Inspection on 17/10/06 for Longdean Lodge

This inspection was carried out on 17th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Longdean Lodge 04/07/07

Longdean Lodge 11/04/06

Longdean Lodge 07/11/05

Longdean Lodge 09/06/05

Longdean Lodge 13/09/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Longdean Lodge Longdean Lodge Hillsley Road Paulsgrove Portsmouth Hampshire PO6 4NH Lead Inspector Mark Sims Unannounced Inspection 17th October 2006 10:00 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 Longdean Lodge DS0000044492.V307936.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. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longdean Lodge Address Longdean Lodge Hillsley Road Paulsgrove Portsmouth Hampshire PO6 4NH 023 9238 3021 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) www.portsmouthcc.gov.uk Portsmouth City Council Mrs Rita Mangeolles Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability over 65 years of age (8) of places Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2006 Brief Description of the Service: Longdean Lodge provides accommodation and personal care for up to thirtynine older persons and is owned and run by Portsmouth City Council and managed by the Health and Housing Directorate. Longdean Lodge is arranged over three storeys and is broadly divided into five units, one providing intermediate care to older persons returning to live independently in the community. All bedrooms are single occupancy. Each wing of the home has a dining and sitting area, and there is a large communal lounge in addition to this, and a specified smoking area. Service users have their meals in the dining rooms in the designated units, or elsewhere if they choose. There is recreational space outside, with seats, and a patio off the rehabilitation wing. Gardens surround the home and consist of shrubs, trees and some plants to the front of the home; there are lawned areas also, and new boundary fencing has recently been installed to improve security, as well as CCTV. Service users who use frames and wheelchairs are able to access the garden. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second ‘Key Inspection’ for Longdean Lodge, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the core and/or key National Minimum Standards. The fieldwork visit, the actual visit to the site of the home, was conducted over one day and undertaken by Mark Sims and Janet Ktomi, where in addition to any paperwork that required reviewing the inspectors met with service users, relatives and staff and undertook a tour of the premises to gauge its fitness for purpose. The inspection process also involved far more pre fieldwork visit activity, with the inspectors gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service and linking with previous inspectors who have visited the home. The inspection process is intended to reflect the service delivered at Longdean Lodge over a period of time as opposed to a snapshot in time. What the service does well: What has improved since the last inspection? The following is an indication of the areas where the service has improved its performance: • • • • • • New accountancy system established to support service users. Revised and re-issued terms and conditions of residency. Improved reporting under Regulation 37. Improved care planning Improved recording and monitoring of accidents Improved documentation of meals provided to service users. DS0000044492.V307936.R01.S.doc Version 5.2 Page 6 Longdean Lodge • • • • • • Alterations to the Council’s complaints process to include managers in outcomes. Improved arrangements for handling of laundry and updating staff. All Environmental Health Issues addressed. New admission guidance, agreed with care managers and homes’ managers. Improved visiting and reporting under Regulation 26. Improved Quality Auditing and use of feedback. 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. The summary of this inspection report can be made available in other formats on request. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 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 Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 2: Each service user is provided with terms and conditions of residency. Standard 3: All service users are assessed prior to admission, details of their assessments retained on file for reference purposes. Standard 6: The home provides an intermediate care facility within the Victory Unit, which meets its specified goals and is supported by a multi-disciplinary team approach. EVIDENCE: Assessments: The evidence indicates that service users have their needs assessed prior to being offered accommodation at Longdean Lodge and that the manager uses this information to ensure that the potential service users’ needs can be met by the home. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 9 • At the last inspection the visiting officer reported that: ‘The assessment procedure is not robust and does not ensure the needs of prospective service users can be met’. At this visit the files of four service users were reviewed and found to contain assessments completed by either the home’s manager, her assistant managers or care management assessments completed by professional social workers. Both the internal and care managers’ assessments appeared to contain information relevant to the needs and abilities of the service user, as well as personal information relating to medical histories, family contacts and relationships, medication regimes, etc. • • The service users’ plans or care plans also demonstrate that peoples’ needs, wishes and/or abilities are re-assessed on admission to the home, Portsmouth City Council (PCC) providing its services with access to a corporate care planning system, which includes various needs assessment tools. During the fieldwork visit the service manager for Longdean Lodge made time to call in to the home to meet with the inspectors and to offer the manager support should she have required it. During his time in the home the service manager, Mr Wallace Court, described the work the PCC has undertaken, since the last inspection, to improve their admissions process, including an agreed criteria, with care managers, around the information to be gathered and shared with the home’s