Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 22/12/06 for Langwith Lodge Care Home

Also see our care home review for Langwith Lodge Care Home for more information

This inspection was carried out on 22nd December 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users say the home can meet their needs, which are assessed and reviewed. Their health, personal and social care needs are generally well set out in individual care plans. Service users are generally treated with respect and their right to privacy is upheld and their needs appear to be met by the numbers and skills mix of staff. Service users needs appear to be met by the numbers and skills mix of staff. The activity provision appears to satisfy service users social, religious and recreational interests and needs and they can maintain contact with family and friends and the local community as they wish and are helped to exercise choice and control over their lives. Service users are provided with a nutritious diet and are happy with the food provided. Service users and staff said they were aware of how to make complaints and are confident that they would be dealt with. Service users live in a generally clean and well-maintained environment. The home is run in the best interests of service users with a new acting manager in post who is yet however to be registered with the Commission for Social care Inspection. Service users are safeguarded by, the accounting and financial procedures in the home

What has improved since the last inspection?

There was evidence that Quality Monitoring systems are in place and most of the records were available for inspection. There was evidence of a Service User guide and contracts in place and training records for most staff were available. Some improvements have been made in respect of health and safety and infection control, however further development of the infection control procedures and full implementation of the recommendations made by the health protection team will ensure that service users and staff are fully protected.

CARE HOMES FOR OLDER PEOPLE Langwith Lodge Care Home The Park Nether Langwith Mansfield Nottinghamshire NG20 9ES Lead Inspector Jayne Hilton Key Unannounced Inspection 22nd December 2006 11:30 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 Langwith Lodge Care Home DS0000008742.V324912.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. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langwith Lodge Care Home Address The Park Nether Langwith Mansfield Nottinghamshire NG20 9ES 01623 742 204 01623 744 611 awlangwithlodge@btconnect.com www.yourhealth.ltd.uk Your Health Ltd 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) Care Home 54 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (42) of places Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: Langwith Lodge is an adapted large country house, set in its own private grounds overlooking a lake within a scenic rural setting. The home is owned by Your Health Ltd. There are two units, the main house and the Horton Suite, which adjoins the main house. Lift Access is provided to the first and second floors, for those who cannot manage the stairs. The home provides 24-hour care and support for 54 older people and service users with dementia. Information was provided by the acting manager on 22-12-06 on the range of fees charged; these are between £314-£380 service users pay extra for newspapers, hairdressing and chiropody. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection took place over 5 daytime hours. A further seven hours was spent reviewing a service users care notes and the outcome is included within the report. The main method of inspection used was called ‘case tracking.’ This involves selecting three residents and looking at the quality of the care they receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Many of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading residents’ records and documents. The residents who were “case tracked” were not able to help by giving an opinion about the care provided. Due to time spent on some specific areas of concern one resident who could express an opinion was interviewed and others were communicated with throughout the inspection process. Relatives were observed visiting the home but due to the busy festive time of year and the focus of the inspection, comments from one relative only were obtained. Six members of staff, the acting manager and the responsible person [representative of the Registered Provider] were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided to residents. The Health Protection Agency and Environmental Health Officer identified a number of concerns during their last visits to the home, in relation to some infection control issues, so a full tour of the building was undertaken. All communal areas were seen and all bedrooms in the Horton suite to make sure that the environment is safe, well maintained and homely. This is the second key inspection of the home this year because of the number of concerns about the quality of the service provided and the safety of residents. A new acting manager has been in post from October 2006. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 7 There was evidence that Quality Monitoring systems are in place and most of the records were available for inspection. There was evidence of a Service User guide and contracts in place and training records for most staff were available. Some improvements have been made in respect of health and safety and infection control, however further development of the infection control procedures and full implementation of the recommendations made by the health protection team will ensure that service users and staff are fully protected. What they could do better: The monitoring and documentation in care plans, in relation to service users nutritional needs are not fully satisfactory and must be improved to ensure service users needs are fully and appropriately met. The systems in place for the protection of service users do not fully meet the standard, as training for all staff is needed in this area. The practice of the management of medicines in the home does not protect service users safety. This is an outstanding requirement from two previous inspections and urgent action is required by the Registered Person as failure to comply will result in Enforcement Action being taken. There are some outstanding aspects of health, safety and infection control to