Inspection on 04/07/07 for Longdean Lodge

This inspection was carried out on 4th July 2007.

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 17/10/06

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 Jan Everitt Unannounced Inspection 4th July 2007 09:30 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.V340972.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.V340972.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) rita.mangeolles@portsmouthcitycouncil 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 (25), Physical disability over 65 years of age of places (14) Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 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 which provides intermediate care to older persons returning to live independently in the community, (known as the Victory Rehabilitation Unit) The service also accommodates persons needing long-term care, those that are admitted for a short six-week assessment period and those that are admitted to the home on a regular respite care programme. The home has the facilities to also admit people in an emergency situation for a short stay. 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. The building has a specified smoking area for service users only. 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 are laid to lawn with shrubs, trees and some planting areas to the front of the home. The city council have erected a new boundary fencing to improve security, as well as CCTV that monitors the entrances and some external areas. Service users who use frames and wheelchairs are able to access the gardens. Fees at the home range from £185 to £421 per week depending on the service provided. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site inspection visit to Longdean Lodge, which was unannounced, took place over a one-day period on the 4th July 2007 and was attended by one inspector. The registered manager, Mrs. Rita Mangeolles and an assistant manager, assisted the inspector throughout the visit and was available to provide assistance and information when required The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The provider had returned the Annual Quality Assurance Assessment (AQAA) to the CSCI and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit made to the home on 17th October 2006. Documents and records were examined and staff working practices were observed where this was possible, without being intrusive. The inspector toured the home and spoke to residents, visitors and staff in order to obtain their perceptions of the services that the home provides. Relatives and service users spoken to expressed a high level of satisfaction with the service provided. Surveys were distributed to service users, relatives, care managers, GP and other visiting professionals. Sixteen service user surveys, and four relative/carer surveys were returned to the CSCI. A visiting care manager was spoken with at the time of the visit. The outcome of the surveys indicated that there was a high level of satisfaction with the services and that generally residents and relatives were pleased with the home. At the time of the inspection the home was accommodating twenty-four people. There were no residents at this time being accommodated who were from a minority ethnic group. What the service does well: Longdean Lodge has a wide range of facilities to admit people who have a variety of care needs, the majority of which are long stay residential care needs. The short stay, programmed respite care, assessment and rehabilitation services come under the intermediate care service provided in the home for which there is a designated area and separate staff. The home has a comprehensive pre-admission assessment process and receives care needs assessments from care managers before the potential service user is assessed. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 6 The home is homely and clean and well maintained. Service users’ health care needs are well met by the home, which is supported by the primary health care team and other visiting professionals. Service users and relatives say that staff are friendly and helpful. During this visit it was noted that the general atmosphere in the home was relaxed and good interaction was observed between the service users and staff. The inspector observed service users being unhurried in their activities and care being delivered at the resident’s own pace. Service users and relatives comments on surveys were: ‘My mother is very settled’. ‘I receive ample support from care staff and management’. ‘Very considerate with food as she likes her own bread’. ‘The food is exceptionally good’. ‘There is always someone about to help’. ‘You always get choices’ ‘I am aware that everyone here is doing their best and do a good job in the main and I personally am as well and as happy as I can be. I have no complaints’. ‘The staff are very good’. ‘Never had any complaints’. ‘My mother is very happy here. ‘I like living in the home and being treated well. Thank you for such a good service’. There is a high level of satisfaction with the food and the choices people have. The intermediate care service for people who have rehabilitation needs following a medical crisis or who have not been managing at home, has been an immense success with a high percentage of people being able to be discharged back into their own homes. The PCC is looking to increase the number of allocated places for assessment and programmed respite care to respond to the needs of the local community. What has improved since the last inspection? The PCC have written a new medication policy that is now operational and staff have a full understanding of this. The manager has, by fund raising and appealing to organisations, raised enough funding for the outside area to be more accessible to service users by having doors installed in the downstairs quiet room. These will lead out onto a Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 7 patio area that will have screening provided to give privacy when sitting out. Also the front patio area is in the process of being improved and upgraded. The manager has now ensured that the recruitment information about all staff is maintained in their personnel files stored in the home. The manager is organising the training of designated staff, that have volunteered, to learn to drive the day centre bus. This will enable this transport to be used at week-ends to take service users on outings into the community. The manager has procured more staff hours. The activities programme has widened in the last twelve months and takes into account service users’ preferences. The intermediate care unit is having a therapy room created from one of the dining rooms with specialist equipment installed. This will enhance the multidisciplinary team’s ability to emulate service user’s own homes, and try equipment that could be used to support them in their own homes. 