Inspection on 15/11/05 for Langley House

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Langley House 20/06/08

Langley House 05/07/07

Langley House 01/08/06

Langley House 02/03/06

Langley House 31/03/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Langley House Langley Marsh Wiveliscombe Somerset TA4 2UF Lead Inspector Ms Rachel Fleet Unannounced Inspection 15th November 2005 09.45 Langley House DS0000060091.V259252.R01.S.doc Version 5.0 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 House DS0000060091.V259252.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 Adults 18-65. 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 House DS0000060091.V259252.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Langley House Address Langley Marsh Wiveliscombe Somerset TA4 2UF 01984 624612 01984 624797 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) Voyage Ltd Mrs Rebecca Patricia Parsons Care Home 14 Category(ies) of Learning disability (14), Physical disability (1) registration, with number of places Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for 14 persons in categories LD and PD There is a low doorway in the bedroom on the second floor within the three bedded unit. This room is suitable only for service users who are under 5 ft 2 in in height. Registered for one named person with a learning disability and physical disability to reside within the main house. (Please see letter from CSCI dated 12/10/04) 31st March 2005 3. Date of last inspection Brief Description of the Service: Langley House is a large detached former hotel, set in its own grounds. It is registered with the Commission for Social Care Inspection to provide care for up to fourteen people between the ages of 18 - 65 years who have a learning disability. The home can also accommodate one client who also has a physical disability, within the main house - which has two ground floor rooms accessible for such clients. It also has eight first floor bedrooms. There is a separate annexe providing accommodation for up to three people, and a self-contained flat for one person, at the site. The Registered Manager is Mrs Rebecca Parsons. The Registered Provider is Voyage Ltd. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector was at the home for nearly seven hours, for this unannounced inspection. The manager was away on a study day, so Alex Berkley (Senior carer in charge) assisted during the visit. There were seven male clients in the main house, one client living in the flat, and two were living in the annexe. The inspector met most of the clients as she went around the home, but none were able to express their views on the home or the care they received due to having significantly limited verbal communication skills. She also spoke with three staff, and looked at records, including care plans with associated documentation for case-tracking purposes. What the service does well: What has improved since the last inspection? Hand-written entries on medication charts are completed correctly. Fire doors were not propped open. Staff accident reports are now stored securely. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 6 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 House DS0000060091.V259252.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 The home uses individualised approaches to ensure that prospective clients’ needs are assessed. Less involvement in pre-admission procedures may reduce certainty that the home can meet the needs and aspirations of prospective clients, affecting the success of the subsequent admission. EVIDENCE: Senior staff described how some clients had been visited in their previous care setting, with staff spending day and night shifts there in one case, to make a proper assessment of their needs. Prospective clients visited the home unless it was felt it would not be in their best interest, and a care manager’s letter was seen, which confirmed pre-admission procedures staff had described. These also gave staff opportunities to assess needs. Concerns were expressed by staff as to the appropriateness of the home for one client. It appeared the home’s staff were not involved in the first stages of assessment procedures, with Voyage Ltd. senior staff external to the home making initial assessments of the resident’s needs. An alternative care setting was being sought. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&7 Clients’ individual needs are reflected well in their care plans, ensuring staff are fully informed as to how to support them. Clients receive good assistance to help them make safe decisions for themselves. Where clients are not able to be involved in decision-making, some procedures are not sufficiently robust to ensure their rights are properly protected. EVIDENCE: Individuals’ care plans were comprehensive, personalised and up-to-date. Risk assessments had also been recorded, though these were not cross-referenced to the care plans. Staff said care plans were reviewed if risks were reassessed, and all said they were regularly referred to. There was a discrepancy between the frequency of observation indicated in the care plan for one resident and that which was carried out during the inspection, the latter being done less often than stated (although still being carried out very regularly). Staff were heard offering options and guidance appropriately to residents. A community professional met with a client during the inspection as part of a plan relating to decision-making. Clients were encouraged to shop for their Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 10 own clothes, rather than staff buying items for them. There was little recorded evidence of multidisciplinary input where decisions had been made for residents. The manager confirmed care managers, relatives and previous carers were always consulted - before a peephole was fitted in one client’s door, for example. But none of these were independent advocates for clients. Individual records were kept for each client’s personal monies, with cash balances kept separately and receipts numbered against entries - facilitating auditing of these accounts. Only one signature was recorded for transactions, however. Two of three accounts checked were otherwise satisfactory; one had slightly more cash held than shown on the records. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15 & 16 Clients benefit from a variety of appropriate activities, and from good links with the wider community around the Home. Clients’ rights are upheld, although agreed restrictions should be recorded, to fully ensure this continues in the long term. EVIDENCE: One client had obtained a certificate after attending a college-based course. Besides outings for leisure, clients also went out shopping, to the hairdresser’s, etc. clients went out during the inspection to different activities or for recreation, either with peers or alone, depending on other needs and considerations. An art therapist visited during the inspection. Staff said there were no issues with neighbours or the surrounding community. The home uses its own transport. Family involvement was evident from care records. Staff spoke of clients mixing with their peers or being given their own space, working closely with clients throughout the inspection to ensure as harmonious an atmosphere as possible. A Christmas party was planned for clients from all the local Voyage homes. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 12 Language used in written care records was appropriate, and reflected concern for clients as individuals. One had a door key for their door, and staff spoke about maintaining clients’ privacy, and independence. Movement within the home is controlled by use of digipad door-locking devices; such restrictions were not referred to in care plans seen. But clients were able to go outside as they wished (though staff accompanied them to ensure their wellbeing). Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 There is good, individualised support for clients, with evidence of multidisciplinary working to ensure that health care needs are met. Medication procedures are not sufficiently robust to ensure clients’ welfare. EVIDENCE: Clients looked well cared for. Some spent time outside, with staff; one remained in their room, with staff near by; others used the lounges. Care records showed flexible routines – around rising times and bedtimes, for example. Staff were seen to check their understanding of signing and behaviours used by clients, with clients seeming satisfied with the responses they got and outcome of the interaction. Short-term health problems (such as sore throats) were noted in care records with monitoring, GP advice and care given also detailed and reflecting great concern for individual clients. There was evidence of regular contact with a consultant psychiatrist, for advice and reviews of care. The manager has confirmed that staff have had relevant training on the administration of enemas, from an appropriate professional, to meet certain care needs. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 14 Medication charts were signed, only minimal stocks were kept, and only senior care staff administered medications. However, one had not received much training for this role at the home initially, and had not had any updating for over a year. One chart showed a greater dose of diazepam had been given than was stated on the chart. There was some reference to a review of this medication by the GP in care records. Procedures for keeping one medication have been discussed with staff, regarding safer systems. Records were not being kept when it was taken out from the home (if clients went out) and returned again later, for example. The GP was not routinely informed of any other preparations clients might be taking (such as cod liver oil), and there was no homely remedies policy. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The home has various strategies to try to ensure clients are protected from abuse, neglect and self-harm. However, clients would be better protected if all staff were aware of relevant reporting procedures, and if agreed restrictions were recorded and reviewed. EVIDENCE: Relevant policies include guidance for staff on contacting outside agencies if abuse is suspected; staff said they had phone numbers for external managers. Some staff had had training on protection of vulnerable adults, but one carer had not and was not sure of procedures to follow if abuse was reported. There are management strategies in place for daily routines to protect clients from abuse and self-harm – for example, high staffing levels so that clients can have one-to-one attention. There are digipad door locks in use, including bedroom doors; one bedroom door also had a peephole, allowing observation of the resident. Staff were clear that such devices were for clients’ benefit and protection. But individuals’ care records seen did not, for example, include the use of the digipad locks (why they were necessary, etc.). Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The standard of the accommodation provided is good and well maintained providing a homely place to live, with good standards of cleanliness and hygiene. EVIDENCE: The home - on this unannounced inspection - was clean, and well maintained in terms of décor. Care is taken pre-admission to ensure the environment is adapted for the new client. Staff said repairs are dealt with quickly. An asbestos survey has been carried out. Procedures to prevent cross-infection were being used, to manage a particular ongoing risk. Washing machines had recommended programmes. Staff who handled laundry during their shift did not undertake any kitchen duties. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 33 Clients are supported by caring and skilled staff. Staffing levels and sickness patterns need monitoring, to ensure clients’ continued welfare and that all their needs are met. EVIDENCE: Staff felt there were good training opportunities available. Senior managers within Voyage give training regularly. Some staff had attended sessions on autism, epilepsy, protection of vulnerable adults, Total Communication and Learning disabilities, within the last year. Those spoken with were knowledgeable about clients’ needs, their likes and dislikes, and how to support them. Two were undertaking NVQ2 in Care. Clients looked at ease in their home, some interacting freely with staff. There was evidence that clients’ dependency levels were monitored. Staff were concerned about staffing shortages, some due to sickness; although they understood Voyage was trying to recruit, they were concerned for clients’ welfare – feeling there was insufficient support for personal development and activities, for example – and for staff safety. They felt the team were very supportive of each other, and a senior staff member was always on call, but staff were working extra shifts to cover vacancies. Care staff are responsible for housekeeping duties (cooking, cleaning, etc.); staff said the laundry accumulated sometimes, because of staff shortages. There were eight staff Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 18 initially on duty, to care for ten clients. Two staff then came from another Voyage home, to cover absences due to sickness. A third person reported they were sick that day. Another manager was at the home to deal with a specific matter, in the absence of the home’s own manager. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41 & 42 Clients’ rights and best interests are safeguarded by good standards of recordkeeping. There are good systems to promote health and safety, but two aspects of fire safety measures are not fully addressed in practice, potentially putting clients and staff at risk. EVIDENCE: Accident records for staff are kept securely. Other records seen were well maintained, updated regularly, and also kept securely. All staff take basic food hygiene courses, and some had had infection control training recently. Fridge and freezer temperatures -recorded daily – were within the appropriate ranges. Manual handling training certificates, dated August 2005, were seen. Several staff had not had fire training for over six months, and one staff said they had not had any training since coming to work at the home, although they had had training in another care setting. Fire safety checks had been recorded at recommended intervals. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 2 X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X 3 2 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Langley House Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X X 3 2 X DS0000060091.V259252.R01.S.doc Version 5.0 Page 21 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 YA20 Regulation 13 (2) Requirement You must make suitable arrangements for recording, handling, safe administration and safekeeping of medicines, including that a) a record is kept of medications received into the home & leaving the home; b) medication is administered according to the prescriber’s instructions; c) accurate records are kept of current medications; d) the GP be informed of over-the-counter preparations being taken by clients. You must ensure that fire safety training is provided to all staff. Timescale for action 31/12/05 2 YA42 23(4) 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 22 No. 1 2 Refer to Standard YA3 YA7 Good Practice Recommendations The registered person should demonstrate the home’s capacity to meet the assessed needs – including specialist needs - of prospective clients, before they are admitted. You should consider including independent advocates for clients in multidisciplinary decision-making. And obtain two signatures for recorded transactions involving clients’ personal monies. You should ensure that any restrictions on clients are agreed in their contract and care plan. You should ensure that staff that administer medication are appropriately trained, including updating and review of practice. You should ensure all staff are aware of procedures for responding to suspicion or evidence of abuse, through training or other means. You should continue to monitor staffing levels and sickness patterns to ensure clients’ welfare and that all their needs are met. 3 4 5 6 YA16& YA23 YA20 YA23 YA33 Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Langley House DS0000060091.V259252.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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