Inspection on 12/07/06 for Langton House

This inspection was carried out on 12th July 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 12/01/06

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 July 2006 10:00 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.V298395.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langton House Address Wharf Road Wroughton Swindon Wiltshire SN4 9LF 01793 812661 01793 845439 bartleya@swindon.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 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Any person outside the category of older people who was 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. For the purposes of this registration the definition of short term care, respite care, or intermediate care, is care and accommodation that does not exceed 8 weeks in any one care episode. That the home may provide care and accommodation for people aged over 55 years and under 65 years so long as they are receiving intermediate care, or short term care or respite care and that not more than 2 people aged between 55 years and 65 years are accommodated in the home at any one time. That intermediate care may only be provided for up to 9 people in the area known as the `Rehabilitation unit`. 12th January 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Langton is a two storey purpose built care home that provides care and accommodation for up to 41 older people over 65 years. The home includes a rehabilitation unit that accommodates up to 12 people 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. 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 home has a large well maintained garden and includes a courtyard suitable for those who use wheel chairs. There is ample car parking. Typically the home is staffed by 3 care staff per shift covering the main house and 3 staff per shift in the rehabilitation unit. Additionally there are support staff who clean, house keep, administrate and garden. At night, 3 awake staff cover the whole of the service and they have to on-call staff if needed. The day centre is staffed separately. The aim of the home is to provide a high standard of care without taking away service users rights to choice, dignity and privacy. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 4 different days 3 of which were unannounced. The inspector met with 4 service users in private and spoke informally with several small groups of service users. He also spent time talking to 2 visiting family members as well as interviewing 3 staff individually and 2 staff together and health care workers in the rehabilitation unit. Time was spent with members of the management team including the new acting manager. Various policies and procedures were examined including case documentation and staff records. The judgments contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? What they could do better: If the service intends to admit people with a diagnosis of dementia or past mental disorder it must be registered to do so. Care planning needs to be more person centred. Assessments should give more attention to nutritional screening, history of falls, continence care and other practicalities. Decisions about how to care for people with complex needs and people near the end of their life should to be better co-ordinated and where appropriate involve multidisciplinary decision making. Those people, who may be few in numbers, that are admitted for rehabilitation should not be discharged if their circumstances require a more holistic assessment of their needs. The way complaints are Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 6 captured, managed and actioned needs to improve. Service users who request help to the toilet should get the help when they request it. 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.V298395.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. 3. 4. 6. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. Information about the service needs to be updated to reflect recent changes. There is room to improve the standard of assessments and to pay more attention to the challenges presented by people with complex needs. It appears that people with dementia care needs and mental health needs are being admitted to the home when it is not registered for these categories. Most service users praise the staff for the care they provide, very few complain. People who have rehabilitation services highly praise the standard of care they receive. EVIDENCE: The current statement of purpose and service user guide have not been updated to reflect recent changes to the service. The manager reported this work is in hand. Assessment and care planning systems are currently in a transition stage. There are plans for a long overdue upgrading of these. There was evidence in case documentation that some service users’ admission details record only the Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 9 very basic of information and assessment templates have questions that ignored or not answered. Staff reported their concerns about the current care planning system. One staff member said that the current system encourages dependency and has a lack of clarity about family involvement. Other staff report concerns that on occasions medical staff use jargon in their assessment and care planning documentation that they did not understand, though one staff member qualified this by saying this had improved recently. According to the acting manager, staff working at the home and data in the pre-inspection questionnaire; the service accommodates people with dementia care needs and people with mental health needs. This is contrary to its current registration status. Some assessments and review notes of people with dementia indicate that the persons need can be adequately met at the home. For other service users this is assumed. It is reported that most of the service users who have dementia care needs or mental health needs receive short term or respite care and are not at the home for long periods. As the service is not registered to provide care for people with a diagnosis of dementia or mental disorder this should cease or be regularised by seeking a variation to the category of registration. All service users getting rehabilitation services are assessed prior to admission. In some cases the assessment details for people receiving rehabilitation are not sufficiently holistic. For example in one case insufficient consideration was given to current mental health needs and for another privately funded