Inspection on 23/05/06 for Langwith Lodge Care Home

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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 22/11/05

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 Key Unannounced Inspection 23rd May 2006 09:45 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.V293694.R01.S.doc Version 5.1 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.V293694.R01.S.doc Version 5.1 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.V293694.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 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. Fees charged: This information could not be obtained on the day of the inspection. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection was carried out on 23rd May 2006 from 9.45 until 4.15pm. The manager was not unfortunately available on the day of the inspection and some records were not available for inspection. The methodology used for the assessment of the service included a part tour of the environment, examination of seven care plans and associated records, speaking with five service users, eight staff, [two were interviewed] and direct and indirect observations of practice. What the service does well: Service users say the home can meet their needs, which are assessed and reviewed. All of the service users spoken with confirmed that they were happy with the service provided and that their needs were met. The service users spoken with praised the staff and the facilities. A rating score given by one service user was that the home provides an adequate service. Another stated that they had no complaints. The home specialises in the provision of care for people with dementia and staff was observed to treat service users with patience and respect when communicating with them. Service users do not have the information they need about the home, despite the documentation being finalised. Prospective service users and relatives appear to have an opportunity to visit the service prior to admission, but evidence for this was limited. Service users 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. 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 generally 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 live in a clean and well-maintained environment. There is some evidence that equality and diversity is promoted. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Service users say the home can meet their needs, which are assessed and reviewed. Service users do not have the information they need about the home, despite the documentation being finalised. Prospective service users and relatives appear to have an opportunity to visit the service prior to admission, but evidence for this was limited. The home does not provide an intermediate care service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service EVIDENCE: The home has provided CSCI with a finalised statement of purpose which is one combined document with the service user guide and which includes terms and conditions documentation. Unfortunately there was still no evidence on the premises that service users are issued with these documents. A copy was not displayed in the home and service users spoken with were not aware of the document. A copy of the last inspection report was not displayed in the home, Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 9 neither was there any information displayed which informed service users or visitors how they could access it. Care plans do not contain any evidence that service users/relatives have had written confirmation that the home can meet the individual needs of the service user. 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. 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 the care plans examined. 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. A section for Hair and nail care is included within the assessment document, however foot care was not identified in any of the assessment or care plans examined. Clinical observations are included within the assessment and one service users blood pressure and pulse had been recorded on admission. As the home does not provide nursing services this is not appropriate and staff are not trained to undertake these tasks. Staff confirmed that they had equipment for this in the home and the inspector advised that the practice of blood pressure monitoring should only occur when requested specifically by a GP for individual service users and this therefore would need to be written into a care plan. Through observation of staff practice and referencing to the assessment/preference information there was evidence that staff were not always respecting the service users preferences and indeed were not aware of what had been documented in respect of this within the assessment and care plan documentation. This was in respect of gender preferences for personal care. Care staff reported that they do look at care plans periodically [this varied depending on the member of staff] and that handovers take place to communicate information. A new member of staff who had been employed for approximately twelve weeks reported that he had not yet looked at any care plans. Service users or their representative’s signatures were included on most of the assessments examined. 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 users spoken with Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 10 praised the staff and the facilities. A rating score given by one service user was that the home provides an adequate service. Another stated that they had no complaints. 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. There were no visual cues observed around the home to assist service users with orientation. Staff spoken with reported that they try to reassure newly admitted service users and inform them of meal times and where specific rooms are etc. Care staff reported that the home does take emergency admissions on occasions but said they were not aware of any service users staying for trial visits. A member of staff reported that relatives tend to look around the home prior to service users being admitted to the home. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 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 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. Service users wishes for the end of their life are generally documented. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service EVIDENCE: Seven 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 but could be further improved. One service user who had noted incidents in relation to mental health/depression had various relative contents contained within the care plan folder but care plans and risk assessments should be more detailed in relation to recent events. Incidents of verbal and Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 12 physical aggression are noted in daily notes. Daily notes did not report about the holistic needs of service users. 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 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 but the information had not been transferred to the care plan. 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 are used for bedrails but one service user who’s needs have changed recently did not have up to date care plans and risk assessments in relation to current care needs and use of bedrails. Weight charts were up to date wherever possible, where service users refuse regular weight monitoring this needs to e documented as such. Waterlow assessments are used and where service users have pressure areas wound healing charts are completed. Care plans do not however identify any equipment used for pressure relief and therefore need reviewing and inclusion of this information. 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 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, who moved to the home in April. Information within this service users care plan was sparse. Accident records indicated falls for this individual, some which had resulted in injuries to the head and face area. There was no indication that medical advice had been sought where head injuries had occurred on most occurrences of this type of accident recorded in the accident book. Life history information has been gathered for some service users, however the inspector’s opinion is that where information on previous hobbies is obtained that this is expanded upon for appropriate activities that can be provided or that the service user may be interested in for example where they may have had hobbies in their younger days such as boxing, dancing and other sports that related activities are sought for this individual within the plan of care. Not all care plans had a photograph of the service user in place. Care plans were reviewed generally and did mostly reflect any changes within the review notes, however new care plans had not been devised in relation to Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 13 the changed needs and therefore the care plans did not reflect the current needs of service users and how those care needs would be met. A senior member of staff was able to relay good knowledge and the current status and history of three particular service users whose condition had deteriorated. Care charts had been implemented for food and fluid intake and turning and continence management every two hours, however on examination of these there were several gaps noted, particularly for the day before the inspection where three two hourly checks had not been fully documented. Oral care and denture care was documented within care plans, however there were no risk assessments evident for the use of Denture soak tablets and this is recommended. Medication management was 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 not seen, the member of staff responsible for medication management on the day of the inspection was unable to locate the policies, the drug error policy 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. It was reported that there were no service users currently who self medicates, staff reported that there was a risk assessment and monitoring record for the individuals care plan to ensure that the service user is still able to carry out the task, whenever this is appropriate. There was evidence of sample signatures of those staff that dispense medication. There were now photographs of service users with the medication record chart but some had become detached or missing. Fridge temperatures were recorded and the medicine storage room temperatures were being taken. The member of staff spoken with in relation to medication management was unable to inform the inspector of the safe storage temperatures for medication. It is recommended that the records kept inform staff of the safe temperature measures and alert staff of what action to take should the temperature reading be above the safe temperature and that this action be recorded on the record. Both readings could be recorded on the same page with space for comments. The controlled drugs record book balance was checked with a sample of medication and found to be correct. The British National Formulary in the medicines room was dated 2003, a copy, which is not more than twelve months old, should be provided. There were several bottles of medicines stored on the drugs trolley which were transported into the communal areas, within the pot, box there were loose packets of ‘Adcal’ and ‘Paracetomol’ and a box of ‘Ibuprofen’; these were all placed within the cabinet at the request of the inspector. Loose packets of ‘Stelazine’ and ‘Adcal’ were found on shelves within the medicines cabinet, which had been removed from the identifiable/ labelled prescription container, which is not appropriate or safe practice. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 14 The staff member was observed not to wash her hands prior to starting the dispensing process and was prompted to do this by the inspector. The member of staff was observed to sign the medication administration record sheet prior to visibly observing the medication as taken which is not appropriate practice. The medicine trolley was also left unattended in a fully open state whilst the staff member took out medication and went to seek other staff. The inspector was present and this may have been distracting for the staff member at the time. The deputy manager attended the home in the afternoon for a training event and the issue was discussed. The deputy manager affirmed to the inspector that the medicines trolley is not usually left open and unattended. A member of staff reported that one service user needed to have medication covertly administered, on examination of this service users care plan there was no indication of this being part of the service users plan of care, neither was there any evidence of a multi-professional decision for this. The registered person must address this issue urgently as it is not acceptable for this practice and a copy of the policy for refusal and covert administration be submitted to CSCI. At the previous inspection it was noted that 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. As the policies were not available at this inspection this area could not be assessed as met. Training is provided in house and by distance learning and the staff member dispensing medication on the day of the inspection confirmed that the manager undertakes competency assessments for this periodically but was unsure if this is documented. 