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.V340972.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 Longdean Lodge DS0000044492.V340972.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users are assessed prior to admission, details of their assessments identify if the home can meet their needs. 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: The inspector viewed a sample of four service users care plans. Those looked at were two long stay residents and the others were from the Victory unit, the Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 10 rehabilitation service that Portsmouth City Council has established within the same building. There was evidence in the files that an assessment had been undertaken by the manager, or in the case of the rehabilitation unit, the head occupational therapist (OT). The inspector observed that the files also contained the 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 OT from the Victory unit spoke with the inspector and demonstrated through the care plans how the assessment to the Victory Unit was undertaken and how the unit has a set admission criteria to work to when assessing if a person is suitable for rehabilitation. Service users spoken with said they had seen someone before they came to the home and had received information about the home. 50 of the service user surveys received by CSCI indicated that the service user had received enough information prior to going into the home. However, other comments on the surveys said ‘I can’t remember, I took advice and relied on my social worker’, ‘I did not receive any information about the Victory Unit I did not know I was coming’. ‘I did not receive information but now know this is the right place for me’. The multi-disciplinary team involved with the ‘Victory Unit’ have now produced a DVD/Video presentation for all prospective clients of the ‘Unit’ that gives an overview of the service and its facilities. This includes: 1. A ‘Unit’ overview Virtual tour 2. Staffing 3. Eligibility 4. Testimonials 5. Social life 6. Statistics 7. Frequently asked questions. Comments from relatives suggests that they consider they were well informed about the home and its facilities and had the opportunity to visit the home prior to their relative being admitted. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 11 Longdean Lodge DS0000044492.V340972.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and social care support needs of the clients is well managed internally and is clearly meeting people’s needs. Service users are encouraged to manage their own medication and are protected by the policies and procedures of the home. 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. EVIDENCE: The inspector viewed a sample of four service user’s care plans. Two were those of permanent residents and two were for rehabilitation clients. The care planning documentation system is that which has been introduced throughout Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 13 the Portsmouth City Council (PCC) homes and has introduced far more structure and cohesion to the process. The information recorded is: • • • • • • • Client personal information. 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 Discharge planning for those on the Victory Unit. There was evidence in the care plan records that review meetings had been held for the two permanent residents and family and service users had attended. These records are maintained on each of the units and staff have easy access to care plans in order to inform their practice. The risk assessments were discussed with the manager. The previous report had identified the risk assessment tool was not being used effectively by staff who often failed to distinguish between general care needs and activities that possess a risk to the clients. The risk assessment tools 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 manager agreed that the staff do not find it an easy tool to open and identify what the level of risk is and what they need to be aware of. The manager told the inspector that this has been the general opinion of other PCC homes and has been discussed at the unit manager’s meetings. Consequently the risk assessments are currently being reviewed by the policy co-ordinator. The Victory Unit has a different risk assessment tool used by the multidisciplinary team that has been designed by the OT. This has been discussed with the policy co-ordinator at PCC and is now under consideration. The Victory Unit has different care planning and risk assessment documentation. This clearly states a programme of rehabilitation following a full assessment by all the disciplines. The inspector observed that some of the care plans had been signed by the service user and the rehabilitation clients are required to sign to say they agree with the programme of rehabilitation that has been planned for them. The care plans were evidenced as being reviewed at least monthly. Daily records are maintained in a separate file and detail each resident’s activities through the day. Twelve of the fifteen service users surveys returned indicated that they consider they receive the care and support they need, providing evidence that Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 14 the staff of Longdean Lodge provide good levels of care and support and that the service users are well cared for. In general information relating to service users’ contacts with health and social care professionals is documented by the assistant managers and a separate logging system is maintained for this purpose. The inspector viewed these records, which are part of the care planning system. There was evidence that the service users’ health care needs are appropriately addressed, and that other health and social care professionals record the outcome of their visits. The AQAA received, documented that the home is served mainly by two GPs, one of which visits fortnightly to review service user’s medication and to see any resident that the home requests him to review. The home has a good relationship with the primary health teams who visit the home if requested. Fifteen comment cards returned to the inspectors recorded ‘Always’ in response to the question ‘do you receive the medical