CARE HOMES FOR OLDER PEOPLE
Long Close 23 Forest Road Branksome Park Poole BH13 6DQ Lead Inspector
Gill Kennedy Unannounced 26 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Long Close Address 23 Forest Road, Branksome Park, Poole, Dorset, BH13 6DQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 765090 01202 768958 long_close@btconnect.com Mr Keith London-Webb Mrs Christine Jennette Barrow CRH 17 Category(ies) of OP - 17 registration, with number of places Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30 December 2004 Brief Description of the Service: Long Close is situated in a quiet residential area of Branksome Park, and set in pleasant woodland gardens. The home is easily accessible to shops in Westbourne, local amenities and beaches. It is registered under the category of OP (Older Persons) for up to seventeen elderly service users. The home caters for people who have low to medium personal care needs. The majority of rooms are single en-suite and some have access to the garden or a balcony. There is a spacious lounge leading on to the dining room. The home has a passenger lift that is able to accommodate wheelchair users. Mr London-Webb the proprietor lives on site and shares the day to day running of the home with the registered manager Mrs Barrow. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. During the inspection Mrs Barrow, the registered manager, and Mr London-Webb, the proprietor, were available to provide information and answer questions and were helpful and co-operative. The files of three residents were read during this inspection. Five residents were seen privately to discuss their views about life in the home and the services provided. Two staff were also interviewed in private. The time taken on this inspection was 6 hours and 12 standards were considered. CSCI comment cards were left at the home for residents, relatives and professionals to complete to ascertain their views about the services provided at the home. At the time of writing this report 12 replies had been received from residents. The terms resident and service user used in this report are interchangeable. What the service does well:
The home does assessments on prospective residents to make sure that they are able to meet their needs. Following admission, during the first week, they refine and develop a plan of care and staff are advised about the help that residents require. There are good relationships with the local GP’s surgeries and residents’ healthcare needs are promoted. Residents like living in the home and are positive about key aspects affecting their quality of life. For example, residents seen during the inspection said ‘staff excellent’ and ‘staff are good and kind’. All twelve residents who returned CSCI Comment Cards said they felt well cared for and liked the food provided. There are robust systems in place to protect residents interests and staff have relevant training to make them aware of these issues. The home is comfortable and well maintained. All rooms are very individual and residents are able to bring their own possessions and pieces of furniture if they wish. There is an ongoing programme of refurbishment and when a room is vacated it is usually re-decorated. At the time of the inspection the garden
Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 6 at the rear of the property was looking attractive with well-stocked flowerbeds and one resident was out enjoying the sun. The use of agency staff is limited as the home is able to provide continuity of care, as there is a core of committed staff who have worked at the home for several years. Good working relationships exist between staff at all levels. Regular staff meetings aid communication. The manager and proprietor are very visible in the home and this provides support for staff and also makes sure residents can easily talk with them. The home seeks residents and relatives views by sending out questionnaires and has recently published their first newsletter, among other things this newsletter welcomed new people to the home and provided information about forthcoming events. 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. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. Standard 6 was not considered as the home does not provide intermediate care. The home has systems in place to make sure that service users needs are fully assessed before they are admitted into the home and they are assured they will be met. EVIDENCE: The three files seen had assessments completed which formed the basis of care planning. Prior to admission Mrs Barrow would visit prospective residents and compile the pre-admission assessments. This would assist her in forming a judgement as to whether the home would be able to meet their needs. After this a letter was sent to the service user confirming the home would be able to meet their needs and evidence of this was seen. Residents spoken with confirmed that they had been visited prior to admission and where possible they had visited Long Close before deciding to live there and were assured that their needs could be met.
Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9. There is a consistent care planning system in place to provide staff with the information they need to meet service users needs. Service users health care needs are promoted and maintained in line with their care plan. Systems for the administration of medicines need some adjustments. EVIDENCE: The files of three residents were seen. There was a resume in the front of each file, followed by a clear care plan. Staff spoken to during the inspection were well informed about service users needs and illustrated how they used car plans to see what they had to do for residents. Three GP’s surgeries provide services, and information seen on surveys conducted by the home demonstrated that there were good relationships with the primary healthcare teams. There are no service users with pressure sores in the home.
Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 10 Opportunities are provided for exercise and residents weight and diet are monitored with action initiated if there is any cause for concern. Residents are assisted to obtain other therapeutic services, either provided at the home or are taken to opticians and dentists by the proprietor or manager. There are policies and procedures in place for the administration of medicines that are available for staff to access. Seven staff dispense medication, six having done a basic one day course. It would be beneficial if all staff dealing with medicines could do an accredited course. Where practical, residents are encouraged to self medicate, there are two residents at present able to do this and they have risk assessments on file. How these assessments might benefit from minor additions was discussed. The monitored dosage system is used with MAR charts. It was noted on three MAR charts medication had been handwritten and this was not signed by two competent people as required. Also where residents had been admitted to the home with medication the number of pills they had with them had not been recorded on the MAR chart to provide a clear audit trail. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15. The home is able to meet the expectations of most service users in their daily lives, but there is a small group of resident who would like more activities. A wholesome and nutritious diet is provided in a spacious dining room. EVIDENCE: All twelve residents who replied to comment cards said they liked living at the home. Nine felt suitable activities were provided, but two said they only felt this sometimes and one person said they were not. In a survey conducted by the home 67 of residents said they did not want any more activities, but 22 did mention other things they would like to do. Entertainments on offer are advertised and they include bingo and quizzes. All five service users seen were satisfied with their social lives. A record is kept of activities provided in the home, including outings. Apart from the Extend class there is no programme of weekly activities and the last outing was September 2004, although residents would be taken out individually on some occasions.
Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 12 One resident who had been at the home a short time said she had been introduced to other people and enjoyed chatting in the communal lounge. The residents seen were all satisfied with the food provided. One person said ‘pretty good’ and another ‘home made – beautifully cooked’ and all the comment cards returned indicated that this was the general view. A high level of satisfaction with the food was also reported in the home’s own quality monitoring system. Special diets are catered for and residents are offered a choice for each meal. Drinks and snacks are provided throughout the day. Menus supplied to CSCI showed a varied and wholesome diet was supplied. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There are systems in place that make sure any issues of abuse would be brought to the management’s attention. EVIDENCE: There is an Adult Protection and Prevention of Abuse Policy and procedures for staff to follow should any concerns be raised. Staff are issued with the Whistle Blowing Policy and an information leaflet and this was confirmed by written evidence and in discussion with staff. It was clear there was good communication between management and staff aimed at protecting residents. Seven staff and the manager had recently attended a one-day course on ‘Sexuality in Care Homes’. One member of staff said it highlighted issues she had not considered before and another said it had re-affirmed to her the importance of being sensitive to the emotional and sexual needs of older people. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Long Close is clean, comfortable and well maintained. EVIDENCE: It was observed that the home was kept to a good standard although in some areas paintwork was chipped. Mrs Barrow explained this was to be included in the current year’s refurbishment programme. A record is kept of routine maintenance and it was noted that rooms had been redecorated when residents had moved on. New roofing had been supplied to the area leading to residents’ balconies. The first issue of the home’s News Letter, published in March 2005, details the work that had been done within the last year to upgrade the home and outlines plans for improvements for 2005, with suggestions sought for improvements from service users. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 15 New laundry equipment has been provided which has a sluicing facility and complies with the necessary regulations. There is a member of staff employed five mornings a week to do the cleaning and from observation and discussion with residents both bedrooms and communal areas were found to be clean and hygienic. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The number of staff employed, and the skills they have, meet the needs of residents. EVIDENCE: Long Close caters for residents with low to medium care needs. Mrs Barrow said that half of the fourteen current service users were able to manage their own personal care, apart from needing help with bathing. This was borne out from reading care plans and in discussions with service users. The home uses the Residential Homes Guidance to provide them with information on how many staff are needed. The roster indicates that sufficient staff are employed with an appropriate skill mix. There is a stable staff team, some of whom have worked at the home for over ten years. Over the last eight week period three shifts were covered by agency staff. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 33. The manager and proprietor run the home well and are committed to providing an inclusive quality service. EVIDENCE: There are regular recorded meetings for service users and staff where they are able to air their views. Both staff and service users spoken with felt the manager and proprietor were approachable and their daily presence was evident in the home. Since the last inspection Mrs Barrow has developed an Annual Development Plan. This includes a correlation of feedback from questionnaires from residents and their families. Also an attractive newsletter has been compiled that provides information on the home and seeks ideas from residents as well as encouraging people by stating that ‘the home is happy to help in any way so please don’t be afraid to ask for anything.’ Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x 3 4 x x x x x Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 19 NO 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 Regulation Requirement Timescale for action 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. Refer to Standard OP9 OP9 OP9 OP12 Good Practice Recommendations Where MAR charts are handwritten these should be checked and signed by a second competent person. All staff who administer medicines should have accredited trainining. When new residents bring medcines in the home these should be checked and the no of tablets marked on the MAR chart to provide an audit trail. Consideration should be given to providing a weekly programme of activities that includes regular outings. Long Close D55 S4050 Long Close V222044 260405 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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