Inspection on 12/01/06 for Langton House

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Langton House 03/11/09

Langton House 08/10/08

Langton House 10/10/07

Langton House 12/07/06

Langton House 29/06/05

Langton House 18/02/05

Langton House 20/07/04

Langton House 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Langton House Wharf Road Wroughton Swindon Wiltshire SN4 9LF Lead Inspector Stuart Barnes Unannounced Inspection 12th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Langton House DS0000035472.V270583.R01.S.doc Version 5.0 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. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Langton House Address Wharf Road Wroughton Swindon Wiltshire SN4 9LF 01793 812661 01793 845439 bartleya@swindin.gov.uk 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) Swindon Borough Council Mrs Alice Bartley Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Full time is defined as working 37 hours per week. That intermediate care may only be provided for up to 12 people in the area known as the `Rehabilitation Unit` When the home has a vacancy after April 1st 2004, other than in the `Rehabilitation Unit` this vacancy must not be filled until such times as the home is able to recruit the full time equivalent of 18 care staff in substantive posts. Any such calculation must not include staff solely designated to work in the day care facility, the home manager and ancillary staff such as administrators, cooks, cleaners, housekeepers and gardeners. The `Rehabilitation Unit` will provide`Intermediate Care` for people aged 60 years and over, subject to an assessment prior to admission that their needs can be met in a care home for older people. Any person outside the category of older people who were receiving care and accommodation at the home as at 31st October 2003 may remain living in the home, subject to an assessment or review of their needs at least every 6 months that the home is able to satisfactory meet their care needs. 29th June 2005 4. 5. Date of last inspection Brief Description of the Service: Langton is a two storey purpose care home that provides care and accomodation for up to 41 older people over 65 years. The home is situated in the village of Wroughton on the outskirts of Swindon town. It is owned and managed by Swindon Borough Council. Those living in the home have their own single bedrooms and there is a vertical passenger lift between the floors for easy access. The residents benefit from a large well maintained garden and a small courtyard suitable for those who use wheel chairs. There is ample car parking. The home includes a rehabilitation unit that accomodates up to 12 people aged over 60 years for a period of typically less than 3 months. Additionally there is a day care facility that is integrated within the home for those who live in the wider community. Typically the home is staffed by 3 care staff per shift covering the main house and 3 staff per shift in the rehabilitation unit. At night, 3 awake staff cover the whole of the service and they have access to on-call staff if needed. The day centre is staffed separately. There are additional support staff who clean, house keep, administrate and garden. The aim of the home is to provide a high standard of care without taking away service users right to choice, dignity and Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 5 privacy. The council have plans to refurbish part of the home during the later part of 2005/early 2006 which may result in a reduction of services for a period of 6/9 months. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The terms resident or service user that may be used throughout this report are interchangeable and mean the same thing. At the time of this inspection the refurbishment programme was well under way and as a result the home was only accommodating 19 residents. The day care service and the rehabilitation service had been transferred to other venues under different management. The manager was not able to confirm if, or when, such services would return to Langton House. The manager confirmed that the number of residents accommodated at the home will not exceed 19 until phase 3 of the refurbishment programme is completed. This is expected to be at the end of March 06. This inspection was unannounced. It lasted approximately 6½ hours. Its main focus was to check the progress of the recommendations and requirements made at the previous inspection i.e. June 2005 and to inspect those National Minimum Standards (NMS) not inspected at the previous inspection. In total 12 out of 38 NMS were inspected. The inspector was able to tour parts of the building that were in use but did not access those areas restricted by the site manager pending the refurbishment. Time was spent sitting with residents informally in their lounge while they were watching television and chatting to each other and speaking to 4 service users in private in their rooms. Time was also spent talking to several staff as they went about their duties and with the homes manager. A small sample of relevant case documentation and other records were looked at. What the service does well: What has improved since the last inspection? There has been some all round improvements in updating terms and conditions of residency and the information about the services provided. Service users satisfaction levels are increasing. Service users continue to praise the home Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 7 and the staff for their wonderful care and support. The home is quite good at meeting people’s needs. Service users praised the standard and the provision of meals. Staff access to relevant training appears to be quite good. The accommodation is much improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, Service users are provided with relevant and helpful information about the services provided, including the terms and conditions of residency. Most current