Inspection on 05/05/04 for Langrigg House

Care Home For Older PeopleLangrigg HouseLangrigg Road Morton Carlisle Cumbria CA2 6DXUnannounced Inspection5th May 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Langrigg House Address Langrigg Road, Morton, Carlisle, Cumbria Email address cumbria.care@cumbriacc.gov.uk Name of registered provider(s)/company (if applicable) Cumbria Care Name of registered manager (if applicable) Mrs Eileen Joy Muir Type of registration Care Home No. of places registered (if applicable) 40 Tel No: 01228 606391 Fax No:Category(ies) of registration, with (number of places) Dementia (13), Old age, not falling within any other category (40) Registration number F100000303 Date first registered 1st April 2003 Was the home registered under the Registered Homes Act 1984? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 21st May 2003 NO YES 05/02/04 If Yes refer to Part CLangrigg HousePage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 35th May 2004 10:00 am Liz KelleyID Code094951Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionEileen Muir, Registered ManagerLangrigg HousePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementLangrigg HousePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of Langrigg House. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.Langrigg HousePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Langrigg House is located in a suburb of SW Carlisle and is central to local amenities such as health centre, shops, Post Office and on a bus route. The internal layout had been redesigned to offer shared accommodation in four smaller units each included a sitting/dining room, and kitchenette. Langrigg House offered a separate 10 bedded EMI unit and dedicated respite accommodation. These were both located on the ground floor and each had its own separate lounge. The EMI unit had a large lounge and conservatory area, which allowed for service users to have visitors in private. The home had bathrooms (7), showers (2), and toilets (20), which were fitted with suitable equipment and adaptations. Thirteen bedrooms had en-suite facilities. Sluice facilities were suitably located within the home. Service users were able to move around the Home independently with the help of passenger lifts, ramps, handrails and grab rails. A range of equipment was available to assist with the safe moving and handling of service users. There was a call bell system throughout the home. The registered provider is Cumbria Care, previously known as the local authority provider, who also operated a day service for older people situated within the home.Langrigg HousePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.)Langrigg HousePage 6 This was an unannounced inspection carried out over a morning and afternoon period and service users, staff, relatives and the manager were interviewed. Service users spoken to were very happy with the care they were receiving, one commenting `you couldnt fault them, we are well looked after. A good rapport was observed between staff and service users, and warm and friendly exchanges were noted. Since the last inspection the needs of the service user group as a whole had lessened as examination of care plans, interviewing staff and by observation concluded that there were fewer people with complex healthcare needs. A combination of deaths and moves to a nursing setting had brought this about. A letter of thanks to all staff from a relative of a service user who had passed away at the Home recently gives an indication of how they felt about the care ` It is particularly good for us as a family to be able to speak up for the high standard of care provided by Langrigg House, when the public at large can be so critical of Care Homes. Unfortunately media highlights of poor standards come to be regarded as general and fill potential residents and their families with fear. Langrigg House has nothing to hide. We fell privileged to have seen at first hand what real care is- love, patience, tenderness, and kindness. Keep up the good work. On the day relatives spoken to were also pleased with the care their relatives were receiving, however a number spoke of lack of stimulation, particularly in the afternoons. Speaking to service users and by observation confirmed this. The staffing levels within the Home had not yet met the level set for the end of March 2004 to bring the Home in line with the national Residential Staffing Forums (RSF) levels. This was reflected in the difficulty in meeting individual social and recreational needs. For example service users said they would like to go out more and staff said it would be nice to spend time having more one-to-one conversations. Choice of Home (Standards 1-6) 5 of the 6 standards assessed were met The Home had a Statement of Purpose and Service User Guide; these contained useful and relevant information that would enable prospective service users to make an informed choice about the suitability of a placement. Since a recommendation at the last inspection the manager was developing the Statement of Purpose to include information about the nature of the care, approach, staffing experience and qualifications within the EMI unit. A satisfaction survey had recently been carried out and the manager stated that the results would be incorporated into the Service User Guide. The results of this internal survey were a level of 97.6 from service users and 95.12 from relatives. Arrangements were made for service users to visit prior to entering the home. A number of service users stated that the Home had a good reputation in the local community and were particularly pleased to be able to stay in the local area. Health and Personal Care (Standards 7-11) 3 of the 4 standards assessed were met The staff were able to demonstrate comprehensive