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. 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. Service users were observed to be given mail unopened. The post was observed to be left on a window ledge in the entrance by the postman, which does not protect service users or the homes general mail. The provision of a letterbox would ensure all mail was safeguarded. Service users wishes at the end of life were mostly recorded in the care plans examined, the information tended to focus on funeral arrangements and should be expanded to encompass any special requests or facilities and any spiritual needs requests for this time. Staff were spoken with and the staff member agreed to explore this area in staff meetings to ensure staff make themselves aware of individual service users wishes at this sensitive time. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 15 Through discussion with staff it was demonstrated that staff respected individuals privacy and dignity in dying and death as in life and although policies on dealing with dying and death were not available for inspection the inspector was satisfied that service users and their relatives were treated, palliative and sensitively. There was a funeral taking place on the day of the inspection for a service user from Langwith Lodge and a staff member was attending the funeral. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, -15 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 generally 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service 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. A ramp is currently being installed so that service users who use wheelchairs can use the bus. There were no activities recorded for this month, staff informed the inspector that the activities person had been off sick. It did Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 17 not appear that staff had supplemented activities in the activities people’s absence and the registered person should address and provide contingency for this. Life history information has been gathered for some service users, however the inspector’s opinion is that where information on previous hobbies is obtained that this is expanded upon for appropriate activities that can be provided or that the service user may be interested in for example where they may have had hobbies in their younger days such as boxing, dancing and other sports that related activities are sought for this individual within the plan of care. One service user has his own computer and many others have their own interests and hobbies supported by the home. Information was given to the inspector about service users specific cultural and religious needs, however on checking the individuals care plan the religious needs were different to the one reported by the member of staff. That said the staff member was able to demonstrate a fair knowledge about different religions and cultural needs of individuals. 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. There were no policies available but staff thought there was an equality and diversity policy and that training was being arranged on the topic. There was some evidence at the inspection that staff were not always Knowledgeable of service users requested preferences and therefore could not respectful of service users wishes. Service users and staff confirmed that visitors were welcome at any reasonable time. Unfortunately no relatives were spoken with at this inspection. Staff demonstrated through discussion how they promote service users independence, choices and decisions within their daily routines, such as what to wear etc. Some care plans contained information in relation to service users participation within the civic process. Service users confirmed that they could get up and go to bed when they choose and all had made choices of the meals. The menu displayed on the day of the inspection was the wrong one and was duly replaced by the cook when this was pointed out. Records were seen of service users choice options. The menu appeared varied and nutritious. The inspector noted that the bread and butter pudding was served up a while before being served. The cook stated that the custard would warm the pudding up. The pudding was probed at 36 degrees centigrade. The cook stated that he would ensure that this practice would be addressed. Service users asked at lunch reported that the pudding was just warm and the custard hot. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 18 Observation of staff practice in assisting service users with eating was appropriate. Service users were not rushed and said they enjoyed their food. One service user said he had gained weight because of the good food. The options offered on the day of the inspection were Cheese and potato pie or mushroom omelette, chips or creamed potatoes, beans or chopped tomatoes. One service user needs food to be minced and several service users require a diabetic diet. 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.V293694.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Although there were no procedures displayed on how to make a complaint, service users and staff said they were 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. 