Inspection on 27/09/06 for Langley Nursing Home

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Langley Nursing Home 25/08/05

Langley Nursing Home 11/04/05

Langley Nursing Home 23/09/04

Langley Nursing Home 22/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Langley Nursing Home 44 Langley Road Slough Berkshire SL3 7AD Lead Inspector Ruth Lough Unannounced Inspection 30th September 2006 10:45 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 Nursing Home DS0000011000.V307415.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 Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langley Nursing Home Address 44 Langley Road Slough Berkshire SL3 7AD 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) 01753 676500 01753 653920 Langley Nursing Home Ltd Mrs Veeda Dennis Gill Care Home 11 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (11) of places Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th August 2005 Brief Description of the Service: Langley Nursing Home is situated on the main road near to Langley shops and High Street. The home is privately owned by the Trustworth Group Ltd and 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. The current fees for the home range from £565 to £670 per week. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit that took place over one day. The inspection included a review of information provided by the home and service user surveys returned prior to the visit. Nine service user questionnaires were returned to the commission, the majority of which had been completed on the service users behalf by relatives or friends. The documents and records that were available on the day were used as part of the information gathering. Service users’ and visitors’ opinions of the service were also obtained during the day visit. Discussion with and observation of the management, nursing and care staff was also included as part of the day visit to the service. 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. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Langley Nursing Home DS0000011000.V307415.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 Nursing Home DS0000011000.V307415.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that service users needs are assessed appropriately and thoroughly before admission. EVIDENCE: The assessment documents and records of 2 service users were reviewed. The assessment process is carried out by either the manager or a senior member of the management team of the company, before the service user is admitted to the home. The assessment includes obtaining information from other professionals and the service users and their families, where possible. The health and medical needs of the service user are identified and their social activities and interests are recorded. The medication that the service user is currently taking is also noted. The service users’ mobility and the equipment they need to remain mobile and achieve their personal care needs are documented. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 9 To enable staff to learn more about the individual service users’ wishes about how they wish to live, they use a family history document. This is where the home enlist the help from families, friends and other professionals to support the information obtained from the service users about their life history. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and staff ensure that service users health and personal care needs are met. EVIDENCE: Comments from the service users’ survey indicated that over 50 thought that their needs were always met by the home. Other comments were “Very high standard in this home. Staff very helpful.” Also “The staff of the home always try their best to keep up with my mothers care and support.” One observation from a relative was “that mother does receive the care and support she needs. I do find however, that the nursing home is not often keen to move away from its routine and can sometimes be a little inflexible in the way things are done. As a result, individual care and attention can be lost on a day to day basis.” During the inspection visit 2 service users’ plans were reviewed, one service user had been admitted since the last inspection visit and the other had been resident in the home for over 10 years. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 11 In the care plans staff are provided with key document tools to help them to provide consistent care to the service users. These tools are: the personal profile which includes medical conditions, contact details of relatives, life history, activities of daily living, continence, nutrition, weight, observations. They use the “waterlow” scoring system to assess the service users health risks in regard to possible pressure sore, and circulatory and skin integrity damage. A general risk assessment and a safe moving and handling assessment give staff enough information to ensure that service users and staff are not put at risk. They also identify meeting goals and objectives for the service users for staff to manage the service users confusion. The service users are assisted to obtain external resources of medical care. All other healthcare professionals such as those by the service users own general practitioner, physiotherapist or chiropodist record the outcomes of their visit in the service users care plans. One relative commented “when my mother needs the doctor, one is always called” another stated that “Sometimes the staff don’t notice something wrong”. The home use nutritional and continence assessment care plans that inform the staff of the service users’ needs. However, the instruction of how they are going to met such as supplementary snacks or drinks or how often and what assistance the service user will require to the toilet, is not recorded. There are no service users currently resident in the home that have pressure sores. The staff ensure that the majority of the service users are mobilised as best as they are able or provided with a variety of furniture or wheel chairs with different pressure relieving cushions. The staff record in detail the outcomes of the service users’ day. However, the home could be compromising its legal responsibilities for record keeping. This is through that not all the staff are acknowledging what they have recorded by the use of their full signature, and the home do not keep a record of sample signatures to verify the entries. Service users’ medication needs are documented in their care plans and the nursing staff are provided with policies, procedures and document