CARE HOMES FOR OLDER PEOPLE
Longfield Preston New Road Billinge End Blackburn Lancs BB2 6PS Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 6th December 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 Longfield DS0000005829.V255575.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. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Longfield Address Preston New Road Billinge End Blackburn Lancs BB2 6PS 01254 675532 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) Longfield (Care Homes) Limited Mrs Tina Hegarty Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24) Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. A maximum of 24 service users requiring personal care who fall into the category MD(E) A maximum of 24 service users requiring personal care who fall into the category DE(E) 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 Booklet 7 - 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. That, when the number of service users accommodated at the Home falls below 21, the maximum number of service users to be accommodated at the Home shall be 20, providing the staffing levels set out in condition 3 are complied with. 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 paragrapg 3 above) the staffing levels imposed by the CSCI following such discussion be complied with. The service must, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI 13th July 2005 4. 5. 6. Date of last inspection Brief Description of the Service: Longfield Care Home provides 24 hour long term personal care for up to 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 accessible 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 accessible by public transport. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours. No additional visits have been made since the last unannounced inspection. At the time of this inspection 21 residents were living at the home. 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 manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
Risk assessments relating to falls and nutrition must be completed for all residents. The weight of each resident must be checked every month or more often if a resident is losing weight. Care plans must be reviewed monthly and updated when the needs of the resident change. The resident or their relatives must be involved in care planning. This will ensure that the care needs of all residents are fully met. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 6 To prevent errors in the administration of medication written instructions should be in place explaining when medication prescribed ‘when required’ should be given. All hand written instructions on the medicines administrations records should be signed and witnessed. The manager was advised to check and record daily the temperature of the rooms where medication is stored. This will make sure action is taken to prevent the deterioration of medication should the temperature of these areas exceed 25 degrees Celsius. To protect residents from abuse recruitment procedures must be thorough. Two written references must be obtained for all new employees before they start working at the home. References supplied by the manager for staff she has worked with previously are unacceptable. All prospective employees must complete an application form. All members of staff must be supported in their work and career development by regular formal supervision six times a year. This should improve motivation and the standard of care at the home. 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 DS0000005829.V255575.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 Longfield DS0000005829.V255575.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): EVIDENCE: None of these standards were assessed. Standard 3 was assessed and met at the last inspection. Standard 6 is not applicable to this service. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9 Detailed information relating to all aspects of health care was not included in some care plans. This meant that there was the potential for some health care needs not to be fully met. EVIDENCE: The individual care plans of three residents were inspected. These plans identified the personal care needs of each resident and explained how these needs were met. However, not all care plans contained falls and nutritional risk assessments. One resident who had lost weight had not been weighed since August and the care plan had not been updated to address this problem. Care plans and risk assessments were not reviewed monthly and there was no evidence to suggest that residents or their relative had been involved in care planning. A report about the care given to each resident was written during each shift. Records of the visits of other healthcare professionals e.g. chiropodist, GP etc were included in the care plans. Appropriately trained members of staff were responsible administering medication. Although medication was stored correctly the manager was advised to check and record the temperature of this area daily. Records relating to the management of medication were seen. Hand written instructions on the medicines administration records were not signed and
Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 10 witnessed. Written instructions should be available for individual residents stating when medication prescribed ‘when required’ should be given. During the inspection members of staff were observed attending to residents in a polite and friendly manner. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 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 the following standard(s): 15 The meals were wholesome and menus were varied. EVIDENCE: The meal served at lunchtime looked wholesome and appetising. The menus were varied and alternatives to the set meal were readily available. Lunchtime was unhurried allowing residents time to chat and enjoy their meal. Members of staff were observed assisting residents in a sensitive and patient manner. A meal was kept warm for a resident who was asleep at the time the meal was served. All the residents asked said they had enjoyed their lunch. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 Complaints would be taken seriously and investigated. Appropriate procedures were in place to ensure the protection of residents at the home. EVIDENCE: A complaints procedure was in place. This had been amended to explain that complaints could be made directly to the Commission for Social Care Inspection. No complaints have been made to the home or the commission since the last inspection. Policies and procedures relating to the protection of vulnerable adults were in place. This issue was discussed with three members of staff. They were aware of the procedure and said they would report any concerns immediately. