CARE HOMES FOR OLDER PEOPLE
Longbridge Deverill House Church Street Longbridge Deverill Warminster Wiltshire BA12 7DJ Lead Inspector
Thomas Webber Unannounced Inspection 19th January 2006 08:40 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 Longbridge Deverill House DS0000057131.V275576.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. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Longbridge Deverill House Address Church Street Longbridge Deverill Warminster Wiltshire BA12 7DJ 01985 214040 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) Equality Care Ltd Jean Proctor Care Home 27 Category(ies) of Dementia - over 65 years of age (3), Learning registration, with number disability over 65 years of age (2), Old age, not of places falling within any other category (27), Physical disability over 65 years of age (1) Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The maximum number of service users who may be accommodated in the home at any one time is 27 Not more than 1 service user aged 65 years and over with a physical disability may be accommodated at any one time No more than 2 service users aged 65 years and over with a learning disability may be accommodated at any one time No more than 3 service users aged 65 years and over with dementia may be accommodated at any one time 12th July 2005 Date of last inspection Brief Description of the Service: Longbridge Deverill is a private residential home offering accommodation and personal care to a total of 27 service users over the age of 65 who require care primarily through old age, although the home is also registered to accommodate 3 service users with dementia, 2 with leaning disabilities and one with a physical disability within the overall total. The home is registered under Equality Care Limited and the registered manager is Ms Jean Proctor. The home is a detached 300 year old listed building, which has been extended several times and is situated on the busy A350 in the village of Longbridge Deverill between Warminster and Shaftesbury. There is a railway station in Warminster and the A303 is about a ten minute drive to the south of the village. The home is located close to limited local amenities and there is a bus stop immediately outside the entrance to the home and car parking facilities are available to the front of the property. The home provides all single bedrooms for residents use. However, there are two shared bedrooms, which would only be used as a shared facility for married couples or relatives who wish to share. All, apart from one single bedroom, are provided with en-suite facilities. Residents bedrooms are located on the ground and first floor levels. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, undertaken during the course of one day from 08:40 to 12:25. The main purpose of this inspection was to obtain the views of the residents regarding the care and services provided by the home. These were ascertained in conjunction with a tour of the premises and the views of sixteen residents and the two relatives of a resident were sought on an individual and group basis. In addition a number of core standards were checked which included residents’ care plans and associated documentation, menus, complaints, levels of staff on duty, staff training and supervision and health and safety. What the service does well:
The home is run and managed by persons who are appropriately qualified and have sufficient experience within the care setting. Information is provided to residents on how to complain should they wish to and residents are confident that any complaints/concerns would be listened to, taken seriously and acted upon. Residents spoken to commented that they had no complaints or concerns. However, the home has received and investigated five concerns raised by residents, which have related to food and the service provided. The home continues to provide sufficient numbers of staff on duty at all times to meet the needs of the residents as well as working towards achieving a trained workforce. Residents are supported and protected by the home’s recruitment practices. Staff were observed undertaking their duties in a caring and attentive manner. Residents spoken to commented very positively about the care provided by the staff and these were supported by the comments made by the relatives of a resident met during the course of the inspection. The home is accessible, safe and suitably maintained to meet the residents’ individual and collective needs. Residents are provided with individual bedrooms which they have personalised to their individual wishes. Residents have access to a number of toilet and bathroom facilities. The home is maintained to a good standard being clean, tidy and comfortable and provides suitable laundry facilities. Residents spoken to commented positively about the standard, cleanliness and the level of accommodation provided as well as the laundry arrangements in place stating that their clothing is returned in good condition. Residents are supported to maintain contact with their families and friends. Residents, within their capabilities, can exercise personal autonomy and choice and they receive a varied, appealing and balanced diet with meals being eaten in a congenial setting. Residents spoken to commented favourably with the
Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 6 quality and quantity of food provided, confirming that they receive plenty and alternatives would be provided to meet their individual preferences. 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. Longbridge Deverill House DS0000057131.V275576.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 Longbridge Deverill House DS0000057131.V275576.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): EVIDENCE: These Standards were not assessed during this inspection as the core Standards had been satisfactorily checked at the last inspection. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 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 the following standard(s): 7 Residents’ care plans and accompanying risk assessments have been established for all residents although the quality of content of their care plans is somewhat deficient. EVIDENCE: Care plans have been established for all residents. However, discussion was held with the manager about the need to develop the content of these to ensure that residents’ care plans identify the full extent of their needs and how these would be met. Residents’ care plans are reviewed monthly by the home with residents’ placements being reviewed initially after six weeks and thereafter yearly which involves all interested parties. Manual handling and nutritional assessments have also been established for all residents and are reviewed quarterly. Waterlow assessments are also completed on admission and are reviewed at least monthly. Risk assessments would be completed where specific risks are identified and garden risk assessments have recently been introduced by the home. The manager was advised of the need to ensure that all sections of the residents’ admission forms are fully completed. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 10 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): 13, 14 and 15 Residents are supported to maintain contact with their families and friends. Residents, within their capabilities, can exercise personal autonomy and choice and they receive a varied, appealing and balanced diet with meals being eaten in a congenial setting. EVIDENCE: The home supports and encourages residents to maintain contact with their families, friends and representatives and has an open policy with regard to visiting times. Residents can choose whom and where to see any visitors, either in the privacy and comfort of their own bedrooms or in the communal rooms available. Observations and discussions with some residents confirmed that they can exercise personal autonomy and choice within their individual capabilities. Residents can and have brought items of furniture and personal possessions to make their bedrooms more homely. They can choose what time to get up and go to bed, how and where to spend their time, where to eat, and what activities to participate in. Residents, who are capable, can also handle their own financial affairs in the privacy of their own bedrooms. A satisfactory and varied four weekly menu is in operation, which provides a choice at breakfast time with set meals at lunch and teatime. However,
Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 11 alternatives are provided for these meals if required to meet the preferences of the residents. Drinks and snacks are also available at other set times of the day. Although residents are encouraged to use the dining room for their main meal as part of socialisation, they could choose to eat all their meals in their bedrooms if they so wished. Residents spoken to commented favourably with the quality and quantity of food provided, confirming that they receive plenty and alternatives would be provided to meet their individual preferences. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 12 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 Information is provided to residents on how to complain should they wish to and residents are confident that any complaints/concerns would be listened to, taken seriously and acted upon. EVIDENCE: A satisfactory complaints procedure has been established by the home and a copy of this procedure is displayed on the notice board within the home. The home encourages residents to express any concerns, however minor, about the care and services provided. Since the last inspection the home has received and investigated five concerns raised by residents, which have related to food and the service provided. Records showed these concerns have been responded to promptly and suitably resolved. However, the new forms previously established which identifies the outcome has not been used and as a result the outcomes to these have not been recorded. The manager will ensure that the updated monitoring complaints forms are completed for any future concerns investigated. Residents spoken to commented that they had no complaints or concerns. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 13 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, 20, 21, 23, 24 and 26 The home is accessible, safe and suitably maintained to meet the residents’ individual and collective needs. Residents are provided with individual bedrooms which they have personalised to their individual wishes. Residents have access to a suitable number of toilet and bathroom facilities. The home is maintained to a good standard being clean, tidy and comfortable and provides suitable laundry facilities. EVIDENCE: The home has an on going programme of maintenance to enhance the residents’ living environment and a number of improvements have been carried out since the last inspection. These include the refurbishment and redecoration to some residents’ bedrooms, the quiet room, a lounge and the front hallway was in the process of being redecorated at the time of the inspection. Improvements have also been made to the garden. Due to the layout of the premises, the home provides two passenger lifts and a stair lift to enable residents to access all parts of the building. A call bell system is installed in each room, which can be used by residents to call for staff
Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 14 assistance. There is a spacious, safe, well maintained and accessible rear garden, which is used and appreciated by the residents, weather permitting. The home provides sufficient communal space to meet the needs of the residents. These consist of two large lounges and a separate dining room. The range of facilities provide the option for a variety of activities to take place as well as providing residents with a choice of where to sit. The communal rooms are suitably furnished, providing a combination of domestic and natural lighting. The home provides sufficient bathroom and toilet facilities, which meet the needs of the residents and the facilities include a hydrotherapy bath. The home provides all single bedrooms for residents’ use. However, there are two shared bedrooms, which would only be used as a shared facility for married couples or relatives who wish to share. All, apart from one single bedroom, are provided with en-suite facilities, consisting of at least a toilet and wash hand basin. Residents’ bedrooms are suitably furnished and equipped to ensure comfort, privacy and to meet their assessed needs. Residents can and have brought items of furniture and personal possessions to make them more homely. Residents’ bedrooms are normally redecorated and refurbished where there is a change of occupancy. Locks have been fitted to residents’ bedroom doors where this has been requested and is based on a risk assessment. In addition all residents’ bedrooms have been or are in the process of being provided with a lockable storage space, which consists of either a safe or a lockable cupboard. Residents spoken to commented positively about the standard, cleanliness and the level of accommodation provided. The home continues to be maintained to a good standard being clean, tidy and comfortable. The laundry room provides suitable facilities to meet the needs of the home. Residents’ clothing is labelled to ensure that garments are appropriately returned and residents commented favourably about the laundry arrangements in place and that they are returned in good condition. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 15 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, 28, 29 and 30 The home continues to provide sufficient numbers of staff on duty at all times to meet the needs of the residents as well as working towards achieving a trained workforce in line with the National Minimum Standards. Residents are supported and protected by the home’s recruitment practices. EVIDENCE: The home ensures that there are sufficient staff deployed by providing four members of care staff on duty in the mornings with three members of care staff on duty in the afternoons and evenings. There are two waking night staff on duty each night together with a member of staff sleeping in. The above staffing levels exclude the number of ancillary staff employed. Staff were observed undertaking their duties in a caring and attentive manner. Residents spoken to commented very positively about the care provided by the staff and these were supported by the comments made by the relatives of a resident met during the course of the inspection. Since the last inspection, the home has introduced new induction booklets, known as ‘Training Record of Induction and Competence in Care’, which are now being completed by new staff employed. The home continues to support staff in either obtaining or working towards achieving NVQ training at various levels. In addition evidence was available to confirm that staff attend other relevant training such as care for the dying, dementia awareness, manual handling and residents’ sensory needs. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 16 A sample of files for two newly appointed staff were checked and showed that appropriate recruitment practices are, in the main, being followed. However, the home could still benefit from ensuring that a full employment history is obtained in respect to all new staff employed and any gaps are explored and the reasons recorded. The home’s application form could benefit from being updated to reflect this deficiency. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 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 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, 35, 36 and 38 The home is run and managed by persons who are appropriately qualified and have sufficient experience within the care setting. Residents’ financial interests are being suitably maintained. Staff are appropriately supervised. The health, safety and welfare of the residents and staff are promoted and protected, apart from some the areas relating to fire prevention. EVIDENCE: The manager has a First Level Nurse qualification and has subsequently obtained the NVQ 4 and Registered Managers’ Award. She also has appropriate management and supervisory experience in the relevant care setting to the client group she manages. The manager continues to undertake periodic training to update her knowledge, skills and competence whilst managing the home. The management team are clear about their roles and responsibilities. The manager is complemented and supported by one of the co-proprietors of the company whose main role is the overall administration of
Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 18 the company. She has also achieved the NVQ 4, City and Guilds Advanced Management in Care qualification and also has appropriate management and supervisory experience. The home has secure facilities for the storage of residents’ monies. A spot check of the system of money held by the manager on behalf of the residents was carried out and found to be satisfactorily maintained. The issue for ensuring that staff receive regular, formal one to one supervision as identified at the last inspection has been suitably addressed as discussed with the manager. Safe working practices have been established within the home, which complies with the relevant legislation. Policies and procedures are in place to ensure a safe working environment. Staff continue to receive ongoing training in relation to health and safety. Risk assessments have been completed in respect to the residents or the building. Radiator covers have been fitted to all radiators for the protection of the residents. Items identified in the last Fire Officer’s report dated 9th September 2005 are reported to have been complied with. Examination of the fire log book showed that some staff need to receive fire instruction more frequently if the home is to maintain this frequency for all staff. The date when staff are provided with fire instruction needs to be recorded. Although there was no evidence that a fire drill had been carried out for July/September 2005, additional fire drills had been carried out in May 2005. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 19 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 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 3 3 X 3 4 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 3 X 2 Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14 Timescale for action The registered individuals must 06/03/06 ensure that all sections of residents’ admission details forms are fully completed. The registered individuals must 31/03/06 ensure that residents’ care plans are recorded in sufficient detail. The registered individuals must 20/02/06 ensure that the updated complaints monitoring forms are used for any future concerns investigated. The registered individuals must 31/03/06 ensure that all staff receive fire instruction on a quarterly basis and the date is always recorded when this is received. Requirement 2. 3. OP7 OP16 15 22(3) 4. OP38 17(2) Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 21 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 OP29 Good Practice Recommendations The registered individuals should ensure that a full employment history is obtained and any gaps are explored and the reasons recorded. The home’s application form could benefit from being updated to reflect this deficiency. Longbridge Deverill House DS0000057131.V275576.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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