CARE HOMES FOR OLDER PEOPLE
Longcliffe Nursing Home 300 Nanapantan Road Loughborough Leicestershire LE11 3YE Lead Inspector
Kim Cowley Key Unannounced Inspection 12th April 2007 11:00 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 Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 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. Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Longcliffe Nursing Home Address 300 Nanapantan Road Loughborough Leicestershire LE11 3YE 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) 0121 705 3356 01509 266379 longcliffenursinghome@daisybroadband.co.uk None Shankar Leicester Ltd Ms Lea Bredsdorff-Larsen Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability over 65 years of age of places (42) Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. No one falling within category OP may be admitted into the Longcliffe Nursing Home there are 42 persons of category OP already accommodated within this home. No one falling within category PD(E) may be admitted into Longcliffe Nursing Home where there are 42 persons of category PD(E) already accommodated within this home. No person to be admitted to Longcliffe Nursing Home in categories OP or PD(E) when 42 persons in total of these categories/combined categories are already accommodated in this home. Not applicable Date of last inspection Brief Description of the Service: Longcliffe Nursing Home is situated in the rural village of Nanpantan on the edge of Charnwood Forest. It is registered to accommodate 42 older people, some of whom have physical disabilities. The property, an old coaching inn, has both single and double bedrooms. It is on two floors with a passenger lift for access. Two singles and one double bedroom have ensuite facilities. On the ground floor there are two lounges and dining room. At the rear of the property is a secluded garden area with a patio, and a car park. The home is staffed by qualified nurses and carers. There are good local transport links, and shops and a pub nearby. The fees range from £319.00 to £475.00 depending on care needs. There are additional charges for hairdressing, chiropody, holidays, and newspapers. Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection that included a visit to the home and inspection planning. Prior to the home visit, the inspector spent half a day reviewing information relating to the home. During the course of the inspection, which lasted five hours, the inspector checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means the inspector looked at the care provided to three residents living at the home by meeting or observing them (not all residents were able to give their views due to their mental health); talking with the staff who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. The inspector also met other residents, a visiting professional, the Registered Manager, the Owner, and care and nursing staff. Prior to the inspection four completed residents’ surveys and seven completed relatives’ surveys were returned to CSCI. Comments taken for these surveys have been used throughout this report. What the service does well:
Longcliffe Nursing Home, which has been under new management/ownership since December 2006, provides residents with a good standard of accommodation and care. The premises are homely, comfortable, and well decorated and furnished. All areas inspected were clean, fresh, and tidy. Four residents were interviewed during the inspection and all praised the home. The following comments were made, ‘I couldn’t find a fault with this home’, ‘I am very happy here and the care is excellent’, and ‘This home has a lovely atmosphere, everyone’s so friendly.’ A visiting professional told the inspector ‘This is one of the best nursing homes I’ve been too.’ Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 6 Relatives also made many positive comments about the home. One said, ‘This home and staff care for my (relative) with love, kindness, respect and dignity at all times. I could not manage without the support and care this home provides.’ Another commented, ‘This staff do their best to support people to live the remaining years of their lives by trying to please them and make them as happy as possible with their present disabilities.’ The home employs nursing, care, and ancillary staff. Staffing hours provided exceed the recommended minimum, which means that staff have more time to spend with residents. Both residents and relatives said how pleased they were with the staff team who they said were ‘lovely’, ‘really good’, and ‘always smiling’. A relative said, ‘The care home matron and staff do their best to make every resident, whatever colour or disability, as comfortable as possible.’ The Manager talks to residents every day to check they are satisfied with the care provided, and also to relatives when they visit. She told the inspector, ‘What I hope I achieve here is a homely atmosphere with friendly staff who work together as a team and have good morale.’ The Owner visits the home a few times a week and chats to residents and relatives to get their feedback on the service. A relative commented, ‘The people in charge of the home do their best to make it possible for the residents to live the life they choose.’ 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
Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 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 Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ needs are assessed prior to admission to ensure the home is suitable for them. This judgement has been made using available evidence including a visit to this service. (Standard 3 was inspected.) EVIDENCE: The Manager assesses residents who are interested in coming to the home. She visits them in their own homes or in hospital in order to do this, and spends between one and two hours with them. She also talks to relatives and health professionals to get their views on the resident’s needs. These steps help to ensure the home is suitable for the resident and that staff can care for them properly. Once admitted, each resident has a trial period of at least four weeks. The Manager said, ‘When I assess residents I ask do we fit in with them, and do they fit in with us, and can we can we give them good quality of life?’ One resident commented, ‘When I came here I wasn’t able to look round myself because I was in hospital but my relatives did and they said it was lovely and I
Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 10 would like it here. They were right.’ And a relative said, ‘The choice of this home was made by myself after visiting three other places.’ On the day of inspection a group of relatives were looking round the home to see if it was suitable for their family member. The Manager said potential residents/relatives are welcome to visit the home at any time before making a decision as to whether it would suit them. Some residents come for a period of respite care first. At present the home does not admit residents with ‘challenging behaviour’. Care records were sampled and showed that residents were properly assessed prior to admission. Five have been admitted since the home opened and all had the appropriate admission documentation on their files, including a completed assessment form. Standard 6 was not inspected, as this home does not provide intermediate care. Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Staff in the home, and in the wider community, meet residents’ health and personal care needs. This judgement has been made using available evidence including a visit to this service. (Standards 7, 8, 9, and 10 were inspected.) EVIDENCE: Care plans are in place to ensure that residents’ health, personal and social needs are met. These are written by the nursing staff, and based on the Manager’s assessments. All residents case tracked had the necessary risk assessments in place. Since taking up her post the Manager has reviewed and improved care plans. The Manager said care plans are discussed with residents (and their relatives where appropriate) and they can become involved in their own care planning if they wish. Care plans showed many examples of good practice and provided evidence of residents improving and becoming more independent since they had been in the home. For example one resident, who initially needed to be hoisted, was now mobile. Another resident had gained weight since her admission after her diet was reviewed and improved, following the advice of a dietician.
Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 12 GPs and District Nurses from seven different local surgeries visit the home when required. Records showed that residents are referred for specialist health care when necessary. A visiting health care professional told the inspector, ‘When I make recommendations the staff here follow them up.’ Nursing staff are responsible for administering medication, overseen by the Manager. The home’s contract pharmacist carries out inspections to ensure that medication is being properly kept and administered. He also provides staff with advice and training where necessary. Arrangements for health and personal care ensure that residents’ privacy and dignity are respected at all times. During the inspection staff were observed behaving respectfully towards residents and providing care in a discreet manner. Residents comments about the quality of care in the home included, ‘The staff shower me or give me a bath when I want’, ‘Staff come straight away if I call them’, and ‘I’m very well looked after here.’ Relatives also showed satisfaction with the care provided and made the following comments: ‘I am kept up to date with the important things that happen to my (relative).’ ‘My (relative) has been in the home for a number of years – she is in very poor condition but the excellent care she has received means she has lived much longer than we expected when she went in.’ ‘Since my (relative) has been admitted into Longcliffe they have looked after her very well.’ ‘The home looks after the residents well, even if the residents sometimes are not as understanding and helpful as they might be.’ Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Daily life and social activities enable residents to lead purposeful lives. This judgement has been made using available evidence including a visit to this service. (Standards 12, 13, 14, and 15 were inspected.) EVIDENCE: An activities co-ordinator is employed three hours per day from Monday to Friday. She is in the process of assessing each resident to find out their hobbies and interests so she can design an activities programme for them. Current activities include bingo, board games, exercise classes, sing-a-longs, films, raffles, jewellery making, card making, gardening, hand massage, days out, and garden fetes. Church services are held in the home once a month. Activities are provided on both a group and an individual basis. Staff are escorting one resident to the seaside for a week’s holiday. Another resident has the activities co-ordinator read to her in her room. This is good practice as it enables all residents to take part in activities, including those who are unable or unwilling to take part in group activities. Residents who spoke with the inspector said that they could receive visitors at any reasonable time and they were assured privacy during visits. A visiting professional commented on the friendly atmosphere in the home and said, ‘I’ve
Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 14 been in the dining room with the residents at mealtimes – the atmosphere is sociable.’ Three cooks and two kitchen assistants are employed for breakfast, lunch and tea preparation seven days a week. The emphasis in the home is on healthy eating and the Manager said fresh produce is used wherever possible. Meals are served at the following times: Breakfast Lunch Evening meal Supper 07.30 – 09.00 12.30 – 13.30 17.30 – 18.30 on request Residents with particular dietary needs are well catered for. The cooks have met with a dietician and a swallowing therapist to help them plan appropriate and tempting meals for those we require soft or pureed food. Vegetarians and diabetics are catered for. Detailed records are kept, where necessary, so residents’ individual progress and likes and dislikes can be monitored. Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents feel able to talk to staff about any concerns they might have. This judgement has been made using available evidence including a visit to this service. (Standards 16 and 18 were inspected.) EVIDENCE: The home has a written complaints procedure, which is given to all residents (or their representatives) prior to admission. A copy of the complaints procedure is also displayed in the home. The Manager said she encourages residents to tell staff if they have any concerns, or to come to her, or approach the Owner. One resident said, ‘If there was a problem I’d go to the Manager.’ Relatives surveyed indicated that they were aware of how to complain if necessary: ‘I have read the instructions and procedures on the care home notice board and understand what to do in case of complaint in the home.’ ‘If I made a complaint it would first be put to the Manager and if the matter was not rectified then I would take the complaint to the Owner of the home.’ ‘I would speak to a nurse or the Manager if my (relative) was unhappy.’ There have been no formal complaints since the new Owner and Manager were registered. Two minor informal complaints have been made and both have been resolved with records kept. The Owner and Manager treat complaints
Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 16 positively and encourage residents and visitors to speak out if there is anything they are not happy with. Staff are trained in safeguarding vulnerable adults during their induction and later during their NVQ studies. The home has a whistle blowing procedure in place, and a procedure for reporting suspected abuse. The Manager said staff are made aware of these procedures, which are to be reviewed annually. Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents live in an environment that is safe and well maintained. This judgement has been made using available evidence including a visit to this service. (Standards 19 and 26 were inspected.) EVIDENCE: The premises, and old coaching inn, are homely and non-institutional. Many of the original features of the property have been kept and bedrooms are unique and personalised. All areas inspected were cleaned to a high standard, and well decorated and maintained. To the rear of the home is a secure patio garden with a fountain and a shaded seating area. During the inspection residents were seen walking round the patio escorted by staff. Since the new Owner and Manager were registered a number of improvements have been carried out to the premises, including the redecoration of the dining room, which now appears light and airy. In addition the hairdressing and staff room have been refurbished and new offices and a nursing station created. The
Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 18 Owner said further improvements are planned for the premises and funds have been put aside for this. Residents’ comments about the environment included, ‘My room is huge and very comfortable’, ‘I like my room very much’, and ‘The home is very clean.’ A visiting professional said, ‘This is a nice environment and it’s always clean when I come here.’ Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Friendly and professional staff meets residents’ needs. This judgement has been made using available evidence including a visit to this service. (Standards 27, 28, 29, and 30 were inspected.) EVIDENCE: The home employs nursing, care, and ancillary staff. Staffing hours provided exceed the recommended minimum, which means that staff have more time to spend with residents. During the inspection staff were observed as being professional and caring in their approach to residents. All residents interviewed said they were pleased with staff team and the following comments were made: ‘The staff are all lovely – there not one that’s odd.’ ‘The staff tell me themselves they’re happy here. Everyone seems easy with one another.’ ‘The staff are really good, they are always smiling.’ ‘The staff are all lovely and I’m very happy here.’ Relatives also expressed satisfaction with the staff team: ‘Everyone on the staff is very caring and helpful.’ ‘The nursing staff are qualified people and the caring staff are well trained to look after the welfare of the residents.’
Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 20 ‘The care home matron and staff do their best to make every resident, whatever colour or disability, as comfortable as possible.’ ‘From my experiences I have always found the nursing and caring staff to be kind and thoughtful towards the residents.’ A member of staff told the inspector, ‘The Manager is helpful and supportive. ‘The work is nice, and we get time to talk to the residents.’ Recruitment procedures were discussed with the Manager. She confirmed that all staff are subject to CRB and POVA checks and references are obtained for this. This helps to ensure residents are safeguarded. Staff receive good training opportunities. The ‘Skills for Care’ induction is used, followed by NVQs. At present 80 of staff are qualified to at least NVQ Level 2 or it equivalent. Additional training courses are ongoing and records showed that staff are encouraged to develop their existing skills and learn new ones. In addition all staff receive an annual appraisal with the Manager. The training and supervision arrangements in the home help to ensure that staff are competent to do their jobs. Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents live in a home that is safe and well managed. This judgement has been made using available evidence including a visit to this service. (Standards 31, 33, 35, and 38 were inspected.) EVIDENCE: The Manager is a qualified nurse with seven years experience in the care of older people. She is supernumerary, although she does occasional nursing and care shifts so she can have a good understanding of how the home is run. She works Monday to Friday office hours, and visits the home at weekends to see the staff and relatives who are not in during the week. She said, ‘What I hope I achieve here is a homely atmosphere with friendly staff who work together as a team and have good morale.’ Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 22 The Manager said she talks to residents every day to check they are satisfied with the care provided, and also to relatives when they visit. She has organised a relatives’ meeting for 29.08.07 at 7.30pm to give all relatives the opportunity to discuss the service with her and each other. The Owner visits the home a few times a week and chats to residents and relatives to get their feedback on the service. Residents, relatives, and staff praised the new Owner and Manager, making the following comments: ‘The Manager is kind and very helpful.’ ‘The new Management seems very good.’ ‘The people in charge of the home do their best to make it possible for the residents to live the life they choose.’ ‘Information is always posted on the home’s notice board.’ All residents handle their own financial affairs, or their relatives manage their affairs for them. Records showed that the Owner and Manager have taken the necessary steps to promote and protect the health, safety, and welfare of residents and staff. A full-time handyman is employed to oversee this area. Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 23 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 4 X 3 X X 3 Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N/A 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 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. Refer to Standard Good Practice Recommendations Longcliffe Nursing Home DS0000069023.V335279.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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