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service EVIDENCE: The complaints procedure was not examined, as there was not a copy displayed within the home. The policy is included in the service user guide, but the inspector could not access a copy on the day of the inspection. Service users 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 yet again as the manager was not in attendance. The registered person must provide information and copies of any complaints since the previous inspection to CSCI At a 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 Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 20 regarding the responsibility for investigation. This was not assessed at this inspection, however the home had in the pasty been in the position to use the reporting procedures. The situation had been dealt with appropriately. Staff spoken with stated they were not aware of the whistle blowing policy; policies were not available to them on the day of the inspection Staff reported that they had not undertaken adult protection training of at least one-day duration. The deputy manager reported that some staff had attended training in this topic but no records were available to support this. The home should to review protocols in relation to how male carers are deployed in relation to personal care. At the previous inspection it was found that 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 was 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] This area could not be assessed, as no records were available on the day of the inspection. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Service users live in a clean and well-maintained environment; however there are some aspects of health, safety and infection control to address to ensure service users and staff are fully protected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service EVIDENCE: It was reported that approximately 49 service users were in residence on the day of the inspection. Staff members were not sure how many people were in the home on the day of the inspection and the person in charge of the home on the day, did not have up to date information for those service users currently in residence at the home. The inspector noted that this might be a problem should there be a fire and roll call The home has a handyperson who takes responsibility for repairs, decorating, health and safety checks etc. Staff reported that any repairs or hazards are Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 22 reported verbally to the handyman. The maintenance book was provided to evidence this. Unsafe practices were observed in relation to health and safety for example a member of staff was going to attempt to stand on a wheel based office chair to change a light bulb and when challenged by the inspector a small table/stool was used. The electricity supply was not switched off prior to the bulb being replaced. 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. There are grab rails and 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. Window restrictors and radiator guards were noted around the home. Service users have keys to their rooms if they are able and lockable facilities are provided. 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 in one bedroom and near the end rooms on the first floor, in the main house, which needs to be addressed. One fridge was observed to still have a damaged seal. One fridge had been recently replaced the cook stated that this had been reported and action was in place to rectify this. The carpet in the service area near the laundry still looks stained and worn and had not yet been replaced as stated it would be at the last inspection. In the Horton Suite the conservatory walkway was extremely warm-it was a sunny day and the heat in the area was excessive. The homes central heating was on and there were fans placed in several places around the walkway, which did not appear to be functioning and effective, as the provider had intended. The inspector notes that he provider has attempted to address the heat in the walkway by the provision of the fans however this had not Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 23 remedied the problem. It is recommended that roof blinds may be a good option to reduce the direct heat and glare from the sun. If made more comfortable the walkway could be possibly adapted into a garden room /seating area with some innovation and add to the pleasant facilities already provided. Hoist and lift servicing records could not be examined, as these were not available The laundry area is sited between the two parts of the home, the trolley of clean linen is stored outside in the corridor. Service users were observed wandering inn this area and touching clean linen as it was transported to parts of the home. There is an infection control risk and the system in place needs to be addressed. The laundry door was wedged open with a wooden wedge. The staff member reported that the door was kept shut when not in use, however the practice of wedging fire doors open is not appropriate and the issue should e addressed within the fire risk assessment and a magnetic door closure may be a suitable option. The staff toilet heater was very rusty and requires attention. No fire risk assessment could be produced for inspection but fire safety records were otherwise satisfactory. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 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 met the standards in relation to staff recruitment, induction, training and development. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service EVIDENCE: The rotas were examined. It was thought 49 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. 