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 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 the following standard(s): 19 The home was clean, comfortable and well maintained. This meant the residents had a homely place to live. EVIDENCE: At the time of the inspection the home was clean, free from offensive odour and well maintained. This provided a safe and comfortable environment for the residents. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 14 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, 28, 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. 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. Six members of staff, including the manager, had been appointed since the last inspection. The files of two of these employees contained evidence that all the required pre-employment checks had been completed prior to appointment. The other three files contained only one written reference. Moreover, the manager had supplied two of these references for employees she had worked with previously. Two of these employees had not completed application forms. It was evident from discussion with the manager that training for all members of staff was a priority. Induction training was in place but this needed further development in order to meet the current standards of the National Training Organisation. Several members of staff had received training in dementia care, medication and infection control. Five members of staff had achieved NVQ qualifications and seven were working towards these. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 15 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): 31, 33, 35, 36, 37 and 38 Residents and their relatives were consulted about the quality of the care and services provided at the home. Appropriate procedures and training were in place to safeguard the health, safety and welfare of residents. EVIDENCE: The recently appointed manager had completed NVQ levels 2 and 3 in care and was working towards level 4. The manager was advised to complete the application forms to become the registered manager and return them to Commission. The home achieved the Blackburn with Darwen Social Services Quality Assurance Award. The assessment procedure involved obtaining the views of residents, relatives, friends and staff. An action plan had been developed to address any outstanding issues. An annual development plan was in place. Anonymous satisfaction questionnaires were given to residents periodically.
Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 16 Records of transactions involving resident’s money were seen. However, resident’s personal allowance was pooled in a section of the Longfield bank account. Individual records of the amounts deposited and withdrawn were seen. All members of staff had an annual appraisal. Records to support this were seen. The manager explained that she was in the process of implementing formal staff supervision and a system for recording this was seen. However, a member of staff consulted during the inspection had not received any formal supervision. A member of staff qualified to administer first aid was on duty for all shifts. Training in moving and handling and fire safety had taken place and was ongoing to ensure all members of staff had attended. Records of the routine servicing of equipment were seen. Up to date records of fridge, freezer and food temperatures were not available. A record of the food provided for individual residents was not kept. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 2 2 Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4)(b) (c) Requirement The registered person shall ensure that (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risk the health or safety of service users are identified and so far as possible eliminated. A falls risk assessment must be completed for each resident. Timescale for action 30/12/05 2 OP7 15(2)(b) (c)(d) The registered person shall – (b) 27/01/06 keep the service user’s plan under review. (c) Where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s care plan; and (d) notify the service user of any such revision. All care plans must be reviewed monthly and updated when the resident’s needs change. Resident’s or their relatives must be involved in care planning. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 19 3 OP8 12(1)(a) (b) The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. A nutritional risk assessment must be completed for each resident. Resident’s weight must be monitored. The registered person shall not employ a person to work at the care home unless (b) he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 7 of schedule 2 Prospective employees must complete an application form. Two written references must be obtained before a new employee starts working at the home. References supplied by the manager are unacceptable. (Timescale of 13 July 2005 not met) The registered person shall ensure that persons working at the care home are appropriately supervised. All care staff must have formal supervision six times a year. Records of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and any special diets prepared for individual service
DS0000005829.V255575.R01.S.doc 30/12/05 4 OP29 19(1)(b) Schedule 2 06/12/05 5 OP36 18(2) 31/03/06 6 OP37 17(2) Schedule 4 06/12/05 Longfield Version 5.0 Page 20 users. Accurate records of the food provided must be kept for all residents. (Timescale of 18/11/05 not met) 7 OP38 13(3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Fridge, freezer and food temperatures must be checked and recorded daily. 06/12/05 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 Refer to Standard OP9 OP9 OP9 OP30 Good Practice Recommendations The temperature of the area where medication is stored should be checked and recorded daily. Written instructions should be in place for individual residents stating when medication prescribed when required should be given. All handwritten instructions on the medicines administration records should be signed and witnessed. The induction programme should meet the standards set by the National Training Organisation. Longfield DS0000005829.V255575.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington 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 DS0000005829.V255575.R01.S.doc Version 5.0 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!
