CARE HOME ADULTS 18-65
Langley House 47 Collington Avenue Bexhill-on-Sea East Sussex TN39 3NB Lead Inspector
Alexis Reilly Key Unannounced Inspection 30th May 2006 10:30 Langley House DS0000021152.V294748.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 DS0000021152.V294748.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 DS0000021152.V294748.R01.S.doc Version 5.1 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 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) Mrs Rajeswaree Jeeawon Mrs Rajeswaree Jeeawon Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19) of places Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of people to be accommodated is nineteen (19) People admitted will have suffered or be suffering from a mental illness People accommodated will be between the ages of nineteen (19) and sixty five (65) years on admission 10th February 2006 Date of last inspection 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. The fees charged in the serviced are £322.40 per week. The current e mail address is Devi@Langley.net. Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out by two Inspectors between the hours of 10.30 to 1.00pm, and involved discussion with the home’s manager and staff, and three residents. Other residents were seen in the home. Additional comments have been received from mental health professionals and residents have returned surveys these comments are included in the report. The inspectors examined care documentation, risk assessments, menus and health and safety files. The complaints log and the sheets, which record the administration of medication, were also inspected. The inspector saw all communal areas, the kitchen, and staff room and each resident’s bedroom. An immediate requirement was given during the inspection, which was to clear a gate, which had been blown by the wind and was obstructing a fire exit door; the providers ensured this had been completed prior to the inspectors leaving the home. What the service does well: What has improved since the last inspection?
The Manager and the Director of the home demonstrate through discussion with the inspectors they are now carrying out a comprehensive assessment for prospective residents. This has resulted in them not offering a placement to two prospective residents as their needs were deemed to be to complex for the service to meet. The quality of care documentation and risk assessment are continuing to be improved, and residents state that they are now being consulted more fully about the choice of food served, and the range of leisure activities they would like. Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 6 A number of communal bathrooms and toilet areas have been upgraded, and satisfactory arrangements have been put in place for the storage of controlled medications, in line with the requirements of the last inspection report. However the Registered Manager must ensure they obtain the relevant bound book to record the administration of the controlled medication. Comments from residents spoken to on the day of the inspection were ‘I like it here’, ’I feel more settled food is good’, ‘I like taking the dogs for a walk and I do the clearing up, ‘It was my birthday last week I was brought lots of presents, and I like going in the garden, but it is to wet at the moment’. Comments from mental health professionals who visit the home ranged from ‘for the most part the resident seems happy with what’s going on’, ‘this person could do with a little more support then they get’, ‘my clients is generally happy there and is pleased with their new room’. 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 DS0000021152.V294748.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 DS0000021152.V294748.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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Following the requirements of the last inspection report, the home is now accommodating service users, on the basis of a thorough assessment, and evidence that they can meet each individual residents needs. EVIDENCE: The home’s Statement of Purpose has been revised to reflect that Langley House cannot accommodate adults with complex care needs, and the care assessment documentation, and care planning has been revised to ensure that residents are only being accommodated on the basis of a thorough assessment, and evidence that the home can meet their needs. The Manager and Director demonstrated through discussion with the inspectors they are now caring out a comprehensive assessment for prospective residents. They are requesting full information and up to date social work assessments to enable them to assess a persons needs, this has resulted in two prospective residents not being offered a place, due to complex needs. Langley House DS0000021152.V294748.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): 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The service creates plans of care for residents, and carries out comprehensive assessments. Within this framework residents are supported to take risks as part of an independent lifestyle. EVIDENCE: A new electronic format for the assessment and recording of residents care needs has been devised, and the inspection of the new records for a number of residents showed that these were comprehensive, in their identification of need, assessed risk, and guidance to staff about the management of care needs and assessed risk. However, the process of transferring these from written documents had not been completed at the time of the inspection and the service has been given until the 1st July 2006 to complete this work. The Manager has assured the inspectors that this work will be completed by that date. A hard copy will be printed off and kept in a file in the office for staff to access on a daily basis. Residents each have their own diary in the service, which with the help of staff they will write in each day. This forms the basis of the daily notes for residents. At the time of the inspection four residents were doing their own
Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 10 daily notes. Staff in the service were completing the remaining residents daily notes. Residents are now encouraged to participate in the preparation of meals in the home; this is supported by a risk assessment. Langley House DS0000021152.V294748.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): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents take part in appropriate leisure activities, and access the local community. Appropriate relationships are encouraged, and resident’s rights are respected. Residents enjoy their meals. EVIDENCE: The home is taking appropriate action to ensure that the varying cultural and social needs of residents are being met, and that residents have genuine opportunities to participate in the day-to-day life of the home, and local community. Different religious observations and cultural preferences for food are catered for in the home. The challenge of involving residents in the day to day life of the home is considerable, with a number clearly wishing to enjoy their own company. However, many residents require support to enable them to enjoy a range of social and leisure activities that have the potential to enhance their self worth and self esteem.
Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 12 In this regard, in response to the requirement of the last inspection report, the home has consulted with residents, and devised a programme of activities and pursuits to reflect their expressed wishes. This is based around group activities both inside and outside the home, and the Inspectors have highlighted the importance of working in addition, on an individual basis with residents, to enhance their life skills and quality of life. These activities include, sessions on beauty, cooking, watching the latest movie releases and waking the dogs. The activities are popular within the home and some are more well attended then others. Residents were complimentary in discussion with Inspectors, and in the comment cards they filled out following the inspection, about the quality of food served in the home. The Inspectors were pleased to note that all residents have access to the Internet, and their own e-mail address, and that three residents are routinely using a laptop, as a means of communication, and accessing information. The home is to be commended for its use of information technology, to broaden the lives of residents, and to enhance their contact with a wider community. The service is also in the process of running Information Technology as one of its activities for the residents. Contact and interactions with resident’s families is encouraged, and a number of residents see their family members and friends on a regular basis. Residents are free to bring friends or partners into the home to visit if they so wish. The menus have been created following discussions with the residents and are on a five-week rota to enable all the chosen dishes and meals to be included, alternatives for lunch and supper are also listed daily. Langley House DS0000021152.V294748.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): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. There is evidence that Residents physical and mental health needs are monitored within the service. Residents are supported to remain well both physically and emotionally. Residents are not fully protected by the homes policies on administration of medication. EVIDENCE: The staff team now ensure that residents are receiving personal support in the way they prefer and require, and that resident’s emotional and health needs are being met. Staff refer and use the information detailed in the care plans and risk assessments to ensure that the support they offer is appropriate and tailored to the individuals needs which ensures residents stay well physically and emotionally. The arrangements for the storage and handling of medication were found to be satisfactory, although the service must ensure they obtain a bound book for controlled medication and a list of staff signatures should be available with the medication sheets. Langley House DS0000021152.V294748.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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The service has an accessible complaints procedure in place. Residents are listened to and complaints are taken seriously. The service has an up to date Adult Protection Policy. EVIDENCE: In discussion with residents, and from the comment cards received, it is clear that residents are aware of the home’s complaint procedure. Complaints are dealt with appropriately and taken seriously. The Registered Manager has completed the Protection of Vulnerable Adults training and also a refresher course for ‘Train the Trainer Protection of vulnerable Adults Training’. The home has an up to date Adult Protection Policy in place. Langley House DS0000021152.V294748.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): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The home is providing a high level of comfort, within a safe environment. EVIDENCE: The on-going programme of refurbishment and redecoration is creating a homely and comfortable environment. New carpet has been laid in all the communal areas of the home. As each bedroom is being decorated the resident will have a choice of a television and DVD players in their bedroom. The garden is in need of some attention to make it more inviting for residents to use. The Registered Manager informed the inspector that this would be addressed as the summer month’s progress and the weather becomes more pleasant. Langley House DS0000021152.V294748.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): 32,34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. There is evidence that appropriately trained staff can meet resident’s individual and joint needs. No new staff have been recruited since the last inspection therefore staff recruitment files were not inspected. EVIDENCE: There is evidence that staff are now focussing on working more individually with residents, in respect of the quality of their lives, both within and outside the home. The Manager ensured the inspector that no new staff are recruited until the relevant checks are carried out on them. Residents have taken part of the interview process for new staff in the past. The Registered Manager goes through the statement of purpose with staff each six months and again in supervision to ensure this is continually monitored. Each staff members goes through the homes procedures annually and signs to say they have read and understood the policies. The registered manager supervises the staff and has obtained the relevant supervision qualification. Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 17 The service has the following staff trained in NVQ qualifications. Three have completed NVQ level 2, One staff member is currently completing NVQ 2 and one staff member is due to commence training in September 2006. One member of staff has NVQ level 3; one staff member is currently doing NVQ 3. The Assistant Manager is completing her GNVQ advanced 3, and is currently on the access course for the RMN (Registered Mental Nurse training). Staff have completed First Aid and Medication training in April 2006, Health and Safety training in November 2005, and Food Hygiene training in January 2006. The Registered Manager and Assistant Manager completed Train the Trainer update for the Protection of Vulnerable Adults training in December 2005. Langley House DS0000021152.V294748.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): 37,38,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The revised admissions policy, and resident’s involvement in the day-to-day life of the home, suggests that the home is managed and run appropriately and that the residents views are included in the development of the service. The home must address the requirement with regard to fire safety in the home to ensure residents health and safety is fully protected. EVIDENCE: The home is continuing with the marked improvement following concerns about the adequacy of its management, staff skills, and the appropriateness of some of the residents accommodated. The Registered Manager has now demonstrated that full assessments are being carried out on prospective residents, which in some cases has lead to prospective residents not being offered a placement. It will be important that the home’s manager ensures that periodic reviews are carried out to ensure that the home is working within the term of its Statement of Purpose, and the National Minimum Standards.
Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 19 Comments from residents spoken to on the day of the inspection were ‘I like it here’, ’I feel more settled food is good’, ‘I like taking the dogs for a walk and I do the clearing up’ and ‘It was my birthday last week I was brought lots of presents, and I like going in the garden, but it is to wet at the moment’. Further comments gained from resident questionnaires were ‘staff are usually available when I need them, and they listen and act on what I say’, ‘there are sometimes activities in the home which I take part in’, ‘I usually like the meals’ and ‘the home is always fresh and clean to a good standard’. Comments confirmed residents had received a standard contract, and received information prior to moving into the home, some residents confirmed they make arrangements for their own activities and entertainment, preferring to meet with friends and partners, and also go swimming. Comments from mental health professionals who visit the home ranged from ‘for the most part the resident seems happy with what’s going on’, ‘this person could do with a little more support then they get’, ‘my clients is generally happy there and is pleased with their new room’. Quality assurance audits are carried out in the home annually and focus on catering, medication, general administration and housekeeping. The Director will come in and carry out these checks. Residents questionnaires are carried out every 6 months and visitors questionnaires are available at the front door. The analysis of the last quality assurance survey highlighted an issue with the menus in the home this has resulted in the menus being changed and now offered on a 5-week rota with recorded alternatives at each meals time. The service had an independent fire company carry out a fire risk assessment of the premises in March 2006. The service must ensure that the identified priority work is completed by the 1st July 2006 and they notify the commission in writing to that effect. Checks on fire alarms and emergency lighting are carried out weekly. The Gas safety record was dated 17th November 2005. The service records water temperatures but must ensure these state the actual temperature recorded not just that it is within the safe range. COSHH policy and environmental risk assessments are in place. Langley House DS0000021152.V294748.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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 3 X X 2 X Langley House DS0000021152.V294748.R01.S.doc Version 5.1 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 YA6 Regulation Requirement Timescale for action 01/07/06 2 YA20 3. YA42 15(1)(2)(a)(b)(c)(d) Ensure that a completed care plan, inclusive of a risk assessment, is in place for each service user, and available to staff at all times. 13(2) A bound book must be obtained to record the administration of controlled medication. Staff should supply a list of signatures for reference to the medicines administration sheets. 13(4)(a) That the work highlighted 23(2)(b)(c) in the fire risk 24(4)(a)(b)(c)(d)(e) assessment is completed, and they notify the commission in writing to that effect. 01/07/06 01/07/06 Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 22 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 YA42 Good Practice Recommendations The actual temperature of the water must be recorded in checks; it is not sufficient to note that it is within the required safe temperature range. Langley House DS0000021152.V294748.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East Sussex Area Office 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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