address to ensure service users and staff are fully protected. Further development of the infection control procedures and full implementation of the recommendations made by the health protection team will ensure that service users and staff are fully protected There was not sufficient evidence provided to meet the standards fully in relation to staff recruitment, induction, training and development, as one staff member’s file was not available for inspection. The Commission for Social Care Inspection [CSCI] have not received some notifications from the home in respect of events, which affect the health and well being of service users as required under Regulation 37. The inspector requests that all backdated incidents as specified under the regulation be Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 8 notified to CSCI for the dates from the last inspection and in respect of issues raised by the health protection teams report. Requirements are set in relation to the above. Several good practice recommendations are made also. 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. The summary of this inspection report can be made available in other formats on request. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 9 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 Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users say the home can meet their needs, which are assessed and reviewed. Information about accessing a copy of the inspection reports for the home should be included in the Service User Guide. The home does not provide an intermediate care service. EVIDENCE: There was now evidence on the premises that service users are issued with a service users guide and contract. A copy of the last inspection report was not displayed in the home, neither was there any information displayed which informed service users or visitors how they could access it. That said a copy of Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 11 the report was seen on the care staff workstation. The responsible person stated in the improvement plan from the previous inspection that this information will be in a revised service user guide. Service users benefit from a fairly comprehensive assessment, which offers service users the opportunity to express preferences and which is reviewed approximately six monthly. The date of when the service users moved to the home was not clearly indicated on all of the care plans examined. Extended Community Care assessments were seen where applicable. The assessment documents include service users preferences for make up, perfume/ aftershave, expressing sexuality, number of pillows, keys for bedroom, religious needs and worshipping. The cultural and diversity needs of service users need to be expanded upon however. As the home provides care for people with Dementia it is expected that the individual’s capacity for consent would be addressed within the assessment and care plan process. All of the service users spoken with confirmed that they were happy with the service provided and that their needs were met. The service user spoken with individually praised the staff and the facilities. The home specialises in the provision of care for people with dementia and staff, were observed to treat service users with patience and respect when communicating with them. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users health, personal and social care needs are generally well set out in individual care plans however the monitoring and documentation in relation to service users nutritional needs must be improved to ensure their needs are fully and appropriately met. The practice of the management of medicines in the home does not protect service users safety. Service users are generally treated with respect and their right to privacy is upheld. EVIDENCE: Five service users care plan files were examined, these related to the assessment of needs and offered instruction to staff of how the needs of the service user would be met. There was however a lack of consistency in practice Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 13 in monitoring and addressing the changing needs of service users and the implementation of new or revised care plans. There was evidence within the care plans examined that the mental health needs of service users are monitored as are incidents of verbal and physical aggression, however care plans do not identify how aggression is presented in every case and this requires attention. The care plans examined were neat and tidy. The staff work in co-ordinated teams and care plans clearly indicated who was the service users key worker. There was evidence of nutritional assessments within the assessment documentation, however one service user had no care plan in place despite noted changing needs in relation to his nutritional needs, neither was there any indication of any consultation with a GP in relation to the service users changing needs in relation to his increasing frailty, particularly for referral for his weight loss. Service users weights are monitored but the documentation in place does not identify triggers for action and the evaluation process was clearly flawed. There were also no records of food intake for this particular person despite noted weight loss over a period of time. Another service user with identified nutritional needs did have a care plan in place and care charts which identified, fluid and food intake, turning for wound healing. A requirement is made in relation to improved monitoring for service users nutritional intake. Risk assessments were in place for pressure sores, manual handling, agitation and risk of falls and were, noted to be in place and appropriately reviewed. It is recommended that personal care charts are implemented or specific reference is made in daily records for care of hair and nails that can be monitored and evaluated. One service users plan had a care plan in place for Use of Denture soak tablets but the denture soak tablets were observed to be left in his room. Risk assessments are were seen to be currently being prepared by the acting manager. Despite identifying a risk of denture soak tablets this has not been addressed on admission. The use of denture soak tablets should be identified within the assessment documentation to ensure service users are not placed at risk. Healthcare checks such as Chiropody, dentist, hearing checks are not included within the care plan structure and records. Separate records