managers, improved documentation that now considers the information referred to within the National Minimum Standards (NMS) and the need for the care managers to accept that the final decision on the suitability of a placement lies with the registered manager. These arrangements or agreements are relatively new at this time and Mr Wallace Court accepts they may yet require further amendment, however, he is confident that the PCC is moving in the right direction and sustainable improvements are now being made. • • In conversation with a care manager for the ‘Victory Unit’ (A PCC rehabilitation Unit), it was evident that a set eligibility criteria has now been established and that prior to admitting clients to the ‘Unit’ this is discussed with managers. The multi-disciplinary team involved with the ‘Victory Unit’ has also produced a DVD/Video presentation for all prospective clients of the ‘Unit’, which includes: DS0000044492.V307936.R01.S.doc Version 5.2 Page 10 • Longdean Lodge 1. 2. 3. 4. 5. 6. 7. 8. • A ‘Unit’ overview Virtual tour Staffing Eligibility Testimonials Social life Statistics Frequently asked questions. Comments from service users, gathered both on the day of the fieldwork visit and via comment cards collected in the build up to the visit indicate that generally people felt they knew what to expect from the service and that their care needs have and are met at the home: Twelve of the fifteen comment cards returned ticked ‘Yes’ in response to the question ‘did you receive enough information about this home before you moved in so you could decide if it was the right place for you’. Thirteen of the fifteen confirming ‘Always’ in response to the question ‘do you receive the care and support you need’, the remaining two respondents ticking ‘Usually’. In addition to this information one service user described how ’I came and viewed the home first. I then decided I’d like to give it a try’. • Relatives of potential service users were also seen during the fieldwork visit, confirming during conversation that they were visiting the home on behalf of their aunt, who was presently in hospital. Terms & Conditions: It was also evident from the fieldwork visit and information gathered in the build up to the visit, that work on terms and conditions of residency had been undertaken. • Over 50 of the comment cards returned confirmed that a contract/terms and conditions document had been provided, the remaining comment cards indicating that people either could not recall having received a contract/terms and conditions or stated they had not received the stated document. Three service users’ files, scrutinised during the fieldwork visit, were also noted to contain signed copies of the contract/terms and conditions literature. Whilst one service user described how his son had read a document to him, which related to the service and his residency. • • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 11 Intermediate Care: The service provides an intermediate care facility, referred to as the ‘Victory Unit’, which meets the needs of the local community and is supported by a multi-disciplinary team approach. • As indicated above the ‘Victory Unit’ has a very well established eligibility criteria, which not only do the staff adhere to but is communicated to the potential clients via both written documentation and visual presentation, DVD/Video. A tour of the premises established that the ‘Victory Unit’ is housed within one of the home’s wings, the premises basically divided into four wings, with centralised communal facilities available should residents wish to use them. In conversation with the manager it was ascertained that the ‘Unit’ is staffed separately from the rest of the home, a statement supported by the duty roster, which denotes the staff allocated to work within the ‘Unit’ a V for Victory suffixed in front of the carer’s name on the roster. During the fieldwork visit one of the inspectors spent time out in the home observing practice and talking with service users, relatives and staff. Notes made during this time indicate that the ‘Unit’ is independently staffed and that the carers allocated to the ‘Unit’ confirmed that this is their designated area of work and that they are overseen by one of the assistant managers. The inspector also observed professional input being delivered within the ‘Unit’ and as described above, spent time in conversation with one of the care managers visiting the ‘Victory’. • • • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. Standard 7: The PCC care planning system appears promising and in time will ensure the service users receive a consistent and individualised approach to care delivery. Standard 8: The health and social care support needs of the clients is well managed internally and is clearly meeting people’s needs. Standard 9: The management is failing to adhere to the PCC’s medication policies and procedures and therefore not adhering to best practice when managing service users’ medications. Standard 10: The service users feel they are treated with respect and dignity and that their rights to privacy are promoted by the staff and general ethos of the home. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 13 EVIDENCE: Service User’s Plan: The evidence indicates that the home’s care planning programme is improving and that the documentation introduced by the PCC, within the last six months, has introduced far more structure and cohesion to the process. • Five care plans were reviewed during the fieldwork visit, this representing 30 of the home’s resident population at the time of the visit. The care plans were generally well set out and structured documents, which included: 1. 2. 3. 4. 5. 6. 7. 