CARE HOMES FOR OLDER PEOPLE
Long Close 23 Forest Road Branksome Park Poole Dorset BH13 6DQ Lead Inspector
Sally Wernick Unannounced Inspection 10:00 30 September 2005
th 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 Long Close DS0000004050.V254502.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. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Long Close Address 23 Forest Road Branksome Park Poole Dorset BH13 6DQ 01202 765090 01202 768958 long_close@btconnect.com 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) Mr Keith London-Webb Mrs Christine Jeanette Barrow Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th April 2005 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 DS0000004050.V254502.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was one of the two statutory inspections required in accordance with the Care Standards Act 2000. Since the previous inspection no complaints against the home have been received or investigated. The inspection was unannounced and took place on 30th September between 10am and 2pm. Ten standards were considered. During the inspection eight residents and two members of staff were spoken with. Throughout the day the inspector observed staff interaction with residents and the carrying out of routine tasks. Resident’s rooms and communal areas were inspected. Mrs Barrow the registered manager, and Mr London-Webb, the proprietor, were available to provide information and to assist in the inspection. What the service does well:
Residents are assisted to maintain as much independence as possible and are encouraged to maintain contact with their families and local community. The premises are comfortable and well equipped, with two communal rooms, wide corridors, passenger lift and attractive gardens. Rooms are individual and residents are able to bring in their own possessions and furniture if they wish. There is an ongoing programme of refurbishment and when a room is vacated it is usually redecorated. Since the last inspection carpets have been replaced and the programme of redecoration has continued. Staff are kind and helpful to residents and both the registered manager and provider encourage and facilitate external visits to GP’s and other community providers where possible. Residents are treated with respect and their privacy is protected. The quality of daily life presents as very good with a variety of recreational and social activities and home cooked meals. Good working relationships exist between staff at all levels. Staff meetings are attended by all and form a central part of communication. The manager and proprietor are very visible within the home assisting staff and engaging regularly with residents. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 6 Long close has a very clear statement of purpose and regularly seeks residents and relatives views by sending out questionnaires. They have a yearly newsletter and monthly planned activities. The home is well run by a caring manager and proprietor. Comprehensive systems are in place to offer quality care to residents and this is reflected in the wide-ranging policies and practice. 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
Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Long Close DS0000004050.V254502.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 Long Close DS0000004050.V254502.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): Not assessed during this inspection. EVIDENCE: Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 & 10 Systems for the administration of medicines could protect service users if some adjustments are made Service users feel they are treated with respect. EVIDENCE: At the current time two residents are self-medicating and there are appropriate risk assessments in place to monitor that. There is a clear procedure in place for the safe handling of drugs, which all staff have signed. However, the administration of medication in the mornings does not comply with guidance from the Royal Pharmaceutical society. Records are kept of all medicines received and dispensed and recorded appropriately on MAR charts. Staff who dispense medication have completed a basic one-day course but have yet to undertake accredited training. A record is maintained of current medication for each resident including those self-medicating. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 11 Of the residents that the inspector spoke to all were positive about the care they received and were positive about the gentle caring nature of the staff. Privacy and dignity were respected with staff knocking on doors and performing tasks discreetly. Some residents have their own telephones and contact with family and friends is actively facilitated. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 & 14 The home is generally able to meet the expectations of residents spoken to in their daily lives and efforts are made to retain links with the local community. Residents enjoy the flexibility afforded to their visitors and the social opportunities this affords. EVIDENCE: Since the last inspection there has been an increase in staff led activities with Tuesday being the day that a structured event takes place. For example Bingo, quizzes and more recently origami. A 100yr birthday celebration for one of the female residents included a string quartet and a visit by the Mayor and Mayoress. The party was reported in the local press and was a big success. Extend regularly visit Long Close and on the day of the inspection the hairdresser was present. The lack of space means that hairdressing often takes place in the sitting room however, those residents who prefer may take advantage of this facility in their own rooms. There are regular visits by a chiropodist and family and friends are encouraged to visit at any time during the day with one resident’s daughter arriving daily at 6.30am. There are links with the local church and the vicar also periodically visits. There are scheduled outings although these are less frequent in the cold weather.
Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 13 Staff do try and encourage residents to take morning coffee in the sitting room although a tray is taken to their rooms if residents prefer. When residents arrive at the home they are given information on advocacy and “care aware” services and all residents are encouraged to and do manage their own finances. The registered manager was aware of the importance of enabling residents to access their personal records however; this information is not currently included in the documentation currently provided by the home. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 There is a clear complaints procedure in place and active steps are taken to ensure that all residents are given clear written advice. EVIDENCE: On their arrival at the home all residents are provided with a copy of the Complaints Procedure. Information on which is also contained in the Terms and Conditions. One resident spoken to stated that she knew what to do in the event of a complaint although none have been received during this inspection period. Staff spoken to say they were confident that they could raise any issue of concern with both the registered manager and provider. It was clear that there was good communication between management and staff and positive values were upheld in general day-to-day practice. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 15 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 Service users live in a well-maintained environment but safety can be improved. EVIDENCE: There continues to be an ongoing programme of refurbishment at the home. Carpets have recently been replaced in communal areas and there are plans to replace the furniture. There is a range of new beds and a safe well-maintained environment forms an inherent part of the homes philosophy. The home’s fire warning system was serviced by approved contractors and tested by the home’s staff. Records showed that fire safety training had been carried out but had not been accompanied by a staff signature. The staff have been trained in moving and handling and were due to attend further training in the coming month. All electrical installations are serviced regularly and there is a full range of Health and Safety policies, which are reviewed every two months. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 16 The home currently carries out a fire drill every year and a brief record is made of the outcome. The manager must demonstrate via the fire risk assessment what the frequency of drills needs to be each year to ensure as far as practicable that service users are familiar with the fire routine. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 17 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): 29 & 30 Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are trained but competency is not based on an individual training assessment and plan. EVIDENCE: Long close currently has 15 residents and is supported by a stable staff team some of whom have been working at the home for over ten years. There have been no staff changes during the previous year although the owner’s son has joined the team in a training capacity. Agency staff have been employed on two occasions during this period. The inspector looked at staff files to see how the home handled recruitment. Records were complete with evidence of identity, two written references, CRB checks and an understanding of the importance of POVA first checks. Staff meetings were compulsory and were used as both a venue for training and for sharing information on good practice. Evidence was seen that training had taken place at the home in areas including First Aid, moving and handling, dementia, infection control, skin care and “Sexuality in Care Homes”. This course had proved highly beneficial to staff as it re-affirmed the importance of being sensitive to the emotional and sexual needs of older people. There is further training planned in the benefits of hypnotherapy and managing stress.
Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 18 There was an appropriate skill mix across the staff team however, some staff were reluctant to undertake training in NVQ as they had been at the home for a number of years and are confident in their abilities. The registered manager stated that training was often influenced by residents’ needs and through staff identification. At the current time the individual training needs of staff are not formally assessed and recorded. Staff consider that they are well supported by the management and can approach either the registered manager or provider if there is a problem. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 19 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 & 38 Statutory training, maintenance and safety checks are taking place to protect the health, safety and welfare of residents and staff. Whilst generally robust systems were in place to ensure the health and safety of residents there were some omissions that could place them at risk. EVIDENCE: At the current time the registered manager confirmed that all of the residents are financially independent and take responsibility for their own financial transactions. Residents are asked on admission to Long Close whether they require assistance from an advocate and many have friends and relatives who if needed can represent their interests. Subsequent to the inspection the registered manager confirmed by telephone that she holds an NVQ 4 in management and care and is able to demonstrate that she keeps up to date with training. Similarly the staff have all attended a
Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 20 range of relevant training courses throughout the year, which is clearly recorded. There is however, no formal supervision process, which allows for identification of training needs nor formal appraisal to assess learning and developmental needs of staff. There is no identified system for monitoring staff member’s progress. During a tour of the premises a topical cream prescribed for a service user was found in a communal bathroom as well as nail scissors and cleaning materials. In one of the bedrooms a topical cream was seen on the wash hand basin. For the safety of the service users it would be preferable if such items were stored more securely. Visitors are asked to sign in and out of the building. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 21 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 1 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 2 X 2 Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? None 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. Standard Regulation Requirement The home must determine the necessary frequency of fire drills involving service users in accordance with the fire risk assessment, taking into consideration the circumstances of service users. Timescale for action 1 OP19 23(4) 05/01/06 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. Refer to Standard OP9 OP9 Good Practice Recommendations All staff that administer medicines should have accredited training on medicines, how they are used and how to recognise and deal with problems in use. The home should have a cupboard that complies with the misuse of Drugs (safe custody0 regulations 1973 for storing controlled drugs (CDs) It is strongly recommended that the system for giving medicines be reviewed so that they are administered, after checking the details on the medicine record chart, directly from the labelled container in which they were dispensed by the pharmacy. Details of any medicine sensitivity or ‘none known’ should
DS0000004050.V254502.R01.S.doc Version 5.0 Page 23 3. 4.
Long Close OP9 OP9 5 OP19 5 OP38 be included on or with the MAR chart. The report of the fire drill involving service users should be expanded in order to give a clearer idea of the nature and outcome of the exercise, noting any issues that arise. The home should advise service users that they may access their personal records in accordance with the Data Protection Act 1998 by including this information in either the statement of purpose or service user guide. The home should conduct a training needs assessment for each staff member, as part of his or her appraisal, and keep a record of the outcome. The home should conduct supervision sessions with staff members every two months and make a record of the outcome. 6 OP38 All cleaning materials that may pose a hazard to service users health should be stored securely when not in use, in accordance with COSHH regulations. The home’s risk assessment should be amended to include advice about storage arrangements. Topical creams prescribed for service users should be stored safely. Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Poole Office 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
© 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 Long Close DS0000004050.V254502.R01.S.doc Version 5.0 Page 25 - 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!
