Inspection on 29/06/05 for Langton House

This inspection was carried out on 29th June 2005.

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

Other inspections for this house

Langton House 03/11/09

Langton House 08/10/08

Langton House 10/10/07

Langton House 12/07/06

Langton House 12/01/06

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 Announced 29 & 30 June 2005 at 9:30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Langton House Address Wharf Road Wroughton Swindon Wiltshire SN4 9LF 01793 812661 01793 845439 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Swindon Borough Council Mrs Alice Bartley Care Home 41 Category(ies) of OP Old age registration, with number of places Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 accomodation 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. Date of last inspection 18 February 2005 Brief Description of the Service: Langton is a two storey purpose built care home that provides care and accomodation for up to 41 older people over 65 years. The home includes a rehabilitation unit that accomodates up to 12 people for a period of typically less than 3 months. Additionally there is a day care facility that is intergrated 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 rehabilitaion 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. The council have plans to refurbish part of the home during the later part of 2005 which may result in a reduction of services for a period of 6 months. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was by appointment and was carried out over 2 days. The inspector spent time reviewing the progress made in meeting the requirements and recommendations made at the previous inspection. Also reviewed were the plans for commencing the refurbishment programme. Time was also spent viewing parts of the accommodation and talking to the staff that were working at the home. The inspector spoke informally to several service users while they were either sitting in communal areas or in the dining area. He also spoke to 7 service users in private. At the time of the inspection the home was only accommodating 25 service users pending the commencement of a major refurbishment. Most standards were inspected but in view of the planned refurbishment that is due to commence in the coming weeks only 2 standards in relation to the premises were inspected. What the service does well: What has improved since the last inspection? Service users now have better documentation that explains the terms and conditions of their stay. More service users are more actively involved in their assessments and the way care plans are carried out is slowly improving. More service users than before are praising the service for the meals and menus. The standard of accommodation has improved since the last inspection. More staff are becoming successful at obtaining a relevant National Vocational Qualification. There is an improved focus on the service meeting the needs of service users and ensuring the overall health and welfare of all service users. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 6 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 DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 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 standard(s) 1, 2, 3, 4, 5 and 6 The service provides relevant and useful information about the services it provides, which is periodically updated and includes written terms and conditions. Assessment and care planning documentation is generally satisfactory but there is room for some improvement. People who receive intermediate care consistently express very high satisfaction levels praising the staff and the service provided. Staff who work at the home have access to National Vocational Qualification training courses but some staff need refresher courses for statutory courses. EVIDENCE: The statement of purpose and service user guide were examined. They provide accurate and relevant information on the service provided and they have been recently updated, but they do not yet provide the views of those who use the service. People living at the home said they were provided with a copy of the guide. Copies of the terms and condition were available in the case documentation that was sampled and service users confirmed that they were given information about the home, including the terms and conditions. There is a system of care planning in place, which records mainly, but not exclusively, routine tasks associated with personal care. The manager told the Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 9 inspector of the plan to improve this system to include more input from service users. There is draft documentation in the home that confirms this plan is being actioned and that it includes a format that will gather more information and record better the expressed wishes and feelings of the service user. The home is still failing to send all service users a letter confirming the outcome of any placement application and whether the service can meet or not as the case may be their care needs. Case documentation shows that service users are supported to access local health care services or/and specialist services. Files show good oversight of medical care needs. Most service users reported favourably on the care they receive. For example one person said, “it’s very good here- you are well looked after.” Another said, “You are looked after very well- you can see the Doctor when needed.” While a different person reflected that, “there is nothing wrong with the place but some people are never satisfied.” Another stated that, “the staff are very caring and you get help when it is needed.” A female service user enthused that, “ the care is wonderful. The girls (staff) have been very good and it is like a palace here-everyone has been wonderful.” Someone else reported they were also, “able to see the Doctor when needed and that they were involved in setting up their daily programme. There is also evidence in the compliments