Inspection on 12/02/08 for Langley Lodge

This inspection was carried out on 12th February 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Langley Lodge 27/02/07

Langley Lodge 21/03/06

Langley Lodge 10/08/05

Langley Lodge 18/03/05

Langley Lodge 23/09/04

Langley Lodge 10/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Langley Lodge 39 Imperial Avenue Westcliff On Sea Essex SS0 8NQ Lead Inspector A Thompson Unannounced Inspection 12th February 2008 09:30 X10015.doc Version 1.40 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 Lodge DS0000015540.V359797.R01.S.doc Version 5.2 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 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 DS0000015540.V359797.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langley Lodge Address 39 Imperial Avenue Westcliff On Sea Essex SS0 8NQ 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) 01702 340186 F/P 01702 340186 Lodgel@btconnect.com Mrs Patricia A Campfield Mrs Patricia A Campfield Care Home 26 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (26), of places Terminally ill (2) Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing and personal care to be provided for up to a maximum of two people who may be over the age of fifty-five years and have a diagnosed terminal illness. Terminal illness placements to be limited to the ground floor only Nursing and personal care to be provided for up to 26 Older People Nursing and personal care to be provided for up to a maximum of three people who are over the age of sixty-five years and who have a diagnosis of Dementia. 27th February 2007 2. 3. 4. Date of last inspection Brief Description of the Service: Langley Lodge provides nursing care and accommodation 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 amenities 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 DS0000015540.V359797.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection commenced on Tuesday 12th February 2008, with a second short announced visit taking place on Thursday 6th March to complete the process. The content of this report reflects the inspector’s findings on the day/s of the inspection along with information provided by the service and feedback by residents, relatives, staff and other parties. Practice and procedures occurring after this inspection will be reported on in future inspection reports. Discussions were entered into with residents, the registered provider/manager, the administrator, relatives and staff on duty. CSCI survey questionnaires were also provided to residents, visitors and staff. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. Comments received from residents included: ‘ the food is very good’, ‘I’m very happy here’, ‘I get asked for my choice at mealtime, there are two choices’, ‘the food is marvellous, and I do get enough to eat’, ‘the staff are very kind’, I have no complaints, if I did I would speak to the matron’, ‘everyone here is very helpful and I have no complaints’. Visitors spoken with said they had no concerns about the care and support provided to residents by the staff and manager. Questionnaires were also left at the home so that relatives had the opportunity to make their views on the service known to the Commission. It is unfortunate that at the time of writing this report none had been returned, however any comments received after this report has been finalised will be recorded to inform future inspections. Staff confirmed they were supported by the manager. They also said that they had been offered training opportunities appropriate to their roles, and that there was a good ‘team spirit’ at Langley Lodge. Twenty five standards were looked at and the outcomes for residents against nineteen of these was good, with six adequate. As a result this report includes five statutory requirements for action, and five good practice recommendations. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. People’s needs are assessed prior to admission so the individual and the home can be sure the placement is appropriate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider/manager or a senior member of the nursing staff visits prospective new residents to undertake an assessment of nursing need. Evidence of this process was seen in care plan files for residents admitted since the last inspection. Assessment headings covered included: nursing care, personal hygiene, daily routines, social/hobbies, diet, allergies, sleep, mobility, fears, falls, psychological need, hearing & foot care. The manager confirmed that trial visits are available for prospective new residents. A care plan is compiled after admission, as seen on individual files. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. The health and personal care residents receive is individualised and based on their assessed needs. Residents rights to privacy is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were inspected. These included background information, personal details, and next of kin contacts. Care needs were shown with a short term action plan and long term goals. Care needs were based on the admission nursing needs assessment. There were risk assessments covering general risks, manual handling, pressure care, and use of bed rails. Care plans had been regularly reviewed but not on a monthly timescale. There is a recommendation on this point. Residents are weighted regularly and daily records are kept of the on-going care provided. There were also records of contact and visits from the GP. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 10 Continence issues are supported by contacting the community continence nurse, and hearing needs are provided for by GP referral to a local hospital. A chiropodist and an optician visit the home regularly. The homes medication policy and procedures followed the Royal Pharmaceutical Society guidance for care homes. This covered ordering, receipt, storage, administration, homely remedies and returns of unused stocks. There was a self medication policy and assessment and a peg feed policy. Nursing staff deal with medication, medication administration records were inspected no shortfalls were noted. Discussions with individual residents indicated that they were treated with respect by staff, as did observation of staff going about their duties and interactions with residents. Staff on duty were seen to be caring in their dealings with residents, and those spoken with said staff were helpful and considerate. Visitors spoken with also said they were satisfied regarding staff attitudes and the care provided. Some residents said they had their own mobile telephone, others use the home’s payphone on the ground floor. The manager said that private rooms have telephone sockets. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. People who use this service can expect to be encouraged to maintain contact with family and friends and to be provided with good food, but they could not be certain they would have the opportunity to regularly participate in meaningful activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider/manager said that activities are offered to residents and that since the last inspection one member of staff had taken on the role of organising activities and events on some afternoons. Some records had been kept of the type of activities available but these had not been updated since July 2007 and those seen did not evidence that regular, varied in-house activities are offered to residents. It is recognised that some progress had been made on subject since the last inspection but we (CSCI) still judged that further development on the range and frequency of activities available to residents is needed. This report includes a requirement on this issue. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 12 Evidence was seen that entertainers visit the home at approximately two monthly intervals, and the provider/manager reported that community activities and interests available included attendance at a local church, visiting church ministers, a visiting mobile library and a ‘talking book’ service. The manager said that Langley Lodge did not hold any residents monies for safekeeping. Any expenditure incurred by the home, on behalf of a resident, is invoiced to the resident or designated relative Inspection of private rooms confirmed that residents had been permitted to bring their own personal items with them on admission. There was also confirmation of this direct from residents, who told the inspector of the personal items they had been permitted to bring in with them. Menus evidenced choice and variety. Breakfast is served to residents in their rooms, the provider/manager confirmed that cooked breakfasts are available. The main daily meal is lunch with two main choices and a third option available. Afternoon tea is at 3pm with cakes and tea is at around 6pm, which is always a hot or cold option. All residents spoken with said they got enough to eat and comments about the food were positive, actual quotes made are included in the summary section at the front of this report. The cook had worked at Langley Lodge for over 20 years, food storage areas seen evidenced that goods stocks are kept and that local fresh produce is used as much as possible. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. People living at the home are protected from abuse and any complaints are responded to and managed. This judgement has been made using available evidence including a visit to this service EVIDENCE: The Langley Lodge complaints procedure was seen and contained guidance on how to make a complaint and who to complain to. Also included were timescales for responses from staff. Evidence was seen to confirm that records are maintained in the home of complaints received and of any investigation and resulting outcomes. The provider/manager said that no complaints had been received since the last inspection. Residents spoken with said they knew who to speak to if they had any concerns, and they seemed confident that any concerns would be investigated properly. The homes policy on adult protection was inspected, there was written guidance for staff on recognising and reporting abuse, and action to be taken by staff if abuse is suspected. Staff spoken with displayed awareness of this subject and procedure and had received training on adult protection procedures, however certificates seen to evidence this showed that the most recent training was in 2005. It is recommended that staff are provided update training on this subject so that they are kept informed of current good practice on recognising and reporting any suspected abuse. Langley Lodge also had a written ‘whistleblowing’ policy which provided guidance to staff on their responsibilities to report any concerns to management. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26 Quality in this outcome area is good. The people living at Langley Lodge benefited from living in a comfortable and well maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Langley Lodge is a nursing care home equipped with single room and shared room accommodation. Communal space comprised of one lounge / conservatory and one small dining area on the ground floor, and a sitting area on the first floor. Outdoor space was available off the ground floor lounge with access to a walkway around the garden which was accessible to residents. Close by there is a small garden pond with a ‘waterfall’ feature. The pond had a low fence around it but was uncovered. Although this feature is small it is recommended that action is taken by the provider/manager to minimise the risk of people falling into the water. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 15 Bedrooms seen were well decorated, clean comfortable and made homely with people’s personal possessions. During discussion with residents all said their rooms were warm and comfortable. Ten of the single rooms on the ground floor had private en-suite wc and wash hand basin, and all radiators seen had low temperature surfaces. Lighting in residents rooms was considered domestic in character and considered fully appropriate for individuals requirements /needs. Two of the single rooms had their own patio doors with garden access. Langley Lodge has two bathrooms with one of these also having a ‘step into’ shower. Both of the baths had hoists and wcs and there were communal wcs around the home. On the day of the inspection the premises were considered to be clean and hygienic and the laundry was equipped with appropriate equipment for the home’s laundry needs. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 16 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. Residents are supported and cared for by a team of experienced staff. However recruitment records need to evidence that all required checks have been made, and some training updates were overdue. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s staff duty book was viewed. This showed that staffing levels on the first day of the inspection as two nursing and four care staff on duty during daytime hours, with one nurse and two care staff on at night. The manager’s shifts are extra. Separate and additional rostered staff were employed to undertake cooking, administrative, maintenance and domestic duties. The manager said that she has a ‘pool’ of bank staff for covering staff leave etc and does not need to use agency staff. Discussion with staff confirmed that staff meetings are held. Files were inspected for staff employed since the last inspection. Evidence was seen to confirm that application forms had been completed criminal records checks undertaken, PIN numbers verified and that copies of proof of ID and photographs were held. Two references had been sought on one file seen but only one had been returned. The inspector was advised that a second reference was still being asked for, however it is required that at all at least two written references are on file for all new staff employed. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 17 The manager said that new staff undergo the home’s induction programme but there were no records of this since the last inspection. The manager did produce the format for induction and staff spoken with confirmed they had received induction training, however records of this must be available for inspection to evidence the subjects covered. Training records and discussion with the manager and staff confirmed that staff had been provided training on first aid, MRSA, skin care, food hygiene, dementia awareness, activities, diabetes, vital signs workshop, record keeping and infection control. Training on POVA (adult protection guidance) had been provided but for some staff this training was three years ago. It is recommended that update POVA training be provided to staff to ensure awareness of current good practice guidance on this subject. Update training was also due for manual handling (due annually). The manager said she was aware of this and had training planned for after completion of the MRSA course currently underway, however this report requires that update lifting & handling training takes place by 31/5/08. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 18 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is good. Management systems are good and the home is run in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered provider/manager is a nurse and has owned and run the home for over forty years. Several the staff team also have long service at Langley Lodge and those spoken with confirmed they receive good support from the manager, however records were not available to confirm that regular 1-1 supervision meetings occur. It is recommended that these meetings take place at least six times a year. The manager said that quality assurance questionnaire forms are sent to residents twice a year, and to all intermediate care service users. Four of these were seen and included questions about the support provided, food and premises. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 19 These survey forms evidence that the views of service users are sought but there also needs to be an annual collation of responses with a summary of any resulting actions. This report includes a statutory requirement on this point. The manager said that Langley Lodge did not hold any residents monies for safekeeping. Any expenditure incurred by the home, on behalf of a resident, is invoiced to the resident or designated relative. The home had COSHH data sheets for cleaning substances used. There were premises fire risk assessments in place. Random samples of records required to be kept were inspected. These included: complaints, assessments, care plans, staff rotas, staff recruitment, visitors book, fire drills, menus, medication, background info’ and next of kin details and fire procedures. All seen were satisfactory except some recruitment records (see standard 29). Discussions with staff, management and inspection of records confirmed that training is provided to staff in fire safety, food hygiene, and first aid, but update training on moving & handling and adult protection (POVA) needed to be provided to all staff. Certificates and service records were available for inspection to confirm that fire alarms & equipment, stair lift, hoists, emergency lights, gas supply and electrical installation supply had all been tested/serviced within recommended timescales. Portable electrical appliances had been checked in 2006. Records were seen to confirm that the maintenance person carries out monthly checks on the temperature of the hot water supply in the home. Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 20 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 3 3 Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 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 OP12 Regulation 16 Requirement Arrangements must be made for all service users to have the opportunity to engage in a range of suitable and meaningful activities, which meet their needs and wishes. Previous timescales of 30/04/06 & 30/06/07 not met. All recruitment checks need to be in place for all new staff employed. New staff must receive documented and structured induction training, which is based on the Skills for Care common induction modules. Staff need update training on lifting and handling practices to ensure they are trained for their roles. The system used for periodically reviewing and improving the level of services provided by the home needs to take account of the views of service users, DS0000015540.V359797.R01.S.doc Timescale for action 30/06/08 2 OP29 19 30/04/08 3 OP30 18 31/05/08 4 OP30 18 31/05/08 5 OP33 24 30/09/08 Langley Lodge Version 5.2 Page 22 their relatives and other stakeholders such as health & social care professionals, and include an annual summary of the findings and of any resulting actions. 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 3 Refer to Standard OP7 OP28 OP30 Good Practice Recommendations Care plans should be reviewed at least once a month so that any change in needs is documented. 50 of care staff should reach NVQ level 2 or equivilant so that staff have the skills for their role. Staff should be provided update training on safeguarding adults (POVA), so that they are aware of the latest good practice guidance on this subject. Staff should have recorded 1-1 supervision meetings at least six times a year to evidence they are supported in their work. The small garden fishpond close to the rear of the conservatory lounge should be covered, to try to minimise any risk to service users. 4 OP36 OP38 5 OP19 Langley Lodge DS0000015540.V359797.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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