CARE HOMES FOR OLDER PEOPLE
Longfield Killicks Road Cranleigh Surrey GU6 7BB Lead Inspector
Lisa Johnson Unannounced 24 May 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 H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Longfield Address Killicks Road Cranleigh Surrey GU6 7BB 01483 275505 01483 277753 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) Surrey County Council - Adult & Community Care Ms Jennie Whitfield Care Home 50 Category(ies) of OP Old Age (25) registration, with number DE(E) Dementia - over 65 (25) of places Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Gene Kelley and Fred Astaire Units will be used exclusively for Service Users who require dementia care. 2. Gracie Fields and Audie Murphy Units will be used exclusively for Service Users in the category OP (Old Age not falling within any other category). 3. Respite care may be provided to one Service User within Audie Murphy Unit for a named person. 4. Accommodation and services may be provided to named persons aged 6065 years with prior written agreement of the CSCI. 5. Respite care is offered to 10 Service Users on Charlie Chaplin Unit for a period of up to 6 weeks. Date of last inspection 30 September 2004 Brief Description of the Service: Longfield is a large detached three-storey residential Care home. The home provides personal care and accomodation for fifty older people. The home is managed by Surrey County Council and is situated on a large housing estate adjacent to the villlage of Cranleigh. All rooms are for single occupancy. The home has five separate units, which provides 40 permanent places and 10 short stay/intermediate care places. Each unit has its own sitting/dining room and kitchenette. The home grounds are of a good size, well maintained and have disabled access. There are parking facilities to the front of building. Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection undertaken for the year 2005/2006. This was an unannounced inspection, which meant that staff and residents were not aware that it was due to take place. The inspection was carried out by two inspectors who arrived at the home at 9.45 am. Inspectors spent the first part of the visit talking to the manager and looking at some of the documentation in the home such as the homes Statement of Purpose, staff training records and personal files. The inspectors looked at the some of the service user care plans, risk assessments, medication records, menus, temperature recordings and quality assurance systems. The second part of the visit consisted of the inspectors touring the premises and talking to some of the service users about what it is like to live in Longfield and to the staff to gain their views. The inspectors would like to thank the staff and service users for their time, assistance and hospitality during the inspection. What the service does well: What has improved since the last inspection?
The action required by the Commission at the last inspection had been completed. Some care plans were sampled on this inspection and work has been undertaken to update some of them. The care plan used in the home is a detailed document. Each service user care plan now includes a recent photograph of the service user. Two staff personnel files were sampled and contained the required information. New staff have been recruited to the home with an additional deputy manager appointed. The kitchen fridge and freezer temperatures are now being recorded on a daily basis in accordance with basic food hygiene legislation. Cleaning materials were found to be kept and stored safely out of reach of the service users. A
Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 6 fire door has been repaired and some new furniture has been obtained in the home. 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. Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.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 Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.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) 1,3 & 5 The home provides service users and prospective users with adequate information about the service provided. Pre-admission assessments were completed and trial visits to the home were encouraged for prospective service users. EVIDENCE: The homes Statement of Purpose was seen and is detailed in content and provides information about the service and what it provides. All of the service users receive an assessment prior to admission to the homes. Service users and relatives have opportunities to visit the home to assess its suitability. Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 9 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 The health and personal care needs of service users were met. Progress has been made in updating care plans since the last inspection. Further work is required in order that all plans are completed and agreed with the service users or their representative. EVIDENCE: Three care plans were sampled at this inspection. The plans were large, but detailed. One care plan was incomplete, but there was evidence that reviews were taking place. The manager stated she was considering introducing a new format, a copy of which has been forwarded to the Commission for Social Care Inspection. The manager stated that the new plan would be more service user friendly. A requirement has been made that all care plans are to be completed and signed by service users where possible. Relatives, representatives and significant others (e.g. other health care professionals) should also be consulted where appropriate. The home has contact with a local G.P., district nurses and care managers Medication records were sampled. Medication administration records were complete for internal medications. The controlled medications cupboard was checked and medication was stored correctly and a count on the stock for one
Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 10 medication was checked and found to be correct. However there were some gaps noted on the medication a record for the administration of external medications and a requirement has been made in respect of this. Risk assessments are in place for a service user who self medicates and these were sampled during the inspection. Staff were observed to be treating service users with dignity and respect, service users privacy was maintained when in their bedrooms and bathrooms. Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 11 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 is able to demonstrate that service users are given opportunities for leisure and recreational activities. Contact with the local community, family and friends was being maintained by the home. Adequate arrangements were in place for service users meals. EVIDENCE: An activities timetable was observed to be in place. The manager informed the inspectors that the activities coordinator has left and that the home is in the process of recruiting. In the meantime care staff are undertaking activities and this was evidenced. Some service uses were undertaking craftwork in the homes activity room. Service users spoken to stated that they enjoyed these activities. Outings take place to the local shops and market. Some service users attend the local day centre and go to the local church. The manager informed the inspector’s that local school children come into visit service users in the home. A garden party is being held in July. The homes menu was sampled and on the day of the inspection roast pork was being served. The home has its own cook who informed the inspector that a list of service users preferences are available and that alternatives can be provided if service users don’t like the menu for that day. Service users spoken to said that they were happy with the meals. The manager informed the inspectors that two service users will be leading on meal planning and will be consulting with other service users in the home, which was a positive step.
Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 12 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 Staff have good knowledge and understanding of adult protection issues, which promotes the safety of service users. An appropriate complaint policy was also in place. EVIDENCE: Thee inspectors looked at the homes Statement of Purpose, a complaints procedure is available and included in the document. Two staff training records were examined and evidence was recorded that staff receive training in adult protection. The inspectors spoke to two staff in the home and they were very clear about adult protection procedures and stated that they would report incidences of abuse. From observations on this visit staff were observed to have positive interactions with service users and were respectful. Two service users in the home told the inspectors that staff are kind and felt that they could approach staff. Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 13 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, 20, 21, 23, 24,25&26 Although some improvements were noted to the environment since the last inspection, the service does not meet the required standards. Action needs to be taken to improve the environment creating a comfortable and safe environment for the service users living in the home. EVIDENCE: There has been some improvements to the environment and some decorating and new furniture been obtained. However the environment does not comply with required standards. Some of the service users were happy to show the inspectors their bedrooms, which were decorated with personal belongings. The home was generally clean, however two bedroom carpets require replacement in the Charlie Chaplin unit due to very strong pervading odours. Sluice facilities were found to be insufficient on each floor and staff were observed to be carrying commode pans out across corridors which could cause cross infection. Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 14 The inspectors noted that ventilation is inadequate in the bathrooms. The window in the downstairs lounge requires urgent attention due to its wide opening. At present this could be accessible for an intruder to enter the premises. The small kitchens on each floor were clean and well maintained, but it was noted that opened packets of cereal were left uncovered in cupboards and must be stored and sealed in appropriate containers. At the time of this inspection a vast amount of work is being under taken place to replace pipe work and one wing of the home was closed. Some service users have moved into other vacant rooms in the building after consultation with service users and implementation of risk plans. This work is expected to take at least several more weeks and may result in some of the service users moving out of the home for a temporary period. The Commission for Social Care inspection is to be kept up to date on this issue and any proposals. Longfield H58-H09 s33052 Longfield v225815 240505 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, 28, 29 and 30 On the whole, adequate recruitment practices and checks were completed on staff to ensure the safety of service users. However, further checks should be made in respect of the employment rights of staff. The home has made good progress in ensuring that staff records are complete and development of staff is given a high priority EVIDENCE: The staff rota was sampled. Staffing levels were found to be satisfactory. The home has recruited some new staff and has appointed a second deputy post to the home, which will enhance staff supervision and development. Other senior and care worker posts were also being advertised as well as an activities coordinators post, which has become vacant. On speaking to some staff team members they felt that their development needs were responded to and that they receive regular supervision. Staff training records were sampled and there was clear evidence that mandatory training is taking place, including Adult Protection and infection control. Staff have received training in dementia care and the majority of staff have completed National Vocational Qualifications in care. Detailed induction training is in place for all new staff. Two staff personal files were sampled and contained the required documents. The manager informed the inspectors that job descriptions for staff are in the process of being updated. An issue was raised about recruitment checks and the employment rights of one staff and a requirement was made that this is followed up immediately.
Longfield H58-H09 s33052 Longfield v225815 240505 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) 31,32,33&36 The home is making progress in addressing staff issues and the manager has a development plan in place to increase staff moral and stability. EVIDENCE: The previous home manager has retuned to the home since the last inspection after completing the diploma in social work. There has been instability in the staff team due to management and staff changes with a history of some disharmony within the staff team. An independent investigation has taken place which has resulted in an action plan being implemented resulting from the requirements and recommendations of the report. A copy of this action plan has been made available to the Commission for Social Care Inspection and progress is being made. The staff stated that they felt more settled, felt happy and were supported, and that they received supervision. There is a quality assurance and monitoring system in place to monitor the quality of care provided and evidence of this was sampled. Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 17 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 3 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 2 3 x 3 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 x 2 Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 18 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 OP 8 Regulation 15(1)(2) Requirement Service users care plans must be updated with the involvement of service users , relatives/representatives and significant others. All medication administration records must be fully completed and signed by staff in respect of all medicines adminstered including external medications. Carpets must be reolaced in two bedrooms A suitable number of sluices must be made available to prevent cross infection in the home. Adeuquate ventilation must be provided in the bathrooms The window in the downstairs sitting room must be made secure Opened packets of food must be stored appropriately The registered persons must ensure adequate recruitment checks and practices regarding the employment rights of all staff. The registered persons must keep service users, relatives and the commission up to date on Timescale for action 2months 24/7/05 2. OP 9 13 (2) immediate 24/05/05 3. 4. 26 26 23(2)(d) 23(2)(K) 3months 24/5/05 3months 24/8/05 3 months 24/8/05 immediate 24/5/05 immediate 24/5/05 immediate 24/5/05 5. 6. 7. 8. 26 26 38 29 23(2)(P) 23 (2)(b) 16(2)(j) 18 9. 26 23(1) immediate 24/5/05
Page 19 Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 proposals that are being considered while the work on the water pipes is taking place. 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. Refer to Standard Good Practice Recommendations Longfield H58-H09 s33052 Longfield v225815 240505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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