and complaints register of many relatives praising the home for the way it meets particular needs. For example one family member wrote, “The lovely ladies (staff) of the rehabilitation unit have given a great deal of time reassuring a very confused, frightened, and sick lady after being hospitalised for the first time in her long life of 95 years” Another simply wrote, “my mother is so much better now – thank you.” As well as comments that praised the service there were 5 critical comments. One person said the “you get a morning cup of tea but I wish it was hotter – it is not very hot.” Another stated they did not like their room because of the poor outlook and a third said that, “recently there has been too much toast each day – sometimes with more than one meal.” Someone else said, “The staff are mostly very good but you have a couple here who are not.” When asked to suggest an improvement in the home someone said, “I would like not to have so much football on the TV – there is too much of it.” Examination of the staff records show that staff training is being encouraged with a good take up of (NVQ) National Vocational Qualification training. There are some gaps in the record of who has attended statutory training courses. Records show that when a person seeks a place at the home they are encouraged to visit the home along with any family member before accepting the place. This can include a short stay for respite care as in the case of one person who recently accepted a place at the home. The manager said that people who are admitted from hospital are not always able to visit before hand and that where this happens extra effort is made to provide them with information about the home just before they are admitted or very soon afterwards. A current service user confirmed this. All potential applicants are encouraged to view the available accommodation and stay for a meal, something confirmed by several current service users. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 (in part)) and 10 The home is achieving good overall standards of health and welfare provision; service users confirm they are treated with respect, consideration and kindness. Service users in the rehabilitation unit appeared to have more ownership of their care plan than those in the rest of the service. Staff were observed to respond to requests for help and assistance in a respectful and dignified manner. EVIDENCE: Staff were observed to knock on bedrooms before entering and to talk discretely when someone appeared disorientated and them not being able to locate the toilet. Bathrooms and toilet areas provide suitable locks. All the files that were examined included a completed admission form complete with a profile of the person, as well as an up to date personal care plan, other personal information, an assessment of risk including a handling assessment and an outline daily care programme. These files also showed periodic updates and amendments when there was a change of circumstances or need. For example one person’s care plan had been amended 4 times this year to reflect changing needs. Another persons had been updated 3 times in the month of May 2005. Additional to such updates there was evidence of joint working with Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 11 care managers and relevant health care professionals in undertaking a detailed annual placement review or case review. It was not evident on all care plans what input service users had in drawing them up. In the rehabilitation unit their documentation shows that care programmes are reviewed very frequently; typically weekly but sometimes daily. A feature of this (and previous) inspections is that those that get a service in the rehabilitation unit knew more about the main aims of their care plan and appeared more committed to reaching their set goals, than those people placed in the rest of the service. Documents show that a range of staff, including specialist staff, carry out assessments. Case files show that service users are supported to access optician, dentists, audiologists and other specialist but it is not always clear from the assessment documentation the required frequency or in some cases the need for such services. Case documentation also shows access to specialist continence and tissue viability nurses on a referral basis using the local GP service. No evidence was found of nutritional screening on admission but there was evidence of people with eating difficulties being referred to specialists, after admission. Those living at the home report that staff show them respect and kindness and confirm they wear their own clothes. One service user commented on how well her clothes are laundered and ironed and indicated that the staff make a special effort for her because she likes to be well presented. One service user told the inspector that they have observed care staff drop tablets on the floor and to pick them up and pop them into the mouth of the person they have been prescribed for. It was said this has happened more than once and it is not very hygienic. The inspector agrees with this service user. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 The home is good at supporting able residents to access the wider community but not so good at being able to support those who need a lot of help or supervision when out. Staff make good efforts to support families to keep in touch with family members who live at the home and to keep them well informed. This home appears to have good relationships with its near neighbours and the wider community. EVIDENCE: It is custom and practice that a person living at the home would only go out of the home unescorted if the risk of doing so had been assessed and agreed in accordance with current best practice. One service user told the inspector of their active life style outside the home that includes going out most days either shopping, visiting friends or attending social groups and includes coach trips. This person’s risk assessment appeared in order. Case documentation shows that many service users do not go beyond the boundaries of the home unless supported by a family member or friend or, for some, a staff member who is willing to take them out, outside their normal working routine. The visitor’s book and feedback from the staff confirm that a service of worship takes place at the home periodically for those who want it and that school children and that community groups visit usually around Christmas time. People from the Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 13 village also use the home for their day services. Staff reported that plans were well advanced for the annual summer fete. Case documentation details known family contacts, including any expressed routines or customs. There are no formal restrictions on visiting hours in the main part of the service: but in the rehabilitation unit it is preferred that morning visits are best avoided to allow people to give the necessary time and attention to complete their exercise programmes. Service users in the unit said this ‘rule’ is not hard and fast. Service users can be seen in private. Information about the home and the councils own policy stress the importance of offering choice. Service users confirmed that choices are offered, such when to retire at night, when to get up, whether to stay in your own room or use communal areas and alternative food options. In practice some choices are limited due to aspects of group living. For example people who need assistance with dressing or bathing may have to take their turn. Observation during the inspection confirms that service users do get up a different times and records indicate that service retire at different times. It was also observed that certain service users had different meal options. One service user exercised her right not to go to hospital; something they indicated to the inspector was a very important decision they needed to make for themselves: even though their doctor had suggested hospital as the best place for them. Several service users reported that they have chosen the décor in their bedroom. Many service users praised the food. More service users praised the food than criticised it. One said the cook, “will ask you what you want” Another said the. “there is nothing wrong with the food here.” Someone else said, “…you get plenty to eat here.” Another that, “the food is great.” But as already reported there were also comments about some repetition of to much toast and cold tea. Examination of the notes of the residents meetings confirm that staff seek feedback on menu planning and food preferences. It is evident that changes are made based on the feedback received. A feature of this inspection was the number of service users who indicated how helpful and personable the current cook is. Examination of the menus show that they offer variety and choice of typically traditional English food and no salads or pasta meal or options for fresh fruit. It was observed that a relative visiting to enquire about a place was told the visiting times and that this information is available in the service users guide and in the documents on the case file. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 The home has a very low record of recorded complaints or of incidents of serious concern. There is a basic awareness of the what to do if a person discloses or alleges they have been abused but some staff impress as thinking that abuse is something that is only done by others outside the home and would not be done by workers or people who are also receiving a service. Service users report feeling safe at the home. The recording of complaints still seems a bit hit and miss when it comes to expressed niggles and dissatisfactions. Those who manage the service are too trusting of agencies to only send them staff who have a satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. The rights of service users are respected and upheld. EVIDENCE: All service users are provided with information about how to complain and notices displayed in the home enhance this. The council also has a system of recording comments that include compliments. All the service users who completed a survey form i.e. 11 in total reported feeling safe. No one reported feeling unsafe. There are no recorded complaints in the previous 12 months. Records in the home show that most staff do not receive awareness training on abuse, which include the local protocols, though staff who undertake NVQ do cover this area. Service users do report certain dissatisfactions e.g. cold tea, disruptive fellow residents, rude staff and meals that are not being captured as part of the complaints policy. One service user has clearly made representations about having paid out a large sum of money for decorating her own bedroom a short while ago and being asked to move to a different room. It was found that one recruitment agency had sent to the home a person who had not undertaken a CRB and POVA check. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 15 The Council has a detailed whistle blowing policy and an adult protection policy, which takes account of government guidance, and the document tilted, “No Secrets.” It is the policy of the home not to use any physical restraint. The manager said no such need had arisen and staff dealt with any aggression mainly by distraction or providing extra attention. Such incidents were said to be “not very often.” The Council also has a robust system for managing any moneys that belong to a service user if that service user cannot manage this for them selves; and there is no one else to do it. The home employs dedicated staff to keep a record of any monies or valuables held on behalf of service users. This includes periodic audit and spot-checking. There is a policy in place that prohibits staff from benefiting from a service users estate, or receiving gifts; other than small tokens of appreciation such as flowers or chocolates where refusal might offend. One matter was brought to the attention of the inspector that if permitted may indicate a conflict of interest. The manager undertook to look into this matter with the persons concerned. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The accommodation has improved and there are clearly plans to improve it further in the next 6/9 months with a major refurbishment. The standard of cleanliness and hygiene appeared satisfactory in those areas seen. EVIDENCE: Service users report feeling safe. Actions requested by the local environmental health officer at her last visit have been actioned and the local fire safety officer on his most recent visit reports the home (in respect of fire safety) was being kept to a high standard. Records show a low level of accidents and none recently arising from any deficits relating to the premises. Since the last inspection the way equipment is stored has been improved, some areas have been redecorated and the lighting improved i.e. alongside corridors. Toilets and bathrooms have been upgraded. Plans are advanced for a major refurbishment that includes an advanced fire protection system and more comfortable and larger bedrooms. Several bathrooms, toilets and communal areas were seen as well as bedrooms used by the service users and all appeared clean and pleasant. The Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 17 dishwasher was out of action. The grounds are well maintained. The laundry facilities were seen and they appeared tidy and include equipment suitable for the size of the home. There are plans to further upgrade these facilities. The home has a dedicated infection control policy that care staff were aware of. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 This rehabilitation unit appears to be well staffed at all times. The main house less so on some occasions and to achieve adequate staffing levels the home is reliant on using agency or bank staff. Most staff have gained the relevant National Vocational Qualification and several have attended various statutory courses. The home has not yet taken adequate action to satisfy itself all staff, including Agency staff, have undertaken a Criminal Record Bureau check. More attention is needed to keep the staff training records up-to-date and accurate EVIDENCE: Documentation provided by the manager indicates that 160 shifts over an 8 week period included one or more bank or agency staff member. It was reported that due to the reduction of service users being cared for pending the refurbishment programme this number was reducing; a fact indicated on the staff rotas. The home is well staffed at night with at least 3 people working. The home does not employ anyone under the age of 18 years so all personal care is delivered by people over 18 years old. Staff records confirm that all supervising staff are 21 years or over. Eleven service users report feeling safe at the home; this represents 100 of those who made written comments to the Commission. It was found that 2 staff sent by an employment agency had not undertaken a relevant Criminal Record Bureau/POVA check before commencing work at the home. Staff are aware of the local systems for dealing with any allegations of abuse or neglect and receive awareness training in this area. Records show that over 20 staff had successfully obtained a relevant National Vocational Qualification (Level 2) of which approximately 6 had undertaken further training at level 3. Records Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 19 also show and staff confirm that they are provided with relevant statutory training such as manual handling, first aid, fire safety and basic food hygiene. Closer examination of these records show few staff undertake health and safety training or training in assessing risk. Furthermore for the majority of staff they have had no recent update in training in respect of fire safety and first aid. In some cases several staff have had no such training since 1999. Staff report there is an effective induction programme in place. Service users describe the skills of the staff at helping them with their needs. For example one commented you are looked after very well. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, and 36 While the home has an experienced and caring manager some management issues are not being addressed in a sufficiently robust manner. Workers at the home reported anxieties about not being sufficiently informed about imminent changes and there were some dissatisfaction within the staff team about workloads. The overall standard of record keeping is considered adequate or better in most cases. This is a service where health, safety and wellbeing of service users are actively promoted. Quality assurance is improving but needs to improve more. Some supervisors are neglecting to provide adequate supervision to care workers. EVIDENCE: The manager meets the Commission’s requirements and is deemed a fit person to manager this home. Service users report that the manager is “very caring” and it was observed during the inspection little cameos of interaction between the manager and different service users that illustrate patience and compassion on the managers part. The inspector met with 10 staff; the Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 21 majority of whom were critical of the lack of information about the proposed changes. They said that the lack of information meant they were not able to reassure service users about the future, especially in relation to the provision of intermediate care. Comments were also made about the lack of adequate dishwashing facilities in the kitchen and that the dishwasher repeatedly broke down. It was not working on the day of the inspection. Neither was it clear to the catering staff how the management intended to provide for meals during the period when it is planned to refurbish the kitchen. Most staff at this meeting indicated that they get a lot of relevant training and that the service users are well cared for. Those staff that have supervisory