Inspection on 13/07/05 for Longfield

This inspection was carried out on 13th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Longfield 24/06/09

Longfield 06/10/08

Longfield 29/05/07

Longfield 19/05/06

Longfield 06/12/05

Longfield 16/03/05

Longfield 01/07/04

Longfield 24/02/04

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

CARE HOMES FOR OLDER PEOPLE Longfield Preston New Road Billinge End, Blackburn Lancashire BB2 6PS Lead Inspector Susan Hargreaves Unannounced 13 July 2005 10:00 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. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Longfield Address Preston New Road Billinge End Blackburn Lancashire BB2 6PS 01254 675532 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) Longfield (Care Homes) Limited Mrs Tina Hegarty Care Home Only Personal Care (PC) 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia - over 65 years of age (MD)(E) 24 of places Dementia - over 65 years of age (D)(E) 24 Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 A maximum of 24 service users requirng personal care who fall into the category MD(E) 2 A maximum of 24 service users requiring personal care who fall into the category DE(E) 3 That, taking into account the fact that the home is presently accommodating 21 service users, Longfield Care Homes Ltd should provide at the home at all times, staffing levels in accordance with the levels stipulated in Residential Care Homes information Booklet7 - Residential Care Homes for People who are Elderly and who also have a Mental Disorder, dated April 1997 - in respect of care homes accommodating between 16 and 20 service users. 4 That, when the number of service users accommodated at the Homes falls below 21, the maximum number of service users to accommodated at the home shall be 20, providing the staffingf levels set out in condition 3 are complied with. 5 That, if Longfield Care Homes Ltd wish to accommodate at the home in the future, more than 20 service users, the staffing levels required be discussed with the CSCI and that (in substitution for paragraph 3 above) that staffing levels imposed by the CSCI following such discussion be complied with. 6 The service must, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. Date of last inspection 16 March 2005 Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Longfield Care Home provides 24 hour long term personal care for up 24 older people who have a mental disorder or dementia. The property is a detached, converted house in its own grounds. The enclosed garden area is acccessible to all residents. Parking for staff and visitors is available to the side of the property. Accommodation is offered in single and twin-bedded rooms. Communal rooms are spacious. The home is situated on a main road leading into Blackburn, approximately one and a half miles from the town centre and easily accessed by public transport. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours. No additional visits have been made since the last announced inspection. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the deputy manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Several good practice recommendations have been made to further improve care planning and the management of medication. Pressure sore risk assessments need to clearly identify how the overall risk has been determined. When the risk factors change a new risk assessment form should be completed. Written instructions should be available for individual residents explaining when medication prescribed ‘when required’ should be given. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 7 The complaints procedure needs to be amended to state that complaints can be made directly to the commission. This will accurately inform residents and their relatives of their right to complain. To protect residents from abuse recruitment procedures must be improved by obtaining two written references for all new employees before they start working at the home. To fully meet the needs of the residents members of staff must receive appropriate training in dementia care. In order to promote the health and welfare of residents all members of staff must have training in fire prevention and moving and handling. A member of staff qualified to administer first aid must be on duty for all shifts. 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. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Admission procedures were thorough. A pre-admission assessment was completed for each resident prior to admission. EVIDENCE: Individual records of three residents were inspected. Each contained a preadmission assessment of need. A senior member of staff visited prospective residents in hospital or their own home prior to admission. The deputy manager confirmed in writing to prospective residents that their care needs could be met at the home. The assessment of need provided important information for the care plan. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.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 and 10 The health and personal care needs of the residents were identified and met. Care was given in a manner, which promoted the privacy and dignity of all residents. Medication was managed efficiently promoting good health. EVIDENCE: The individual care plans of three residents were inspected. These identified the needs of each resident and explained how these needs were met. Risk assessments relating to nutrition, moving and handling, falls and pressure sores had been carried out. However, because a risk assessment for one resident had been reviewed and altered it was difficult to see clearly how the overall risk of developing a pressure had been determined. The deputy manager was advised to complete a new risk assessment form when the needs of the resident changed. Information about how any identified risks were addressed was written in the care plan. This included the use of pressure relieving equipment. Care plans also contained information about social interests and hobbies. A detailed report about the care given to individual residents was written during each shift. Records of the visits of other healthcare professionals e.g. GP, mental health team, chiropodist, etc. were included in the care plans. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 11 Care plans were reviewed monthly. At the time of the inspection none of the residents were self-medicating. Appropriately trained members of staff were responsible for administering all medication. Records relating to the management of medication were seen to be up to date. The deputy manager was advised to provide written instructions for individual residents stating when medication prescribed ‘when required’ should be given. Medication was stored correctly and the temperature of this area was checked and recorded daily. The deputy manager was advised to obtain a copy of the Royal Pharmaceutical Society’s guidelines for the administration of medicines and an up to date British national Formulary During the inspection members of staff were observed attending to residents in a polite and friendly manner. Personal care was carried out in the privacy of the resident’s own room. One resident said, “The staff are very nice.” A visitor said the staff were polite. Privacy and dignity was discussed with five members of staff. They all described in detail how they promoted privacy and dignity when helping residents with personal care. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.