Inspection on 22/11/05 for Langwith Lodge Care Home

This inspection was carried out on 22nd November 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

Langwith Lodge Care Home 08/05/08

Langwith Lodge Care Home 17/05/07

Langwith Lodge Care Home 22/12/06

Langwith Lodge Care Home 23/05/06

Langwith Lodge Care Home 04/03/05

Langwith Lodge Care Home 26/08/04

Langwith Lodge Care Home 09/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Langwith Lodge Care Home The Park Nether Langwith Mansfield Nottinghamshire NG20 9ES Lead Inspector Jayne Hilton Unannounced Inspection 22nd November 2005 12:30 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.V253788.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 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 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) Your Health Ltd Ms Alison Lousie Walters 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.V253788.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th May 2005 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. The home provides 24 hour care and support for 54 older people and service users with dementia Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out on the 22nd November 2005 by Jayne Hilton Regulation Inspector and was of two and a half hours duration. A further visit was made on 29th November 2005 for one hour to inspect areas that could not be inspected at the two previous visits due the manager being on leave. The focus of the inspection was to assess the requirements set at the last inspection and to assess the key standards not inspected at the previous inspection undertaken by examining a sample of three care plans, speaking with ten service users and speaking with three staff members. A sample of records were examined, however this was limited due to the manager not being available and therefore some records could not be accessed. A Tour of the environment was also a component of the inspection, direct and indirect observations were undertaken. What the service does well: Service users know the home can meet their needs, which are comprehensively assessed and reviewed. Service users health, personal and social care needs are generally well set out in individual care plans. All of the ten service users spoken with conformed that they were happy with the service provided and that their needs were met. The service users spoken with highly praised the staff and the facilities commenting that there is none better. A rating score given by them was 9/10. Service users are treated with respect and their right to privacy is upheld. Service users wishes for the end of their life are documented. The activity provision is satisfies service users social cultural, 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 very happy with the food provided. Service users, relatives and staff are aware of how to make complaints and are confident that they would be dealt with. Service users generally have their legal rights protected but further work is needed to ensure that all service users are able to participate in the civic process should they wish to do so. Service users benefit from comfortable, clean and homely surroundings, The numbers and skill mix of staff meets Service users needs also. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Service users do not have the information they need about the home, despite the documentation being finalised. The management of medicines requires some minor improvement. Improvement is needed regarding record keeping and accessibility for inspection. The financial practices in the home need to be improved to ensure service users financial interests are safeguarded. The complaints policy requires amendment and sited in a prominent position. The systems in place for the protection of service users do not fully meet the standard as training for staff is needed in this area and a clear policy for staff undertaking shopping on behalf of service users is needed. The manager should work full time supernumery. Staff are not provided with a copy of the General Social Care Councils code of conduct. Recruitment practices are not in line with current guidance and urgent action is required to ensure that service users are protected by the homes recruitment policy and practices. Minor maintenance issues need action. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 7 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. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 Service users know the home can meet their needs, which are comprehensively assessed and reviewed. Service users do not have the information they need about the home, despite the documentation being finalised. EVIDENCE: The home has now finalised the statement of purpose which is one combined document with the service user guide and which includes terms and conditions documentation. Unfortunately there was no evidence that service users are issued with these documents. Care plans do not contain copy of the contract and all ten service users spoken with were not aware of the document. It is advisable that service users or their relatives sign to say they have received the document and completed contracts are included within the care plan folder. The complaints procedure in the Service user guide states ‘National Care Standards’, which should be ‘Commission For Social Care Inspection’ Service users benefit from a comprehensive assessment, which offers service users the opportunity to express preferences and which is reviewed Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 10 approximately six monthly. Service users or their representative’s signatures were not included on all of the assessments examined. All of the ten service users spoken with conformed that they were happy with the service provided and that their needs were met. The service users spoken with highly praised the staff and the facilities commenting that there is none better. A rating score given by them was 9/10. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Service users health, personal and social care needs are generally well set out in individual care plans. The management of medicines requires some minor improvement. Service users are treated with respect and their right to privacy is upheld. Service users wishes for the end of their life are documented. EVIDENCE: Three 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. Care plans were seen for social and leisure activities and a separate record is kept by the activities co-ordinator of participation. The evidence to demonstrate that the mental health needs of service users are monitored could be further improved. Incidents of verbal and physical aggression are noted in daily notes. Daily notes did not report about the holistic needs of service users. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 12 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, primary carer and associate workers. There was evidence of nutritional assessments within the assessment documentation but 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 etc. There was no record/history of falls documented in the plans either and 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. Risk assessments were in place for bedrails [the term cot sides should be reviewed as not an age appropriate term.] Weight charts were up to date. [These are kept separately with daily notes] Care plans were seen for pressure areas and waterlow assessments are used A service user and relative confirmed that District nurse services support the home with pressure sore care, catheter and stoma care. Care plans were in place, which took into account the behaviour of a service user. Continence management appeared to be well managed, from observation in care plans and toilet regimes. Care plans were generally signed unless there was a justified reason for them not being signed however the ten service users spoken with stated that they were not aware of and had not contributed to their care plans. Care plans were generally reviewed apart from one new service users. Medication management was re-assessed, focusing on the areas needing improvement at the last visit. The trolley was secured to the wall when not in use, medicines policies were seen, the drug error policy needs was displayed in a prominent position for staff to access in an emergency and includes that all medication errors will be notified under regulation 37 to CSCI. One service user self medicates, there was a risk assessment and monitoring record on the individuals care plan to ensure that the service user is still able to carry out the task. There was evidence of sample signatures of those staff that dispense medication. There were now photographs of service users with the medication record chart. Fridge temperatures were recorded, however there was no evidence of the medicine storage room temperatures being taken. Ten 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. The medicines policies were observed to be related to Nursing Home guidance, particularly the full policy for medication errors. The policies should be reviewed in conjunction with the Royal Pharmaceutical Societies guidance booklet on medicine administration in care homes. The deputy manager was Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 13 given a contact number for the home to obtain this and review the homes medicines policies. Staff who assist service users with the administration of insulin are assessed as competent by the district nurse and signed authority was seen for this. Service users wishes at the end of life were recorded in the care plans examined. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 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 activity provision is satisfies service users social cultural, 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 very happy with the food provided. EVIDENCE: The social and recreational needs of service users are recorded within the assessment process and records are kept of service users participation. 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. A minibus has now been provided and more trips out are planned. Service users and staff reported that a trip had been recently arranged to Harry Ramsden’s fish and chips restaurant in Nottingham The Deputy manager reported that since the last inspection that staff assist visiting entertainers, ensuring that they are not left alone with service users and that staggered breaks are organised to facilitate this support. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 15 Christmas activities were posted around the home and service users informed the inspector that a lunch was being organised at the local Public house and that a Christmas Fayre was going to take place shortly. One service user has his own computer and many others have their own interests and hobbies supported by the home. Service users confirmed that they could get up and go to bed when they choose and all had made choices of the meals. The service users highly praised the cooks and reported that the main cook regularly consulted with them about the standard of food and was very approachable. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 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, 17, 18 Service users, relatives and staff are aware of how to make complaints and are confident that they would be dealt with. The complaints policy requires amendment and sited in a prominent position. Service users generally have their legal rights protected but further work is needed to ensure that all service users are able to participate in the civic process should they wish to The systems in place for the protection of service users do not fully meet the standard as training for staff is needed in this area and a clear policy for staff undertaking shopping on behalf of service users is needed. EVIDENCE: The complaints procedure examined was included in the service user guide, and states that complaints will be responded to within 7 days but needs the change the name of the Commission. Service users, relatives and staff spoken with reported that would feel confident to make a complaint should they have one. The complaints records were not available for inspection as the manager was not in attendance. The deputy manager reported that there had been no complaints made to the home since the previous inspection. One service user clearly confirmed that she had used her right to a postal vote recently, but one service user unfortunately missed the opportunity to use his vote despite wishing to participate in the process. The fault of this may not have been with the home but with the electoral and possibly because it was a Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 17 recent change of address. However other service users spoken to appeared to be unsure of whether they had been offered the opportunity to use their vote and all demonstrated a dissatisfaction that the local candidates had not visited the home during the campaign or sent any information about themselves. The inspector recommends that a system be developed that included service users wishes to participate in the civic process within