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. The inspector has been unable to access records on three out of four visits to the home and this must be addressed. The manager was reported to be covering night shifts dud to staff paternity leave. An immediate requirement was set in relation to recruitment practices at the last inspection. The manager had responded to the immediate requirement stating that the identified issues had been addressed, however the records could not be examined at this inspection due to the manager not being available. The deputy manager reported the practice in place, which appeared Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 25 satisfactory and a newly employed member of staff confirmed he did not commence employment until two references and a CRB had been obtained. The Registered Provider must provide evidence to CSCI that recruitment practices meet regulation and that all staff files contain the required documentation as specified in schedule 2. The Registered Provider should also address the issue of the lack of management presence at three inspections. Staff members confirmed that they had undertaken training in the following, food hygiene, fire training, manual handling, NVQ2 and medicines management. A health and safety course was being held on the afternoon of the inspection. There were no records available to support this. There was no evidence to confirm that staff have undertaken, training in First Aid, 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, including equality and diversity training. A newly employed member of staff confirmed that he was undertaking an induction and that experienced staff were mentoring. [There was no supporting evidence that the induction met with skills for work standards] The member of staff [who had been employed for 3 months] had not yet undertaken formal Manual handling training and was observed with another member of staff using grip holds and underarm holds with a service user when assisting to mobilise the person which is not appropriate. Staff who confirmed manual handling training reported that practical training was provided. Observation of staff practice on the day demonstrated that staff were using some unsafe techniques when assisting service users to mobilise. Staff reported that they are paid for attendance at training and was enthusiastic in their work and for self-development. Evidence that all staff receive appropriate training for their work must be provided to CSCI. Staff spoken with was 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 from the previous two inspections. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37,38 The overall management of the home is not satisfactory; the manager’s absence at several inspections has been detrimental to the inspection process. Suitable arrangements have not been put into place where the manager is on leave from duties. There was no evidence that the home is run in the best interests of service users, failure to meet regulation in respect of record keeping and some poor practice in relation to Health and Safety. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service EVIDENCE: As the manager was not available at the time of the inspection standards 31 and 32 could not be fully assessed. It was reported that staff meetings are held six monthly. It is recommended that these are organised with more frequency and minutes kept available for inspection. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 27 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. Service users and staff spoken with were not aware of any service users surveys being carried out. There was no evidence available of quality monitoring in the home or provider visits under regulation 26. There was no evidence of service user/relatives meetings currently held. The inspector recommends that these should be reinstated and combined with an event such as a mince pie and sherry evening. Minutes of any meetings should be taken. At the previous inspection 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]. This could not be assessed at this inspection. Staff was not aware of any one to one supervision meetings held in the home. Some records were not accessible due to the manager not being available yet again. The deputy manager did attend part of the inspection but did not have have access to the records kept in the office. The Care Home Regulations 2001 specifies that records must be available for inspection in the home as follows: (1) The registered person shall— (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; (b) ensure that the record referred to in sub-paragraph (a) is kept securely in the care home. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 28 (2) (3) The registered person shall maintain in the care home the records specified in Schedule 4. The registered person shall ensure that the records referred to in paragraphs (1) and (2)— (a) are kept up to date; and (b) are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. (4) The records referred to in paragraphs (1) and (2) shall be retained for not less than three years from the date of the last entry. This is an outstanding issue-failure to comply may result in enforcement action being taken and the registered provider and managers fitness being questioned. Two accident books was available and examined, these contained details of accidents from January and did not comply with the Data Protection Act by its use. CSCI have not received any notifications from the home since the previous inspection including notification of death as required under Regulation 37. A sample notification form was left for the manager to copy and use. The inspector requests that all backdated incidents as specified under the regulation be notified to CSCI for the dates from the last inspection. Care Plans are stored securely. The Health and Safety poster was up to date and protective clothing and gloves, paper towels and liquid soaps were observed around the home. The health and safety aspects in relation to appropriate servicing of equipments, gas safety and electrical circuit and portable appliance testing could not be assessed as records were not available. There are some areas in relation to staff practice as identified in the report for the provider to address. Staff training in all health and safety topics could not be evidenced and therefore the standard assessed as not met. 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.V293694.R01.S.doc Version 5.1 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 2 2 2 2 2 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 1 1 1 Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 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 OP3 Regulation 14 (1) Requirement The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so— (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; (d) the registered person has confirmed in writing to the service user that having Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 31 Timescale for action 22/08/06 regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. (2) The registered person shall ensure that the assessment of the service user’s needs is— (a) kept under review; and (b) revised at any time when it is necessary to do so having regard to any change of circumstances. (1) Unless it is impracticable to 22/08/06 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. (2) The registered person shall— (a) make the service user’s plan available to the service user; (b) keep the service user’s plan under review; (c) where appropriate and, unless it is impracticable to carry Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 32 2. OP7 15 out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and (c) notify the service user of any such revision. 