CARE HOMES FOR OLDER PEOPLE
Longdean Lodge Hillsley Road Paulsgrove Portsmouth PO6 4NH Lead Inspector
Richard Slimm Unannounced 9 June 2005 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 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 H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Longdean Lodge Address Hillsley Road, Paulsgrove, Portsmouth, PO6 4NH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 023 9238 3021 Portsmouth City Council Application pending Care Home 39 Category(ies) of OP - 31 registration, with number PD(E) - 8 of places Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13/09/04 Brief Description of the Service: Lonngdean Lodge provides accommodation and personal care for up to thirtynine older persons and is owned and managed by Portsmouth City Council Social Services Department. The home has been recently registered with the Commission for Social Care Inspection. The home has three stories and is broadly divided into five units, 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 chose. 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. The Commission have processed an application for the home to have a designated unit for eight service users who need rehabilitation in order to return to their own homes following hospitalisation. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 9th June 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 joined 5 residents for lunch on their wing of the home. The inspector checked records and other relevant documentation, interviewing care, kitchen and management staff. Two visitors were spoken to and one made positive comments about the services provided at the home. The other was generally satisfied but the inspector did feed back some concerns about personal care issues. The new wing is posing some challenges to staff across the home. Eighteen residents were spoken to and 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. This report will make three requirements and five recommendations. What the service does well: What has improved since the last inspection?
A significant amount of work had been carried out to improve the organisation of resident information at the home. Action had been taken to improve assessment records as well as update and provide consistent care planning formats across the home. Security at the home had been improved by providing improved fencing and CCTV cameras. Action had been taken to improved consultation with residents at the home by introducing more
Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 6 frequent resident meetings. Communal corridors and a number of bedrooms had benefited form redecoration, and there are plans to redecorate 17 bedrooms providing 6 with new carpets, in consultation with the residents concerned. Policies and procedures continue to develop in line with current best practice. Staffing levels had been improved. Action has been taken to improve activities provided in the home, in order to promote residents’ quality of life. The manager confirmed that staffing practices in the area of manual handling and moving is being appropriately monitored and supervised, and other core training needs are being identified in order to provide relevant support to staff in this area. 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 H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 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 standard(s) 3 The home does not record assessment information about residents’ personal interests and wishes adequately. The home does not actively / adequately involve residents in their own assessments and the development of their care plans, or ensure that residents sign their own care plans EVIDENCE: The home has a system of assessment and care planning. While assessments continue to develop in line with the needs of residents and the national minimum standards (NMS), increased emphasis should be placed on establishing what potential residents want from the home, and 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 not fully aware of the existence of their care plans and assessments. Consequently there was a lack of clarity for these people of what they could expect in the context of their daily support from staff. One visitor to the home was concerned about what in her opinion was a lack of support to maintain personal hygiene to her relative. A number of care plans had not been signed by the resident concerned and/or their representative. Residents in the rehabilitation wing stated that they had been assessed by social worker,
Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 9 occupational therapist and physio-therapist, and that they were aware of their care plans. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 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 standard(s) 7-8-9-10 Residents’ personal, and some aspects of their 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 home promotes the residents’ right to self –administer their own medications where appropriate. More complex and/or dangerous medications are usually administered with the support of the staff. The home maintains signed records of medications administered by staff members. Residents are treated with respect by the staff of the home. The core values for residents are promoted. EVIDENCE: Care planning systems are currently being reorganised into a standard format across the home. Plans in place provided documented information to guide staff in meeting certain needs of residents. Care plans and assessments of need could be shared more with residents, and increased emphasis put on residents wishes. Medicine administration records were available, signed and up to date, residents confirmed that they were happy with the support they get to ensure they have their medications at the appropriate times. Residents who are on the rehabilitation wing of the home were encouraged and enabled to keep their medication and to manage these themselves independently with the support of the home. Risk assessments were in place, and the home was
Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 11 aware of the type and amount of medications kept on the wing. Staff members were observed to interact in a professional, sympathetic, good humoured and polite manner with residents’. 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 they were always treated with dignity and respect by the staff members who support them. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 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 standard(s) 12-13-14-15 The home actively listens to the wishes of residents, but does not fully record these in assessment documentation. The home promotes residents rights to stay in contact with family and loved ones, and to maintain links with people from outside of the home. The home could promote further resident choice and control over their lives. The home provides a full varied and nutritious diet. EVIDENCE: Assessment materials did not appear to focus closely on areas such as social and recreational wishes and interests. Residents confirmed that there were a number of activities regularly available within the home. Two visiting relatives were spoken to, and residents confirmed that they were free to contact family and friends whenever they chose to. One of the two relatives was very positive about the support provided to their mother living at the home, the other had some concerns that were passed back to the manager of the home at the time of the visit. Residents had freedom of movement around the home. The home has increased the frequency of resident meetings and residents confirmed that they were aware of these meetings and attended them. There is a need to put in place anonymous resident surveys, and the managers are to consult residents at their next meeting as to the style and type of survey needed. The cook was aware of differing dietary needs of residents and also had a good awareness of residents likes and dislikes. A visitor confirmed that the kitchen staff got things right most of the time for her relative. All residents spoken to indicated that they were happy with the variety, quantity and quality of food
Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 13 provided at the home. The inspector had lunch with five residents, and the meal served was both appertising and well presented. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 14 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 standard(s) 16-18 The home provides all residents and/or their advocates with a complaints procedure. The home takes all complaints seriously and fully investigates complaints and ensures complaints are fully documented. The home makes appropriate arrangements for the protection of residents from abuse. The home makes arrangements to promote the safety of residents. EVIDENCE: All new residents are provided with information about the home in the welcome pack and this contains details of the complaint procedure. There had been no formal complaints since the last inspection visit. The home has copies of the adult protection procedures for Portsmouth City Council (PCC). Staff members training in adult protection is provided on an on going basis by PCC. Residents spoken to confirmed that they felt safe at the home. Staff confirmed that security at the home had improved since the fencing and CCTV had been put in place. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 15 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 standard(s) 19-26 The home provides a safe valuing environment for residents. The home was cleaned to a good standard. EVIDENCE: The home provides separate domestic staff who work hard to keep the home clean and tidy. All bedrooms are single. The home was well presented, 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. Residents were appreciative of the efforts made by both care and domestic staff. 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 17 bedrooms and for 6 of these rooms to be re-carpeted. The external aspect of the premises was not inspected on this occasion. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-29-30 Care staffing levels at the time of the visit were insufficient. However, domestic, laundry kitchen and other ancillary staff were 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, needs to be reviewed. The home provides staff with training and development opportunities. The home was unable to evidence safe staff recruitment practices. The manager of the home is not NVQ 4 qualified, and does not have the Registered Manager Award (RMA). Staff supervision needs review. Team building opportunities are needed. The home needs to provide 24 hour cover with first aid trained staff. EVIDENCE: The inspector was advised that the Portsmouth City Council human resources department undertake all checks on staff necessary to protect residents. However, staff records needed to evidence this were not available on site as required by the legislation. The staff roster indicated that the home was not 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 short of the published guidance. However, the overall staffing of the home including all care, ancillary and management hours was 176.99. hours over the guidance. Consequently there would appear to be a problem with regard to the provision of adequate care staffing levels and the deployment of staff generally across the home. The home is providing opportunities for staff to be trained to NVQ 2 and 3. The applicant for registered manager does not currently have NVQ 4 or the registered managers award. Other training opportunities are provided to ensure that baseline
Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 17 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. Residents stated that they were very happy with the staff working at the home, but there were times when they had to wait for staff to be available to assist them with personal care, and delays in the responsiveness of care staff at other peak times of the day. The development of the rehabilitation wings, and the provision of group living for residents across the four other wings in the home is posing a number of challenges to staff and managers, and consequently resources should be made available, to provide adequate staffing levels and for some team building to be carried out. It is the view of the commission that the home needs to provide a minimum of two staff to provide care in each group living unit at peak times. There is also the need to ensure that the staffing arrangements for the rehabilitation wing of the home are provided separately to the main home. Staff supervision takes place, and this would benefit from further development in order to ensure that care practices are monitored with care staff during these individual sessions. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33-35-36-38 The home has not formally surveyed the views of residents in an anonymous format. Residents are not always fully 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. The responsible individual is not arranging for inspection reports from CSCI and Regulation 26 visits to be made available to the registered body PCC, in order to adequately monitor the conduct of the care home they run. Staff receive regular supervision, however, some aspects of supervision could be further developed as identified above. Management have in place systems to monitor health and safety within the home. EVIDENCE: A number residents’ stated that they felt the degree that they were consulted in the daily running of their home had improved. Anonymous resident surveys have not been carried out with residents. The homes’ manager has applied to be registered. The certificate of registration was displayed. The registered
Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 19 persons advised the commission in April 2005 of the arrangements made for any residents money deposited with the home for safe - keeping. These arrangements are still unsatisfactory, and fail to comply with legal requirements. The inspector was advised that there is a meeting this week to discuss the changes that are needed in order to ensure the home operates legally in this area. 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. These reports, and copies of inspection reports from CSCI do not currently get forwarded to the registered body on a frequent basis to ensure the good conduct of the homes run by PCC. Staff interviewed confirmed that they receive regular professional supervision. The manager of the home takes all reasonable steps to promote a safe working environment. Residents confirmed that there are frequent fire alarm tests at the home. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x 1 2 x 3 Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 35 Regulation 20 Requirement The home must not pay money into a bank account on behalf of a resident unless that account is in the name of the individual resident concerned. The home must keep records relevant to the recruitment process for staff as identified in Schedule 2. These records must be available for inspection in the home. The applicant for registration as the manager of the home must have NVQ 4 registered managers award qualification or equivalent. The registered persons must indicate the action plan in writing to the CSCI to be put in place to meet this standard. The home must provide adequate care staffing levels, in order to meet the assessed needs of residents at all times, and the homes statement of purpose. Care staffing levels must take account of the group living arrangements and separate care staff must be provided in the rehabilitation wing of the service. The registered persons must Timescale for action 9/7/05 2. 29 17(2) 9/7/05 3. 30/31 9 9/7/05 4. 27 18 31/8/05 5. 30 12-13 31/8/05
Page 22 Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 ensure that at least one staff member is on duty at all times who has received first aid training that is in date. 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 3/7/12 Good Practice Recommendations It is recommended that assessments identify personal goals/interests/hobbies and the type of activity that the resident expects to be provided at the home. Care Plans should be signed by residents or where needed relatives/advocates. It is recommended that all managers should be fully trained in first aid, this will be the most efficient way to ensure the home is able to comply with the requirement above. Opportunities for team builidng should be provided. Anonymous resident surveys should be carried out, and the results displayed in the home. Surveys of wider stakeholders including visiting professionals and other visitors should also be carried out. Staff supervision should ensure that care practices and the philosophy of the home are in line with best practice, and that staff are provided with the necessary resources to carry out their roles effectively and in the best interests of residents. 2. 30 3. 33 4. 36 5. Longdean Lodge H55-H03 S44492 Longdean lodge V219950 090605 stage 1.doc Version 1.30 Page 23 Commission for Social Care Inspection 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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