records and systems to monitor serviceusers health care needs. Service users said that they could have a GP of their choice and staff helped them to arrange appointments. The home had developed good working relationships with local health care professionals, for example District Nurses and community psychiatric Nurses. Daily Life and Social Activities (Standards 12-15) 2 of the 3 standards assessed were met The home had a routine, which enabled the personal care needs of 40 service users to be Langrigg House Page 7 delivered in an effective way. Wherever possible flexibility was given if service users or relatives request it. For example in discussion with service users they confirmed that they can choose to eat in their rooms, and choose what time to go to bed or get up in the morning. The Home had developed a monthly activities programme and had tried out some interesting activities such as manicures, Easter Bonnet Parades, and singers/entertainers. As previously mentioned service users and relatives would like to see more stimulation and attention in the afternoons. When this does occur, such as a Christmas shopping trip this can only happen through staff who gave up their own time and this demonstrated the goodwill of staff to ensure service users had these opportunities. A requirement was made to put a comprehensive activities programme in place, including one-to-one sessions, and to increase staffing levels to facilitate this. Complaints and Protection (Standards 16-18) 2 of the 3 standards assessed were met The Home had a complaints procedure, which had the appropriate 28-day response time. A record was kept of all complaints. One complaint had been received in the last year, and this was examined and found to be properly dealt with. Details of how to complain were posted around the home, and a summary can be found in the Statement of Purpose with appropriate contact details, including advocacy agencies. All staff had received training relating to the protection of vulnerable adults. There were policies and procedures in place to safeguard service users. Environment (Standards 19-26) 6 of the 7 standards assessed were met The home is located to the SW of Carlisle on a large housing estate, which is well served by public transport, and contains numerous local shops and a post office. The internal layout had been redesigned to offer shared accommodation in four smaller units that included sitting/dining rooms, and kitchenettes. Each of these units were furnished and decorated in a homely manner, and were warm and pleasant to spend time in. All of the bedrooms in the Home were for single occupancy. There were only 15 bedrooms, which meet the minimum standard of 10sqm; the remainder (25) were below the lower size, some significantly lower. This had been detailed in the homes Statement of Purpose and Service Users Guide. The home also had a condition placed on its registration, which limits the use of the smaller rooms for people who use wheelchairs independently. There was currently one service user who independently used a wheelchair and they were in a large room. At the last inspection a recommendation was made for Cumbria Care to assess the style of lift currently in use, which had heavy metal double gates and can only be used with staff assistance, therefore limiting independence. The manager said that the organisations Accommodations Manager had requested quotes to be taken up to change the lift to a more user-friendly version. The bedrooms were equipped with a range of furniture according to the wishes of the occupant, and some service users had chosen to bring some of their own furniture from home. The EMI unit had recently improved its security by installing a digital lock to the units front door. The manager had instigated this development after an incident when a respite service user had wandered out of the building. Staffing (Standards 27-30) Of the 4 standards assessed 2 were met From examining staff rotas and by interviewing staff and service users it was evident that staffing hours were not up to the levels required as apart of the Homes s registration, which requires 891.33 care hours with an additional 209 for overhead hours. The Home was currently running on 698 care hours. The inspector judged that the present staff team were hard working and dedicated and were being effective in meeting the basic care needs of service users. Where care was being compromised was in the needs over and above basic care, for example in areas of social, recreational and emotional care. Cumbria Care was Langrigg House Page 8 directed to apply the Residential Staffing Forums formula to include these aspects and to increase staff levels to meet this level in order to meet the holistic needs of service users. The figure of 891.23 care hours is the minimum of care hours, and should not include managerial, administrative or ancillary hours. A requirement was made, therefore, to provide at least one extra member of staff between 1.00pm and 4.30pm. Management and Administration (31-38) Of the 5 standards assessed 4 were met Mrs Muir demonstrated that she was a competent and experienced manager able to meet the demands of a large care home. The manager gave a clear sense of direction and leadership, and in interviews with staff and service users both groups were clear on the managers ethos and aims for the home. Staff interviewed had received relevant training to ensure the health and safety of the people who lived and worked in the Home. Records of supervision sessions were examined and appropriate formats were followed, these were dated and signed. Written records were kept of all financial transactions relating to service users finances. The manager stated that the Home was to shortly employ an administrative assistant to help out with office