Chiropodist and Optician since I moved into the home” There are good arrangements for ensuring that each service user has their needs, including cultural, social and religious needs, assessed prior to them moving into the home. Good arrangements are also in place for ensuring that needs are meet and reviewed on an ongoing basis. Service users spoken with said that they felt happy with they arrangements for making a complaint. One service user said, “You don’t really need to make a formal complaint as (the acting manager) sorts things out quickly” All service users spoken with spoke very highly of the acting manager and relaxed and positive interactions were noted between the acting manager, service users, visitors and staff members alike. There is a happy atmosphere in the home, service users chatted and joked with staff members throughout this inspection. A visitor said, “If I have any problems (the acting manager) is always helpful” Another visitor said of the acting manager “She is very good” Another said, “She is marvellous” There are good arrangements for staff training and staff members receive good support to allow them to do there jobs well. There are excellent opportunities for service users to engage in social and leisure activities and meals are of good quality. The home is well maintained, clean and homely. Health and safety is generally taken seriously. Service users have bedrooms that meet their tastes. One service user said, “I have been so lucky to get such a lovely bedroom” Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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
Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 7 contacting your local CSCI office. Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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 the following standard(s): 1, 3 and 6. There are appropriate procedures for ensuring that service users have their needs assessed prior to moving into the home and improvements have been made regarding information provided to service users prior to them moving into the home. Service users therefore have their needs met and wishes respected. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Improvements have been made to the Service User Guide. Information about the size of rooms in the home and details about fire precautions have been added to this document in line with a Requirement made at the last inspection of the home. This document now includes all information required by Regulation. The Service User Guide was situated in the entrance hall of the home and easily available to service users and their visitors.
Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 10 There are good arrangements for ensuring that each service user has their needs assessed prior to them moving into the home. The acting manager said that a full assessment of need is undertaken for each service user prior to them moving into the home. A representative from the home visits privately funded service users in their own homes, or in hospital to carry out an assessment prior to them moving into the home. A Care Management assessment is obtained for service users who are funded by a local authority. Needs assessments for the two most recent service users to be admitted to the home were examined. There was detailed information in place for each service user. Assessments included a social history, risk assessments and details about the service user’s personal and health care needs. Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10. The arrangements for planning care are good and ensure that the care and health needs of service users are well met. In general, service users are treated with respect and have their dignity upheld. However, one incident was observed were a service user‘s dignity was not upheld, or their rights respected. Practice such as this does not ensure the wellbeing of service users. National Minimum Standard 9 was assessed as being met at the last inspection of the home and as there have been no changes regarding this Standard in the home, it remains that it is considered met. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A Requirement was made at the last inspection of the home regarding the need to ensure that service user’s care plans were stored securely in order to
Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 12 respect confidentiality. This Requirement has now been met. Care plans are now stored in a locked cupboard in the staff room. Care planning in the home continues to be good. Care plans for the two most recent admissions to the home were examined. Both contained detailed information about the service users needs. There was also information in care plans about how staff members should support service users to be independent. Care plans contained risk assessments and had been signed by a representative of the service user. Care plans detailed the arrangements for supporting service users to have their religious needs meet. There are currently no service users from an ethnic minority group living in the home, the acting manager said that she would discuss any specific cultural needs on an individual basis and detail these in the care plan. There were records detailing that reviews of care plans occur with the involvement of the service user. Care records indicate that service user’s health needs are well addressed by staff in the home. Each service user is registered with a General Practitioner as part of the admissions process. Files examined contained contact details of their General Practitioner. Multi-Disciplinary sections in care plans detailed that General Practitioner’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. One visitor said that they were “Very happy” with the arrangements for their relative’s health care. Another relative said “They arrange all the health appointments and transport” A service user said “I’ve been able to keep my own General Practitioner, Chiropodist and Optician since I moved into the home” All service users spoken with spoke very highly about the care that they received in the home and said that their needs were well met. One service user said of the acting manager “She can’t do enough for you” A visitor, who’s relative lives in the home said “I couldn’t be happier with the care provided here, the staff are wonderful” Another visitor said, “If I have a problem, the owner will sort it out immediately” Whilst in the main service users were noted to be treated respectfully by staff members, there was one incident were a service users dignity was not upheld. One staff member was observed to take a salt and pepper pot from a service user at lunchtime, and instead of allowing the service user to add salt and pepper to their meal, added it for them. The acting manager was not able to give an explanation as to why this happened. Unless a care plan details otherwise, service users must be allowed to add their own condiments to meals. It is recommended that refresher training in dignity and respect occur for the staff member involved. Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15. National Minimum Standards 12, 13, 14 and 15 were assessed as being met at the last inspection of the home and as there have been no changes regarding these Standards in the home, it remains that they are considered met. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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): 16 and 18. The home has systems in place for dealing with complaints. This ensures that service users and their family members know that their complaints will be taken seriously. There continues to be failures in the home’s staff recruitment procedures. They are not robust, and therefore people living in the home are not fully protected from abuse. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home has a complaints procedure, which is made easily available in the Service User Guide. The acting manager said that no complaints have been made since the last inspection of the home. Service users spoken with said that they felt happy with the arrangements for making a complaint. One service user said, “You don’t really need to make a formal complaint as (the acting manager) sorts things out quickly” A procedure for responding to allegations of abuse was available in the home. Records indicate that staff members have undergone training in the protection of vulnerable adults. Two staff members spoken with confirmed that they had received such training and were able to describe what they should do following an allegation of abuse.
Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 15 There has been an ongoing failure by the Registered Provider to ensure that staff members are fully vetted before being employed to work in the home. This does not ensure that service users are fully protected (Refer to Standard 29 of this report) Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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 the following standard(s): 19 and 26. National Minimum Standards 19 and 26 were assessed as being met at the last inspection of the home and as there have been no changes regarding these Standards in the home, it remains that they are considered met. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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, 28, 29 and 30. National Minimum Standard 27 was assessed as being met at the last inspections of the home and as there have been no changes regarding this Standard in the home, it remains that it is considered met. There is a good staff training and development programme that provides staff members with the skills necessary for meeting the needs of service users. There has been an ongoing failure to ensure that the procedures for the recruitment of staff are robust. Therefore, people living in the home are not fully protected from abuse. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: All staff members have a training profile and personal development plan. 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. Training profiles identified that staff members are well trained in both safe working practices, and care practices such as ‘Understanding Dementia’ ‘Promoting Continence’ and ‘Foot Care’. Induction and foundation training is in line with ‘Skills for Care’ specifications. Over half of the current staff team have achieved an NVQ Level 2 in Care and a further five staff members are scheduled to undertake this qualification.
Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 18 The Commission for Social Care Inspection has recently taken enforcement action against the Registered Provider in relation to the failure to obtain Criminal Records Bureau and Protection of Vulnerable Adults checks for new staff members. These checks are now in place for all staff members. However, there continues to be a failure by the Registered Provider to ensure that new staff members are fully vetted prior to commencing work in the home. Only one written reference was available for the most recently employed staff member. Efforts have been made by the Commission for Social Care Inspection to work with the home in ensuring the welfare of service users, however, the Registered Provider has continued to breach Regulations regarding safe staff recruitment. It is of serious concern that the Registered Provider’s poor recruitment practices continue to place the safety and wellbeing of service users at risk. The Commission will undertake enforcement action regarding this issue. The Registered Provider must be in receipt of two satisfactory written references, prior to any staff member commencing work in the home Also, he must apply for a second written reference for the one staff member who has recently been employed, with only one written reference. Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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, 33, 35 and 38. Staff members continue to receive good support and guidance from the manager, and there is an effective quality assurance system, this ensures that the home is run in the best interests of the service users. There are good arrangements for handling service user’s finances, which ensure that service users financial interests are safeguarded. There have been improvements in the arrangements for managing health and safety in the home, this ensures that the well being of service users, in general, is promoted and protected. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 20 The Commission for Social Care Inspection has received an application by the current acting manager to become registered, in line with a Requirement made at the last inspection of the home. The acting manager has continued to demonstrate good practice and competence in running the home. Improvements in the home have been ongoing since she has taken up her post. All service users spoken with spoke very highly of the acting manager. Relaxed and positive interactions were noted between the acting manager, service users, visitors and staff members alike. There were certificates indicating that the acting manager has continued to update her knowledge and skills by attending a number of training courses. One service user said, “You don’t really need to make a formal complaint as (the acting manager) sorts things out quickly” A visitor said, “If I have any problems (the acting manager) is always helpful” Another visitor said of the acting manager “She is very good” One staff member spoken with confirmed that they received support and guidance from the acting manager. Another staff member said, “She ensures that we do training” There are good systems for monitoring quality in the home. The acting manager has recently provided service users and their relatives with questionnaires in order to gain feedback about the home. A large number of responses were available. Two visitors spoken with confirmed that they had been invited to take part in a survey about the home. There are good systems in place for handling service user’s money. There are secure facilities for the safe keeping of small amounts of service user’s money. Records and receipts are maintained for each transaction and two staff members must sign when money is handled on behalf of a service user. One service user spoken with said that they were happy with the arrangements for keeping their money. A Requirement was made at the last inspection of the home regarding the need for safety checks to occur on portable electrical appliances in the home. There were records detailing that this has now occurred. Records available also detailed that safety checks have occurred on the home’s emergency lighting and fire detection systems and that fire drills have occurred. There were up to date Landlord’s gas safety, and electrical installation certificates. Suitable insurance is in place. Records also indicate that there are good systems in place for ensuring that all staff members are training in safe working practices. A risk assessment has been carried out in relation to fire safety in the building. Records were available detailing that the London Fire and Emergency Planning Authority visited the home in August 2005 and it complies with the requirements. However, the kitchen door had been propped open with a mop and bucket at the time of this inspection. This is potentially dangerous. Doors in the home must not be propped open with anything other that a fire safety devised approved by the local fire office. A Requirement is made regarding this issue. It is acknowledged that the acting manager had
Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 21 taken action to ensure that the magnetic fire safety devise attached to this door was to be repaired, and that the home was in fact waiting for an engineer to rectify this problem. Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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. 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 3 X 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 3 17 X 18 3 3 X X X X X X 3 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 3 X 3 X 3 X X 2 Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No. 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 OP29 Regulation 19 (1)(a)(b) (i) Requirement The Registered Provider must: 1. Be in receipt of two satisfactory written references, prior to any staff member commencing work in the home. 2. Apply for a second written reference for the one staff member who has recently been employed, with only one written reference. The Registered Provider must ensure that doors in the home are not propped open with anything other that a fire safety devised approved by the local fire officer. 01/06/06 Timescale for action 01/06/06 2. OP38 23 (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 Good Practice Recommendations
DS0000013390.V287817.R01.S.doc Version 5.1 Page 24 Langley Court 1. Standard OP10 The Registered Provider should ensure that refresher training in dignity and respect occurs for one staff member. Langley Court DS0000013390.V287817.R01.S.doc Version 5.1 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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