CARE HOMES FOR OLDER PEOPLE
Langley Lodge 39 Imperial Avenue Westcliff on sea Essex SS0 8NQ Lead Inspector
Carolyn Delaney Un-announced 10th August 2005 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Langley Lodge Address 39 Imperial Avenue Westcliff on sea Essex SS0 8NQ 01702 340186 01702 340186 Lodge@btconnect.com Mrs P A Campfield 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 P A Campfield CRH 26 Category(ies) of OP Old Age 26, TI Terminally ill 2 registration, with number of places Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18/03/05 Brief Description of the Service: Langley Lodge provides nursing care and accommodatio for up to a maximum of twenty-six older people including up to a maximum of two people who have been diagnosed with a terminal illness. The home is situated in a quiet residential area of Westcliff on Sea, close to the sea front, Chalkwell Park and the local shops and amenties on London Road. Langley Lodge is a large well-maintained older style property. The home provides fourteen single bedrooms and six double bedrooms. People living at the home have access to a small dining area, large lounge / conservatory and a large well maintained garden area. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection carried out between the hours of 13.00 and 17.30 on 10th August 2005. Records including assessment documents care plans and daily care notes were examined for three residents. Three residents and six visitors to the home were spoken with to obtain their views about the home. Training records were examined for all of the nursing and care staff working at the home. Records in respect of the recruitment of staff employed since the last inspection were not available at the time of this inspection. These were requested and made available on 16th August 2005. Four members of staff, including the homes manager were spoken with during this inspection. Records in respect of the receipt and administration of resident’s medicines were also examined. On the day of this inspection there were twenty people living at the home. What the service does well:
Langley Lodge provides care in a large attractive and homely environment. Staff work well as a team in order to ensure that the people living at the home are well cared for. All of the people who were spoken with during this inspection spoke positively about the home, the manner in which it is managed, the nursing care and kind attention provided by staff. Residents said that the quality and quantity of food provided by the home was very good. Fresh produce such as meats, fish and vegetables are purchased by the home on a weekly basis and residents are provided with a variety of home cooked dishes. One resident who has lived at the home said that ‘There is none better’. Visitors to the home commented that it is always maintained clean and free from any unpleasant odours. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 6 A strong management team including the manager who is a registered nurse with many years clinical and management experience supports staff working at the home. Many of the care and nursing staff have worked at the home for a number of years. The home does not rely on the use of agency staff, which contributes to the continuity of care provided to the people who live at the home. What has improved since the last inspection? What they could do better:
Records in respect of the administration of medicines should be maintained consistently. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 7 The reasons for why people are nursed in bed should be recorded and where they can, (for example, through the use of specialist chairs etc) people should be assisted and encouraged to spend time out of bed. Records in respect of staff recruitment, training and supervision and records in respect of monies and valuables held by the home must be available for inspection. 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 Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 The nursing and general needs of all prospective residents are assessed prior to their being offered a place at the home and wherever it is possible people are invited to visit the home so as to assess its suitability. EVIDENCE: The homes manager or another registered nurse visits prospective residents in their own home or in hospital to carry out a detailed assessment of their nursing, safety and general needs. Two people had moved into the home within forty-eight hours of this inspection. Records in respect of the assessments carried out were very detailed and staff were aware of these peoples care needs and preferences in respect of meals and how they wished to spend their time etc. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 & 9, Staff working at the home are aware of residents nursing and general care needs, risks to health and safety and how to minimise these risks and meet each individuals needs. Nursing staff ensure that residents receive medicines, which are prescribed to treat their medical conditions. Recording in respect of the administration of medicines is not carried out consistently. EVIDENCE: Plans in respect of the nursing and general care received by people living at the home were very clearly written and identified what each persons needs were and how staff were to assist them in meeting these needs. Assessments in respect of risks to residents living at the home such as risks of developing pressure sores/ ulcers, risks from injuries from moving, falls and use of bedrails etc were well documented and kept under review None of the residents living at the home had pressure sores / ulcers at the time of this inspection. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 11 There was evidence that staff acted so as to ensure that people living at the home received the medicines for which they had been prescribed. For example when one resident was admitted to the home and did not have an allocated general practitioner staff liaised with the local Primary Care Trust (PCT) and general practitioners to ensure that this person received oxygen therapy as required. Not all staff who work at the home consistently maintained records in respect of the administration of medicines. Staff did not always sign Medication Administration Records (MAR) to indicate that medicines had been administered and where MAR were handwritten by staff there was no system for ensuring that these were checked and countersigned by another member of staff so as to minimise the risks of recording errors. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 & 15 People living at the home are supported according to their wishes and capabilities so as to assist them to enjoy their free time as they would if they lived at home. Relatives and visitors are welcomed. People living at the home receive a wide variety of fresh and home cooked meals, which meet their nutritional needs and preferences. EVIDENCE: On admission to the home staff obtain and record information in respect of what each individual’s preferences in respect of daily activities, such as what time they prefer to get up and go to bed, what foods they like and how they like to spend their days. Residents may spend their time in their bedrooms, the communal areas or the garden according to their choices and capabilities. The home employs the services of external entertainers on a regular basis and residents who are capable pursue activities outside of the home. Two residents spend the majority of their time in bed. The reason for this was not clearly recorded. It was reported that one resident who has Parkinson’s
Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 13 disease and that staff were awaiting advice from the Parkinson’s Society in respect of the most suitable chair to enable this person sit out of bed. Relatives and other visitors to the home said that they were always welcomed warmly when they visited the home. All of the residents spoken with said that the choice, quality and quantity of food provided by the home. Many people who had been admitted to the home from hospital had gained and maintained weight gain. A number of people had been admitted with PEG tubes for receiving nutrition. Many of these were now capable of taking food orally. The homes manager understands the importance of food and nutrition and ensures that residents receive a variety of fresh foods bought locally on a weekly basis. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home is managed in an open manner and staff act so as to protect the welfare and best interests of people who live there. EVIDENCE: There had been no complaints made about the home since the last inspection. The complaints policy and procedures had been assessed as satisfactory previously and were not assessed on this occasion. It was positive to note that since the last inspection that the majority of staff had received training updates in respect of the protection of vulnerable people. Training dates have been planned for those members of staff who have not yet received training updates. Staff working at the home are aware of the correct action to take, including whom to report any incidents of inappropriate behaviour towards people living at the home. The management of the home are also aware of the correct procedures to follow, including informing local social services and the Commission for Social Care Inspection (CSCI) in the event of any alleged incident of abuse of people living at the home. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 & 26 Langley Lodge provides a safe, comfortable and well-maintained environment for the people who live at the home. EVIDENCE: The home employs a dedicated team of maintenance, domestic and catering staff so as to ensure that the home is well maintained safe and clean. The communal areas are very homely and comfortable in nature with a large bright conservatory / lounge area which leads out into a well-maintained garden. Residents may take their meals in the dining room or their bedrooms if they choose. Two bedrooms on the ground floor have doors, which lead out into separate patio style areas of the garden. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 16 Both residents and visitors to the home commented that it was clean and free from any unpleasant odours. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 & 30 Staff are recruited, trained and employed to work in the home in sufficient numbers so as to ensure that the needs and interests of the people who live there are met. EVIDENCE: Staff duty rotas indicated that appropriate numbers of suitably qualified and trained staff are employed so as to ensure that the needs of residents living at the home are met. The home does not need to rely upon the use of agency staff and this helps to maintain continuity of care for the residents who live at the home. The manager said that there had been only twenty residents living at the home for some time, however staffing levels were maintained on the basis of a full occupancy of twenty-six, as a number of residents required extra assistance and supervision at mealtimes. Files in respect of the recruitment of staff were not available for assessment on the day of this inspection. Information was requested and provided on 16th August 2005. Evidence was provided that staff are recruited to work at the home according to a robust policy and procedure and that checks are made including Criminal Records Bureau Checks and references in respect of previous employment prior to people being employed to work at the home. Staff received regular mandatory training and relevant updates and refresher study days. The majority of staff files had been recently audited and staff training needs identified. Staff could demonstrate that they had the skills and
Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 18 knowledge to provide nursing and general care for the people who live at the home. Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 & 37 A competent and skilled registered nurse manages the home with many years experience in management. A team of dedicated staff supports the homes manager. Staff, residents and visitors all commented that the home was well managed EVIDENCE: Staff, residents and visitors all commented that the home was well managed and that staff worked well as a team so as to best care for the people who live there. Staff said that they were supported and that they received supervision. A number of records including those in respect of staff supervision were not available for examination on the day of this inspection
Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 20 Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 4
COMPLAINTS AND PROTECTION 3 3 x x x x x 4 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x x x x 2 2 x Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 22 no 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 OP9 Regulation 13(2) Requirement The registered person must ensure that all staff maintain records in respect of the receipt and administration of medicines in a consistent manner so at to minimise the risks of mishandling and errors. The registered person must ensure that all records as required for the protection of people living at the home are maintained up to date and available for inspection upon request. Timescale for action Immdiate & ongoing 2. OP29 OP30 OP36 OP37 4(1)(c) 7 9 17 19 & Schedules 2,3 & 4 30/9/05 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 OP12 Good Practice Recommendations The reason for residnets spending all day in bed should be recorded within their care plans and wheverer it is practicable residents should be encouraged to sit out of bed to avoid the complications associated with continues bed rest. Some records in respect of staff training would benefit from updating.
I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 23 2. OP30 Langley Lodge Langley Lodge I06-I56 S15540 Langley Lodge V240830 100805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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