duties get extra training but this is not always translated into providing care staff with the supervision they need. Some staff get very little. One supervisor was unable to explain to the inspect there supervisions were not taking place on a regular basis. Examination of certain supervision records show that some team members highlight dysfunctional team working. The inspector found no evidence to show that these concerns had been taken forward to a resolution. It was also observed during the inspection that one colleague was critical of another and they were falling out about mutual expectations. The council takes seriously its equal opportunity policy, which includes some monitoring. Copies of the General Social Care Council code of conduct were available in the home and staff confirm they are given copies. Staff appeared to have a good grasp of the chain of command and each other’s main duties and responsibilities. The manager has consulted with service users about life in the home and sent out a questionnaire but this had not been fully evaluated. Good attention was given to most but not all the requirements and recommendations made at the previous inspection. Staff report that formal meetings with their supervisor are irregular. The manager confirmed that there is still some slippage on who gets supervision and that arrangements to supervise night staff are inadequate. Where supervision is provided the recorded notes indicate that staff expressing a ‘wish list’ for training appears to dominate the agenda for some people. Some supervision records do not show a good focus on the issues about service users. The Council have undertaken an extensive review of the home. Service users and their families report that they were able to attend a meeting about the proposed changes. Records are kept secure. Service users are told they can access their records. The manager said in practice few do. The standard of record keeping varies depending on who writes it or inputs it. Some records were not up-to-date. The service has numerous policies and protocols in place that are designed to promote the health, well being and safety of those using the service. These policies cover those listed under the relevant National Minimum Standard (NMS). The Council take seriously its duties to provide a safe living and working environment and has various specialist departments that can support these objectives in a planned and methodical way. There is an effective system of capturing and recording any incidents and accidents. Case documents show that each service user has their own personalised assessment of risk that typically covers areas such as smoking, managing medication and manual handling. Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 2 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 1 3 2 2 x x 1 2 3 Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 13(2) Requirement Timescale for action 30/06/05 2. OP16 22(1)(2) 3. OP18 OP29 19(1)(4)( 5)(6) The practice of staff picking up prescribed tablets that fall to the floor and giving them to service users must cease. The guidance on what 30/09/05 constitutes a complaint should be reviewed so that it picks up any expressed concerns made by any service user. This includes any concerns regarding any proposed changes to the service and how these changes may negatively impact on any service user that expresses a concern. No one working at the home that 30/05/05 has contact with service users as part of their job role, whether deployed from an Agency or otherwise, must commence work at the home unless they have undertaken a satisfactory POVA and applied for a CRB that is considered satisfactory. (This requirement duplicates a similar requirement made at the previous inspection) 4. OP30 18(1) The manager must ensure that all relevant staff have completed training in first aid, fire safety, 30/09/05 Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 24 5. 6. OP19 OP36 23(2)(c) 18(2) 7. OP7 12(5)(b) 8. OP3 14(1)(d) 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. The home must ensure it has a reliable and dependable dishwasher Urgent management action must be taken to ensure all staff that provide care and support to the service users receives regular and effective supervison from a person or persons. Regular is defined as meeting not less than 6 ocassions 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 as well as other staff. Any such meeting should be recorded including any action plan. (This requirement was made at the previous inspection) Further consideration must be given as to how best to ensure that any identified staffing problem is addressed and dealt with in an efficient and satisfactory manner that takes full account of the homes stated purpose. All services users must be sent in writing the outcome of any assessment of need, including confirmation of which needs the home can meet and which needs they cannot meet. This is only required if such documentation is not in place 30/09/05 30/09/09 30/09/05 30/09/05 Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 25 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. Further consideration should be given as to the best way to support and assist service users to have ownership of their care plan and to be active participants in drawing it up. It is recommended that a policy is drawn up clarifying the frequency that any refresher course is needed in respect of training in; first aid, fire safety, moving and handling people, food hygiene and health and safety at work including assessing risk. All staff training records should be kept upto date. 2. OP7 3. OP30 4. OP30 Langton House DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 26 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire 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 DD51_D01_S35472_LANGTONHOUSE_V190269_290605_STAGE4.doc Version 1.30 Page 27 - 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. 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