CARE HOMES FOR OLDER PEOPLE
LANGLEY NURSING HOME 44 Langley Road Slough Berks SL3 7AD
Lead Inspector Julie Willis Unannounced 11 April 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 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 NURSING HOME Version 1.10 Page 3 SERVICE INFORMATION
Name of service Langley Nursing Home Address 44 Langley Road, Slough, Berks, SL3 7AD 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) 01753 676500 Langley Nursing Home Limited Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places LANGLEY NURSING HOME Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: The number of persons for whom accommodation is provided at any one time shall not exceed 11 The category of persons for whom accommodation is provided shall be that of general nursing and medical care for the elderly Four of the eleven beds may provided accommodation for the elderly mentally infirm Date of last inspection 23 September 2004 Brief Description of the Service: Langley Nursing Home is situated on the main road near to Langley shops and High Street. The home can accommodate 11 service users over the age of 65 years, 4 of whom may be mentally frail.The home is an adapted premises on 2 floors serviced by a passenger lift. The home has 4 shared rooms and 3 singles. There are parking facilities to the front of the home and a large garden laid mostly to lawn at the rear. LANGLEY NURSING HOME Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out the inspection on a weekday morning and afternoon over a three and half hour period. The inspector toured the home during which all bedrooms and communal areas were visited. A number of care records, staff files and health and safety documents were examined during the course of the inspection. The inspector spoke at length to 6 of the 11 service users and 5 relatives. At the beginning and end of the inspection discussions took place with the Acting Manager about the inspectors findings. What the service does well:
This pleasant family run home had a warm, friendly and welcoming atmosphere. Staff appeared caring and attentive and demonstrated that they knew the needs of each user well. They were clearly able to meet the needs of the users in a sensitive and discreet manner, which maintained their right to dignity, privacy and independence. Service users confirmed that staff were “thoughtful”, “hard-working, gracious and kind”. Relatives confirmed that they are made welcome at any time and offered appropriate hospitality during their visits. They said they were kept “well informed” by staff about the health & welfare of the user and knew that they could raise any issues of concern directly with one of the Sisters and, “that their complaints would be treated seriously and dealt with promptly”. Service users are provided with opportunities to participate in activities as part of their daily routine. Service users confirmed that staff are happy to sit and do quizzes with them, to play games, do their hair or manicure their nails and that this use of staff time is positively encouraged by the homes management who view activities as a positive part of everyday living. LANGLEY NURSING HOME Version 1.10 Page 6 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.
LANGLEY NURSING HOME Version 1.10 Page 7 The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. LANGLEY NURSING HOME Version 1.10 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 NURSING HOME Version 1.10 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) 1, 3 & 4 People who may wish to use the service are provided with sufficient information to enable them to make a decision as to whether or not the home can effectively meet their needs. EVIDENCE: The statement of purpose and service user guide are detailed and specific to the range of facilities and services provided by the home. Information is given in a plain English and sufficient information is provided to enable a potential user or purchaser of the service to make an informed decision as to whether the home can meet their needs. A full assessment of need will be carried out by a senior nurse prior to admission who will then formulate a care plan upon which the care will be delivered. The tool adopted for the purposes of assessment is comprehensive and holistic in content. LANGLEY NURSING HOME Version 1.10 Page 10 During the course of inspection the home was clearly able to demonstrate how it meets the need of its service users. Staff individually and collectively appeared to demonstrate the skills, knowledge and experience to deliver the services the home offers its users. Staff have received the training they need to carry out their work role. LANGLEY NURSING HOME Version 1.10 Page 11 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 & 10 The health and personal care needs of users were well met by a staff team that appeared caring and attentive to the needs of users. Care was being delivered to service users in accordance with individual care plans. EVIDENCE: The principle on which the homes philosophy of care is based is to respect the privacy, dignity and autonomy of the individual. Staff were observed in practice to promote these values by ensuring that personal care was provided in a discreet and sensitive manner. Two service users files were selected and examined in detail. They appeared to be comprehensive, well documented and up to date. The use of clinical tools to identify risks to users in relation to tissue viability, nutrition, dependency rating, environmental risks, bathing and falls were fully developed. Care plans and treatment plans were in place to reduce the risks identified. Examination of the daily records clearly evidenced that care was being delivered in accordance with the individuals care plan. Examination of the storage and administration of medication indicated that nurses were following a safe and effective system, in line with current good