their plan of care, needs and wishes and that pr-active work is carried out to ensure that local candidates are aware of the 50 possible voters in the home and for them to be included in their campaigns. At the previous inspection there was a policy for protection of service users from abuse, however this did not reflect the reporting procedures of the Nottinghamshire adult protection guidance and gives incorrect information regarding the responsibility for investigation. This was not assessed at this inspection, however the home had recently been in the position to use the reporting procedures. The situation had been dealt with appropriately. Staff confirmed that copies of the whistle blowing policy were now available to them. Staff reported that they had not undertaken adult protection training of at least one-day duration. The policy folder is now located the staff work area. Staff sometimes undertake shopping on service users behalf, but there were no clear guidance for staff and the system in place did not fully protect service users from financial abuse. Staff were not aware of their obligations under the Financial Acts, that they must not use store bonus cards etc when making purchases on service users behalf. The Inspector wishes to confirm that there was no evidence that there had been any breech of this practice, however systems need to be in place to ensure that staff have the information they need when handling service users monies and regarding making purchases on their behalf. The auditing procedure also needs to be improved to reflect this also. [St 35 covers financial practices also] Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 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 Service users benefit from comfortable, clean and homely surroundings, however some areas are in need of minor repair or replacement to ensure standards are maintained. EVIDENCE: The home has a handyperson who takes responsibility for repairs, decorating, health and safety checks etc. Staff reported that any repairs or hazards are reported verbally to the handyman. There was no maintenance book provided to evidence this. A part tour of the building was undertaken, including the Horton suite and the home generally was in good repair, free from hazards and well decorated. Furniture and fixtures were of good quality. The lounge areas and dining facilities were spacious, homely, appeared comfortable and were clean. There are some attractive features throughout the home, such as original fireplaces, tiles and decorative ceilings. Service users commented on the pleasant environment. The service users rooms examined were spacious and well personalised. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 19 There are call alarms sited around the home and a passenger lift provides access to the first floor. Service users spoken with confirmed call alarms are answered promptly. There was evidence that handrails identified as needed at the previous inspection had been fitted and the deputy manager confirmed that the home is assessed in accordance with individual needs for the provision of aids and adaptations. Window restrictors and radiator guards were noted around the home. At the previous inspection one service users window and frame were observed to be in desperate need of a clean on the inside and there was several dead insects on the window and frame. A check at this visit noted that although the situation did appear to be improved, there were still a number of dead wasps visible on the window frame. Service users have keys to their rooms if they are able and lockable facilities are provided. The deputy manager and handy man confirmed that number of vanity units were on a replacement programme list. The handyman now carries out monthly checks on water outlet temperatures and that where temperatures are above safe temperatures that this is commented on and the action taken to rectify with a retest documented. The home was observed to be otherwise clean and free from malodour throughout, apart from some minor malodour noted in the corridor near the office, which needs to be addressed. One toilet floor near the office was noted to have engrained dirt and staining and this requires attention. Two fridges were observed to have damaged seals. The cook stated that this had been reported and action was in place to rectify this. A new upright freezer had been purchased since the last inspection. The carpet in the service area near the laundry looks stained and worn; the deputy manager reported that this is being replaced. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 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, 29, 30 Service users needs are met by the numbers and skill mix of staff and training provision appears improved since the last inspection, however there were still gaps in the overall training provision noted. The manager should work full time supernumery. Staff are not provided with a copy of the General Social Care Councils code of conduct. Recruitment practices are not in line with current guidance and urgent action is required to ensure that service users are protected by the homes recruitment policy and practices. EVIDENCE: The rotas were examined. 50 service users were in residence on the day of the inspection. Six staff were rotered for daytime shifts and four at night. Catering and domestic hours were assessed to be satisfactory. The manager does not work super numery full time. Management hours are allocated currently 3 days every two weeks. 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. A sample of four staff files were examined, it was established that the recruitment practices in the home were not satisfactory. New staff had been allowed to commence employment prior to the necessary checks being Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 21 received for POVA checks [Protection of Vulnerable Adults Register] and CRB disclosures. An immediate requirement was set in relation to this. A sample of files did not all have copies of birth certificates/passport/driving licence as required by schedule 2 of the regulations. The personal files of staff were otherwise well organised and contained copies of the interview paperwork, training, supervision and appraisals. Staff members confirmed that they had undertaken training in the following, food hygiene, fire training, manual handling, NVQ2 and medicines management. There was evidence to confirm that arrangements were in place that staff were to undertake health and safety training, including COSHH [Control Of Substances Hazardous to Health], First Aid, however there was no evidence regarding infection control or Adult Protection. This must be achieved. It is strongly recommended that training be provided for staff in dealing with challenging behaviour, diabetes care and other topics in relation to service users specific needs. Where staff are requested to undertake clinical procedures such as stoma care and bladder washes etc by the district nurse that the district nurse provides the training and signs that the staff member is assessed as competent to do so. Staff spoken with were not aware of the General Social Care Councils Code Conduct, this information must be provided for all staff as required by regulation. This is an outstanding requirement. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 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): 33, 35, 37, The home operates in the best interests of service users regarding quality monitoring. Improvement is needed regarding record keeping and accessibility for inspection. The financial practices in the home need to be improved to ensure service users financial interests are safeguarded. EVIDENCE: There was now evidence of quality monitoring in the home, a service user survey has been carried out and is currently being collated to send to head office for evaluation and feedback. Provider visits and regulation 26 audits were observed to be undertaken monthly. There are no service user/relatives meetings currently held, as the manager reported that these have been poorly attended in the past. The inspector recommends that these should be reLangwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 23 instated and combined with an event such as a mince pie and sherry evening. Minutes of any meetings should be taken. A sample of service users personal monies accounts was examined and these were doubly signed, neat and tidy. It was reported that various items of valuables are stored within the safe but there was no receipting system in place for this. A Review is needed for the handling of service users small cash amounts, to include relatives being issued with a receipt for cash handed over to staff and in the provision of receipts being attached and numbered with the appropriate record sheet. It was reported that a managing director audits the accounts periodically. It is recommended that evidence be documented where the accounts are audited. Policies and procedures in relation to the financial systems need implementing to cover the above issues and in relation to staff not benefiting from making purchases on service users behalf [Standard 18] Some records were not accessible due to the manager not being available. It is acceptable that staff personal files and other confidential information was not accessible to the inspector, however other records should be. The Inspector recommends that the deputy manager have access to the records that are not kept openly in the office. The accident book was available, it was noted that there were 25 incidents of falls since the beginning of August. There was no evidence of monitoring of incidents of falls, neither was there any running record/history of falls record sheet within service users files. The fire records were examined and although these appeared to be satisfactory, there were two fire tests missed when the handyman was on holiday and it was not clear that the list of names in the record were of staff that had undertaken fire evacuation practice. Action should be taken to address this. The issues observed at the previous inspection appear to have been addressed regarding Health and Safety practices. Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 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 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 2 17 2 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 X 2 X Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 25 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 OP9 Regulation Medicines Act 7,9,19 Requirement Ensure the storage temperatures of medication are recorded. [Room temperatures] Outstanding The registered person must ensure that staff are not permitted to start work prior to being in receipt of a satisfactory POVA check and CRB disclosure. Immediate Ensure all staff personal files contain all the information required by regulation, as specified in Schedule 2. Ensure all staff are issued with a copy of the General Social Care Councils code of conduct. Outstanding Training programmes for all staff must be available for inspection and include, adult protection and infection control Ensure all records required by regulation[excluding those protected by Data Protection Act 1998] are available in the home for inspection. Ensure the fire tests are carried out weekly and a fire safety risk DS0000008742.V253788.R01.S.doc Timescale for action 22/01/06 2 OP29 29/11/05 3 OP29 7,9,19 22/01/06 4 OP30 18,CSA section 62 18 22/01/06 5 OP30 22/01/06 6 OP37 17 22/01/06 7 OP37 16,17, 23 22/01/06 Langwith Lodge Care Home Version 5.0 Page 26 assessement in place. 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 3 4 5 6 7 8 9 10 11 12 13 14 Refer to Standard OP1 OP8 OP9 OP16 OP17 OP18 OP19 OP26 OP26 OP27 OP33 OP35 OP8OP37 OP37 Good Practice Recommendations Ensure evidence is provided that service users /representatives are issued with service user guides. Use the term bedrails instead of cot sides The registered person should obtain a copy of the Royal pharmaceutical Societys guidance on administration of medicines in care homes and update the medicine policies. Update the complaints procedure as specified and ensure is placed in a prominent position in the home Review the procedures for supporting service users with the civic process as stated in the report. Ensure that there is evidence that service users personal accounts are audited periodically Re-instate the maintenance-reporting book and ensure works are signed off. Replace the carpet in the service area Replace/repair then damaged seals on the fridges The manager should work full time supernumery Re-instate the service users meetings and attempt to encompass with an event. Ensure the financial systems, policies and procedures are improved as highlighted within in the report Evaluate the number of falls and incorporate a running history and evaluation of falls within the care plan process Delegate someone the task of testing the fire alarms in the managers absence Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Langwith Lodge Care Home DS0000008742.V253788.R01.S.doc Version 5.0 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!