person it appears that undue pressure was put on them to leave the home to prevent bed blocking, before them having all their care and accommodation needs assessed. It was observed that during the inspection the acting manager fielded off a request from a health care professional asking the home to admit a person from hospital the same day. It is noteworthy that the manager insisted that no such admission can take place without consultation with the family first. Care workers reported anxieties about how best to deal with requests from family members about the families wishes, when these do not fit in with the service aims or the service users preferences. Care staff also talked about the difficulties of caring for service users when the decisions service users make badly affect the service users well being. They gave examples of not wanting to wash or be washed, not wanting to eat or refusing their medication. Examination of one person’s case documentation indicates a rather reactive approach to some of these very difficult issues and the absence of any planned multidisciplinary meeting that included family and service user input. Several service users report that the home is good at meeting their needs. No service user made any significant adverse comment about the home. Some of them commented on the personal and professional qualities of the new acting manager; a view also endorsed by several care workers. Comments about the home by service user’s include;1. I like being able to walk around the home. I have been in 3 places [care homes] and this is by far the best. 2. The staff are wonderful. 3. The staff are very kind and they had helped her settle in the home. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 10 The staff are good when you need help. The home is good with [arranging my] medical attention. The staff are very helpful to me. I am very happy at Langton House. Two service users said the staff always provide the support and care they need and two others stated the staff usually provide the care and support they need. Seven relatives sent comment cards to the Commission. All 7 reported favourably on the care provided. These are typified by 2 comments;• My mother is extremely well looked after – I can’t praise Langton House staff enough.” • The key worker seems very committed to Mums welfare. My mum is able to make choices, [and] is always well dressed in matching clothes. The acting manager reports that care staff strive to; “care for service users with great gentleness.” Notwithstanding these compliments two relatives have made formal complaints to the home before the current acting manager assumed responsibility for it, about the care offered to their family member. They cited alleged rudeness and rough handling was occurring. These matters were investigated (see under complaints) Some negative comments were made by service users, i.e. 1. There are too many agency staff being used. 2. Some of the agency staff [Eastern European] speak little English and you cannot understand them. 3. My bed is a bit hard. 4. Agency staff should be [better] informed about their duties. The home has a recently refurbished intermediate care facility with dedicated health care staff working in specialist roles (consultant, nursing, physio, occupational therapist) on a shift or sessional basis, alongside care workers. This facility includes a range of equipment designed to assist rehabilitation. Service users continue to highly praise this facility. As one put it “The care is excellent I don’t know how the staff do it.” The acting manager is now deploying the majority of care staff to cross - work i.e. to work in both the rehabilitation unit and the residential facility. This appears to be reducing a ‘them and us’ mentality. After some initial scepticism staff report favourable on this change and confirm its benefits. Examination of case documentation appears to show that needs which extend beyond physical rehabilitation appear to be ignored, and in one case to the service users detriment. 4. 5. 6. 7. 8. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 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): 7.8.9.10. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. The current care planning system is outdated and is not sufficiently person centred. Health care professionals praise the home for the standard of care provided. Relationships with health care professionals appear to be good. Medication is well managed. Service users confirm that care workers treat them with respect and in a dignified way. There is a need to better manage end of life care but this is partly compensated by the compassion and sensitivity of new acting manager in dealing with death and dying. EVIDENCE: The managers of the service acknowledge that the current care planning system is not sufficiently comprehensive or adequately person centred. They have plans to introduce a new format to address these concerns. The current care plans do not always sufficiently detail what staff have to do to prevent skin breakdown, ensure fluid intake or monitor food intake though there has been some improvement in acknowledging the importance of doing so. Supervising staff who were interviewed spoke about how important it is to do these things and gave the impression they give these elements of care more Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 12 attention than previously. In one example it was not clear in the plan how staff were expected to, “monitor memory function” as requested by a health care worker. Care plans were much better at detailing what personal care tasks were required or the need for “cuddles” i.e. reassurance at bedtime. There was evidence to show that care plans are updated from time to time. There is also evidence of good working relationships with health care professionals, though one worker said changes to the district nursing service meant that it was not so easy to ask district nurses to call in as referrals were now more formal arrangements. All the GP’s of those service users’ case tracked (3) said they were satisfied with the overall standards of care at Langton House and that their patients had not complained about the home. The same GP’s said that the service incorporates any specialist advice in the care plan(s) and the staff appear to have a good understanding of the service users needs. The inspector observed a good rapport between care staff and health care workers including doctors during the inspection. Two community nursing staff also reported favourably on