LANGLEY NURSING HOME Version 1.10 Page 12 practice guidance, to ensure that service users were administered their medication safely. The inspector spoke at length to 6 of the 11 service users and 5 relatives or advocates that visited during the course of the inspection. All of the users and visitors were complimentary about the qualities and caring attitudes of the staff. This was further evidenced by favourable comments recorded in the compliment book in the past three months such as “ we are more than happy with the way she is cared for and looked after” and “ Veeda sets high standards and all the girls work hard here” and “ head & shoulders above other homes”. Service users and their relatives confirmed that staff sought the advice and support from other health and social care professionals proactively to ensure the health and welfare of users. LANGLEY NURSING HOME Version 1.10 Page 13 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, 14 & 15 Service users are provided with a range of activities that provide mental and physical stimulation. EVIDENCE: Service users and their relatives were complimentary about the range of activities in which they may participate. Entertainers regularly visit the home and the staff are pro-active in engaging users in one-to-one activities such as card games, dominoes, hand massage and manicures as well as providing free hairdressing to all users. The inspector spoke to four relatives and an advocate during the course of the inspection all confirmed that they were made welcome at any time and offered appropriate hospitality during their stay. Service users confirmed that they may rise and retire at a time of their choosing and services are provided in a flexible way to meet individual expectations. Examination of the menu, observation and discussion with users and catering staff evidenced that service users are offered a varied and nutritious diet and have access to drinks, snacks and fruit throughout the day. LANGLEY NURSING HOME Version 1.10 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) 16, 18 The home has a satisfactory complaints system and there is evidence that service users and their relative’s views and comments are listened to and acted upon. EVIDENCE: Examination of the complaint records indicated there have been 2 complaints made by service users and their relatives about the home in the past 12 months. Both were well documented and there was evidence of outcomes provided to both complainants by the management. Since the last inspection all staff have received refresher training in the Abuse of Vulnerable Adults provided by the Responsible Individual who has recently become a certificated POVA trainer. LANGLEY NURSING HOME Version 1.10 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, 24, 25, 26 Standards of cleanliness and hygiene in the home ensure service user safety and provide users with a comfortable and homely place to live. EVIDENCE: A tour of the home took place during which the bedrooms were seen. Most are shared rooms with screens provided between the bed spaces to maintain the privacy of users. Rooms were light, airy and spacious and decorated and furnished in a homely manner. There is a need to re-decorate under the window in one bedroom (as identified during inspection), as there was evidence of damp. LANGLEY NURSING HOME Version 1.10 Page 16 Communal spaces were clean and comfortable. The position of the seating in small semi-circles provided users with the opportunity to sit facing their friends. Cantilever tables were provided in front of each seat on which users put personal items and their drinks. LANGLEY NURSING HOME Version 1.10 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, 28, 29, 30 Service users are protected and safeguarded by the homes robust approach to recruitment and selection. Staff are sufficiently trained and experienced to meet the needs of users in their care. EVIDENCE: At the time of inspection the home was adequately staffed with nurses, carers and ancillary staff to meet the needs of the users. The home appears to have a stable staff team of committed individuals who aspire to providing quality care to the users. The majority of the care staff are currently undertaking National Vocational Qualifications to further enhance their knowledge and skills. The Registered Nurses employed at the home are encouraged to maintain their professional competence and enhance their skills by attending appropriate professional training to meet the needs of users. An examination of the homes staff files evidenced that all necessary checks are carried out on new staff prior to their employment. All staff are required to provide a full employment record, to provide two verifiable references and complete a criminal records check. LANGLEY NURSING HOME Version 1.10 Page 18 New and existing staff are supported to fulfil the requirements of their work role by demonstrating their competence. Management regularly observe the care practice of staff whilst they carry out the tasks of the job. These sessions are recorded in the staff file as clinical supervision. LANGLEY NURSING HOME Version 1.10 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, 32, 33, 34, 35, 36, 37, 38 The home appears well run despite the prolonged absence of a Registered Manager. The service users live in a safe environment where risks to their safety are assessed and managed effectively. EVIDENCE: There is a need to recruit a Registered Manager to the home in order to provide continuity for users. The current arrangements of the Senior RGN acting up as Manager, although satisfactory in the short term, is not sustainable in the long term. The Acting Managers role should be formalised to that of Registered Manager or alternative permanent arrangements should be made to fill the vacant post. At the time of inspection the inspector had the opportunity to talk with the financial advocate for one of the users. It was clear that the home does not
LANGLEY NURSING HOME Version 1.10 Page 20 hold funds on behalf of users and all daily needs and requirements are dealt with by invoicing the users next of kin or the person with financial authority or power of attorney for monies owing. This policy safeguards users from financial abuse. The home has undertaken a quality assurance survey since the last inspection. Head Office is currently collating the results. The results will be shared with users and purchasers of the service and used by the home to focus the service more effectively on the needs of users in the future. Examination of a number of the health & safety records indicated that all necessary checks and servicing of equipment in relation to fire safety and the maintenance of the water system are routinely undertaken to safeguard the health & welfare of users. Unnecessary risks to users are identified using a range of clinical tools and risk assessment strategies. So far as possible the risks are reduced or eliminated by putting in place effective procedures, aids and other equipment. LANGLEY NURSING HOME Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 3 3 x N/A 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 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 1 3 3 3 x 3 3 3 LANGLEY NURSING HOME Version 1.10 Page 22 YES 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 31 Regulation 8 (1) Requirement Ensure that a Registered Manager is recruited to the home. The previous time scale of 23.3.05 was not met. Ensure that the rear facing shared bedroom is decorated beneath the window sill where water damaged. Timescale for action 23rd October 2005. 2. 19 23 (2) b 14th July 2005. 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 NURSING HOME Version 1.10 Page 23 Commission for Social Care Inspection 1015 Arlington Business Park Theale Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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