are kept for chiropody, opticians but the information had not been transferred to the care plan. There was no record/history of falls documented in the plans either and Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 14 this is recommended to evaluate the incidents of falls and implement revised risk assessments as necessary. Key workers should transfer information from the accident records to the running record of falls, which the manager can then evaluate. Records of these checks should be clearly documented as part of the overall care package. Continence management appeared to be well managed, from observation in care plans and toilet regimes. Medication management was assessed, focusing on the areas needing improvement at the last visit. A staff member was observed giving medication and signed the medication administration record [MAR] prior to giving out the medication and visibly observing that it had been taken All the MAR charts were, noted to be otherwise completed satisfactory A cross balance check of Controlled Drugs and dates written on medication opened were satisfactory. Staff reported that no service users were self-medicating currently. A number of items had been left in care plan cupboard. [Lactulose, liquid medicine, paracetomol, eye drops, inhalers etc] and therefore not stored appropriately. Ends had also been ripped off Paracetomol boxes, which removed use by dates. The medication policies have been reviewed in conjunction with the Royal Pharmaceutical Societies guidance booklet on medicine administration in care homes. The old policies were noted however to be still in situ in the Horton Suite. Training is provided in house and by distance learning. As there were still some identified issues in relation to the management of medication and requirements were outstanding at the previous inspection a serious concern letter has been sent to the provider for immediate action. Failure to comply may result in enforcement action. Service users spoken with confirmed that staff treated them with respect and that their privacy and dignity was upheld, that mail is given unopened, that staff knock before entering rooms, during personal care etc. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 15 Staff spoke with were able to demonstrate how they maintain and respect service users privacy and dignity. Observation of staff practice on the day supported this. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activity provision appears to satisfy service users social, religious and recreational interests and needs and they can maintain contact with family and friends and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users are provided with a nutritious diet and are happy with the food provided. EVIDENCE: The social and recreational needs of service users are recorded within the assessment process and records are usually kept of service users participation. [The activities co-ordinator is currently on maternity leave and staff have not continued to maintain this record] Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 17 Each service users plan contained an activity programme which included music to movement, co-ordination therapy, hymns and `prayers, quiz, board games, bingo, nostalgia hour, 1:1 chats, crosswords, craft hour and day trips according to the weather. There were no complaints regarding activities made by service users. It did appear from service user and staff comments that staff had supplemented activities in the activities persons absence despite the lack of record keeping in this area. A service user confirmed that there had been some recent trips out organised and that service users went to Crystal Peaks at Sheffield recently although a planned trip to Mansfield shopping was postponed due to the weather. Some service users went to a local pub for a Christmas meal. Activities provided in house include a bonus ball, exercises, quiz, television CD’s, Billy and Hillary to sing/entertain. A service user said “it will be nice when activities lady comes back staff are doing their best with the time they have”. On speaking with staff members about equality and diversity issues it was demonstrated that although training was clearly needed that equality and diversity was respected and that any such specific needs would be promoted. Service users and staff confirmed that visitors were welcome at any reasonable time. One relative spoken with at this inspection confirmed she is made welcome. Staff demonstrated through discussion how they promote service users independence, choices and decisions within their daily routines, such as what to wear etc. Service users confirmed that they could get up and go to bed when they choose and all had made choices of the meals. Records were seen of service users choice options. The menu displayed appeared varied and nutritious and service users spoken with said the food was very nice. Observation of staff practice in assisting service users with eating was appropriate. Fresh vegetables were seen and the cook reported that this is delivered twice a week. Food was covered and date labelled in fridges. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 18 It is recommended that the cook undertake the intermediate level food hygiene training and seek advice from the Environmental Health Officer in relation to probing of soups, stews and casseroles. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and staff said they were aware of how to make complaints and are confident that they would be dealt with. The systems in place for the protection of service users do not fully meet standard 18, as training for all staff is needed in this area. EVIDENCE: The complaints policy is included in the service user guide and service users confirmed that they felt able to raise any concerns or complaints should they have any. Complaints records were viewed; one complaint was recorded since the previous inspection dated 30/10/06 re poor hair and nails care. It is recommended that that staff indicate on daily notes or implement personal care charts that hair and nails have been attended to and to re visit complainant to see if complaint fully resolved. The registered person was requested to send a copy of the complaint investigation identified at the previous inspection. This had not been received at the Commission for Social care at the date of the inspection. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 20 There was a policy for protection of service users from abuse. Staff records highlighted that not all staff have undertaken training in abuse awareness. Staff spoken with were able to demonstrate that they would report any concerns in relation to The Protection Of Vulnerable Adults. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a generally clean and well-maintained environment; however there are some outstanding aspects of health, safety and infection control to address to ensure service users and staff are fully protected. EVIDENCE: The home was visited by the Health Protection Agency in October 2006 and made several recommendations to improve infection control within the home. The Environmental Health Officer made a visit on 18/9/06 and made recommendations. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 22 A Tour of premises was undertaken at this inspection, which focused on the recommendations made by the Infection Control Nurse All bedrooms in the Horton Suite were examined. The Commission for Social care Inspection [CSCI] requested on 17/11/06 that the registered person provide a response and action plan in response to the Health Protection Agency’s report from their visit. This had not been received at the date of the inspection. The Responsible person said that action was being taken and that a response had been made. There was no copy of the action plan/response to CSCI available in the home. The communal areas smelled fresh and appeared clean. The managers office has been refurbished and also clean and fresh smelling. All Linen stores were checked and these were found to be satisfactory. Not all sluice rooms have foot-operated bins but the acting manager said these were currently being actioned. The Sluice room door on the ground floor doesn’t close because of a sink unit; the registered person should seek advice from the environmental health officer in relation to this room. Liquid soaps and paper towels were seen around the home, but one toilet did not have these, the toilet was also depleted of toilet paper and a towelling hand towel was in use. A damp area was noted near room 40 and a canister of wasp killer seen left in the corridor was removed at once. In the Domestic Supplies room two mops were observed, to still be, stored with their head down. The acting manager reported that they were looking at new systems for colour coding and that staff would be spoken to again about appropriate storage of mop heads. A door lock was noted to be broken on first floor sluice but the handyman fixed this during the inspection. In the Laundry the cupboard under the sink was noted to be in need of clean. Gloves were seen but no aprons. The laundry door is a fire door and was not fitting flush into rebate, however handyman fixed this during the inspection. In the Horton Suite all rooms examined two rooms smelled of urine and two soiled chairs were observed in a room that is vacant. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 23 A rug was observed to be a potential trip hazard in the toilet adjacent to room 4 and a piece of carpet left outside room 4 was also trip hazard, the handyman removed these at once. Clinical bins were left ajar/unlocked and just needed closing firm. Work in relation to the Electrical certificate is currently underway, confirmation was seen from the contractor that setting is in progress and test results will be completed in Jan 07 Quotes for new waste bins have been obtained and the registered person has stated that these are to be provided 10 days after New Year A Fire risk assessment is in place and water-testing records are also in place. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs appear to be met by the numbers and skills mix of staff, however management hours require addressing. There was not sufficient evidence provided to meet the standards fully in relation to staff recruitment, induction, training and development, as one staff member’s file was not available for inspection. EVIDENCE: The rotas were examined. It was reported that thirty-eight service users were in residence on the day of the inspection. Five/Six staff were rotered for daytime shifts and four at night. Catering and domestic hours were assessed to be satisfactory but the exact number of hours is not identified on the rota. The manager does not work super numery full time. In order for the manager to undertake and fulfil her responsibilities under the Care Standards Act 2000 it is strongly recommended that she work full time supernumery. Recruitment procedures were examined and three out four staff files were satisfactory. One file requested could not be located. The acting manager reported that the previous manager who has moved posts within the Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 25 organisation had the file to update it. This is a further breach of records not being available for inspection. A requirement is set in relation to this. Staff members confirmed that they had undertaken training in the following, Food Hygiene, Fire Safety, Manual Handling, NVQ2 and Medicines Management, Health and safety, First Aid and Infection Control as records indicated. Adult Protection and equality and diversity training should be provided for all staff. Training records confirmed sixteen staff have achieved or are currently studying NVQ2 and three staff have achieved NVQ3 and all remaining staff registered apart from three. It is strongly recommended that training be provided for staff in dealing with challenging behaviour, diabetes care, nutrition and other topics in relation to service users specific needs. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of service users with a new acting manager in post who is yet to be registered with the Commission for Social care Inspection. Service users are safeguarded by, the accounting and financial procedures in the home and staff are regularly supervised. Improvements have been made in respect of health and safety and infection control, however further development of the infection control procedures and full implementation of the recommendations made by the health protection team will ensure that service users and staff are fully protected. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 27 EVIDENCE: A new acting manager is in post; she was previously the deputy manager at the home and is currently undertaking the Registered Managers award. The acting manager reported that she is currently making an application to be registered with the Commission for Social Care Inspection. Staff spoken with reported that changes have been made to improve the systems and practice sin the home. Staff and service users spoken with reported that the manager was approachable and staff stated that they were confident in the manager’s abilities to lead the team. There was some evidence available of quality monitoring in the home for example provider visits under regulation 26 and service user surveys. There was also evidence of service user/relatives meetings recently held. Minutes of these were viewed. No dates were seen for the service user surveys and the acting manager was not sure about how evaluation and feedback will be reported back to service users. Service users finances are kept in safe. Staff were observed to receiving money from relative and to give a receipt to the relative, who signed the record sheet Improved practice observed. Records were seen for one to one supervision meetings held in the home. These should be undertaken at least six times a year however. The Commission for Social Care Inspection have not received some notifications from the home in respect of events, which affect the health and well being of service users as required under Regulation 37. The inspector requests that all backdated incidents as specified under the regulation be notified to CSCI for the dates from the last inspection and in respect of issues raised by the health protection teams report. Care Plans are stored securely. Improvements have been made in respect of health and safety and infection control, however further development of the infection control procedures and full implementation of the recommendations made by the health protection team will ensure that service users and staff are fully protected. The registered person must ensure that CSCI are provided with the necessary evidence that service users health welfare and safety are fully promoted and protected. Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 28 Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 29 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 1 2 Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 14 Requirement The Registered Person must ensure that the assessment of service users changing needs is kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. Timescale for action 22/02/07 2 OP8 12 3 OP8 13 4 OP8 12,17 The Registered Person shall 22/02/07 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users The registered person shall make 22/02/07 arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional. Records must be kept of the food 22/02/07 provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for DS0000008742.V324912.R01.S.doc Version 5.2 Page 31 Langwith Lodge Care Home OP9 5 13 individual service users. The registered person shall make 14/01/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In relation to the issues identified within the report. Previous timescale 22/06/06 and 29/12/06 not met. 6. OP16 17,22 Urgent Action Required. Ensure records are kept of complaints and that the records are available for inspection. Provide a copy of the complaint received and the investigation outcome with the improvement plan. Previous timescale 29/12/06 not fully met. 22/02/07 7 OP18 18 8 OP19 13[4][a] Ensure all staff receive training in abuse awareness and evidence of this is available for inspection The Registered Person must ensure all parts of the home to which service users have access are so far as reasonably practicable free from avoidable risks. In respect of all identified issues within Standard 19-26. The Registered Person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. An action plan in relation to the recent health protection Agency recommendations must be sent 22/03/07 22/02/07 9 OP26 13[3] 14/01/07 Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 32 to the Commission for Social Care Inspection as previously requested. 10 OP29 7,19 Urgent Action Required. The Registered Person shall ensure that recruitment records for all staff are at all times available for inspection in the care home. The Registered Person shall give notice to the Commission without delay of [37] [b] the outbreak in the care home of any infectious disease which in the opinion of any medical practitioner attending persons in the care home is sufficiently serious to be notified [37] [e] any event in the care home, which adversely affects the well-being or safety of any service user. Urgent Action Required: You must send the backdated notifications for all service users affected and a copy of the action plan made in response to the Infection Control Team Visit and report recommendations 12. OP38 17,23 Provide evidence of the completion of the five yearly electrical safety certificate to Commission for Social Care Inspection. 22/02/07 22/02/07 11 OP37 37 14/01/07 Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 33 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 Inform service users and relatives/representatives how they can obtain a copy of the inspection reports on the home. 2. OP3 Include capacity to consent within the assessment documentation. Attention to dates of completion on assessments is needed. 3. OP7 Ensure risk assessments are in place for the use of denture soak products used. These should be implemented on admission and relatives be informed of the risks involved. Care plans for managing aggression or challenging behaviour need to identify how the behaviour is presented and detail specific actions of staff in relation to how the specific needs of the service user will be met. Evaluate the number of falls and incorporate a running history and evaluation of falls within the care plan process Ensure weight records have an action section and are used in the evaluation and monitoring of service users nutritional needs. Implement personal care charts which include hair and nail care Ensure records of activities are kept up to date in the absence of the activities co-ordinator Provide training for care staff in nutrition, diabetes, challenging behaviour, equality and divesity and other specific needs of service users and provide intermediate level of food hygiene training for the cook. Ensure at least six sessions of supervision a year are provided for care staff. 4 OP7 5. 6 7 8 9 OP8 OP8 OP8 OP12 OP30 10 OP36 Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Langwith Lodge Care Home DS0000008742.V324912.R01.S.doc Version 5.2 Page 35 - 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!