residents report favourably about the standard of care they receive and this is confirmed by the review of placements undertaken by the home and care managers. Service users need to be told in writing whether the home is able to meet their needs or not. EVIDENCE: Since the last inspection the home has introduced a designated contract/terms and conditions of residency appropriate for people who are admitted for short periods of care or for respite care. This supplements the one available for long term service users. Examination of the documentation in respect of 5 service users show that each person was assessed prior to admission. This includes where relevant; needs associated with personal care, health matters, family contact, history of falls, medication usage and risk. There was no evidence to show that the home had written to those who had been assessed for care at Langton House informing them which needs can or cannot be met by the home. The manager said this information was given verbally something that does not meet the relevant Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 10 requirement. Overall the home is being successful at meeting the needs of residents. This is evidenced from a sample of 6 placement reviews and comments from residents during the inspection. Five out of the 6 reviews seen indicated needs were being met with comments such as; “[is] settled and happy at the home,” or “needs are being met – is gaining weight and benefits from contact with other service users and likes the activities [provided].” Or “staff are managing her care needs [well]”. Comments to the inspector from residents include more qualitative viewpoints such as, “the staff are wonderful” or “[name of staff member] was very good and helped me have a wonderful holiday” or, “they help me with my personal care a lot.” People praised the meals as being; “good” or “very good” and certain residents made comment about being supported and assisted by care staff with specific health care needs ranging from piles, breathlessness, poor mobility and aching bones and joints. One person said, “staff encourage me to exercise and that is good for me”. Four residents praised the home for the improved accommodation including better toilets and bathrooms in closer proximity. But it was also evident that a couple of residents viewed some of the disruption and room changes that have taken place as an irritation to them and they did not always compare favourably their newly decorated and refurbished room with their old room because it had a different outlook or because it was in a quieter part of the home. However the majority views expressed were favourable. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Care planning is still not showing the extent to which service users take part in the process and are somewhat basic. The manager is working with others to improve care planning. EVIDENCE: A review of the current system of care planning is underway with the aim to improve it and to ensure a consistent approach in all care homes managed by the council. Less evident is the extent to which any service user or their representatives are involved in this process. Current care plans outline basic needs but these tend to focus on aspects of personal care and medication needs. Other needs seem to take a back seat. There is evidence to show these plans are periodically reviewed and updated when needs change. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of these standards were inspected on this occasion. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 This care home continues to be a service that is rarely complained about. EVIDENCE: The council has a well-established complaints procedure that details how to complain and what the times scales are for each stage of a complaint investigation. Details about how to complain are included in the service user guide and are posted on notice boards throughout the home. Since the last inspection the manager has given further thought about what response to make when someone expresses a minor dissatisfaction or irritation in the service they receive but indicate they do not want to have their concern dealt with as formal complaint. In such circumstances staff have been reminded of the importance of responding quickly and listening to what is being said. The last recorded complaint was made in 2004. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The accommodation was found much improved and where refurbished it has been revitalised to a very good standard. EVIDENCE: The home is well located and in close proximity of local shops and is on a frequent bus route to Swindon town centre. One service user told the inspector how much she enjoys being able to access the local shops. The inspector toured all parts of the home that at the time of the inspection were currently being used to accommodate residents. The parts of the building that had prohibited access due to the refurbishment and building works were not seen by the inspector or inspected. Stage one and stage two of the refurbishment programme has been fully completed and stage 3 is well underway and is on schedule to complete before April 2006. Phase 1 and Phase 2 of the refurbishment programme have resulted in the upgrading of toilet and bathroom areas, upgrading of bedrooms including provision of new furniture, carpet and curtains as well as improvements to communal areas. Bedrooms have been fitted with ‘touch lights’ something service users said they liked. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 15 Corridor lighting has also been improved. Better sluicing and hairdressing facilities have been provided. The kitchen has also been decorated and provided with new flooring. There were some small areas i.e. the reception hall where the floor covering was of a temporary nature and some ceilings and cabling was exposed pending completion of the work. This work has been assessed to eliminate any undue risk of accidents. There are good and dependable systems in place for the carrying out of remedial work and repairs. The garden appeared well maintained. (Parts of it have been fenced off pending completion of the planned building works.) Toilets and bathrooms were found to be clean and tidy, though some had not had their soap dispenser fitted to the walls and some were waiting for blinds to be fitted. The inspector is satisfied this work will be carried out in the near future. Based on measurements provided by the council the home meets current space standards for existing care homes. All bedrooms provide for single occupancy. If 2 people wanted to share bedrooms they would be able to do so utilising the second bedroom as a lounge or sitting area, if they wish. The home provides a sluice area that includes a small macerator. There is a detailed cross infection policy which staff are expected to follow. A feature of the service is the way the home is kept clean. Cleaning staff were observed to be taking pride in their work and thoroughly cleaning different parts of the home. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 30 Staff continue to be able to access relevant training, including National Vocational Qualification. Service users report that staff are caring. EVIDENCE: Staff records show that relevant staff can access a variety of training courses including courses in;- basic food hygiene, fire safety, first aid, moving and handling people, and health and safety. Since the last inspection additional specialist training has been provided or selected staff in areas such as; administering medication, assessing risk, dementia awareness, sensory loss, and stoma and catheter care. Access to National Vocational Qualification training in care is well established. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 17 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): 35, 36 The system for handling residents finances are well developed but the ‘one to one’ supervision with staff is still not up to standard. EVIDENCE: The service has a detailed written procedure on handling residents monies that staff are expected to follow. The policy emphasises the importance of service users (or those who represent them) retaining their own responsibility for their own money and staff only assisting when there is a need and there is no one else to do so. The home employs a designated administrator to undertake the management of monies and budgets, though on the day of the inspection this person was not at work. The inspector selected at random the financial details of 2 service users and found that the record of monies held by the home reconciled with the cash kept by the home. These records did not show any unusual patterns of expenditure and there were receipts for the larger expenses. However there Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 18 were no receipts available for the visiting hairdresser. Instead the hairdresser countersigns the cash debit. There is evidence to show that the manager undertakes appropriate training in the management of budgets and that the council undertakes periodic financial audits. A valid certificate of employers/public liability insurance cover was in place. The inspector was informed that records detailing past supervision of staff were not available due to certain records having been temporarily archived, as the temporary store was not damp proof. That said, the manager confirmed that while some progress had been made to improve the way staff supervision was carried out she was not yet fully satisfied that all staff were having regular one to one meetings. The challenges associated with the refurbishment programme were given as the main reason for this deficit. Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 19 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 3 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X 3 3 X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X X Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP30 Regulation 18(1) Requirement Timescale for action 30/09/05 3 OP36 18(2) The manager must ensure that all relevant staff have completed training in first aid, fire safety, moving and handling people, food hygiene and health and safety at work including assessing risk. Any such training must be periodically updated and carried out by a competent person. Note: this requirement is repeated, as the inspector was not able to verify it had been met due to the temporary unavailability of certain records pending the refurbishment of the home. Urgent management action must 30/09/05 be taken to ensure all staff that provide care and support to the service users receive regular and effective supervision from a competent person or persons. Regular is defined as meeting not less than 6 occasions in any 12 month period. This requirement includes those who work at the home and carry out management responsibilities and staff who work during the night DS0000035472.V270583.R01.S.doc Version 5.0 Langton House Page 21 3 OP4 14(1)(d) as well as other staff. Any such meetings should be recorded including any action plan. (This requirement has been repeated) The manager must ensure that all those assessed for a place at the home receive in writing a letter confirming the extent to which the home can or cannot meet their needs. 12/03/06 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. Refer to Standard OP1 Good Practice Recommendations The manager should ensure that the views of those who use the service are incorporated into the service user guide Note; this recommendation is repeated as the manager requested further time to complete it. The manager should ensure that the wishes and feelings of those who use the service are recorded in the person’s care plan or individual plan; and are periodically updated. 2 OP7 Langton House DS0000035472.V270583.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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