duties.Langrigg HousePage 9 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report, which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action 1 18 OP27 The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults by 1st April 2004 01.04.04Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard 1 OP22 The passenger lift should be reviewed for the feasibility of providing a more user friendly styleCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS). The service must at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission Langrigg HouseMet (Yes / No) YES Page 10 The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults by 1st April 2004 When single rooms of less than 12sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12sqm they must be given the opportunity to move to a larger room when one becomes availableNOYESLangrigg HousePage 11 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults by 1st April 2004. At the time of inspection this level was determined at 819.98 care hours and this is the minimum of care hours that must be provided Social and recreational activities must be provided, including access to local, social and community activities with staff support as necessary The passenger lift must be accessible and user friendly to allow opportunities for greater independence and free movement of service users. An extra member of staff must be provided between 1.00pm and 4.30pm to allow for social and recreational activities118YA2701.07.04216OP1201.07.04323OP1930.09.04418OP2701.07.04RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings.Langrigg HousePage 12 No.Refer to Standard *Good Practice Recommendations* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.Langrigg HousePage 13 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES YES YES YES YES YES NO NO YES NO YES NO YES YES NO NO NO YES NO YES 18 4 0 YES YES YES YES 26 0 05/05/04 10.45 6.5Langrigg HousePage 14 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Langrigg HousePage 15 Langrigg HousePage 16 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide. Range of fees charged From (£) 325.00 To (£) 377.00Any charges for extrasYESIf yes, please state what the extras are: hair dressing, dry cleaning, telephone calls, escorts to hospital, personal clothing alterations 2 Key findings/Evidence Standard met? The manager had developed a Statement of Purpose and Service Users Guide that was a combined document, and included environmental standards, such as room sizes not meeting the desired standard. Since a recommendation at the last inspection the manager was developing the Statement of Purpose to include information about the strategies of care and approach, staffing experience and qualifications within the EMI unit. A satisfaction survey had recently been carried out and the manager stated that the results would be incorporated into the Service User Guide. The results of this internal survey were a level of 97.6 from service users and 95.12 from relatives. The manager was reminded to inform the Commission for Social Care Inspection(CSCI) of any changes to the Statement of Purpose, and that if this involved changes to either numbers or categories of service users an application for variation to the Homes registration must be submitted to the CSCI for consideration. The document was well laid out, concise and informative, and after these recommended additions it will be very useful for both service users and professionals.Langrigg HousePage 17 Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 3 Key findings/Evidence Standard met? Each service user was given a Residents Handbook at the point of moving into the home and in this terms and conditions were detailed. This was a corporate document and required amending for each service user to be specific to Langrigg House. These amendments and specific information were: room to be occupied; fees payable by whom; additional services to be paid for, over and above those included in the fees; rights and obligations of the service user and registered provider and who was liable if there is a breach of contract. These were examined and found to be in order. Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 3 Key findings/Evidence Standard met? Care Management Assessments carried out by social workers were examined and found to contain all the relevant details on which to admit a person to the home. These were used as the basis of service users daily care plans for meeting their needs while living at the home. Cumbria Cares operational manager assessed independent fee payers.Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 2 Key findings/Evidence Standard met? This standard was measured across the day and based on the views of service users and staff, and on staffing levels and provision of equipment and services. Service users felt their needs were being met and were very happy with the caring attitude of staff. Staff also felt that their needs were being met through supervision and training. The home was judged as being able to meet the current needs of its service users. However there was a marked increase in the comments about lack of stimulation for service users. The manager and Cumbria Care will need to constantly assess and review staffing levels to ensure that they are at levels sufficient to meet these needs. The required tool identified for this is the Residential Staffing Forums (RSF) formula. At the last inspection the use of this tool appeared not to have been taken into account certain key areas, such as social and recreational activities and staff training cover. A recommendation was made that the manager had their own copy of the RSF formula to allow for this level of review and accuracy to take place. The manager now had a copy of the RSF, and in conjunction with