support you need’. One service user recording that ‘she is happy to see the nurse twice a week. Doctor visits every time you have had a fall’. ’I get ample support from the staff and management’. The Victory unit has an OT and an assistant, a physiotherapist and has access to the speech and language therapist and a social worker attached to the team. All residents are able to see the chiropodist who visits six-weekly and the dentist and optician in the community. Observations during this visit provided further evidence of the health care support available to the residents of Longdean Lodge, with a visiting Community Psychiatric Nurse, a Care Manager, and an emergency situation that arose during the day and the prompt response from the manager to call the ambulance. Medication administration records (MAR) sheets were viewed by the inspector whilst observing the lunchtime medicine round. There were three trolleys being used and medication was administered by two managers and a trainee manager. The inspector observed that correct, safe procedures were being followed. The managers report they have had medication training and this is updated yearly, training files confirmed this. The MAR sheets were generally recorded appropriately with codes to identify if medication had not been given. The manager showed the inspector the log that is recorded as evidence that the MAR sheet records have been checked from the morning shift to the afternoon staff. The home is supplied with the blister pack system and medications that cannot be put in these are delivered in separate containers. The inspector viewed the cupboards and trolley and observed that all medications are stored in secure cabinets in a clean and orderly fashion. The ordering and receiving of Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 15 medications is documented and the home check the prescriptions before they are sent to the pharmacist for dispensing, this is seen as good practice, and avoids receiving unwanted medication. There were no residents being prescribed controlled drugs (CDs) at the time of this visit, but the register is appropriately maintained when this does take place. The policy for the management and administration of medication was reviewed in May 07 and this now reflects compliance with a requirement from the last inspection that service users and respite care clients must be admitted with all prescribed medication they are currently taking in its original packaging and must not be secondary dispensed into other containers. The policy also allows for service users to self medicate if they so wish and procedures are in place to assess any risks. Lockable storage is provided in each room to ensure the security of any medication. Service users spoken with told the inspector they were ‘quite happy for the home to keep their medicines to give to them.’ The manager spoken with at the time of the medication round was conversant with the procedures to follow should it be judged as necessary to administer medication covertly to a service user. The inspector observed throughout her tour of the home that staff members were observed giving support to residents in a sensitive and friendly manner. Many of the residents were mobilising around the home independently with walking aids. Residents spoken with said that the staff are ‘friendly, nice and caring and will generally go out of their way to help you’. This was also illustrated in conversations held with visitors/relatives. Staff were observed to be interacting well with service users and knocking on residents doors before entering their rooms. This was confirmed during conversations with service users that they felt that staff treat them with respect and that the ‘the staff are very good’, the staff have a lovely rapport with the residents, each one is included in everything’. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home team are striving to establish a social activities programme, which will meet the needs and preferences of all the service users. The visiting arrangements at the home meet the needs of both the residents and their relatives and good community links are being established. The service users are helped to exercise choice and control over their lives. The home provides meals that are nutritionally well balanced and appetising. EVIDENCE: The home has a designated activities organiser employed at the home for 16 hours per week, who takes the lead in organising the activities programme that is advertised on the notice board. She told the inspector that she plans activities around the service users choices and what they enjoy doing. She has Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 17 been doing this type of job in another PCC home and has many years experience. The inspector viewed the records that she maintains for each service user describing what activity they participated in and their level of response. The activities organiser told the inspector that she trains care staff on how to start a group activity and what equipment is used and this supports her with the activities in the knowledge that when she is not in the home the activities can continue. The home records social histories of the service user as part of the assessment process and these are also taken into consideration when the activities are planned. Preferences for activities and what is enjoyed is also discussed at the resident’s meetings that are held monthly. The AQAA recorded that the home has a wide range of activities and this was evidenced on the planned programme and on the day of the inspection visit the permanent residents were playing bingo and another group were listening to a talk by a visiting speaker. The inspector observed that service users were enjoying the game and there was much laughter and banter amongst the group. The service users who are on a rehabilitation programme, have a separate activities programme devised for them, part of which is linked to their rehabilitation goals and this is planned out for a six week period and displayed on the wall in the kitchen/dining area. These activities can be led by any member of the multidisciplinary team. Eleven of the fifteen service user surveys indicated that there are always activities arranged for them to take part one commenting ‘yes quizzes and all that’. Another commenting that they ‘willingly participate’. The other four said there ‘sometimes’ or ‘usually’ were activities available. The previous report stated that there was a 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. The manager told the inspector the minibus is available at the weekends for outings but the staff are in the process of being trained to drive the bus. The AQAA stated that the home is working on improving the links with the local community. The Victory unit have support workers to support service users to go out into the community to shop and generally gain confidence in daily living skills as part of their rehabilitation programme. The inspector observed that the home has many visitors throughout the day and these are recorded in the visitor’s book. The inspector spoke to a number of visitors who were very complimentary about the home. Two sisters said that they had returned the survey questionnaire received from CSCI and were ‘delighted with the care mother receives’. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 18 The inspector spoke to a number of service users. One lady expressed her happiness at being at the home and how satisfied she was with her care, by writing a poem about the home. She is in the rehabilitation unit and is expressing a choice to live independently in a warden controlled environment after spending some years in a care home. The home is working with her and the housing department to fulfil her wishes. When speaking to the service users the inspector asked them about their daily routines and lives. They all told the inspector that they are able to choose when they get up and go to bed and there is no restrictions on what they wish to do throughout the day. Service users also have choice of how they fulfil their religious observances. The home has choices of food at each mealtime and generally service users spend their days how they wish. The rehabilitation clients do have an agreed programme to follow most days but this is with their agreement before they are accepted for the programme. One resident chooses to smoke and there is a smoking room designated for residents, although the home has a strict policy for staff of no smoking on the premises or in the grounds. The inspector observed in a report by a PCC officer that it has been identified at a resident’s meeting that the residents wished to all have lunch all together on a Wednesday in the main dining room, and weather permitting, have the patio doors open and make it a more social occasion. This took place on the day of the inspection visit, with good communication and interaction between residents. The manager told the inspector that service users are encouraged to come to the dining area that day for this purpose but may stay in another areas if they so wish. The inspector visited the kitchen and spoke to the cook. The kitchen was observed to be very clean with well organised storerooms. The cook is enthusiastic about her job and described to the inspector the systems she has installed for recording and monitoring the kitchen appliances and the cleaning of the kitchen. She showed the inspector the 4-week menu rotation, which is changed to be seasonal. The menus demonstrated a choice of two main menus at lunchtime, from which the service users relate to the cook, who visits the service users every day, their choices for the next day. The AQAA stated that the home is planning to provide the menus in a format that is easier to access and read by the service user. The inspector observed in the rehabilitation unit that menu cards were printed out and on the dining tables to allow those service users to choose their meals. The cook said that she will cook them whatever they wish and one resident always has the same ‘cold meat and mash’. This was recorded by the resident on the survey questionnaire returned to CSCI that read ‘I like cold meat and mash so I normally have that for my meal’. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 19 When speaking to the service users and reading the survey questionnaires there were indications of a high level of satisfaction with the food, which most service users spoken with said was ‘very good’ with comments like ‘the food is 100 , you always get a choice’. The inspector observed the lunchtime meal being served and indeed the food looked well presented and wholesome. Through observation the inspector concluded that there were sufficient staff to support the service users with their mealtime needs. The cook is familiar with special diets such as diabetic needs but has requested to attend more specific training on special diets. The head of PCC kitchens is setting this up. The inspector observed in the care plans that nutritional risk assessments are recorded and care plans describe the action to take to manage this risk. The manager is able to refer to a dietician via the GP who will then assess if a dietician needs to be involved. Weights are recorded regularly as part of the nutritional monitoring. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 20 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. The service users and/or their relatives feel they are listened to and can approach the staff and management with concerns or complaints. Service users are protected from abuse. EVIDENCE: The AQAA received from the home records that no complaints have been received since the last inspection. The manager told the inspector that a record of complaints would be maintained and action and outcome would be recorded. The manager reported that any more minor issues are aired at the residents meetings for which minutes are recorded. A complaints leaflet is available at the home that describes the procedure for complaining. Of the 15 surveys returned from service users, twelve indicated they know how to complain and to whom, with three indicating they did not. One service user stated that ‘she would tell the member of staff, then directly the duty manager’, another commented, ‘Yes the helpful manager downstairs’. Relatives’ surveys returned confirmed they would know how to raise any concerns one saying ‘not needed to complain’. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 21 Generally comments received, and evidence from service users spoken with, would suggest that complaints are handled appropriately but that not many complaints are received. The home has a procedure for safeguarding vulnerable adults. There have been no reported incidences or allegations of abuse. Staff training records demonstrate that staff receive training on Safeguarding Vulnerable Adults at induction and PCC provide this training on a regular basis and it is considered a mandatory training event for all staff. The relatives spoken to at the time of this visit felt that the home were meeting the needs of their family member and that no concerns for their safety and well being were identified. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 22 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The evidence indicates that the service users are living within well-maintained, clean and tidy premises, which is meeting their needs. EVIDENCE: The inspector toured the building with the manager. The home is on three floors and is spread out over a large area. The rehabilitation unit is on the second floor and has separate facilities to that of the permanent residents on the third floor. The rooms on the ground floor are not occupied currently. These rooms are being redecorated and refurbished to accommodate clients on the care programme scheme (respite). The inspector observed that the home was clean and tidy and all rooms are single occupancy. Although no en-suite facilities are available in the rooms, Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 23 the home has created a number of large shower rooms that can accommodate those less able and who use a wheelchair. The other bathrooms were noted to have appropriate equipment installed to support those who had been assessed as needing assisted baths. The home was observed to be pleasantly decorated and rooms had been made individual. Service users spoken to by the inspector as she toured the building said they were very happy with their rooms. The manager told the inspector that she has a maintenance budget each year for day-to-day repairs for which a log is maintained. The inspector viewed the log that records any ‘snags.’ The snag is then reported to the help desk who will then action the repair through the maintenance team. For larger repairs and maintenance the manager reported that she identifies what redecoration or repairs need to be done, this is recorded and discussed with her manager before a decision is made what projects will be undertaken in the forthcoming year. The rehabilitation unit is also undergoing some environmental changes and a physiotherapy room is being created out of one of the dining areas, which is being relocated to a large lounge area. The previous report stated that the grounds were difficult for the service users to access owing to the undulating ground and the position of the home in the middle of a residential area. The manager told the inspector that the home is now in a financial position, with contributions from various sources, to install a new patio door in the quiet room on the ground floor. This will lead straight onto a newly created patio area with seating and flowers and will be screened by fencing to give privacy. The patio area that is positioned in the front of the home is to be refurbished also and with the patio area at the back of the home, this will give three patio areas for service users to sit if they so wish. The manager reports that this work is to be started imminently. The inspector observed when looking at the Regulation 26 visit reports, the management team undertaking these visits are identifying maintenance and health and safety issues to be addressed, and using the reports to secure the finances required to address any issues. The surveys returned to the CSCI, and in speaking to the service users, the inspector understood that their rooms are cleaned everyday and that it is always fresh. Two relatives spoken to said ‘we have never smelt any unpleasant odours and the home is so clean’. A separate domestic staff is employed to maintain the standards of cleanliness around the home. One member of this team was spoken with and he was aware of the COSHH guidelines for the storage of chemicals hazardous to health. These were observed to be stored appropriately in a locked environment and none of which had been left unattended. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 24 The inspector observed on the tour of the premises that paper towels and liquid soap were available for hand washing. The laundry was visited and was clean and well organised with colour coded linen bags to indicate if laundry is soiled, infected or personal clothes. The home has an infection control policy and procedures to support this. The laundry person was able to describe the procedure for the handling of soiled linen and clothes. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 25 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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to meet the needs of the service users. The home has achieved over the target of 50 of the care staff trained to National Vocational Qualification (NVQ) level 2 or above. The recruitment and selection practices of the service are robust. In-house training and development opportunities for staff are good, although the records maintained in house are in need of updating. EVIDENCE: The inspector viewed the staff rotas that demonstrated sufficient staff were on duty across the twenty-four hour period to meet the needs of the service users in residence. The AQAA reported that the home has recently been allocated an increase in carer’s hours by 54 hours per week. The manager told the inspector that PCC are in discussion with the home to allocate more care hours to the home to accommodate service users being able to be supported to go out into the community as part of their rehabilitation programme. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 26 The Victory Unit has a separate staffing group that includes a multidisciplinary team as well as carers and there is a designated manager on duty each day. In discussion with staff it was established that carers normally work on allocated wings, the home is 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 inspector observed that staff were not rushing and were spending time interacting with the service users and those working in the Victory Rehabilitation Unit were giving people time to mobilise and do things at their own pace. A separate housekeeping staff is employed at the home with eight domestics and a laundry staff allocated to these tasks. The inspector viewed the training files of staff and these demonstrated that 96 of care staff have achieved their NVQ level 2 or above qualification. PCC support carers to undertake this training. The inspector viewed a sample of four staff personnel recruitment files; these demonstrated that the manager has obtained all the information on the staff employed and their recruitment records were as required, as stated in Schedule 2 of the Care Home Regulations. The personnel department of PCC maintains the information in the first instance, as the recruitment is coordinated from this department. The manager is involved with recruitment and interviews. The