tools to guide them to administer them safely. However, the nursing staff are not following these guidelines as they record only their first name not their full signature when recording the administration of the Controlled Drugs. The home stores all the medication appropriately in secure facilities that are only accessible to specific staff. All the medication held on service users’ behalf is routinely audited every six months, by the contracted pharmacy that supplies the medication to the home. The home has implemented safe practices for the disposal of the medicines no longer required through contracted services specific for this purpose. The staff have identified that none of the service Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 12 users currently living in the home have the mental capacity to manage their own medication administration. The service users spoken to and information from the survey supported that they and their relatives felt that privacy was maintained and that staff listened to service users. One comment was “The staff are very hard workers and treat everyone with respect.” The majority of the service users share bedrooms and there are only 3 single rooms available in the home. Service users or their representatives when they are not able, confirm in writing, consent to sharing the bedrooms. One service user confirmed that she was happy with sharing her room - it gave her some comfort to think someone else was in the room. The manager stated that staff use mobile screens for privacy when they carry out personal care with the service users. Staff were seen communicating well with service users both when carrying out support with daily activities and entering and leaving the rooms. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports service users to be able to continue with their lives as they wish and according to their capabilities. EVIDENCE: The majority of the service users in the home have poor mental health, and the staff provide a variety of activities that are tailored to interest and stimulate the residents. The activities that are carried out in the home range from; games, music, light exercises/dance and reminiscence. Pastoral visits by the local Catholic priest occur fortnightly and manager stated that he did visit and chat with other service users if they wished. Service users personal choices, interests and preferences are recorded in their care plans to assist staff provide the activity programme. Service users, staff and relatives commented very positively about a recent barbeque in the garden of the home that they enjoyed together. One service user took great pleasure to show the inspector the photos taken during the event. Service users relatives in the survey and visitors to the home confirmed that the staff encourage them to be involved in any activities going on in the Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 14 home. The staff were seen to be supporting service users with playing games during the visit. Service users are able to continue to make decision about how they wish to live through how they personalise their rooms, choice of clothing and what they want and where they want eat their meals. Their decisions are recorded in the care plans. The home is able to provide information for visitors and service users to access information about advocacy support should they wish or need assitance. Service users spoken to on the day of the visit enjoyed the meals provided in the home. Service user and relative comments provided in the survey included “The food always looks very nice and well presented”, “My Aunt has always enjoyed her food and has not made any complaints to me” and “My mother is vegetarian and the home do make an effort to make meals for her and the food she likes.” Service users’ dietary needs are identified through the nutritional assessment process carried out by staff, and their preferences for food are recorded in their care plans. The home has a rotational menu plan and provides service users with alternatives should they not wish to have the planned meal. The staff were seen to assist service users with their meals sensitively, and service users were able to take their meals in the privacy of their rooms if they wish. The kitchen area is kept very clean and tidy with a high standard of cleanliness. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ complaints and concerns are listened to and acted upon effectively. Service users are protected by the staff’s knowledge and the training provided about safeguarding vulnerable people. EVIDENCE: Service users and relatives stated in the survey that they knew how to complain is they were unhappy or had a concern about the service provided. Some of the comments were “I know who to speak to if I’m not happy.” “ Mum has been here for more than 2 years. I’ve never has a reason to complain about anything,” and “My first point of call is always the sister who usually deals with issues quickly and satisfactory.” All the complaints/concerns are recorded in a book that is left in the hallway of the home for visitors, service users and staff to write their concerns. The manager also uses this to record the details, investigation and action taken. This could compromise any confidentiality for those involved. The complaints policy and procedure is on display and in the Statement of Purpose in the home. The home has received one compliant since the last inspection visit that was dealt with within the expected timescale and appropriate action was taken. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 16 Staff are provided with structure training about abuse and the protection of the service users in the induction programme. Copies of the home’s policy and procedures are made available to staff in the staff handbook. Formal training is provided in the home on a regular basis and staff undertake a written test following to confirm that they have a good grasp of the principles. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. That the home is well–maintained and kept clean and hygienic. EVIDENCE: The home is a converted family home that is arranged over two levels. The shared communal space is situated on the ground floor that includes a conservatory extension that overlooks the rear garden that is laid mainly to lawn. All areas of the home are maintained well and there is routine planned repair and renewal programme for equipment and facilities. Recent improvements have included the replacement of the upstairs bathroom with new assisted bath for service users to enjoy. There is a high standard of cleanliness all round the home. Service users and relatives gave comments included : “The home always smells fresh and clean,” Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 18 “Whenever I visit the home is always fresh and clean- bright in the summer, warm and cheerful in the winter.” Another comment form a relative also stated “One of the things I liked about the home was that it is small, lovely and clean. I have never seen it unclean or smelly. It would be nice if the garden was better maintained so that the residents could enjoy it.” Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are supported by a skilled and experienced staff team. EVIDENCE: Service users and relatives gave very positive comments about the staff working in the home. Some of the comments were “I would not want my mum to go to any other home. The care she gets from the staff at Langley Nursing Home is superb. The staff are always friendly and treat the residents with respect.” Another comment was “The staff are friendly and caring. The sister is hardworking and manages staff well. On the whole the home cares for its residents well and relatives are always welcomed at any time of the day.” The home has a planned rota of staff that supports that sufficient staff are employed in the home at all times. The home always has a Registered Nurse on duty at all times who is supported by one or two care staff each shift. The home has domestic staff and a cook to assist with cleaning, laundry and meals. During the evening and night periods there is always the minimum of two staff. There are 7 registered nurses and 8 carers, including Bank staff, currently working in the home. The home has a recruitment policy and procedure that assist the management team to recruit and employ staff appropriately. Two staff files were reviewed to look at how the home has carried this out. One staff member had been Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 20 recruited after the last inspection, the other had been working in the home since 2003. Each file showed that the required information before the staff member is employed, is taken. This includes references, Criminal Records Bureau checks and a health declaration. Apart from the current application form used does not request the applicants full work history (CHR 2001,Ammendment July 2004). Also the applicant is not requested to record in what capacity the referees are know to them. The formal interview process is documented, but this would be improved by recording in greater detail the topics discussed. The induction training process is recorded in great detail and covers the main topics including care skills to support new staff carry out their roles. The manager takes the responsibility of the mentoring and training of new staff employed in the home. The home has an active training programme that includes health and safety topics and those that support the specific needs of the service users such as diabetes, challenging behaviour and dementia. Medication and risk assessment training has been provided for those who undertake these responsibilities in the home. The staff confirmed that they are very happy about the training they receive and feel that they are supported well by management to learn new skills. Three of the carers have an NVQ 2 or above, that is equivalent to 45 of the care staff employed have achieved a recognised training qualification to support their roles. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home is managed well and is run in the best interests of the service users. Service users, staff and visitors are protected by the safe working practices in the home. EVIDENCE: The manager is an experienced registered nurse who is supported well by the management of the company. She has been in this role since January 2006, but has been working with the company for a considerable time before this. The manager and staff work well together and service users and relative expressed they had confidence in them and that they communicated well and acted upon any comments or concerns quickly. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 22 The home has carried out some formal consultations through questionnaires with service users to assess how effective they are providing the service. The proprietor also carries out regular monitoring visits although these are not recorded. There is a system of staff meetings, supervision and appraisals that ensure that information is obtained that contributes to developing the service. The home has not yet collated all this information together in an appropriate format so that it can be provided to service users. The manager stated that the home does not handle any of the current service users’ monies. Service users or their families or representatives who take responsibilities for this role are invoiced directly for any purchases the service user does such as hairdressing or chiropody. The home has a regular programme of routine servicing and maintenance for the equipment, fire safety, utilities and lift. Information is left on display or made available about health and safety topics for staff to follow. There is a good programme of regular training that is also included in the induction process for all safe-working practices that is provided to all staff working in the home. Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 23 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 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 Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 Requirement That the recruitment process ensures that the applicant provides a full work history. Timescale for action 30/11/06 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 4 Refer to Standard OP7 OP7 , OP9 OP16 Good Practice Recommendations That greater detail is recorded in the service users care plans to instruct staff how to carry out providing care to meet the service users needs. That staff acknowledge their entries in the service users care plans and the administration of the Controlled Drugs with their full signature. That concerns or complaints are recorded and stored appropriately to ensure that confidentiality is not compromised. That the interview process is recorded in greater depth to support evidence of the topics discussed. OP29 Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Berkshire Office 2nd Floor 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 © 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 Langley Nursing Home DS0000011000.V307415.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!