the services provided. Case documentation confirms that service users are supported to access a wide range of medical services e.g. GP’s, physiotherapists, occupational therapists, dieticians, staff at specialist clinics, dentists and opticians where required. Current care plans and assessment information however are not routinely or consistently picking up nutritional screening, history of falls and continence care though this is partly compensated by care workers intuitive interventions to encourage food intake or to offer physical support to those who cannot walk well. There is a detailed medication policy which staff are expected to follow. Medication is being appropriately and securely stored. Checks on 3 service users selected at random show that their medicines were being properly stored and administered as prescribed, but in one case unwanted drugs dating back to May 06 had not been returned to the chemist or disposed of. Records show staff are provided with both in-house and external medication training. Staff report that they are assessed as to their medication competency and have to complete a written test. Refresher courses are also provided – one is booked for Oct 06. Discussion took place about how staff respond to service users who refuse medication (and food) and the impact this has on staff and relatives. Two care workers were reassuring and demonstrated sensitivity to the wider issues. However examination of case file documentation and care plans indicate these issues are not being faced in an open, transparent way in a multi disciplinary forum involving service users and or their families. In one case a complex life or death health care matter had been reviewed at a meeting in early August 06 but the minutes of the meeting were not available in the home, some 5week later leaving staff who were not at the meeting unsure and concerned about what to do. In another case one staff member had left a prompt for staff to “ring a district nurse after the weekend re a skin tear” but there was no evidence to show this Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 13 had occurred. The manager later reported that it was decided such a referral was not needed but there was no record to say who and why this was decided. Service users report that care staff are respectful and dignified when providing them with personal care. Staff show understanding of the need to provide dignified care and it was observed that two staff were discrete in discussing toilet needs when, for example, a service user requested assistance. It was observed that service users were well groomed a view verified by one relative who praised the home for the way they groomed their family member. The service user guide and policies promote dignity and choice. There was an absence of any unpleasant odour in the home and GPs were observed to carry out examinations in the service users own room. Discussion took place with the manager about managing ‘end of life’ care. It was acknowledged that more needs to be done in this area by a manager who demonstrates compassion and sensitivity when discussing death and dying. Finally staff report that the medication store does not have an electric socket so drugs cannot be refrigerated. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15. The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. Policies and procedures promote choice and the new acting manager is working hard to make this a reality for service users. Overall service users report satisfaction with the meal arrangements. Visitors are welcomed and the home benefits from good relationships with the wider community. EVIDENCE: Service users report general satisfaction with the meals. They describe them as “excellent” or simply “I like the food very much” whereas one person said they were “not perfect but overall they are good and I have no complaints about the food.” I noted care workers giving discrete support with feeding to those who needed it. Service users confirm that they can take meals in their rooms or in the dining area, which also boasts a shop, as they wish. It was also noted that drinks were made readily available during the hot weather. Service users confirm that their food preferences are considered; although one person said the toast is sometimes cold in the morning. There is one complaint about a service user not getting her tea. This was said to be due to due to a communication problem. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 15 Care staff report that the chef works hard at networking with the residents and that he keeps a record of known dislikes/likes. Menus were not inspected on this occasion but when previously inspected were found to be satisfactory. On two days it was also noted that service users who appeared to be more infirm remained in their dining chairs, some nodding off, well after the meal was finished and cleared away. One staff member said they prefer to remain in the dining area but this could not be verified. Two of the dining chairs had arms that were lose at the joints with the potential to cause injury. There is unrestricted visiting hours. Service users have the option to see their visitors in their bedroom, the communal lounges or in the garden area as they prefer. Visitors are expected to sign in and out and there is a book for this purpose. All 7 relatives who completed a survey form confirmed that they are made welcome at the home. Policies and procedures promote choice. The new acting manager is working hard to make this a reality. There is evidence that getting up/going to bed times are flexible and different people have different arrangements for bathing/ showering/ washing dependant on their assessment and stated preferences. People are free to stay in their rooms or to socialise in the communal areas as they wish. This was evident on all days of the inspection. Managers’ report improved staff morale and that team communication is now producing better outcomes for service users citing more choice as one example. The new acting manager appears passionate about choice and wants to make it a reality. The home is well established in the local community and benefits from good relationships with its neighbourhood. The local church supports residents to attend church and a monthly service is held in the home. Occasionally school children visit to play musical instruments or sing. Access to the wider community is only limited by the absence of transport or any assessed risk. The home is currently being used as a day centre for local