the Operations manager had submitted to the provider Cumbria Care the additional hours they required to meet the RSF and the needs of the service user group.Langrigg HousePage 18 Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 3 Key findings/Evidence Standard met? The home had a policy on admissions and emergency placements. Some service users had the opportunity to use the day care option or the respite service before taking up a permanent residency. The staff on duty stated that the home had an open door policy for prospective residents and visits were tailored to suit the needs of individuals. This policy was examined within the homes Statement of Purpose, and service users spoken to confirmed that they were given ample opportunities to test drive the home before making a decision to move in. A number of service users stated that the Home a good reputation in the local community and they were delighted when they were offered a place. Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short-term intensive rehabilitation and enable service users to return home. 0 Key findings/Evidence Standard met? Intermediate Care is not provided in this establishmentLangrigg HousePage 19 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes 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.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 3 Key findings/Evidence Standard met? A selection of care plans were examined and discussed with keyworkers, supervisors and service-users. The care plans examined were clearly laid out and contained relevant information based on appropriate assessments. These were reviewed on a regular basis with service-users involvement, where appropriate. Evidence was found to demonstrate that the manager carried out periodic quality checks on each care plan. Risk assessments and moving and handling assessments were included with the plans. Keyworkers and other care staff demonstrated a good knowledge of care plans and service-users assessed need. The home had introduced a new format for care plans, and supervisors spent a considerable amount of time implementing them, they also included additional sections to highlight the input from healthcare professionals. All the care plans from the EMI unit were examined and the responsible senior was setting time aside to consult with each persons family.Langrigg HousePage 20 Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) 23 23 Key findings/Evidence Standard met? The Manager was able to demonstrate comprehensive records and systems to monitor service-users health care needs. Each service-user was registered with a GP of their choice and had a named District Nurse. The home and service-users make effective use of the Primary Health Care Team and more specialist services when required. An example of this team approach, with the health professionals, was demonstrated in pressure care management. Service users stated that staff were always willing to arrange appointments with their own GPs when requested, and that they had confidence in the staff to monitor any changing condition and call in assistance when needed. At the last inspection a significant number of service users were requiring higher levels of care, a number requiring assistance from two carers to carry out personal care, and had more complex health issues which had implications on staffing levels and training. This was also indicated in the increase in the number of falls and admissions to hospital. This had resulted in a requirement to provide three night staff. As stated early in the report the Home now had less service users with high levels of healthcare and personal care needs, and the number of night staff had been reassessed and now was sufficient at two per night. The Home demonstrated good links with the Community psychiatric nurses, District Nurses and Occupational therapist. A number of service users had profiling beds as a result of recent OT assessments which had resulted in improved skin care, and an improved hoists had been provided.Langrigg HousePage 21 Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 3 Key findings/Evidence Standard Met? The pharmacist inspector had assessed this standard at the last inspection, and there had been a number of requirements and recommendations as a result. The following were requirements and recommendations: The home was required to either cease secondary dispensing or implement robust protocols with strict cross-referencing and checking systems to prevent errors. The home was required to ensure all service users who self-medicate were risk assessed and give consent. Current medicines storage in kitchenettes was inappropriate due to high temperatures. It was recommended that medication that was currently stored in a domestic refrigerator should be temporarily locked in a box within it until the medicines refrigerator was obtained. It was recommended that the home implement a homely remedy policy. It was also recommended that the home purchase a bound Controlled Drugs register. It was recommended that the home liaise with the supplying pharmacist regarding reports on advisory visits and medicines labelling issues for eye drops and medications in large containers. The Home had followed all of these areas up and implemented measures that now met the requirements, and had received a medications trolley to assist them in the dispensing of medications.Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 3 Key findings/Evidence Standard met? Staff were seen delivering care in a sensitive and respectful manner: addressing serviceusers by their preferred name, knocking on doors and enabling service-users to maintain as much independence as possible. Arrangements were made for service-users to have private use of a telephone. Service users were examined by healthcare professionals in their own rooms, and this practice was witnessed on the day of inspection.Langrigg HousePage 22 Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 0 Key findings/Evidence Standard met? This standard will be assessed at the next inspection.Langrigg HousePage 23 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 2 Key findings/Evidence Standard met? The home had a routine, which enabled the care of 40 service users to be delivered in an effective way. Wherever possible flexibility was given if service users or relatives request it. For example in discussion with service users they confirmed that they can choose to eat in their rooms, and choose what time to go to bed or get up in the morning. The home had an activities programme but staff time was limited due to attending to basic care needs. This had been further exacerbated by the day service provision based in the home recently refusing admission to those people living at the home, and targeting those people who may be isolated living in their own homes. A number of service users stated that they had been upset by this decision and a number of service users and relatives spoken to said that in the afternoons there was little to do, and not very much offered in the way of activities at this time of day. Some service users said they would like to go out more, and gave the example of walking to the local shops to get toiletries and a newspaper. While the service users said they were very grateful that staff went to get these items, and some staff went in their own time as the Inspector observed on the day, they would like to have the choice to go out from time to time. A requirement was made to ensure that appropriate activities and stimulation was offered to service users. This requirement was linked to increasing staffing to the RSF levels. Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences. 3 Key findings/Evidence Standard met? Details of family and friends were very much in evidence in service users care plans including key information and frequency of contact. The Home had space to allow service users to see family and friends in private. A relative the Inspector interviewed said they were made to fell very welcome at the Home and were made to feel a key part of the team caring for their relative. They had been particularly pleased that the family had been supported to arrange and hold a family get-together and party for their fathers last birthday in the large communal lounge of the Home.Langrigg HousePage 24 Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 3 Key findings/Evidence Standard met? The manager stated that each person living in the home was treated as an individual and care plans were tailored to individual needs. The home encouraged service users to manage their own affairs, often with the support of family. Those who indicated a wish were assisted to gain a postal vote for elections. All mail was given directly to the service users to open, and many had brought items of furniture and other possessions into the home, which was duly recorded. Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? Service-users were offered three full meals a day and were able to have a choice; the main meal of the day was served up at lunchtime. Snacks and fruit were available between meals and each of the residents sitting rooms had small kitchens for this purpose. Specialist diets were catered for and menus drawn up in consultation with service-users. The menu was circulated round each unit in the day before to ask what service users would like for lunch and given two main options, with the additional option of a salad. Service users stated that the cook comes to seek opinions on the food and any changes or suggestions, and those spoken to were very complimentary of the meals. The manager had ordered additional sealed inserts for the catering trolleys, which take meals from the kitchen to the dining rooms. This was an issue identified at a previous inspection visit, when service users felt that meals were not always hot enough. There were no complaints on the temperature of the food on this visit.Langrigg HousePage 25 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 1 0 0 1 0 0 100 3 Key findings/Evidence Standard met? The Home had a complaints procedure, which had the appropriate 28-day response time. A record was kept of all complaints. Details of how to complain were posted around the home, and a summary can be found in the Statement of Purpose with appropriate contact details, including advocacy agencies. The manager was recommended to ensure that all existing service users also had a copy available to them that can be held personally by them or kept in their rooms. The one complaint made to the manager was examined and this had been appropriately recorded and dealt with to the satisfaction of the person complaining. The manager had notified the Commission for Social Care Inspection.Langrigg HousePage 26 Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 3 Key findings/Evidence Standard met? The home promotes the use of advocacy services and as previously stated encourages service users to participate in the civil processes mostly via postal voting.Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists YES X3 Key findings/Evidence Standard met? All staff had received training relating to the protection of vulnerable adults. There were policies and procedures in place to safeguard service users. A new member of staff was interviewed and had a sound knowledge of the complaints and whistle blowing procedures. The home was also aware of the issues of restraint and made appropriate assessments of service users prior to using bed sides to ensure their suitability and safe use. The manager also demonstrated a good awareness of other related issues such as the inappropriate use of sedatives and sleeping tablets.Langrigg HousePage 27 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 2 Key findings/Evidence Standard met? Langrigg House is located in a suburb of SW Carlisle and was central to local amenities such as health centre, shops, Post Office and on a bus route. The internal layout had been redesigned to offer shared accommodation in four smaller units that included a sitting/dining rooms, and kitchenettes. A fifth unit is used for respite accommodation. Each of these units were furnished and decorated in a homely manner, and were warm and pleasant to spend time in. The home complied with the requirements of the local fire service and environmental health departments following their last visits. The carpet in the Pennine lounge had been replaced following a requirement at the last inspection. A programme of routine maintenance was examined to ensure that the home was well maintained. At the last inspection a recommendation was made for Cumbria Care to assess the style of lift currently in use, which had heavy metal double gates and can only be used with staff assistance, therefore limiting independence. The manager said that the organisations Accommodations Manager had requested quotes to be taken up to change the lift to a more user-friendly version. Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 3 Key findings/Evidence Standard met? There was sufficient communal space in the Home, which includes three sitting/dining rooms, and two communal lounges that can be used after the day service has finished, one of which was the smoking lounge. The outdoor space was accessible to service users and had outdoor seating. The lighting and furnishings were domestic in quality.Langrigg HousePage 28 Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 3 Key findings/Evidence Standard met? There were sufficient communal toilets throughout the Home in suitable places. The Home has four assisted baths and one adapted shower room, which meets the ratio stated in the minimum standards. The Home had three sluice rooms, and separate hand washing facilities were available within these areas.Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 2 Key findings/Evidence Standard met? The Home initiated assessments from Occupational Therapists and Physiotherapists and the outcomes were detailed within the care plans. Examples of these were seen on the day of the visit, and had resulted in specialist pieces of equipment such as profiling beds and hoists. Service users were assisted to move around the Home independently with the help of ramps, handrails and grab rails. The style of the passenger lift, double heavy gates, makes the lift extremely difficult for service users to use independently. A requirement was made to assess the suitability and review alternatives as service users on the upper floor were dependent on staff or relatives to access the community or to move completely freely around the home. There was a range of equipment to assist with the safe moving and handling of service users and there were assisted baths and suitable shower rooms. The home had spacious corridors with handrails and there was a call bell system throughout the Home.Langrigg HousePage 29 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite YES NO NO 40 16 0 0 15 252 1 0 03 Key findings/Evidence Standard met? All bedrooms in the Home were for single occupancy. There were only 15 bedrooms which met the minimum standard of 10sqm. The remaining 25 bedrooms were below 10 sq.m, some significantly lower. A condition of registration applies to this standard: When single rooms of less than 12sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12sqm they must be given the opportunity to move to a larger room when one becomes available. Where the home falls below the National Minimum Standard for space requirements this had been detailed in the homes Statement of Purpose.Langrigg HousePage 30 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. 3 Key findings/Evidence Standard met? The bedrooms were equipped with a range of furniture according to the wishes of the occupant, and some service users had chosen to bring some of their own furniture from home. Where rooms were too small to accommodate all of the furniture required in the NMS, this must be detailed in the Statement of Purpose and in the Service Users Guide. Service users must be made aware that they can request an extra chair if they wish to see visitors in their own rooms, and supporting evidence will be expected at the next inspection. All bedroom doors had locks and service users can hold their own door keys. All rooms had a cupboard that locks. Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 3 Key findings/Evidence Standard met? All of the bedrooms had a window, which opened, and all had a window restrictor fitted for safety. Central heating radiators and pipes were guarded and all had recently been upgraded and fitted with thermostatically controlled valves. The lighting was domestic in character. There was emergency lighting throughout the Home. The water temperatures were regularly checked and recorded. The Home had been assessed for the risk of legionella and steps had been taken to minimise this risk. Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 3 Key findings/Evidence Standard met? On the day of the inspection the home was clean, tidy and free from offensive odours. The manager had policies and procedures in place, operated to Cumbria Cares QA system and had sufficient domestic staff hours to maintain high standards of hygiene and cleanliness. Service users spoken to said that the Home was always had a fresh, pleasant smell. The sluice facilities were appropriately situated away from service users living areas and had separate hand wash facilities. The Home used soap dispensers and paper towels to maintain hygiene levels and reduce cross infections. The Home had a policy on MRSA and staff were aware of the steps within this policy guidance.Langrigg HousePage 31 Langrigg HousePage 32 StaffingThe intended outcomes for the following set of standards are: · · · · 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 homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours 20 0 0 needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence 12 8 819.98 No. staff hours allocated No. staff hours allocated No. of staff hours provided 0 0 698 0 0 00 26 6 Standard met? 1Langrigg HousePage 33 From examining staff rotas and by interviewing staff and service users it was evident that staffing hours were not up to the levels required as apart of the Homes s registration, which requires 891.33 care hours with an additional 209 for overhead hours. The Home was currently running on 698 care hours. The inspector judged that the present staff team were hard working and dedicated and were being effective in meeting the basic care needs of service users. Where care was being compromised was in the needs over and above basic care, for example in areas of social, recreational and emotional care. Cumbria Care was directed to apply the Residential Staffing Forums formula to include these aspects and to increase staff levels to meet the this level in order to meet the holistic needs of service users. The figure of 891.23 care hours is the minimum of care hours, and should not include managerial, administrative or ancillary hours. A requirement was made, therefore, to provide at least one extra member of staff between 1.00pm and 4.30pm.Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 8 35 3 Key findings/Evidence Standard met? The manager had produced a Training Plan for the home for the next 3 years and a minimum of 8 members of staff will be trained to NVQ level 2 by year ending 2003/04 and the manager felt that a 50 target by 2005 was attainable. The home had two members of staff who were assessor/verifiers for the award. Details of the Training Plan were displayed on the staff room wall, along with the homes Development plan. Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? The Home followed the recruitment procedure of Cumbria Care. The central personnel service of Cumbria Care had recently been delegated to individual Homes and managers. The Inspector examined staff files and those checked contained all the relevant documentation and were clearly sectioned and well organised. The selection procedure included obtaining two written references, a formal interview and an informal interview involving service users, wherever possible. All recently employed staff had CRB disclosure checks. Upon appointment staff were issued with a handbook, which includes job descriptions and terms and conditions. Appointments were subject to a six-month probationary period. Two members of staff were interviewed and they confirmed the recruitment process. Cumbria Care had a code of conduct and all members of staff had a statement of terms and conditions.Langrigg HousePage 34 Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? All staff were given induction and foundation level training which met with NTO workforce training targets, these include Emergency Action, Dementia awareness, COSSH procedures and Mistreatment of Vulnerable Adults training. Each member of staff had a training profile and this detailed that staff were receiving the minimum 3 days paid training per year, as required by the standard. The manager had recently arranged additional training for staff in Parkinsons Disease awareness. The manager nominates key personnel to disseminate training and up-dates for Moving and Handling and Infection Control. At the last inspection the manager was recommended to gain more specialist training on Dementia care, including strategies, delivery of care and suitable activities. The manager had responded by contacting an organisation that provides training materials and packs of information on the approaches to dementia care. In discussion with the senior staff they were keen to try out suggestions for activities such as life stories, and reminisce groups.Langrigg HousePage 35 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 homes record keeping policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 3 Key findings/Evidence Standard met? The manager, Eileen Muir, had considerable experience working in the care sector, being a care assistant in Elizabeth Welsh House and a Senior at Petterill House for 11 years. She had a level 4 NVQ in Management, and was enrolled on additional units to complete the Registered Managers Award, and was therefore on-line to meet the training target deadline by 2005. Across the inspection process the manager demonstrated that she was a competent and experienced manager able to meet the demands of a large care home. Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? The registered manager had introduced regular meetings for both staff and service users. These were held on a quarterly basis and were recorded with actions. The inspector spoke to a service user who was Chairman of the residents committee who discussed numerous topics and concerns that had been resolved at these meetings. The manager gave a clear sense of direction and leadership, and in interviews with staff and service users both groups were clear on the managers ethos and aims for the home. An example of consultation was demonstrated in the recent changes to the staff working pattern.Langrigg HousePage 36 Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 3 Key findings/Evidence Standard met? Cumbria Cares quality assurance system was in operation within the home, and the manager follows the procedures to ensure monitoring of services were carried out. The home had developed from this system its own monitoring of key areas such as admissions and discharges statistics, risk assessment, care plans and manual handling up-dates. These were displayed in the seniors office. Care staff spoken to described new procedures for ensuring quality of the service provided, on a day to day basis this included; frequency and monitoring of cleaning the fridges, microwaves, changing beds, checking sluices etc. A similar system had been developed for ensuring personal care needs were being met. The manager had introduced a service user survey for direct feedback on quality, and had included this in the homes Service Users Guide. The results of this internal survey were a level of 97.6 from service users and 95.12 from relatives Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 0 Key findings/Evidence Standard met? This standard will be assessed at the next inspection.Langrigg HousePage 37 Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders 0 0 13 Key findings/Evidence Standard met? Written records were kept of all financial transactions relating to service users finances. The personal allowance was stored for a small number of service users and each was kept separately and records and receipts were documented. There was a safe in the Home where service users can keep items of value; a receipt was given for items stored.Standard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 3 Key findings/Evidence Standard met? The manager followed the recommended scheduling of supervision issued by Cumbria Care, which is every 4 weeks for supervisors; every 8 weeks for care staff and every 12 weeks for domestic staff. Records of supervision sessions were examined and appropriate formats were followed, these were dated and signed.Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met? The Homes administration was judged to be well organised and efficient in maintaining records and files relating to both the running of the home and in keeping records on service users. During the unannounced inspection process all records that were requested were readily accessible and up-to-date. The manager had identified key areas that required regular attention that were monitored using spread sheets and tables to assist staff in keeping these up-to-date. The Home had recently been delegated responsibility for staff records and files from the central personnel department, and the Home had been given additional administrative hours to manage this area.Langrigg HousePage 38 Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? Staff had received relevant training to ensure the health and safety of the people who live and work at Langrigg House. This included training in moving and handling, infection control, first aid, and fire safety and food hygiene. COSHH information was displayed in appropriate places, and tests and checks of the fire safety equipment and procedures were being carried out. Annual checks of the gas and electric systems were being carried out. The home was recently assessed as to risk from legionnaires and complied with all recommendations, including monitoring water temperatures. The manager carries out a formal monthly inspection of the premises to ensure standards were maintained.Langrigg HousePage 39 PART C(where applicable)COMPLIANCE WITH CONDITIONSYES Condition Compliance The service must at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission CommentsNO Condition Compliance The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults by 1st April 2004 Comments From examining staff rotas and by interviewing staff and service users it was evident that staffing hours were not up to the levels required as apart of the Homes s registration, which requires 891.33 care hours with an additional 209 for overhead hours(for the service user group at that time). The Home was currently running on 698 care hours. A requirement was made to increase staffing levels. The manager had applied to Cumbria Care for these additional hours and confirmation must be sent to Commission for Social Care Inspection when in place.YES Condition Compliance When single rooms of less than 12sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12sqm they must be given the opportunity to move to a larger room when one becomes available CommentsCondition CommentsComplianceLangrigg HousePage 40 Lead Inspector Second Inspector Locality Manager DateLiz Kelley NA Ian Rundle 23rd June 2004Signature Signature SignatureLangrigg HousePage 41 Public reports It should be noted that all CSCI inspection reports are public documents.Langrigg HousePage 42 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the unannounced Inspection conducted on 5th May 2004 and any factual inaccuracies: Providers comments and an action plan are available at the area office where they have been submitted.Langrigg HousePage 43 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateNONote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan (not applicable) which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESNONOOther:NOLangrigg HousePage 44 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I of Cumbria Care (Langrigg House) confirm that the contents of this report are a fair and accurate representation of the facts relating to the unannounced inspection conducted on the 5th May 2004 and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of Cumbria Care (Langrigg House) am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the unannounced inspection conducted on the 5th May 2004 for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Langrigg HousePage 45 - 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. 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