8. • Client personal information Client photographs Physical and mental health dependency assessments Risk assessments, including falls assessments, behavioural assessments, moving and handling assessments. Monitoring tools, weight charts, bathing charts, personal care summaries, etc. Care plans Care plan reviews Running records. In discussion with staff it was ascertained that the care plans are maintained by the keyworkers, each client’s care plan identifying who their keyworker is, and that the plans are maintained within lockable cabinets in each lounge, this making the record more readily available to the staff. As evidenced within the first section of the report the service users largely agree that their care needs are being met, thirteen of the fifteen comment cards returned confirming that this is the situation. Professional comment cards provide further information relating to the care of the service users, all three comment cards confirming that the standard of care provided at the home is satisfactory. One person adding ‘I am always aware of the excellent care provided – happy residents and willing staff’. • • • A visiting professional, spoken with during the fieldwork visit, praised the standards of care provided at Longdean Lodge and stated that she had no worries regarding the service. DS0000044492.V307936.R01.S.doc Version 5.2 Page 14 Longdean Lodge • The relatives of service users also seem satisfied with the care provided at the home, all five comment cards returned indicating that ‘if their relative/friend is unable to make decisions they are consulted about their care needs’. All five also indicate that they ‘are satisfied with the overall care provided’ at the home. Health & wellbeing: The evidence supports the view that the service users’ health care needs are appropriately addressed, although issues regarding their wellbeing were a concern as the risk assessment documents were not always well recorded. • The visiting inspectors, in addition to reviewing the care plans for five service users, as part of the Commission’s case tracking process, also scrutinised their health care records, parts of which cross over into their general care planning documents. It was established that at Longdean Lodge, as with other PCC homes, the bulk of the information relating to service users’ contacts with health and social care professionals is documented by the assistant managers and that a separate logging system is maintained for this purpose. A review of the logs indicated that each resident has a separate health care file and that not only do the assistant managers update these files but often the health/social care professionals themselves will make notes on the files. It also appeared from the entries on the files that referrals to health care professionals was timely and appropriate, a view supported by a visiting General Practitioner (GP) who commented: ‘the staff make appropriate call outs, recognising when a doctor’s visit is required’. • The service users also seem happy with the home’s arrangements for accessing health care support, fifteen of the fifteen comment cards returned to the inspectors recording ‘Always’ in response to the question ‘do you receive the medical support you need’. Observations during the fieldwork visit day also provided evidence of the health care support available to the residents of Longdean Lodge, with one GP, a Community Psychiatric Nurse, a District Nurse and a Care Manager all witnessed visiting the home. In addition to the visits observed the inspectors also overheard telephone calls being placed to GPs, although the content of the conversation was not disclosed. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 15 • • It is also relatively clear, given the professional comments alluded to earlier within this section of the report, that the general consensus is that the staff of Longdean Lodge provide good levels of care and support and that the service users are well looked after. Risk Assessment: However, as with many aspects of life, etc., some elements of the home’s documentation and therefore their care practice can be improved. • The risk assessment documentation used by the PCC are generally poor and therefore not effective when used by the staff, who often fail to distinguish between general care needs and activities that possess a risk to the clients. The risk assessments also confuse staff, as they contain keyword prompts, which the staff clearly feel they should respond to regardless of the risk or lack of risk associated to a specific client. The tools also fail to distinguish between the action, risk, likelihood of occurrence and the plan to manage or monitor the particular risk identified. • The tools used to determine areas of risk, the behavioural charts or the falls charts, etc. were also noted to be poorly or inadequately used, staff identifying that a person might be aggressive or at risk of falls, etc. but failing to produce a risk assessment and plan on how this should be managed/monitored. Medication: During the fieldwork visit one of the inspectors was charged with the responsibility of monitoring the home’s medication system and whilst most elements of its operation were found to be appropriate one area of concern was identified. General practice that was satisfactory: • • • • • • • • Storage Record keeping Checked in on receipt from pharmacist Correct disposal Individually held and/or stored medications Monitoring of medication fridge temperatures, although the use of a maximum/minimum thermometer would be considered good practice. Availability of medication policies and guidance. Medication training for assistant managers’. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 16 Issue of concern identified: • Whilst in the office checking records one of the assistant managers was observed clerking a short stay client into the home. It was during this observation opportunity that the inspectors noticed that the persons medications had arrived at the home pre-dispensed into two seven-day medication dockets, which the family of the resident had been kind enough to set up to help the staff. However, the policy of the PCC is to only dispense medications from their original packaging, which has the prescription information visible on the package. This policy has been produced following the guidelines published by the Royal College of Pharmacists and is therefore based on best practice advice and guidance. Also the medication was not readily identifiable by the staff being asked to dispense it and was not accompanied by the original prescription instructions issued by the GP. When challenged about this the manager and the assistant manager felt the service user and her family had been known to the home for many years and that her GP had previously confirmed the medication regime for this client, although this could have changed between admissions. The