CARE HOME ADULTS 18-65
Langley House 47 Collington Avenue Bexhill-On-Sea East Sussex TN39 3NB Lead Inspector
Christopher Stanley Announced 29 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Langley House Address 47 Collington Avenue Bexhill-On-Sea East Sussex TN39 3NB 01424 212934 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Rajeswaree Jeeawon Mrs Rajeswaree Jeeawon Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) of places Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of people to be accommodated is nineteen (19). 2. People admitted will have suffered or be suffering from a mental illess. 3. People accommodated will be between the ages of nineteen (19) and sixty five (65) years on admission. Date of last inspection 30 November 2004 Brief Description of the Service: Langley House is a care home providing personal care and accommodation to nineteen (19) people with mental health needs. It is owned and managed by Mrs Rajeswaree Jeeawon. The home is located approximately one mile from the centre of Bexhill, with access to shops, pubs, churches and the post office. The accommodation comprises of three floors, and includes communal space plus thirteen (13) single bedrooms, and three (3) shared bedrooms. Five (5) of the bedrooms provide en-suite facilities. At the time of the inspection, the home was accommodating fifteen (15) service users. Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out by two Inspectors on 29 July 2005, between the hours of 10.00 to 14.30, and involved discussion with the home’s manager and staff, four service users, the inspection of care documentation relating to three service users, an inspection of communal areas, and by invitation, the opportunity to see three service users’ bedrooms. What the service does well: What has improved since the last inspection? What they could do better:
The mix of service users accommodated is inappropriate, and includes individual service users with complex care needs e.g. primary drug and alcohol dependency needs that are beyond the skill and competencies of the current manager and staff team, and which are outside the terms of the home’s current registration under the Care Standards Act 2000. Such service users are being admitted without adequate assessment. This inappropriate mix of service users is failing all service users, in that a number are not receiving the skilled and qualified input that they require, due to the complexity of their care needs, and others being fearful and anxious about the challenging behaviour with which these service users present. The assessment of proposed new service users is inadequate, with an over reliance by the home on the information received from the referring agency, and too ready an acceptance of what it contains. This has resulted in the home being unaware of significant behaviours or occurences relating to the person being referred. Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 6 This, in conjunction with an absence of adequate qualification, training and experience amongst the home’s management and staff, inadequate preadmission information, and an absence of an integrated system of care palnning and risk assessment that provides clear guidance to staff about how to manage specific aspects of individual service users’ behaviour, is compromising the safety and welfare of service users, staff, and members of the public. These concerns have been brought to the attention of the home’s owner and Manager previously, and are yet to be satisfactorily addressed. Managers of the CSCI will be meeting in September 2005 with the local Community Mental Health Team, the Contracts Department of East Sussex County Council’s Social Servcies Department, and the home’s owner to discuss how the home’s owner and manager will ensure that it is only accepting and accommodating service users, within the terms of their current registration, and the skills and competencies of the manager and staff. 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 H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,4 Service users, on occasions, are being admitted without adequate assessment, and with complex care needs e.g primary drug and alcohol dependency, in excess of the skills and expertise of the manager and staff team, to the detriment of all those residing in the home. EVIDENCE: Assessment and care documentation was inspected in respect of three service users. This showed that the home is not adequately assessing prospective service users in advance of their admission, and is accommodating a number of service users whose care needs are beyond the current skills and competencies of the manager and staff e.g. primary drug and alcohol dependency, and the home’s current registration. This seriously calls into question whether individual service users can be confident that the home is able to meet their assessed needs and aspirations. In discussion with a number of service users, it was stated that they felt “ wary” and “afraid” of some of those living in the home, and that they therefore “preferred to remain in their room” Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 9 In view of the inappropriate mix of service users being accommodated, the home’s Statement of Purpose needs to be further reviewed, to state clearly that Langley House does not accommodate service users with a primary drug or alcohol dependency, or those whose presenting behaviours pose an active threat to the safety and welfare of other service users, staff and members of the public. From discussion with the home’s manager and staff, it is evident that the home is accepting those referred to them by Local Authorities, on the basis that it is a Local Authority making the referral, without undertaking their own assessment, and assuring themselves that they can meet the assessed needs of the person being referred, within the terms of their current registration, the needs of the existing service users, and the skills and competencies of the manager and staff team. Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 6 The current recording system for the assessment of service users’ needs, care planning, risk assessment and review is inadequate, and fails to provide clear guidance to staff, in respect of how the assessed needs of individual service users are to be met, and the how service users might be supported in pursuit of their individual goals. EVIDENCE: The care documentation inspected lacked depth, and provided little guidance to staff in how to engage with service users in respect of achieving their personal goals, and meeting their assessed needs. Greater attention needs to be paid to ensuring that a comprehensive risk assessment is maintained in respect of each service user, and that these assessments provide clear guidance to staff about how any assessed risk is to be managed. The home is curently devising a new electronic system for the recording of all care information relating to service users, and it was stated that all staff will be trained in how to access and input to this information. Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 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 standard(s) These standards were not inspected. EVIDENCE: Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 18,19,20 There is little evidence that the physical and emotional needs of service users are being met, and that service users are receiving the level of support that they require. EVIDENCE: The home’s inability to meet the complex needs of one service user with a primary drug and/or alcohol dependency, and the needs of service users with complex and challenging behaviours that pose a risk to others, evidences that the home is not meeting their physical and/or emotional needs. The feedback received from other service users, that they were fearful of a number of those residing in the home, is further evidence that service users needs are not being met, and that they are not receiving the level of support that they require. The home is storing and administering a controlled drug for one service user, as part of a detoxification programme for drug dependency. In addition to this being a service beyond that which the home is registered to provide, the arrangements for the storage and administration of this drug did not comply with the requirements of the Controlled Drugs Act. Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 23 A number of service users are afraid those living in the home who present with anti-social and challenging behaviour. EVIDENCE: In discussion with a number of service users, it was stated that they felt “wary” and “afraid” of a number of those living at Langley House, and that they therefore “kept to themselves”, and “spent the time in their rooms”. The inspection took place against the background of recent adult protection alerts, where a service user was alleged to have physically assaulted a service user, a member of staff, and members of the public, in separate incidents. An inspection of this service user’s written risk assessment showed that the home had following these alerts assessed him as posing a low risk to others, nothwithstanding that a recent multi-agency adult protection strategy meeting had determined that he required a specialist residential placement, in view of the escalation of his violent behaviour, and the risk he posed to others. As part of the inspection process, feedback was received from a member of the Community Mental Health Team about what they perceived to be a low level of awareness in the home of the potential for violence, and how to minimise any assessed or known risks to service users, staff and visitors to the home, through agreed strategies. e.g. not leaving one person alone in a room with a service user to is known to be physically abusive. Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 24,25,26,27,28,30 The overall standard and quality decoration is uneven. Where redecoration has recently been completed, the environment is comfortable and pleasing. EVIDENCE: The communal lounge and dining room areas have recently been refurbished and redecorated, and provide a comfortable and complementary resource to service users’ bedrooms. Individual bedrooms are, in general personalised, and attractive. Where new vinyl flooring has been installed, the quality of finish appeared to be poor. All bedroom furniture is being replaced on a rolling programme, and where rooms become vacant, these are being redecorated. A number of communal bathrooms and toilets are in urgent need of attention, and according to the staff are scheduled for refurbishment. Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 It is not possible to be confident that service users are being supported by competent and qualified staff. EVIDENCE: The inappropriate mix of service users, and the absence of skilled and qualified management in the home, is not ensuring that service users are receiving the quality of support that they require. Albeit there is evidence that staff are caring, and respectful in their attitude to service users, the manager and staff do not have the necessary skill and qualification to manage the care needs of individual service users. This is evidenced in the poor quality of assessment, care planning and risk assessment noted, and the poor judgements being made in respect of individual service users e.g risk posed to other service users. Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,41,42,43 The overall quality of management in the home is poor, in respect of the clarity of roles, the home’s clarity of purpose, review and development, and ensuring the health, safety and welfare of service users. EVIDENCE: The manager is assisted by family members in a manner that makes it unclear as to who is managing the home. There is little clarity between the varying roles of the home’s manager and deputy manager, and other family members. In the absence of clear and cohesive management from the current registered manager, and conflicting responses given during the inspection to questions about the specific management of one service user, it is not possible to be confident about the integrity of the home’s management, and the accuracy of the reponses given during the inspection process. The absence of cohesive management is further evidenced by a lack of clarity in the home about the nature of the sevice provided, the poor judgements being made about whom to admit, and the actual risks to which service users, staff and members of the public have been exposed, as highlighted by recent events.
Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 17 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 1 1 1 3 x Standard No 22 23
ENVIRONMENT Score x 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 1 x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 1 x x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x 1 1 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Langley House Score 1 1 1 x Standard No 37 38 39 40 41 42 43 Score 1 1 x 1 1 1 1 H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement Timescale for action By 30/09/05 2. 2 3. 6 That the statement of purpose is amended to clearly identify the range of mental health needs which the home is registered to provide for, stating clearly that the home is not registered to provide care and accommodation for people who present with a current primary drug and/or alcohol dependency, and/or abusive behaviour that poses a risk to service users, staff and members of the public. 14(1)(a)(c That individual service users are ) only admittted on the basis of a thorough assessment of their aspirations and needs, by a suitably qualified and trained person, following consultation regarding their assessment with the service user and/or their representative. 15(1)(2) That individual care plans are (A)(B)(C)( devised, reviewed and revised, D) in consultation with each service user, and all those involved in their care, mental health and welfare. On-going On-going Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 19 4. 18,19 ,12(1)(a)( b)12(2)(3 )12(4)(a)( b) 13(2) 5. 20 6. 23 13(6) 7. 8. 27 32,33 23(2)(b) 18(1)(a) 9. 37,38,41,4 2,43 24(1)(a)( b) The home will ensure that individual service users receive the level of assessed support that they prefer and require, and that their physical and emotional health needs are met. That the registered person shall make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of any controlled drugs received in to the home. That the registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. That all communal toilets are maintained in a good state of repair. That service users are supported at all times by competent and qualified staff, and an effective staff team. That the management of the home is reviewed at regular intervals to ensure that it is providing effective leadership, in keeping with its Statement of Purpose, and the health and welfare of all service users. On-going On-going On-going By 31/11/05 On-going On-going 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. Refer to Standard Good Practice Recommendations Langley House H59-H10 S21152 Langley House V236360 290705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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