Inspection on 02/03/06 for Langley House

This inspection was carried out on 2nd March 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Langley House 20/06/08

Langley House 05/07/07

Langley House 01/08/06

Langley House 15/11/05

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 2nd March 2006 09.50 Langley House DS0000060091.V277245.R01.S.doc Version 5.1 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.V277245.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 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.V277245.R01.S.doc Version 5.1 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.V277245.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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) 15th November 2005 Date of last inspection Brief Description of the Service: Langley House is a large detached home 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 Provider is Voyage Ltd. Mrs Rebecca Parsons (the Registered Manager named above) had left the home before this inspection was carried out, and registration of a new manager is currently underway. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector was at the home for seven hours, for this unannounced inspection. The Acting Manager Mark Coxwell was on duty and assisted the inspector during the visit. Voyage Ltd. has submitted an application, to CSCI, to register him as the manager. There were seven male residents in the main house, one resident living in the flat, and two living in the annexe. The inspector spoke with one resident. She also met several of the other residents around the home, but most were unable to express their views on the home or the care they received due to having significantly limited verbal communication skills. Nearly all residents went out at some time during the day, on pre-planned outings. She also spoke with three staff, and looked at records, including three care plans with associated documentation for case-tracking purposes. All 12 CSCI comment cards sent out to relatives/visitors were returned. Information from these is included in the report. Standards that were met at the last inspection have not been re-inspected on this visit. The report from that inspection, carried out on 15 November 2005, should therefore be read along with this report, for fuller information. What the service does well: What has improved since the last inspection? Prospective residents’ needs are carefully assessed, to ensure the home can meet their existing needs should they be admitted to the home. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 6 Regarding individuals’ needs and choices, independent advocacy for residents has been accessed; two senior staff sign to evidence regular audit of transactions involving residents’ personal monies; and restrictions on residents are recorded in care plans. Medication systems have been made safer. All staff have had fire safety updates. Staffing has been improved, with absences due to sickness much reduced. 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.V277245.R01.S.doc Version 5.1 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.V277245.R01.S.doc Version 5.1 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): 3 Prospective residents’ needs are carefully assessed to ensure the home can meet their existing needs should they be admitted to the home. EVIDENCE: There have been no admissions recently to the home, because it was felt issues relating to the needs of current residents should be addressed before anyone else came to live there. The manager described an appropriate admission process, with the prospective resident’s supporter (family, etc.) viewing the home before senior staff from the home would then visit the prospective resident. He confirmed that someone from the home would always undertake an assessment of needs, before a decision is made to offer any individual a place at the home. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 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): 7&9 Residents receive good assistance to help them make appropriate decisions for themselves, with good systems in place where some decisions are made for them. The home assists clients well to make choices, decisions and take appropriate risks, on a daily basis, adding to the quality of their lives. But written risk assessments need sufficient, updated information to ensure safety and continuity of care. EVIDENCE: A resident said staff let them do what they wanted to do and gave them help when needed. One resident has an advocate. Staff were heard asking residents about meal choices during the inspection. One staff spoke about offering some residents a limited range of choices so that it was easier for the resident to make a choice. Another said that by knowing residents’ likes /dislikes, they could encourage each resident appropriately. Signatures evidenced that the individual accounts were audited every calendar month, by two senior staff at the home. Care staff described appropriate procedures for handling residents’ money on residents’ behalf. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 10 Some residents went swimming, trampolining, etc. Staff knew about risk assessments recorded in residents’ care notes. They confirmed that risks were often managed through having adequate staffing levels, ensuring residents had support and attention needed to prevent harm arising from risks. Care records – including risk assessments - were generally well kept, but one needed updating since recent very positive changes in the resident’s care needs. One included ‘support when agitated’ without specifying what that support should be. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 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): 14, 16 & 17 Residents’ lives are eventful and enriched by the range of activities currently provided. They benefit in their daily lives from respect shown by staff for their rights. Meals are good with regard to nutritional needs and individuals’ preferences. EVIDENCE: Of 12 relatives/visitors’ comment cards, completed in February 2006, two indicated concern about activities – one about opportunities off site, one about on site games, etc. Staff said that during past staffing difficulties (noted at the inspection on 11 November 2005) activities had sometimes been cancelled, but staffing has improved and most residents go out regularly now. Monthly summaries now include monitoring of this – one showed 15 of 26 activities during the previous month took place off site. During the inspection some residents had puzzles out, although there appeared to be a limited stock of these. Staff said some residents who had specific interest had their own models, etc. in their rooms. Some evidence was seen of this. One relative/visitor commented that the television is always on when they visit. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 12 Daily care records included time spent doing puzzles, music therapy and art. They also showed one resident had been out twice in the last three days, and one resident had been out on six days in the previous week. Other records included that a resident had declined to go out. Staff were aware this person often chose to remain indoors, and spoke about attempts to persuade them to be more active. This same resident had been away on holiday. A swing has been constructed in the garden. The manager said that evening outings could probably be arranged at short notice, if a resident wanted to go out. Staff said the subject of residents’ rights was discussed during new staff induction. During the inspection, residents were seen to come and go as they wished (including going outside), although not necessarily unaccompanied. Restrictions were seen clearly recorded in care records. Social workers had carried out reviews with some residents and felt risk assessments were appropriate. A resident said they liked the food provided. Lunch is the main meal of the day, but a meal is kept back for the evening meal if a resident goes out in the middle of the day. The meal observed in the main house was relaxed and calm, with staff ensuring residents were offered all courses even if they left the table during the meal. Staff spoken with were aware of some residents’ special dietary needs. One spoke about communication methods that were being developed, to help residents communicate choices, and that some residents go into the kitchen to indicate their preferences. Some residents are encouraged once a week to go shopping specifically to choose a ‘ready meal’ for themselves, to try to introduce greater choice or variety in their diet. Menus seen were varied and balanced, with fresh produce used regularly. Care records showed residents’ weight was stable or increasing. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 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): 20 Medication procedures have been improved since the last inspection, but aspects still need to be addressed so they are robust enough to ensure clients’ welfare. EVIDENCE: Medication administration charts seen had no hand written prescriptions, signatures were recorded appropriately, as was stock received. Records of medication leaving the home and returned (taken on outings, etc.) needed more detail to make them a good standard. Some staff responsible for administering medication had not had recent updating or review of practice, etc. The manager said this is being addressed; it is company policy that staff have six-monthly updates. One staff said they were going to have more training on medication in preparation for becoming a senior carer soon. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 14 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): 22 & 23 There are good systems for ensuring views are noted and concerns or complaints are addressed. However, making the complaints procedures accessible to people acting on residents’ behalf would further promote residents’ welfare, as would ensuring all staff are aware of procedures for responding to suspicion or evidence of abuse, through training or other means. EVIDENCE: Half of the comment cards from relatives/visitors indicated they didn’t know the home’s complaints procedure. The manager said the complaints procedure will be displayed at the entrance to the home, for future reference. One card indicated the home had dealt appropriately with concerns raised by the respondent. One staff spoke about an issue raised by a relative that had been resolved. Another described how some residents made it known they were complaining about something, even if they couldn’t necessarily say what they were complaining about; staff would then try to find out what the problem was. Care records included that a bolt was being used on an en suite door, with reasons for this given. Inventories were seen of residents’ possessions. Because the care work can be challenging, staff are not rostered to work full days (i.e. 10-12 hour shifts) regularly. Two staff spoken with had not had training specifically on safeguarding or local procedures. But they described some possible signs of abuse, and knew they had a responsibility to report any suspicion that it had occurred. All staff have training on managing aggression. A new staff said abuse awareness had been included in their induction. Senior staff were said to be available to other staff and very supportive. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 15 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): These core standards were met at the last inspection. EVIDENCE: Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 16 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): 33, 34 & 35 Sufficient staff are employed with an appropriate variety of skills and training to meet residents’ needs well. There is a positive approach to staff training and supervision, but a few staff would benefit from updates - ensuring all staff are enabled to give good quality care. Residents benefit from and are protected by good staff recruitment procedures. EVIDENCE: A resident said staff were very kind, and indicated they were happy living at the home. Staff spoken with were knowledgeable about residents’ needs. Staff reported sickness absences were fewer, and morale was better because of this than at the last inspection. The manager said the rota system has been reviewed so there are more staff on duty at the busier times of day. There were 12 care staff on duty (including the manager) when the inspector arrived, looking after nine residents, on this unannounced inspection. Care staff are responsible for cooking and for housekeeping tasks. Residents appeared at ease with staff, and were receiving one-to-one attention from staff during the inspection. Two comment cards mentioned staff concern or good relationships where residents and staff were concerned. All respondents felt satisfied with the overall care provided. Four staff files were checked – all contained required information. The manager confirmed a ‘POVAfirst’ check is always obtained - if the CRB Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 17 disclosure has not been returned - before staff start working at the home. Prospective staff work a ‘trial shift’, in a supernumerary capacity as an observer, before being offered employment – as evidenced during this inspection. A new staff, in describing their own appointment to work at the home, confirmed an appropriate recruitment procedure is followed. Staff spoken with confirmed there were various training opportunities, including for obtaining a Care NVQ, as well as weekly team meetings and supervision. Training records provided showed that whilst newly appointed staff had been on a good variety of short courses specific to the needs of the residents, some longer serving staff (including senior carers) had not had any training or updates in the last year. A new staff said they shadowed other staff during their induction period, and that a record was kept of this time. Supervision is cascaded down through the organisation; one staff confirmed they’d had relevant training for this role. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 18 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): 37, 39 & 42 Residents and staff benefit from good management of the home. Quality assurance systems do not adequately ensure residents and other stakeholders are regularly and fully involved in review and development of the home. Health and safety training for staff is insufficient to protect the welfare of residents and staff. EVIDENCE: Mark Coxwell was registered with CSCI as manager of another Voyage Ltd. care home until moving to work at Langley House in January 2006. An application has been submitted to register him as the manager. He has several years of care experience in a senior role, in other care settings. The staff felt there was a good working relationship with him. They were positive about recent developments at the home, particularly regarding improvement evident in the quality of life of one resident who had very complex needs. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 19 Results of the home’s annual review have been sent to CSCI. It was not clear if these findings were shared with residents and their supporters – the information would have to be in a less complex format than that sent to CSCI. There has not been a residents/relatives meeting recently. Fire extinguishers were serviced in January 2006. Training records provided indicated that six staff had not had updates in the last year on health and safety topics such as manual handling or infection control, although fire safety training has been undertaken. Langley House DS0000060091.V277245.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 X 2 X X 2 X Langley House DS0000060091.V277245.R01.S.doc Version 5.1 Page 21 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA9 YA20 Good Practice Recommendations You should ensure all risk management strategies are recorded in care plans in sufficient detail and reviewed in a timely fashion, to ensure continuity of care. You should ensure that all staff that administer medication have appropriate updating and review of practice. And those records of medications taken on outings, and subsequently received back into the home, are clear and easily auditable. You should ensure that service users and any person acting on their behalf know how and to whom to complain. You should ensure all staff are aware of procedures for responding to suspicion or evidence of abuse, through training or other means. You should ensure each staff member has at least five paid training and development days (pro rata) per year. You should ensure the results of service user surveys are made available to service users, their representatives and other interested parties. DS0000060091.V277245.R01.S.doc Version 5.1 Page 22 3 4 5 6 YA22 YA23 YA35 YA39 Langley House 7 YA42 You should ensure all staff have regular updates on all safe working practice topics – including moving and handling, first aid and infection control – to promote safe working practices. 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