manager will need to speak with the service user and her family and explain that due to policy changes within the PCC and to conform with best practice all future medications will need to be delivered within their original packaging, unless the client is to self-medicate during her stay. • Self-medication is obviously a choice open to the residents, although none of the care plans reviewed contained evidence of a self-medication assessment having been undertaken or suggested that the clients selected for case tracking were opting to self-medicate. However, one of the comment cards returned by a service user did state that ‘Were encouraged to self-medicate’, the remark added to the section regarding access to medical support. • The professional comment cards also appear to be generally satisfied with the home’s management of service users’ medications, two comment cards ticked ‘yes’ in response to the question ‘are service users’ medications appropriately managed in the home’, with the third person electing not to respond but to remark: ‘with respect to the medications, this is usually satisfactory, although sometimes, often DS0000044492.V307936.R01.S.doc Version 5.2 Page 17 Longdean Lodge • associated with agency staff & complex drug regimes, it appears staff lack the appropriate knowledge and experiences required’. In discussion with the manager, however, it was established that the home has a very limited bank/relief of assistant managers and that those people who undertake the role are often experienced assistant managers who have left or retired, etc. and who are expected to complete the same training as the permanent assistant managers. Privacy: The evidence indicates that people can expect their rights to privacy and respect to be appropriately addressed/managed at Longdean Lodge. • Both the comment cards returned by the service users’ relatives and those provided by professional sources confirm that suitable facilities exist for the purposes of meeting with clients/next of kin in private. The tour of the premises established that in addition to lounges and dining areas within each wing the home also has a large communal lounge, large communal dining room and small quiet lounge, each amenity open and accessible to the residents and their families/visitors should they wish to use them. Observational opportunities, during the tour of premises, revealed that service users use the quiet lounge for more solitary activities, reading books/magazines, listening to music, etc., one client observed using the lounge to read away from the bustle and distraction of the communal areas. • • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Standard 12: The staff team are seeking to establish a social activities programme, which will meet the needs and preferences of the service users. Standard 13: The visiting arrangements at the home meet the needs of both the residents and their relatives and good community links are maintained. Standard 14: The service users are helped to exercise choice and control over their lives. Standard 15: The meals are nutritionally well balanced and appetising. EVIDENCE: Activities & Entertainment: The evidence indicates that work is could be undertaken to improve and enhance the leisure opportunities of the service users: • The service user comment cards create an uncertain picture, when seeking to establish the suitability and appropriateness of the home’s activities programme. DS0000044492.V307936.R01.S.doc Version 5.2 Page 19 Longdean Lodge Eight comment cards ticked ‘Always’ in response to the question ‘are there activities arranged by the home that you can take part in’? Five ticked ‘Usually’ in response to the same question and the remaining two ticked ‘Sometimes’. Meaning just over 50 of the service users felt their social care needs were being effectively catered for at Longdean Lodge. • Feedback from the staff was also mixed over the subject of entertainment and leisure, with three out of the nine staff indicating that social stimulation could be improved if the home focused on getting people out more into the community. Two people commenting that the home’s in house activities are both good and accessible occasions, the remaining five people offering no comments or observations on the subject. • During the fieldwork visit several staff commented on the lack of community based or external activities offered to the residents, people believing that a minibus for the home would be the solution to the problem. In discussion with the manager it was established that the home can use the day centre’s minibus, when not in use by the day centre, however, this often proves an inconvenient option, as the day centre require the minibus for transporting clients to and from home, which often means the minibus is in use most of the day. The manager also stated that she has placed a bid/made an approach to the PCC regards this issue and is hopeful of resolving the matter in the near future. Another concern addressed with the manager was the uneven access across the grounds/gardens, which presently afford the service users little opportunity to enjoy walking around the garden or if in a wheelchair getting into the gardens at all. The manager is aware of the problem and obviously would like a path that circumnavigated the home, however, the finances for this expenditure are currently not available and would need the agreement of the PCC. • The staff’s ability to provide people with access to an in house activities programme that meets their needs appear to be more successful with photo albums, accessible within the quiet lounge, evidencing the range of Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 20 events provided at the home and the number of people attending each occasion. Adverts for forthcoming events are posted around the home, the next session noted to be an exercise class on Wednesday afternoon. • It was also noted that each resident has an individually created and maintained activities folder, which not only documents the event attended/ participated in but also whether the session was enjoyable or not. The records establishing that those who attended enjoyed a recent picnic arranged and delivered by the staff. Community Contacts: The evidence indicates that internally contacts with families and