residents but its continued use is under review. Some service user’s report they would like to go out more but according to the manager when events are arranged they decline them. One service user told the inspector about going shopping with staff and two said they attended church. A relative confirmed that staff ensure that her mother is always ready to go out when she calls to visit to take her shopping. The inspector observed one agency staff member attend to service users in the communal lounge without talking to them or without explaining what they were doing i.e. transferring a service user in wheelchair from one room to another. This worker was not able to produce identification and her explanation as to why did not accord with the facts. This example of poor practice contrast with observations of other staff on most days being seen to engage with services in a gentle, respectful manner giving residents quality time as they go about their tasks. One service said he “liked being able to walk around the home and that he can sit in quiet spots if he wants to which he likes.” A community group is helping with the garden project and there are plans to make the courtyard a more shaded and interesting place next year. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 16 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): 16.18. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. In the past year there appears to have been two distinct periods, each with a different culture of caring and management. Overall managing complaints has been poorly done and the service has been slow to inform the Commission as to the progress of its complaints investigations. In one case the response to a complaint was seem to be rather defensive and failed to offer an apology. Staff appear to be aware of what to do if they come across unexplained bruising or other indicators of abuse. Recruitments checks are designed to ensure staff are suitable. EVIDENCE: Under the previous manager there were two reports that staff were rude to service users. A relative also raised concerns about alleged staff insensitivity that caused distress to a family member. To the credit of the staff member concerned, one worker reported to their supervisor their concern about a colleagues conduct. These matters were investigated and resulted in a staff member being warned as to their future conduct. It was noted in one case file that a service user was reported as getting more aggressive towards staff due to their medical condition but there did not appear to be any strategies in place to manage this problem. Three staff files that were selected at random, including an agency staff member, were checked to ensure each person had a current and satisfactory Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 17 Criminal record bureau (CRB) declaration, references and evidence of appropriate training. All 3 staff interviewed were able to explain what they would do if the came across unexplained bruising or other indicators of abuse. Over the past year complaints management has not been satisfactory. The new acting manager had no record of any recent or previous complaints made and until very recently there was no complaints register or details of the complaints raised by 2 family members. These 2 complaints had however been investigated and certain learning points noted. There is a detailed complaints procedure but it is not being fully followed. This procedure is currently under review. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 26. The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. The standard of accommodation is very good, being clean and comfortable and in a good location. Systems are in place to ensure the safety of staff and services users. EVIDENCE: The service provides a very good standard of accommodation having recently been refurbished. It offers each service user their own bedroom and there are now 5 ensuite rooms. Bedrooms meet the relevant standard for size and facilities. The home is ideally located on the outskirts of Swindon in a village location. Fire safety systems are considered fit for purpose and the home also has a sprinkler system for additional fire safety. Contracts for call bells, hoists, waste management, etc are in place to ensure functionality. A tour of the building showed the home was clean throughout with no offending odours. The home employs designated staff to clean and carryout laundry functions as well as Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 19 housekeepers to assist with meals and bed making. There is a large and wellequipped laundry, well away from the food preparation areas. Records show that selected staff undertake infection control training and protective clothing and barrier cream is available to staff. The home has a sluicing facility and an approved contractor takes clinical waste including ‘sharps’ away for safe disposal. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30. The quality rating in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visit to this service. This is a well trained staff group. Staffing levels are adequate, though sometimes dependent on agency staff. Service users would greatly benefit from allowing housekeepers to take them to the toilet when such requests are made. Recruitment procedures are satisfactory. Training records need to be kept up-to-date. Not all staff new to the service are being provided with a suitable induction to the home. EVIDENCE: Over 90 of care workers hold a relevant National Vocational Qualification (level 2) or above. Rotas indicate that the number of staff deployed is adequate for the service, though cover is dependant on the use of agency staff. Feed back from relatives is positive about staffing levels with only one suggesting that at times there were not always enough staff on duty. Since the last inspection 7 staff have left of which 4 have retired, and a new management team has been installed. All supervising staff are over 21 years old. They impress as having wide ranging and relevant experience. It was observed that a service user asked a house keeper to take him to the toilet, a task apparently outside their job role. It must be bewildering to service user that such a simple request must have to wait until a suitable ‘qualified’ person is found. In this example the service user was clearly getting anxious about the delay. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 21 It was observed that one agency staff member was able to provide relevant identification (ID) when requested to do so. Recruitment procedures appear satisfactory with evidence of a relevant CRB/Protection of Vulnerable Adults (POVA) checks, the taking up of references. Terms and condition of employment and expected codes of behaviour are clearly written and available to staff. Records show that staff are issued with the General Social Care Council’s code of practice. Training records do not appear to be fully up to date, or a tool used to prioritise training. According to the pre-inspection questionnaire there is only 1 qualified first aider working in the home. This person would not be able to cover every day or all shifts. However the training record details that while most care workers have had basic first aid training many have not had refresher training. The was little evidence to show that a newly appointed internally promoted manager had an induction of matters peculiar to the establishment with one of them saying they were happy to find out things for themselves. New starters are expected to undertake a formal induction programme. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.33.35.38. The quality rating in this outcome area is adequate. This judgement has been made from evidence gathered before, during and after the visit to this service. Service users and care workers are beginning to benefit from a new management team in a newly refurbished care home. Care needs to be taken to ensure that monthly management reports indicate which areas are satisfactory or not. There are good systems of accident and incident reports, including near misses and health and safety is taken seriously. There are proper checks and balances in place to ensure possessions, including money belong to service users are properly managed. Quality assurance is under developed. EVIDENCE: Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 23 Service users say the home has improved in recent months and they and care workers praise the new acting manager for her personal and professional qualities. The absence of a dedicated administrator for several months has put a strain on the management team. Care workers say management is more supportive and that the new acting manager shows understanding of what we do The statutory management reports required under the Care Homes Regulations 2001 are now more regular but the author(s) do not always indicate whether issues covered or records were satisfactory. For example it is reported, “fire log seen” or “fire log now getting there” illustrate this point. There is a detailed health and safety policy in place which staff are expected to follow. Swindon Borough Council provide specialist advice to the home if needed or requested and care workers are provided with training in moving and handling, fire safety, first aid, food hygiene, infection control (see training records). Maintenance contracts are in place. Safety records are kept such as hot water temperatures, fridge/freezer temperatures, portable appliance tests (PAT). Environmental risk assessments are completed and updated However on the first day of the inspection the inspector was able to enter the building through the front door and enter an inner door because none of these doors were locked. This raises safety issues for people who wander. Accident and incidents including ‘near misses’ are reported and managed. Previous requirements and recommendations have been mostly actioned, though in some cases there has been a delay said to be though due to the manager being on extended sick leave. The home has dedicated staff who deal with service users money if there is no one else able to do so and periodic audits and double checking takes place. The manager has undertaken a recent survey of service users and analysis of the findings show there is a focus on making improvements. Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 24 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 2 X 2 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 4 X X x X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 x 3 x X 3 Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 25 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 OP4 Regulation 14(1)(d) Requirement 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. (This requirement was made at the previous inspection and is repeated) The service user guide and the statement of purpose must be updated to reflect recent changes in the service Assessment details and care plans should cover nutritional needs, history of falls, continence care, where these are factors in the person circumstances. Protocols must be put in place to improve end of life care An electric socket must be provided in the drug store so it can accommodate a small fridge for the purpose of storing medication that needs to be stored at low temperatures A urgent review must be DS0000035472.V298395.R01.S.doc Timescale for action 12/08/06 2 OP1 6 12/10/06 3 OP3 12(1)(a) 12/10/06 4 5 OP11 OP9 12(1) 13(2) 12/12/06 12/10/06 6 OP16 22(1) 12/12/06 Page 26 Langton House Version 5.2 7 8 OP30 OP38 18(1) 22(3)(c) undertaken as to the way homes capture, record and manage complaints. All newly appointed staff must be 12/10/06 provided with induction relevant to their role and responsibilities. Dining chairs with broken arms 12/10/06 must be made good or replaced. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 OP4 3 OP4 Refer to Standard OP3 Good Practice Recommendations It is strongly recommended that the new format for care planning and assessment is introduced into the service without further delay Care workers should be provided with more guidance and support to help them manage circumstances when service users or families make decisions which have the potential to cause harm or suffering. A management review should be undertaken in respect of how best to ensure that service users in the rehabilitation unit are not discharged without a detailed needs assessment if their circumstances indicate such an assessment is in their best interest. It recommended that housekeepers be trained to assist service users to access the toilet. It is recommended that those conducting monthly management reports as to the conduct of the home specify which areas are satisfactory or not, as the case may be. 4 5 OP4 OP33 Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 27 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. Extracts may not be used or reproduced without the express permission of CSCI Langton House DS0000035472.V298395.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!