3. OP9 13[2] In relation to the changing and current needs of service users The registered person shall make 22/06/06 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. See Requirement 6 See Requirement 6 4. 5. 6. OP38 OP26 OP9 13, [3][4] 16[1][j][k ] 13, [3][4] 16[1][j][k ] 13, [3][4] 16[1][j][k ] 22/06/06 22/06/06 22/06/08 After consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home; Keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste; The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person shall ensure that— (a) all parts of the home Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 33 to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, and shall make suitable arrangements for the training of staff in first aid. Ensure all staff are issued with a copy of the General Social Care Councils code of conduct. Outstanding from previous two inspections. Timescale set 22/01/06 Not Met Training programmes for all staff must be available for inspection and include, adult protection and infection control. Outstanding. Previous timescale 22/01/06 Not Met Ensure systems are in place in relation to quality monitoring. (1) The registered person shall establish and maintain a system for— 5. OP30 18,CSA section 62 22/06/06 6. OP30 18 22/07/06 7 OP33 24 22/07/08 (a) reviewing at appropriate intervals; and Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 34 (b) improving, the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. (2) The registered person shall supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available to service users. 8. 9. 10. 11. 12. 13 14. OP37 OP16 OP31 OP33 OP35 OP36 OP38 17 17 17 17 17 17 17 (3) The system referred to in paragraph (1) shall provide for consultation with service users and their representatives. See requirement 14 See requirement 14 See requirement 14 See requirement 14 See requirement 14 See requirement 14 Ensure all records required by regulation [excluding those protected by Data Protection Act 1998] are available in the home for inspection. Outstanding. Previous timescale 22/01/06 Not Met See Requirement 17 See Requirement 17 Ensure a fire safety risk assessment is in place. Outstanding previous timescale 22/01/06 Not Met. (1) The registered person shall give notice to the Commission without delay of the occurrence of— 22/07/06 22/07/06 22/07/06 22/07/06 22/07/06 22/07/06 22/07/06 15. 16 17. OP37 OP19 OP38 16,17, 23 16,17, 23 16,17, 23 22/08/06 22/08/06 22/08/06 18 *RQN 37 22/06/06 Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 35 (a) the death of any service user, including the circumstances of his death; (b) the outbreak in the care home of any infectious disease which in the opinion of any registered medical practitioner attending persons in the care home is sufficiently serious to be so notified; (c) any serious injury to a service user; (d) serious illness of a service user at a care home at which nursing is not provided; (e) any event in the care home which adversely affects the well-being or safety of any service user; (f) any theft, burglary or accident in the care home; (g) any allegation of misconduct by the registered person or any person who works at the care home. (2) Any notification made in accordance with this regulation which is given orally shall be confirmed in writing. Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 36 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 Ensure evidence is provided that service users /representatives are issued with service user guides. [And terms and conditions] Ensure evidence is provided that service users /representatives are issued with service user guides. [And terms and conditions] Ensure staff are aware of service users assessed needs, how their plan of care is to be met and that they respect service users preferences. Include foot care, capacity to consent and expand on information about service users interests and cultural needs within the assessment and care plan documentation. Ensure appropriate practice in relation to Blood pressure monitoring as identified within the report. Ensure appropriate practice in relation to Blood pressure monitoring as identified within the report. Ensure risk assessments are in place for the use of denture soak products used. Staff should address the holistic needs of service users in their daily reports. Include the details of pressure relieving equipment used within care plans. Evaluate the number of falls and incorporate a running history and evaluation of falls within the care plan process Medical advice should be sought where service users suffer an injury to their head or/and face. Address the security of mail received at the home. Review the protocols for gender preferences for personal care. Address the security of mail received at the home. Review the protocols for gender preferences for personal Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 37 2. OP2 3. OP3 4. 5. 6. OP3 OP4 OP7 7. OP8 8. OP10 9. OP14 10. 11. OP14 OP15 care. Provide training for staff in equality and diversity Ensure puddings are served at the appropriate temperature Ensure the correct menu is displayed. Re-assess the use and temperature control of the conservatory area as identified within the report Replace the carpet in the service area and replace the heater in the staff toilet. The manager should work full time supernumery Re-instate the service users meetings and attempt to encompass with an event. 12. 13. 14. 15. OP19 OP26 OP27 OP33 Langwith Lodge Care Home DS0000008742.V293694.R01.S.doc Version 5.1 Page 38 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.V293694.R01.S.doc Version 5.1 Page 39 - 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!