friends, etc., are being well supported, however, given the information above this judgement cannot be applied to community contacts. • During the fieldwork visit large numbers of visitors were both observed arriving at the home, as well as being in and around the property throughout the day. A good number of these people were also spoken with as part of the inspection process and the feedback gathered from these individuals used to inform the judgements of the report. • It was also evident from the relative comment cards that people are made to feel welcome during their visits, all five comment cards responding positively to the question ‘do staff welcome you in the home any time’. The entertainment records referred to above also help establish that community contacts are maintained within the home, entries reflecting that visits have been undertaken by local clergy or that the hairdresser has visited, etc. The tour of the premises revealed that a luncheon club is operated at the home, with the large dining room given over to the local community for the regular get together, this event open to both members of the local community as well as residents of the home, although internal attendance does fluctuate. • • Choice and Independence: Service users are provided with a voice within the home and are able to exercise their rights to self-determination. • The last inspection report indicates that ‘records identify that service users have the opportunity to exercise choice in relation to: leisure and DS0000044492.V307936.R01.S.doc Version 5.2 Page 21 Longdean Lodge social activities and cultural interests- mealtimes & religious observances’. At this visit it was established that the records still provide evidence of the above, as well as including risk assessments for some of the more hazardous activities people pursue, such as visiting the newly opened convenience store. • The minutes of the residents’ meetings also evidence that people are given the opportunity to discuss issues regarding the development of the service, although again these meetings are not always well attended. The service user comment cards also establish that people feel staff listen to them when they make requests/suggestions, 14 out of the 15 comment cards returned acknowledging this to be true. Additional comments included with the question included: ‘yes they are great people’, ‘someone always listens to me’, ‘I feel happy that I can approach the staff at anytime. They are good listeners’, ‘yes the staff always listen and do whatever they can’. Meals & Menus: The evidence indicates that meals are well balanced, nutritious and meet the needs and preferences of the service users: • • Observations of the mealtimes indicated that sufficient staff are available to support the service users with their mealtime needs. Records also indicated that each service user has his/her right to choice upheld, the menu records completed by staff in the presence of the resident and reflective of the meal they opted for from the choices available. The tour of the premises established that the kitchen is a large, wellappointed and equipped facility, which is able to meet the catering needs of the home. All fifteen comment cards returned by the service users indicate that meals are ‘Always’ good in response to the question ‘do you like the meals at the home’. People adding statements such as: ‘The meals are excellent’, ‘I am unable to eat meals provided but alternatives are made, staff very accommodating’, ‘the meals are normally very good’, ‘yes definitely – the food is very good’, ‘the food is lovely, always present well & enough of it’. • • • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 22 • In conversation with service users, over the lunchtime period, their views continued to be positive, all of the people spoken with praising the catering staff for the meals presented. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 23 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. This judgement has been made using available evidence including a visit to this service. Standard 16: The service users and/or their relatives feel they are listened to and can approach the staff and management with concerns or complaints. Standard 17: Service users are protected from abuse. EVIDENCE: Complaints & Concerns: The evidence indicates that generally the service users and/or their relatives are happy to raise concerns or complaints with the home and confident that the issues will be appropriately handled and addressed. • Seven of the fifteen service user comment cards returned confirmed/ticked ‘always’ in response to the question ‘do you know how to make a complaint’. With people adding comments such as: ‘yes I do but I have not had to complain about anything’ & ‘I can make a complaint verbally, also there is a form I can fill out to make a formal complaint’. Five comment cards were completed, indicating ‘never’ in response to the same question, however, three of these forms had additional Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 24 remarks indicating the person felt they had no need to complain: ‘no need to’, ‘I would not usually complain’ and ‘I would not complain’. The remaining three comment cards indicating that the person ‘usually’ knew who to raise complaints with. • All five of the relative comment cards indicating that people know how to make a complaint and all five also confirm they have never needed to use the process. Again the three professional comment cards were unanimous in confirming that they had never received a complaint about the home. • An issue identified at previous inspections, of Longdean Lodge and other PCC establishments, has been the PCC’s failure to effectively and appropriately involve the home’s’ manager (registered manager) in the complaints process, the PCC having a corporate policy they enact on receipt of a complaint. In discussion with Mr Wallace Court it was ascertained that this issue has now been addressed and a new checklist generated for the complaints investigation officer(s), etc, which directs them towards ensuring that the manager remains involved in the process. Adult Protection: The evidence indicates that steps are taken to ensure service users are protected from abuse. • Training records, whilst in need of attention due