CARE HOMES FOR OLDER PEOPLE
Longfield Killicks Road Cranleigh Surrey GU6 7BB Lead Inspector
Lisa Johnson Announced 07 October 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 ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Longfield Address Killicks Road, Cranleigh, Surrey, GU6 7BB 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) 01483 275505 01483 277753 Surrey Children`s Services Mrs Lisa Sharon Soper CRH Care Home 50 Category(ies) of DE(E) Dementia - over 65, 34 registration, with number OP Old age, 16 of places Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Gene Kelly, Fred Astaire and Gracie Fields units will be used exclusively for Service Users who require dementia care. 2 Accommodation and services may be provided to named persons aged 60 - 65 years with prior written agreement of the CSCI 3 Respite care may be provided to six service users within Audie Murphy unit for a period of six weeks 4 Charlie Chaplin unit will be exclusively for service users in the category OP Old Age not falling within any other category Date of last inspection 24-May-2005 Brief Description of the Service: Longfied 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 accomodates 40 residential 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 maintain ed and have disabled access. There are parking facilities at the front of building. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second inspection carried out in 2005/2006. One inspector carried out the announced inspection over seven hours. The focus of the inspection was to review any requirements made at the last inspection and to look at other required standards. A full tour of the premises took place and care plans, policies and procedures and other required documents were sampled. The inspector spoke to eight service users who live in the home and to the registered manager and five members of staff. The inspector received fourteen comment cards from service users; seven cards from relatives and five comment cards were received from health professionals. These comments are reflected in this report. The inspector would like to thank the service users and staff for their hospitality and assistance in carrying out this inspection What the service does well:
There was an open and friendly atmosphere in the home. Good relationships were observed between service users and staff. It was pleasing to see that staff have been undertaking training in dementia care and that staff are implementing these skills. Service users are being involved in tasks such as table laying and that a choice of meals are available each day where residents were seen choosing and serving themselves from dishes at lunchtime with staff also having their meals with residents. The registered manager has completed a new care plan system. Plans were detailed and included the individual’s health, emotional, personal and social needs. Plans sampled included a photograph, pen picture and were signed by service users or a representative where possible. A majority of the comments received from service users confirmed that they feel well cared for and enjoy living in the home. One resident stated, “The staff are lovely, caring”. Another service user stated, “The staff are always willing to help and they are caring”. Comments from relatives confirmed that they were happy with the care their relative is receiving. Comments received include. “We are exceptionally pleased with the care and concern for our relative, staff are friendly and courteous”. “The staff are friendly and really seem to care about my relative”. “I am very happy with my relatives care, the staff are very kind and caring”.
Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 6 One comment received from a health professional stated, “Very person-centred approach to individual residents in the home”. Staff spoken to indicate that home is running in an open management style and that they feel supported and were working together as a team. What has improved since the last inspection? What they could do better:
A requirement was made that each individual should be supplied with a written contract/ statement of terms and conditions with the home. The registered manager is currently reviewing recreational and social activities and although there are some activities that are taking place there is no structured plan available. Comments received from some service users reflect that they would like to be able to participate in more organised leisure activities. A requirement was made that the registered manager increases the activities on offer to ensure that service users have activities that matches their expectations and preferences and satisfies their social, cultural, religious and recreational needs and interests. The kitchen cupboards in the living units were in need of repair and a requirement was made that these are replaced to ensure that service users have comfortable communal areas to live in.
Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 7 Carpets in the hallway of Charlie Chaplin unit require replacing as they were found to be lifting up. One bedroom in Gene Kelly unit requires repainting and the furniture to be replaced. A toilet in Gene Kelly unit also requires redecorating. A system of regular recording of the water temperatures must be implemented to protect the safety, health and welfare and safe of service users. The environmental risk assessments in the home should be updated to ensure the health, safety and welfare of residents and staff are promoted and protected. Some gaps were found in the recording of daily fridge temperatures and a requirement was made that this actioned to ensure that the home meets with food hygiene legislation. A recommendation was made that the registered manager reviews the present staffing levels, as the home will be admitting more people into the service in the near future. The registered manager should consider highlighting the individual’s wishes in respect of dying and death on individual plans. There were some gaps on the read and sign sheets for policies and procedures and a recommendation was made that all staff should sign these. 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 ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 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 ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 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) 2 & 4 Each service user should be provided with an individual contract. Information is provided in the homes service user guide, which ensures that service users and their representative know that the home they enter will meet their needs. EVIDENCE: Each resident is provide with a copy of a service users guide and one service user confirmed that he had received a copy on admission. The guide clearly states what services the home provides. At present individuals are not issued with a contract. The manager stated that work is going on the organisation to implement these. However a requirement was made that each resident has a written contract/ statement of conditions with the home. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 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 & 11 The home demonstrated that detailed individual care plans were in place that meets the health and personal care needs of residents. Service users were protected by the homes policies and procedures for dealing with medicines. Service uesrs are treated with dignity and respect. Policies and procedures for handling dying and death are in place and observed by staff. EVIDENCE: The home has made good progress in updating individual plans. Three plans were sampled and were set out to include the individuals health, personal, emotional and social needs. All plans contained a photograph and a pen picture of each service user and were signed by the individual or representative where possible. Reviews of plans were recorded. Risk plans were in place for example the use of bed rails. Service users have access to a range of health care specialists including a local GP, chiropody; community psychiatric nurse and district nurses were seen in the home during the inspection. Referrals are made to other specialists as required including physiotherapy and occupational therapy. Comments received from three health care professionals indicate that the home works in partnership and that staff demonstrate a clear understanding of service users needs and they are able to visit in private and
Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 11 staff were observed to be knocking on doors before entering service users rooms. Medication records were sampled and a photograph of each individual was present with their records. Records were maintained appropriately and medication stored was stored adequately. There is a plan in for each service user, which states their individual wishes in respect of dying, and death and these are kept with service users main files. A recommendation was made that these are recorded on each individual plan. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 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 & 15 The home needs to increase the range of leisure and social activities in the home to ensure that the lifestyle in the home matches individuals expectations and preferences. Service users maintain links with their family and friends. Service users are provided with well-presented and balanced diets. EVIDENCE: The registered manager is presently reviewing the recreational and leisure activities and there is presently a vacant day services coordinators post. There have been increased opportunities for service users to be involved in tasks such as tea making and laying tables. A recent tea party was held and a band had visited the home and a bonfire party is being arranged. However some comments that were received indicate that residents would like some more arranged leisure activities. A requirement was made that the manager continues to review the activities programme. Service users spoken to and from comments received service users are able to maintain links with their family and friends. Some service users had their own telephones and comments received from relatives confirmed that they are made to feel welcome when they visit and they are able to see their relative in private. The lunchtime meal was seen and was nicely presented. There were two choices available which service users were able to choose from on the day. It was pleasing to see residents being supported to serve their own meals from
Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 13 the dishes provided. The meals were of a good standard and were nutritious. A variety of fruit was available which service users can help themselves to. The meal was unhurried and relaxed and some staff were also seen having their meal with service users. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 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) 16,17 & 18 The home is able to demonstrate that there is an accessible complaint policy in place and that service users and relatives will be listened to. Service users legal rights are protected. Policies and procedures were in place to ensure that residents are protected from abuse. EVIDENCE: There have been no complaints received since the last inspection. Two residents spoken to were clear that they new who they could talk to in the home if they had a complaint or concern, which was also confirmed by the majority of comments, received. Service users were provided with the opportunity to participate in the election by being able to vote. There was one matter that was referred to the local authority under the protection of vulnerable adults and this issue has now been resolved. Two staff members spoken to confirmed that had attended protection of vulnerable adult training and a whistle blowing policy was in place. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 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, 20,22,23,24, 25 & 26 Some improvements are needed to improve the communal areas of the home to ensure that residents have a comfortable place to live. Service users are provided with specialist equipment they require to maximise independence. The home was clean and hygienic. Action is required in responding to the ventilation in one bathroom. EVIDENCE: There has been extensive building work in the home to replace water pipes, which has now been completed. Progress has been made in improving some of the décor and a number of carpets have been replaced in bedrooms and communal areas. However kitchen cupboards were found to be in need of repair and a requirement was made that these cupboards are replaced in all units to ensure that service users have a comfortable communal areas to live in. A toilet in Gene Kelly unit needs to be repainted. A requirement was made that a corridor carpet is replaced in Charlie Chaplin unit as this were coming away from the
Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 16 floor in places. This is to ensure the health and safety of residents and staff in the home. Service users had a range of personal possessions on display in their rooms and some rooms have been decorated. A requirement was made that the furniture and redecoration takes place in one bedroom in Gene Kelly unit to ensure that service users have a comfortable bedroom to stay in. The home provides a range of specialist equipment to assist residents to maintain independence and this included seat raisers, assisted baths, grab rails, pressure relieving mattresses, wheelchairs, lift and stair lift. The home is currently working with the dementia training team and is currently responding to looking at environmental adaptations for individuals who are supported with dementia. A further requirement was made in respect of one bathroom that has inadequate ventilation. Emergency lighting is in place and work has been completed and serviced to replace all of the pipe work. Records were in place for maintenance checks. The home was clean and hygienic and ample hand washing facilities were available. Infection control policies and procedures were in place. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 17 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, 30 The staffing levels were adequate to meet the needs of the residents. Staff are supported to undertake training and development to ensure that they are competent to carry out their job. EVIDENCE: The staffing levels were adequate at the time inspection, as well as the registered manager there were two deputies and eight carers on duty plus ancillary and catering staff in place. At nighttime there are three staff on duty. At present the home has a number of service user vacancies but a recommendation was made that the home should consider reviewing the staffing levels if the number of service users increase. Staff have completed a range of training including mandatory training and have been receiving impact training and a rolling programme for dementia care is taking place Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 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) 31,32,34,35, 37 & 38 The registered manager is able to demonstrate that the home is run in an open and inclusive atmosphere. Feedback from service users is gained to ensure that their views on the service are heard. Suitable accounting procedures are in place and service users financial interests are safeguarded. There are some health and safety issues to address to ensure the safety, health and welfare of service users and staff are promoted and protected. EVIDENCE: The registered manager is experienced and holds the Registered Managers Award. Staff spoken to stated that the home was run in an open atmosphere and that they felt supported by the manager. Significant progress has been made in the team working in the home and moral has improved. Staff spoken to felt supported and were observed to be motivated. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 19 The responsible individual visits monthly to carry out a quality visit and outcomes are recorded. A poster was present announcing the inspection from the Commission for social Care Inspection. The organisation maintains an overall business and development plan but the registered manager holds a budget for the home, which was sampled and that she is able to submit proposals for the home. There is a finance administrator employed by the home who maintains records of service finances and were maintained adequately. A range of up to date policies and procedures were in place and records were maintained adequately and stored appropriately. Policies and procedures are discussed at staff meetings and a read and sign system is in place. A recommendation was made that the registered manager should consider ensuring that all staff sign that they have read the policies as some gaps were found. A range of health and safety procedures was sampled; the fire book and accident records were maintained satisfactorily. Accident, food hygiene and manual handling procedures were available. Infection control and COSHH systems were in place. However there were gaps in records of the daily fridge temperatures. A requirement was made that the temperatures are recorded daily to comply with food hygiene legislation. Environmental health and safety risk assessments need to be updated and the home must implement a system to regularly record water temperatures. Requirements were made and this is to ensure that the health, safety and welfare of service users and staff are protected and promoted. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 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 2 x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 2 x 3 3 2 2 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x 3 3 x 3 2 Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 22 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 2 Regulation Requirement Timescale for action 07/12/05 2. 19 3. 19 4. 19 5. 24 6. 25 7. 8. 38 38 9. 38 10.
Longfield 12 Service users must be provided with an individual contact/ statement of terms and conditions with the home 23(2)(b) A carpet must be replaced in 07/11/05 Charlie Chaplin unit to ensure the safety of service users and staff 23(2)(b) The kitchen cupboards must be 07/12/05 replaced in all the living units to ensure that service users have comfortable communal areas to live in 23(2)(b) A toilet needs to redecorated in 07/12/05 Gene Kelly unit to ensure that service users live in a well maintained enviroment. 23(2)(b) A bedroom in gene Kelly unit 07/12/05 must be redecorated and furniture replaced to ensure that service users have comfortable bedrooms to live in. 23(2)(p) The ventilation in one bathroom 07/11/05 must be addressed to ensure the well being of service users and staff(Previous timescale 24th August 2005 not met) 16(2)(j) The temperature of the fridge immediate must be recorded daily to adhere 07/12/05 to food hygeine regulations. 13(2)( c ) The registered manager must 21/10/05 introduce a recording ststem for regular monotoring of the water temperatures. 13(4)(a)(c The registered manager must 07/12/05 ) update the enviromental risk assessments to ensure the health, safety and welfare of service users and staff are promoted and protected. 16(2)(m) The registered manager must 07/11/05 review the social and leisure ho9 h58 s33052 longfield v242552 071005 stage Version 1.40 Page 23 activities to ensure that service 4.doc users have a range of activities that meet their preferences and needs. 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. Refer to Standard 11 27 38 Good Practice Recommendations The registered manager should consider recording individual wishes of service users in respect of dying and death on their individual plan. The registered manager should consider reviewing the staffing levels when more service users are admitted to the home. The registered manager should consider ensuring that all staff sign that they have read the homes policies and procedures. Longfield ho9 h58 s33052 longfield v242552 071005 stage 4.doc Version 1.40 Page 24 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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