CARE HOMES FOR OLDER PEOPLE
Longdean Lodge Hillsley Road Paulsgrove Portsmouth Hampshire PO6 4NH Lead Inspector
Mr Richard Slimm Unannounced Inspection 7th November 2005 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.V257359.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V257359.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Longdean Lodge Address 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) 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.V257359.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th June 2005 Brief Description of the Service: Longdean Lodge provides accommodation and personal care for up to thirty-nine older persons and is owned and run by Portsmouth City Council and managed by the Social Services Department. The home, and the home’s manager are registered with the Commission for Social Care Inspection. Longdean Lodge has three stories and is broadly divided into five units, one providing intermediate care to older persons retunring 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.V257359.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 7th November 2005 over 1 day. The day was spent visiting service users in their own rooms, and communal areas of the home and interviewing them in order to establish their views of the quality of service provided by the home, the inspector also spoke to the chairman of the resident committee, who confirmed a number of improvements that there had been at the home since the last inspection. The inspector checked records and other relevant documentation, interviewing a number of residents, care and management staff. The main focus of the visit was to monitor compliance with the 5 requirements and 4 recommendations made in the report dated 9th June 2005. Residents’ spoken to all confirmed that they were satisfied with the general quality of the service provided, and a significant number of residents were found to be very happy living at Longdean Lodge. There had been a number of developments and improvements at the home that have benefited residents. It was noted that one resident had been admitted to the home outside of the legal categories of registration. This report will make one requirement, and a warning letter will also be issued separate to the report regarding the recent offence. What the service does well:
The home continues to provide a good level of care and support on a practical basis, and systems are in place to identify resident daily needs. Residents interviewed said that the staff team are very good and caring and always treat them with dignity, kindness and respect. Residents spoken to were found to be very happy living at Longdean Lodge, and considered the home to be their home, this is aided in such a large home by providing separate wings to promote smaller group living. Managers and staff appeared to be committed to providing the best possible service and a commitment to ongoing improvement and development of the home remained evident. A resident in the rehabilitation wing of the home stated that this aspect of the service was very good, and while the efforts of the staff were geared to enabling the goal of returning to live at home, the resident concerned stated that he was not looking forward to returning home and wished to consider moving into residential care permanently. There was a clear commitment to providing staff that were appropriately trained, experienced and qualified. There is a clear plan for the ongoing redecoration of the internal aspect of the home, and residents are being consulted about these matters. This plan includes a programme of works to redecorate all bedrooms, and the communal areas of the home. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 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.V257359.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3-6 The home records assessment information about residents’ personal interests and wishes adequately. The home has improved the involvement of residents in their own assessments and the development of their care plans, ensuring that residents sign their own care plans wherever possible. One resident had been admitted outside of the home’s stated conditions of registration, with no application to vary those conditions. The rehabilitation wing provides a service geared to enabling residents to return to living in their own homes. EVIDENCE: The home is about to update and introduce systems of assessment and care planning. This will be monitored during future visits to the home. Adequate emphasis is placed on establishing what potential residents want from the home, and action taken to find out what their interest, hobbies and types of activities they would like to become involved in at the home and outside of the home. A number of residents spoken to were fully aware of the existence of their care plans and assessments, and had been offered the right to sign these documents in line with best practice. Consequently there was an improved degree of clarity for residents as to what they could expect in the context of their daily support from staff. A resident in the rehabilitation wing stated that a
Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 9 social worker, occupational therapist and physiotherapist had assessed them, and that they were aware of their care plans. Facilities in the rehab wing were set up to promote independence. One individual’s assessment indicated needs that fell outside of the current conditions of registration. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8 Residents’ personal, and social care needs, are known and understood by the staff team. The home promotes independence where possible, and supports residents to access appropriate health care support when needed. The quality and frequency of activities at the home had improved, in line with the stated wishes of residents. Residents are treated with respect by the staff of the home. The core values for residents are promoted. EVIDENCE: Assessment and care planning systems are currently being reorganised into a standard format across all PCC care homes. Current plans in place provided documented information to guide staff in meeting certain needs of residents. Care plans and assessments of need were being shared with residents, and increased emphasis put on residents wishes. Residents’ interviewed confirmed that they were happy with the support they get. Residents who are on the rehabilitation wing of the home were being encouraged and enabled to look after themselves as independently as possible with the support of the staff from both within the home and the domiciliary care agency staff. Risk assessments were in place. Staff members were observed to interact in a professional, sympathetic, good humoured and polite manner with residents’.
Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 11 Health care needs of residents are addressed within care plans and residents confirmed that they could have access to GPs or other health services on request. Staff members spoken to were found to be aware of the need to promote the core values of privacy, respect, choice, independence and rights for residents. Managers were found to be keen to develop ways to increase residents’ rights at the home. Residents’ confirmed that the staff members who support them always treated them with dignity and respect. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 The home actively listens to the wishes of residents, and fully records these in assessment documentation. The home promotes residents rights to be involved in a variety of activities of their own choosing. Residents are encouraged and supported to journey out from the home with support where needed. EVIDENCE: The home has allocated a specific staff member who co-ordinates activities and outings with residents. This staff member collates residents’ interests and consults residents regularly about these matters. Residents said that there had been significant improvements in this area recently, and that staffing levels had improved. Residents are enabled to follow their recreational and religious interests, and the home now provides monthly church services in the home, and support for residents who may wish to attend the local church. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 There was evidence documented to support the view that the home makes appropriate arrangements for the protection of residents from possible abuse. The home makes arrangements to promote the safety of residents. EVIDENCE: The CSCI has been advised of a current investigation into allegations of an adult protection nature, and is liaising with the relevant agencies concerned. At the point of writing the report, full investigations had not been completed, it was unclear if the allegations could be substantiated, or if the issue was one of complaint, rather than adult protection. There are copies of the local adult protection procedures devised in line with national guidance, and staff are provided with adult protection training. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The home provides a safe valuing environment for residents. The home has a plan to ensure that internal decoration is carried out and residents consulted. EVIDENCE: The home was well presented, reasonably maintained and decorated to a good standard internally. Residents said they liked the colour schemes around the home and the way their individual rooms had been decorated, and those who had had their own rooms redecorated confirmed that they had been consulted. The home had benefited from improvements to the boundary fence and CCTV had been provided to improve the security of the home. There are plans to redecorate all bedrooms and for the redecoration of some shared communal areas. The external aspect of the premises was not inspected on this occasion. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-29-30 Care staffing levels at the time of the visit were sufficient to meet the needs and wishes of residents. Domestic, laundry kitchen and other ancillary staff were also sufficient. Deployment of staff, in order to provide adequate care staffing levels, both within the main home and the separate rehabilitation wing of the home had been reviewed, and improved. The home provides staff with training and development opportunities. The home was able to evidence safe staff recruitment practices. The manager of the home has recently started a course at NVQ 4, and will carry onto the Registered Manager Award (RMA) immediately following completion of this course. Staff supervision takes place on a regular basis. The home provides 24-hour cover with first aid trained staff. EVIDENCE: The Portsmouth City Council human resources department undertake all checks on staff necessary to protect residents and staff records needed to evidence this were available on site as required by the legislation. The staff roster indicated that the home was providing adequate care staffing numbers for those residents accommodated and the declared levels of dependency, and the manner in which services are configured across the wings of the home, for the week of the inspection. Care staff hours were over the published guidance. Residents interviewed said that care staffing levels and the deployment of staff generally across the home had improved recently. The home is providing opportunities for staff to be trained to NVQ 2, 3 and 4. The registered manager does not currently have NVQ 4 or the registered managers award, but is training to these levels. Other training opportunities are provided to ensure
Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 16 that baseline training is given to staff in such areas as food hygiene, basic first aid, manual handling and moving, fire training and health and safety. Not all of the managers who cover the home over every 24 hours had been given first aid training, but all will be first aid trained a t the next PCC training course. Residents stated that they were very happy with the staff working at the home, and that staff are usually available to assist them with personal care, with few delays in the responsiveness of care staff at other peak times of the day. Arrangements for staffing the rehabilitation wing of the home are now provided separately to the main home. Staff interviewed confirmed that supervision takes place regularly, and records also evidenced this. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35-36-38 The home has formally surveyed the views of residents in an anonymous format. Residents are consulted about the daily running of their home. The registered persons fail to comply with their legal responsibilities when handling residents’ personal monies. The home promotes the health and safety of staff and residents. Staff members receive regular supervision. Management have in place systems to monitor health and safety within the home, and all managers will be first aid trained at the next available PCC course. EVIDENCE: A number of residents’ stated that they felt the degree that they were consulted in the daily running of their home had improved, this included the current chair of the resident committee. Anonymous resident surveys have been carried out with residents, and there are plans to extend this to other relevant stakeholders. The homes’ manager has commenced training to NVQ 4 RMA level. The certificate of registration was displayed. The registered persons have advised the commission that by 31/12/05 the arrangements made for
Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 18 any residents money deposited with the home for safe – keeping, will comply with the requirements of Regulation 20 of the Residential Care Home Regulations 2001. At the time of the visit these arrangements remained unsatisfactory, and failed to comply with legal requirements. Arrangements are now being made to ensure that there is a monthly visit from a representative of the registered body, and a report provided, under the requirements of Regulation 26. Staff interviewed confirmed that they receive regular professional supervision. The manager of the home takes all reasonable steps to promote a safe working environment, and there are plans to train all managers at the home in first aid. Residents confirmed that there are frequent fire alarm tests, and that they felt safe living at the home. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 1 3 X 3 Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation Requirement Timescale for action 07/11/05 2 OP35 CSA 2000 The registered persons must Section 24 ensure that adequate assessment is carried out as part of the admission procedure to the home to ensure that the resident may be admitted legally within the categories and conditions of registration, in order to ensure that the needs of the resident can be met at the home. The registered persons must make application to vary conditions of registration, and this must be sanctioned by the CSCI prior to the home admitting residents outside of the current registration categories. 20 The home must not pay money 31/12/05 into a bank account on behalf of a resident unless that account is in the name of the individual resident concerned. This requirement remains outstanding from previous inspections. Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Longdean Lodge DS0000044492.V257359.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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