to there poor structure, do evidence that ‘adult protection’ training is provided to the staff team on a regular basis, the matter considered a mandatory training event by the PCC. The PCC, as the Local Authority, is the body charged with investigating and addressing issues of adult protection and to this end have produced a comprehensive protection strategy, copies of which were available in house. As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kin and no concerns regards their safety or wellbeing were identified. Observations also demonstrate or support the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. Historically issues of an adult protection nature have been reported and investigated at the home, however, the evidence indicates that where • • • • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 25 lessons could be learnt they have been, the PCC reviewing and updating its medication procedures following one such event. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. Standard 19: The main building is generally well maintained both internally and externally, however, attention is required to the grounds. Standard 26: The home was found to be clean and tidy throughout and domestic staff observed on duty throughout the fieldwork visit. EVIDENCE: Environment: The evidence indicates that the service users are living within well-maintained, clean and tidy premises, which is meeting their needs. • Both inspectors were accompanied around the home by the manager, as neither had visited the home before and felt it important to familiarise themselves with the layout of the property. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 27 The tour enabled the inspectors to establish that generally the home is in a good state of repair and that the accommodation is entirely single occupancy, although without en-suite facilities. During the tour the manager discussed how the PCC provide her with a small maintenance budget, larger decorative or maintenance work undertaken by the PCC Estates Department. On average, the manager explained, the Estates Department will decorate six to seven bedrooms a year, although she can negotiate to have a bathroom or corridor decorated instead of a bedroom if required. • Through discussions and via their comment cards the staff made it clear that they found it difficult to get clients out into the gardens, as the access to the grounds and around the home is poor. On checking the external areas of the home it was noted that there were no paths around the grounds or areas of easy access for the service users, especially those confined to wheelchairs, etc. • The tour of the premises also highlighted the need for routine checks of fire exits and in particular the route of escape from the secure garden outside of the Victory Unit, the gate leading from the garden secured by a padlock, which has been discussed with the fire authority according to the manager, however, the padlock was inoperable when the inspectors went to inspect the grounds and required some work to free it. One very positive occurrence noted during the visit, was the use the PCC is making of the Regulation 26 visit reports, the management team undertaking these visits identifying maintenance and health and safety issues to be addressed and using the reports to secure the finances required to address the issue. The most recent Regulation 26 reports identifying the need to improve the surface of the car park and entrance to the home, as this is uneven and damaged in places. • The views of the service users and/or their relatives spoken with during the visit or completing comment cards were also largely praiseworthy of the service, people commenting: ‘I think this place is excellent and I do not want to go home’. • Cleanliness: The evidence indicates that the home is clean and tidy throughout. • Remarks on the cleanliness of the home would tend to indicate that the service users feel the standards of cleaning at Longdean Lodge are good, DS0000044492.V307936.R01.S.doc Version 5.2 Page 28 Longdean Lodge fourteen comment cards returned indicating ‘Always’ as their response to the question ‘is the home fresh and clean’, the remaining respondent opting to ticking ‘Usually’. • During the fieldwork visit members of the home’s domestic staff team were observed around the home, cleaning and tidying both communal areas and residents’ bedrooms. The tour of the premises also enabled the inspector to establish that paper towels and liquid soaps were located in each of the communal bathrooms and toilets. The last inspection report also established that: ‘it was noted that there is a high standard of cleanliness throughout the home’. This finding has not changed. • • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 29 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 adequate. This judgement has been made using available evidence including a visit to this service. Standard 27: Staffing levels are sufficient to meet the needs of the service users. Standard 28: The home has achieved the target of 50 of the care staff trained to National Vocational Qualification (NVQ) level 2 or above. Standard 29: The recruitment and selection practices of the PCC are robust, however, it is important to ensure all relevant information is retained on the files of new employees. Standard 30: In-house training and development opportunities for staff appear to be good, although the records maintained in house are in need of restructuring. EVIDENCE: Staffing: The evidence indicates that the company employs staff in sufficient numbers to meet the needs of service users. • Copies of the staffing rosters, supplied prior to the fieldwork visit, establishing that the home is sufficiently well staffed and that carers are available, across the twenty-four hour period. DS0000044492.V307936.R01.S.doc Version 5.2 Page 30 Longdean Lodge • Observations further evidence the fact that adequate staff are available to meet people’s health and social care needs, the staff on duty comprising: 1. 2. 3. 4. 5. 6. 7. 