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 and 15 The daily routine was flexible in order to meet the needs and preferences of residents. A variety of social activities were organised. Visitors were welcomed into the home at anytime. Menus offered variety and choice. EVIDENCE: Social activities were advertised in the home. These included games, craft, mobility and movement and a beauty day. An entertainer visited the home every month. Residents were encouraged to sit outside when the weather permitted. The deputy manager explained that she encouraged staff to sit and chat with residents. One resident said, “I like it when something’s going on in the concert room. Visitors were welcomed into the home at any time. The residents preferred daily routine was recorded in their individual care plans. The meal served at lunchtime looked appetising and wholesome. Although a choice of menu wasn’t offered alternatives to the set meal were readily available. Lunch was unhurried allowing residents time to enjoy their meal. One resident said, “I’ve had a lovely dinner.” Members of staff were observed assisting residents with feeding in a patient and sensitive manner. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 Complaints would be taken seriously and investigated. Members of staff had a clear understanding of adult protection issues, which protects residents from abuse. EVIDENCE: A copy of the complaints procedure was displayed in the home. However, this needed amending to state that complaints could be made directly to the Commission for Social Care Inspection at anytime. No complaints have been made to the home or the commission since the last inspection. The deputy manager explained that complaints would be taken seriously and appropriate records kept. Policies and procedures relating to the protection of vulnerable adults were in place. This issue was discussed with five members of staff. They were aware of the procedure and said they would report any concerns immediately. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 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 standard(s) 19 and 26 The home was clean, comfortable and well maintained. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy, free from offensive odour and well maintained. This provided a safe and comfortable environment for the residents. Discussions on how to further improve the environment had taken place at a recent management meeting. This included redecorating the corridor between the office and kitchen and purchasing new chairs for the lounge. Minutes of this meeting were seen. The garden was well kept and provided a secure area for residents to sit outside when the weather permitted. Residents had personalised their rooms with ornaments, photographs etc. one lady said, “I have a lovely room.” Laundry facilities were appropriate for the size of the home. To promote the health and welfare of resident’s nine members of staff were doing a training course on infection control. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 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 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 and 30 Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were not robust potentially putting residents at risk. Training opportunities were available for all members of staff. However, not all members of staff had received training in dementia care, which could possibly result in the needs of the residents not being fully met. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to meet the assessed needs of the residents. The files of three care assistants were inspected. These indicated that all the required pre-employment checks to ensure protection of the residents had not been completed. Two of the files did not contain two written references. It was evident from discussion with the deputy manager and members of staff that some training opportunities were available. This included induction and foundation training for new employees and infection control. Although the deputy manager said that several members of staff had received training in dementia care the members of staff consulted during the inspection had not had this training. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 16 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) 36 and 38 Appropriate procedures were in place to safeguard the health, safety and welfare of residents. Not all members of staff had received training in moving and handling and fire safety. A member of staff qualified to administer first aid was not on duty for all shifts. EVIDENCE: All members of staff had an annual appraisal and regular supervision. Members of staff consulted during the inspection found the supervision sessions to be helpful. However, the deputy manager was advised to keep written records of the appraisals. To ensure the safety of residents hot water temperatures were checked and recorded monthly. Fire alarms were tested weekly and fire drills took place monthly. A fire risk assessment had also been carried out. However, not all members of staff had received training in fire safety. A member of staff qualified to administer first aid was not on duty for all shifts. At the time of the inspection members of staff described how they would use an inappropriate Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 17 moving and handling technique to assist residents. None of these staff had received training in moving and handling. Safety notices were displayed throughout the home. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 18 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x x 2 x 2 Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 19 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 29 Regulation 19(1)(b) Schedule 2 Requirement The registered person shall not employ a person to work at the care home unless - (b) he has obtained in respect of the person the information and documents specified in paragraphs 1 to 7 of schedule 2. Two written references must be obtained before a new employee starts working at the home. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users - (c ) ensure that the persons employed by the registered persion to work at the care home receive - (i) training appropriate to the work they are to perform. Members of staff must receive training in dementia care. The registered person shall make arrangements to provide a safe system for mvoing and handling service users. All members of staff receive training in correct moving and handling techniques. Timescale of 1 July 2004 and 31 May 2005 not met Timescale for action 13 July 2005 2. 30 18(1) (c )(i) 28 Oct 2005 3. 38.2 13(5) 28 Oct 2005 Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 20 4. 38.2 23(4)(d) 5. 38.2 13(4) The registered person shall after consultation with the fire authority - (d) make arrangements for persons working at the care home to receive suitable training in fire prevention. The registered person shall make suitable arrangements for the training of staff in first aid. 28 Oct 2005 28 Oct 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 8 9 9 16 36 Good Practice Recommendations To ensure the overall risk of developing pressure sores is clearly identified a new risk assessment form should be completed when risk factors change. Written instructions should be in place for individual residents advising when medication prescribed when required should be given. A copy of the Royal Pharmaceutical Societys guidelines for the administration of medicnes and an up to date BNF should be obtained. The complaints procedure should be amended to state that complaints could be made directly at anytime. Written records of staff appraisals should be kept. Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 1st floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Longfield F57 F07 S5829 Longfield V231363 130705 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!