inspector observed that a reference number indicates the clearance for CRB and POVA checks on each file. The inspector observed that the personnel files also contained all supervision records and yearly appraisals. Staff spoken to confirm that they do receive regular supervision and appraisal, at which time their training needs are discussed. The staff training matrix was viewed by the inspector. The manager produced for the inspector copies of various training matrix currently being used by the home to document the educational/vocational achievements of the staff. Although the training certificates are in staff files, the matrix appeared not to have recorded more updated training. The manager agreed that the matrix, which easily identifies all staff training, was not up to date and current. It was evident from viewing the records that the training opportunities for all levels of staff employed at Longdean Lodge is good. Staff spoken to feel they have access to sufficient training events. All new employees undertake a six-day corporate induction with PCC and these are designed to prepare the employee for work with the PCC. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 27 This induction process 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 with PCC. The induction programme includes all the mandatory training in health and safety issues and also includes safeguarding vulnerable adults, the core values of care and is based on the Skills for Care Induction programme standards and is spread over some weeks. All new staff have a local induction to the home and will shadow another carer for one week before being able to work on their own. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 28 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): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager possesses 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. 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.V340972.R01.S.doc Version 5.2 Page 29 EVIDENCE: The registered manager has many years experience working and managing PCC homes. She has gained both her Registered Manager’s Award and the National Vocational Qualification level 4 in Care. Staff spoken to at the time of the visit say they have a high regard for the manager who has driven changes through since being appointed as acting manager two years previously. The inspector observed that the manager has good relationships with her staff and has knowledge about the residents and their needs. Service users spoken to were aware who the manager was and are obviously used to seeing her about the home. The registered manager is supported by a network of other managers and trainee managers who in turn support the staff. The manager has a quality audit system in place and this gives service users, relatives, staff and other professionals the opportunity to comment on the service in general. This is done is a form of questionnaire surveys sent out by PCC, resident’s meetings, relative’s meetings and staff meetings, which are fully minuted and have established agendas. Copies of these records were available for inspection. The inspector viewed the outcome report of the questionnaire surveys distributed by PCC, which has been analysed and published and can be found with the Statement of Purpose on display in the reception. The report states that generally the experiences of service users, relatives, professionals and staff are good with a high level of satisfaction with the services provided and the environment. The manager does her own internal audits by ensuring the MAR sheets are checked for correct recording and she walks the home every day to ensure the standard of cleanliness and general state of repairs of the home is maintained. The returned AQAA stated that the manager and home in general have now a better understanding of the care standards and the importance of being outcome focused in service user’s care, and this reflects in the quality monitoring that is undertaken in the home. The home’s administrators oversee the day-to-day operation of the service users’ personal accounts. All service users have their own named interest bearing savings account. The accounts demonstrate that people’s monies are accounted for on an individual basis, enables all transactions to be audited and tracked and now provides the named person with interest payments. There was an issue with the back dated interest that service users had accrued whilst their monies had been invested in the PCC ‘client national accounts’. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 30 This issue has now been resolved and the inspector evidenced a letter to the service user informing them that the back interest was now in their current savings account. The inspector viewed a sample of current servicing certificates for equipment and systems, which were found to be in order. The fire log did not identify fire training and who had attended and who had been on duty when fire drills had taken place. The training matrix did not identify current fire training. This was discussed with the manager who reported that more recent fire training has taken place and this has not been recorded appropriately. The home has managers who have undertaken the ‘train the trainers’ courses and now undertake some of the training. The inspector viewed the accident book. The accidents are recorded appropriately and the inspector case tracked one accident from the recording, to reporting it on a Regulation 37 notification sent to CSCI and this was detailed in the daily notes of the service user who had fallen. The manager analyses the accidents periodically. Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 31 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 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.V340972.R01.S.doc Version 5.2 Page 32 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 31/08/07 13 PCC management team to ensure the structure and the use of the company’s risk assessments are improved. This requirement remains partially outstanding from the previous inspection report. 2. OP30 Regulation The manager must ensure that 18 the training matrix record is accurately maintained, and identifies the staff training that has taken place. This was a requirement from the previous report with timescale of 1/12/06 31/08/07 Regulation Requirement Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 33 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 Longdean Lodge DS0000044492.V340972.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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