8. The manager The assistant manager Seven care staff Two catering staff Two ancillary staff One maintenance person One activities co-ordinator One administrator • In discussion with staff it was established that carers normally work on allocated wings, the home divided into four main units, the fifth area of the home being redeveloped to provide space for individuals on the care programme scheme (respite). The five relative comment cards returned in the build-up to the fieldwork visit indicate that sufficient staff are available, all five ticked ‘yes’ in response to the question ‘in your opinion are there always sufficient numbers of staff on duty’. The professional comments also appear to support the fact that sufficient and appropriate staffing levels are maintained, people’s testimonies indicating that: ‘there is always a senior member of staff to confer with’ and that people are ‘satisfied with the overall care provided to the service users’. • • Training & Development: The evidence indicates that the training opportunities for the staff are good, although the records maintained in respect of the courses completed require attention. • The manager produced for the inspectors copies of various training records/matrix currently being used by the home to document the educational/vocational achievements of the staff. It was evident from perusing these records that training opportunities for the staff of Longdean Lodge and the PCC in general are good, however, the recording practices of the home do need reviewing, which the manager is aware of and did state was in hand, with all written records being transferred onto a database. • The nine staff surveys returned to the Commission, prior to the fieldwork visit, also establishes that the staff feel they have access to sufficient training events. DS0000044492.V307936.R01.S.doc Version 5.2 Page 31 Longdean Lodge All nine surveys ticked ‘yes’ in response to the question ‘does the home provide funding and time for you to receive relevant training’. The surveys also list some of the courses attended in the last twelve months, including: 1. 2. 3. 4. 5. 6. 7. 8. 9. • Induction Deaf awareness Medications Stroke Moving and handling Risk taking Food hygiene Fire safety Infection control and use of clinical waste systems It was also clear, given the information gleaned from the manager and feedback from the staff, that they are also being well supported when accessing National Vocational Qualifications (NVQ) level 2 courses or equivalent. The evidence within the last report establishing that the home had met and surpassed the 50 ratio recommended within the National Minimum Standards, the percentage rate reported being 75 . Recruitment & Selection: The evidence indicates that improvements shown in the home’s recruitment strategy at the last inspection are being continued, although the manager must ensure she chases up the PCC Personnel Department to ensure copies of all relevant information is available for inspection. • The last inspection report indicating: ‘records in relation to recruitment and selection of staff are now held on the premises’, previously the PCC opting to hold the files centrally, with no employment information available at the home. At this visit the files of two newly appointed staff were reviewed and each was found to contain the following information: 1. 2. 3. 4. 5. 6. 7. An application form Details of interview Contracts Induction information Employment correspondents Two references Supporting identification and documents • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 32 • However, neither file contained details of the outcome of the check against the ‘Protection Of Vulnerable Adults’ register nor did they both contain details of the outcome of the check undertaken by the Criminal Records Bureau’. The manager has since rectified these omissions and faxed details of the checks and the outcomes to the Commission. • Whilst a reference is made to the company’s induction programme, it should be clarified that this is a corporate tool, designed to prepare the employee for work with the PCC. This induction process, which lasts five days, is considered to be an adequate introduction for staff into care work and addresses many of the core principles of care, as well as the practical application of work within the PCC. However, it was unclear whether or not the format of the induction complied with the ‘Common Induction Standards’ introduced by ‘Skills for Care’ and a review and/or updating of the induction might be advisable, if already not in hand. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 33 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. This judgement has been made using available evidence including a visit to this service. The manager possesses a relevant care and managerial qualifications and is an experienced leader. The home’s quality assurance systems ensure the home is run in the best interests of the service users, although some internal monitoring of the staff’s performance is required. The arrangements for handling service users’ monies are satisfactory and designed to ensure people’s financial interests are safeguarded. The health, safety and welfare of both the service users and staff team are appropriately managed and promoted. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 34 EVIDENCE: Management: The evidence indicates that the home is well run and managed and that the service users, their relatives and staff appreciate the changes introduced by the current manager. • Information gleaned from the Commission database and previous inspectors, establish that the manager possesses both the ‘Registered Manager’s Award’ and ‘National Vocational Qualification Level 4 in Care’. Comments received from the residents, their relatives and staff indicate that the manager is considered to be both approachable and supportive and is considered to be responsible for changes within the home: ‘now we have a new manager in charge and with new rules and regulations coming in the home is improving all the time’. ‘there have been a lot of changes within the home over the last few years which I feel benefit the clients and staff’. • The professional comment cards also addressed the management of the home, all three indicating that the management ‘take appropriate decisions when they can no longer manage the care needs of the service users’. The work undertaken on addressing the issues of the last inspection report also provided evidence of the manager’s abilities to run a home in accordance with the