CARE HOME ADULTS 18-65
Longcroft 58 Westbourne Road Lancaster Lancashire LA1 5EF Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 27th September 2005 10:00 Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 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 Longcroft DS0000009993.V251827.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 Adults 18-65. 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. Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Longcroft Address 58 Westbourne Road Lancaster Lancashire LA1 5EF 01524 64950 01524 844082 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) Langley House Trust Mr Joseph Costello Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home shall accommodate a maximum of 14 Service Users in the category MD (mental disorder). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 22nd March 2005 Date of last inspection Brief Description of the Service: Longcroft is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 14 younger adults with mental health needs. The home is one of a number operated by the Langley House Trust, which is a charitable organisation. The home is situated close to Lancaster City Centre and within close proximity of a number of facilities and amenities. It is a substantial detached property set within its own well maintained grounds. Care is provided on a 24 hour basis including waking watch support throughout the night. The home works closely with professionals from other agencies including local probation and mental health services in meeting residents’ needs. Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection which meant that the manager, staff and residents did not know it would be taking place until the inspector arrived. The inspector was assisted throughout the visit by a senior support worker who was acting up in the absence of the registered manager and the deputy manager. In depth discussions took place about various aspects of the running of the home and the inspector also consulted a number of residents and staff members. A tour of the home was undertaken and the inspector examined a variety of documents. As part of the inspection, a case tracking exercise was carried out. This included the inspector examining the care of a number of selected residents from the point of their admission to the home. What the service does well:
During the visit the inspector consulted a number of residents who all appeared relaxed and contented in their surroundings. In general, residents were very positive about life at Longcroft and spoke highly of staff. One resident said ‘’The staff are always good to us and help us.’’ The inspector observed carers working with residents throughout the day. Residents and staff seemed to get on very well and in discussion with the inspector, carers demonstrated a very positive approach towards the residents and their needs. In this and previous inspections, it has been evident that residents at the home benefit from the opportunity to take part in a good variety of activities. Residents are encouraged to develop hobbies such as gardening and bike riding. Within the home, residents are offered activities such as karaoke nights and quizzes. At the time of the visit the inspector observed a number of residents using a computer which has been provided for activities such as games and word processing. Several residents are involved in the newsletter which is produced on a regular basis. Some residents carry out roles as roving reporters conducting interviews
Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 6 and writing stories. Others are involved in the publishing and production side of the magazine. At the time of the visit, some residents were away on a caravan holiday with staff. Another two residents were spending the night away attending a National Conference for service users, which is held by Langley House Trust on an annual basis. This home also performs particularly well in the areas of pre-admission assessment, care planning and risk assessment. Prior to a resident moving to the home a great deal of work is done to ensure that the home can offer an appropriate service and provide a safe place for the resident to live. In discussion with the inspector, one staff member explained that before a resident is offered a place at Longcroft, a great deal of background information is obtained and considered. It is also standard practice for senior staff from the home to meet prospective residents, sometimes on several occasions. The process used by Longcroft is so thorough it usually takes several months. Residents’ care needs are recorded, as is the support required to meet these needs. This information is held in a record known as a care plan. In viewing several care plans the inspector was able to determine that these documents are carefully developed to ensure that the home are providing care that meets all the residents’ needs properly. In addition, the care plans are regularly reviewed to make sure that any changes in a residents’ needs are accounted for. Generally, residents who live at Longcroft are deemed to be at risk of committing offences and as such, their support needs to be carefully planned. Records of all risks and measures required to reduce them are made and included in each resident’s care plan. These are known as risk assessments. The home are very skilled in carrying out risk assessments and work closely with other agencies such as the police and probation services when doing so. The inspector was advised that all risk assessments are passed by local police when developed and any changes made will also be subject to the agreement of local police. This home work very well in liasing with other agencies such as local health services, social workers and probation officers. In viewing residents’ care plans, it was apparent that regular communication is carried out with the agencies and any concerns are immediately addressed. . Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 7 What has improved since the last inspection?
A number of requirements made at the last inspection have now been addressed. All the baths used by residents now have a fail safe regulator on the hot water tap. This means that water cannot be distributed higher than 43 degrees, so there is no risk to residents of being scalded. A number of improvements have been made to residents’ bathing and toilet facilities. Most bathrooms and toilets have been redecorated and in some cases new suites have been fitted. The home have temporarily reduced the number of residents they will take at any one time to 13. This means that the ratio of single places at the home has improved. Finally, a number of improvements have been made to the home’s medication systems. For example, all residents’ medication administration records now have their photograph on which reduces the risk of a staff member giving a resident the wrong tablets. Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 8 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. Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 & 4 A very thorough assessment is carried out in respect of all prospective residents to ensure the home can meet their needs properly. EVIDENCE: The inspector discussed pre-admission assessment with a number of staff members during the visit. All those consulted felt that the home’s procedures were very thorough and that enough information was obtained about prospective residents to ensure that the home could meet their needs. One carer talked of how senior staff members would meet with prospective residents, usually on a number of occasions, prior to their admission. In addition, it was confirmed that prospective residents were encouraged to visit the home prior to their admission, often these visits take the form of overnight stays. Staff consulted felt that enough information was obtained about residents to plan their care well. Staff were able to give the inspector a lot of information about residents and demonstrated a very good understanding of each resident’s needs. In viewing records of pre-admission assessments, it was also evident that the home work closely with other professionals when assessing a prospective resident’s suitability. Professionals such as probation officers, social workers and mental health specialists had been involved with those assessments viewed.
Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 11 In addition, the home have procedures in place to liase with local health and social services about each referral made to ensure that appropriate services can be provided. Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed during this inspection. EVIDENCE: Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed during this inspection. EVIDENCE: Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 19. Residents receive well planned support which takes into account all their needs. EVIDENCE: Each resident has a detailed care plan in place which clearly states all their assessed needs and how these needs will be met. In the care plans viewed, residents had been given the opportunity to state their views and opinions on a regular basis. In discussion, the inspector was advised that the home have access to specialist psychology services which all residents are able to access. In addition, residents are able to access a local counsellor at any time they wish. Residents who were consulted by the inspector spoke highly of carers and were positive about life at Longcroft. One resident said ‘’They ‘(the staff)’ sort things out if you need them to. They always help you.’’ An outreach service is now offered to those residents who have moved away from the home into more independent living. The inspector was advised that this service was in its early stages but that those residents who had been provided with the outreach support had responded well. One staff member
Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 15 commented ‘’It is good to be able to keep working with people to make sure they manage alright. They know they can still rely on our support.’’ In viewing the file of one resident who was managing his own medication the inspector was unable to find a signed disclaimer and risk assessment. The home were advised that these must always be completed if a resident wishes to self medicate. Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed during this inspection. EVIDENCE: Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27 & 28. This home must be refurbished to ensure that residents are provided with an acceptable standard of accommodation. Urgent repairs must be dealt with promptly. EVIDENCE: Longcroft has 14 registered care beds, 6 of which are in 3 shared rooms. Langley House Trust have made adaptations to two of these shared rooms in order to improve privacy for residents. Langley House Trust state that they will revisit the possibility of increasing single rooms in the next financial year. During this visit it was found that one resident had moved form a single room to a double to accommodate some new admissions. Whilst the inspector is satisfied that this resident was consulted and agreed to the move, the home were advised that if this situation occurs again, the Commission should be notified. A tour of the home proved that in general, it was in poor condition. In addition the following issues were noted; .
Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 18 • • • • • • • One resident’s bedroom window was wedged open with a brick and had a crack in the pane. One carpet in a communal area was raised and was creating a trip hazard. A carpet in one resident’s bedroom had moved away from the fixing plate and was creating a trip hazard. There was a large hole in the wall of one of the communal areas. One of the showers used by residents had mould and mildew on the tiling grout and required attention. There was no stair carpet as this had been previously removed due to a tear. The carpet in the downstairs lounge was stained and in very poor condition. In general, the home is in need of total refurbishment. The inspector is aware that a building improvement plan is currently being developed and requests that this be forwarded to the Commission as soon as it has been completed. It is also recommended that when the refurbishment of the home is complete, a rolling programme of routine maintenance should be developed to ensure that all areas are kept in a reasonable state of repair thereafter. The inspector did note however, that some work had been carried out to make improvements to residents’ toilets and bathrooms. The Commission are aware of the presence of CCTV cameras within this home. This was discussed and it was confirmed that there are only cameras present in communal areas. It was also confirmed that all residents had been consulted prior to these cameras being installed. Whilst the Commission does not recommend the use of CCTV cameras within care homes it is accepted that due to the complex needs of the residents at Longcroft their presence is justified. It is recommended that information about the use of CCTV cameras within the home be included in the Service User Guide. There are two communal lounges in the home, one smoking and one nonsmoking. It was noted during the visit that the non-smoking room was being used by one resident for a private meeting which went on for several hours. As a result, any resident wishing to access a smoke free communal lounge was unable to do so during this time. The home were asked to monitor this situation and ensure that all residents have access to a smoke free communal area at all reasonable times.
Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 19 Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33. Staffing levels at this home are adequate to meet the needs of residents. EVIDENCE: In viewing staff rotas the inspector was able to determine that staffing levels are appropriate for the number of residents accommodated at the home. In addition, the home employs a catering staff member, several cleaners and an administrator to ensure that carers are able to carry out their roles effectively. Records showed that the home has experienced an increase in the turnover of staff since the last inspection. However, the inspector had no concerns in relation to this as reasons for leaving in many cases were found to be those such as retirement and internal promotion within the organisation. However, the inspector recommends that the home undertake formal exit interviews with each member of staff who leaves. In addition, it is also recommended that the figures for staff retention be monitored in the future. The inspector was advised that due to some recent staff sickness the home had needed to employ some agency workers. Discussion with the senior support worker confirmed that agency staff had been given a thorough induction and were being provided with ongoing support.
Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed during this inspection. EVIDENCE: Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 3 X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 1 2 2 2 2 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Longcroft Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X X X X X x DS0000009993.V251827.R01.S.doc Version 5.0 Page 23 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 YA20 Regulation 13 Requirement A signed disclaimer and completed risk assessment must be held in respect of residents who are managing their own medication. All parts of the home must be kept clean and in a reasonable state of repair. Urgent repairs, for instance, cracked window panes, must be dealt with promptly. The building improvement plan currently being developed must be forwarded to the Commission for Social Care Inspection as soon as possible. A responsible individual must be nominated by Langley House Trust for registration with the Commission. Timescale for action 27/09/05 2. 3. 4. YA24 YA25 YA24 23 23 23 31/12/05 27/09/05 31/03/06 5. YA38 7 31/10/05 Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 24 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. 5. 6. Refer to Standard YA24 YA24 YA25 YA25 YA33 YA33 Good Practice Recommendations Following the home’s refurbishment a rolling programme of routine maintenance should be developed to ensure all parts of the home are kept in a reasonable state of repair. Information in relation to the use of CCTV cameras within the home should be included in the Service User Guide. Single places should be made available to all residents who require them. Please inform the Commission if a resident who has had a single room for a significant length of time is then asked to share. Exit interviews should be carried with all staff members leaving the home. A system should be introduced for monitoring staff retention figures. Longcroft DS0000009993.V251827.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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