legislation and guidelines. In addition to the registered manager, the home also employs assistant managers, the latter available throughout the fieldwork visit day, the assistant manager overseeing the operational running of each shift. Copies of the duty rosters, included within the dataset information, confirming that an assistant manager is on duty 24 hours a day, seven days a week. Quality Assurance: The evidence indicates that home’s quality auditing system affords the service users and their relatives the opportunity to comment on the services offered at the home. • The home operates both residents’ and relatives’ meetings, which are fully minuted and have established agendas, copies of which are available for inspection/reference. DS0000044492.V307936.R01.S.doc Version 5.2 Page 35 • • • Longdean Lodge The PCC has also introduced satisfaction surveys for residents, their relatives and the staff, selected comments following the most recent survey are included below: Service User Comments: 12 respondents: 14 Questions: 1. Do you feel the home is comfortable and friendly: 12 people responded yes. 2. Do you enjoy the meals: 8 people responded yes and 4 sometimes. 3. Could the variety of activities in the home be improved upon: 3 people responded yes, 2 no, 5 sometimes and 2 did not respond. Relatives/Visitors Comments: 11 respondents: 4 Questions: 1. How adequate did you find the facilities for the purposes of your visit: 7 people responded high, 3 mediums, and 1 medium/low. 2. How helpful you found the staff and managers during your visit: 9 people responded high and 2 medium. Staff Comments: 18 respondents: 15 Questions: 1. Are you aware of the aims and objectives of the home: 17 people responded yes, 1 did not respond. 2. Is training available to you on a regular basis: 17 people responded yes, 1 person responded no. 3. Do you find your supervision a positive and worthwhile experience: 16 people responded yes and 2 people did not respond. Service Users’ Finances: The evidence indicates that this issue has now been appropriately addressed. • A concern at the last inspection was how the PCC was supporting service users in managing their monies, as the PCC was banking all (residents’) incoming monies within its own accounts. This issue has now been addressed with the PCC opening ‘client national accounts’, which are individual accounts operated on behalf of the service users and pays interest. During the fieldwork visit one of the inspectors was provided with sight of the new statements and managed to discuss at length, with the home’s administrators the day-to-day operation of the accounts, which now ensures people’s monies are accounted for on an individual basis, enables all transactions to be audited and tracked and provides the named person with interest payments. • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 36 • One outstanding issue however, still persists, the refunding or paying to clients of back interest, the interest lost when their money was held in the PCC’s own accounts. In discussion with Mr Wallace Court it was ascertained that the PCC is still considering the most appropriate option or method for achieving this goal and that therefore this concern remains unresolved. Health & Safety: The evidence indicates that the health and safety of the service users and staff is being appropriately managed. • No immediate health and safety concerns were identified with regards to the fabric of the premises during the tour of the premises, although as identified via the Regulation 26 reports the car park/entrance to the home requires re-surfacing before the area becomes a hazard. The fieldwork visit establishes that full health and safety policies/guidance documents are made available to the staff, with various locations around the home used to share information with staff, offices, staff room, notice-boards, etc. Health and safety training is clearly made available to staff, with the previsit information evidencing that staff complete fire safety, moving and handling, infection control and food hygiene. Access to paper towels and liquid soaps within bathrooms and toilets are indicators of attention to infection control, as is the availability of a specific infection control policies, as listed identified during the visit. • • • Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 37 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 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 38 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 Timescale for action Regulation The manager must liaise with the 01/12/06 13 PCC management team to ensure the structure and the use of the company’s risk assessments are improved. Regulation The manager must ensure that 01/12/06 13 staff adhere to the company’s polices with regards to medications and that all medications are dispensed from their original packaging. Elements of this requirement remain outstanding from the last report. Regulation The manager must liaise with the 01/12/06 12 PCC to ensure improvements are made around the grounds, thus Regulation enabling service users more 23 appropriate access. The manager must also discuss with the PCC how they intend to address the issue of service users accessing community based activities, shopping, trips out, etc. Regulation The manager must liaise with the 01/12/06 19 PCC personnel department to DS0000044492.V307936.R01.S.doc Version 5.2 Page 39 Regulation Requirement 2 OP9 3 OP12 OP19 4 OP29 Longdean Lodge ensure details of all preemployment checks are provided/available at the home prior to the person commencing work. Elements of this requirement remain outstanding from the last report. Regulation The manager must ensure that 18 the training records for staff are up-to-date and accurately maintained. 5 OP30 01/12/06 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 Refer to Standard OP9 Good Practice Recommendations The manager should obtain a thermometer for the medication fridge which records maximum and minimum daily temperatures. Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 © 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 Longdean Lodge DS0000044492.V307936.R01.S.doc Version 5.2 Page 41 - 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. 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