Inspection on 24/01/06 for Longhouse

This inspection was carried out on 24th January 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Longhouse 06/12/07

Longhouse 28/09/06

Longhouse 28/01/05

Longhouse 05/07/04

Longhouse 20/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Longhouse 6 Whitehouse Park Cainscross Stroud Gloucestershire GL5 4LD Lead Inspector Peter Still Unannounced Inspection 24th January 2006 09:40 Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 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 Longhouse DS0000032212.V272425.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 Adults 18-65. 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. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Longhouse Address 6 Whitehouse Park Cainscross Stroud Gloucestershire GL5 4LD 01453 765647 01453 753838 Amanda.Henderson@gloucestershire.gov.uk 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) Gloucestershire County Council Mrs Amanda Carolyn Henderson Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th September 2005 Brief Description of the Service: Longhouse is a purpose built residential care home providing a respite service for adults with a learning disability. The home is owned and managed by Gloucestershire Social Services Department and is registered to accommodate 5 respite service users. The accommodation is spacious, providing ample communal living areas, including a lounge/diner with snack and drink making facilities and two smaller lounges. Service users have single accommodation with wash hand basins. Separate toilet and bath/shower facilities are nearby. Service users have access to an area of level garden, which has ample seating and tables. There is also a swimming pool, which is maintained and regularly used by service users. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over four hours and the acting manager was able to support the inspection. No residents were at the home during the inspection. A tour of the building was completed. Two files were specifically used to case track the standards inspected and other home files were also reviewed. What the service does well: What has improved since the last inspection? What they could do better: Care planning needs further work to tighten the system and ensure administrative detail is completed and up to date. A number of matters concerning the administration of medication needs further work. Environmental matters must be addressed. The provider must undertake regulation 26 visits, with reports sent to the CSCI. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 6 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. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Whilst there was good information to ensure suitability and also a careful admission process, not all information was complete, which may present a risk to residents. EVIDENCE: Two files were case tracked and there was detail about past history and needs. There was also good assessment completed by the home. A comprehensive approach was taken to ensure the prospective resident would be happy with the Respite placement. This included a trial visit with assessment, followed by two “tea/day” visits and then an overnight stay. The home was focused on ensuring positive admission and the format of admission was very flexible; one example was of a very extended admission process to ensure the resident did not feel pressured to staying at the home. The admission details for one resident did not have contact details so staff may have had difficulty finding the information. One referral did not have the sections: Reason for referral or Aims of referral completed. It was said that work was underway to bring files up to date and this must be completed. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8 Care plans contained good recordings but not all were up to date and mistakes and lack of detail may put residents at risk. Residents need opportunities for consultation about life at the home. EVIDENCE: Four care plans were reviewed and two were case tracked. Evidence of good recording was seen, including thorough detail. One had been recently reviewed and was up to date in all respects. A risk assessment for a section about social activity was comprehensively recorded and up to date in terms of review. Another risk assessment was also clear and detailed. Some files were found to have mistakes and lack of information or clarity of understanding. Points of concern included: a date was missing within a management section; a risk assessment had no detail about the risks; a risk assessment about the swimming pool was unclear concerning supporters; a risk assessment about manual handling had not been completed; a file lacked information needed concerning seizures. A review of staff supervision files found a significant record about a resident, where there had been key worker discussion. The record was important and well recorded but the information may be lost if not replicated within the care file and this must be addressed. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 10 Files all contained an index but the file tabs had no corresponding numbers and were a little difficult reference. The acting manager was aware of the need to bring care files up to date and a positive step had been taken in the provision of more time to complete the task, which was under way. There was no recent written evidence of consultation with residents to ensure they were included in all aspects of life in the home. It was understood that a member of staff had been sick and that meetings with residents would begin again soon. The last minutes were dated 15/06/05. This standard must be considered and ways found to ensure residents can participate in all aspects of life at the home. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15, 17 Residents had choice and a range of activity to enjoy. Residents have friends and supporters who visit. A healthy diet was provided. EVIDENCE: An imaginative range of activity was being provided, meeting individual wishes. Activity included: shopping; visits to the pub and cinema and the local railway station. Records about activity were held on resident’s files. A record of ideas and suggestions was also kept. Families and supporters were very involved with the home and some residents had particular friends who visit. A good record of “Eating and drinking” was maintained and two files showed evidence of a very detailed list of likes and dislikes, one list was very lengthy. Past records of menus were reviewed showing a balanced diet and fruit was available. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 A resident who presents a challenge to the service was being specifically supported in the way they wished. The system of medication had been strengthened since the last inspection and action had been taken on points raised. However, further work was needed to ensure protection for residents. EVIDENCE: One resident had specific needs concerning their environment and this had been addressed with the removal of items from the environment. Medication errors and procedures for safe practices had been identified as a key matter of concern within the last inspection report. Many specific issues have been addressed and a number of new systems and protocols were in place though evidence was found that further work was needed. However, it was clear that senior staff at the home had taken on board the need to improve the systems and had taken many steps to make improvements. Since the last inspection the home had properly communicated two further medication errors to the CSCI. Since the last inspection a new system of counting medication before and after medication was given had been implemented and two staff sign the procedure. Generally, a junior member of staff is the second signatory and checks the work of the authorised staff member. A new form had been produced for this Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 13 purpose of observing the administration of medication. Also since the last inspection, the home had obtained the March 2005 edition of the Gloucestershire Medication Administration in Residential Care Homes document and this was posted up on the front of the medication cupboard. The home manager had also produced a document guide for staff, dated December 2005, which was easy to read and covered key aspects. This was considered to be a good step. All protocols should have the date they were produced and a date for review. The medication record for one resident was not dated and had no date for review or change and the medication signatures section failed to have a complete date. A resident diary record of 10/10/05 contained good recording but did not have any file follow up concerning an incident about a tablet and no evidence of a regulation 37 report. This indicated the possibility of risk to a resident and the need for a tighter system, which includes an outcome to matters of concern. There was only one current medication for a resident being kept in the locked cupboard. The container was not the container of origin and it was not totally clear what type of medication it was. The tablets looked very similar to another container of vitamin tablets. A label was stuck to the medication container with the signature of a supporter stating the medication was to be hidden in food. There was no evidence that the home had followed up a letter from the GP concerning the matter dated 26/07/05, which could pose a risk about consent. There was also no statement in the care plan concerning ‘best interests’. Action must be taken to ensure all necessary steps are taken, with clear chronological recording with outcomes to all points raised. It was also noted that the new home policy concerning this matter had not been followed. It may be helpful for the home to ensure a copy of the Royal Pharmaceutical Society of Great Britain publication is held for reference in the medication cupboard. The system for recording medication provided key information but points from the last inspection had not been implemented. The name of the home should be included on the top of the form. There should be a box to include medicine allergies and the date recorded at the top of each administration column, rather than just the start date. Dose directions should be emphasised including the stated number of tablets and weight of active ingredient. A controlled drug record book was needed, as well as one for the disposal of medication. Some dressing and first aid materials in the cupboard needed to be sorted out. The homely remedies list must be definitive and all items held must be fully recorded. The British National Formulary should be replaced with the September 2005 edition so that staff have access to an authoritative reference. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 14 Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Information about making a complaint was available for residents. Residents must be helped to make their views known. The Home must seek the views of residents Staff must have training so they can understand adult protection to safeguard residents. EVIDENCE: Information about making a complaint was posted up for residents to see and any complaints would be held within resident’s files. Symbols were used to aid understanding. It was understood there had been no complaints since the last inspection. More work was needed so the home can be sure residents are listened to and action is taken to address issues. Staff need to be provided with training, so they have a confident understanding of abuse, its signs and also understand the importance of “No Secrets” and the homes policy and procedures. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Parts of the home were comfortable however the need to take away furniture and equipment on a temporary basis made the home look stark. Some maintenance and health and safety work must be addressed. The home was clean and hygienic. EVIDENCE: Due to the needs of a resident, fire extinguishers in communal areas and parts of the home, which were not locked, had been temporarily removed and the Fire Protection Service should be consulted to ensure the arrangements are satisfactory. The home has a fire exit through two double doors, which used to be the main entrance. Both doors had loose keys in the locks and chains, which were not attached. The acting manager agreed to attach the keys to the chains before the end of the inspection day and the inspector talked with the Fire Protection Service, who said they would consider the matter further with the provider. A resident’s bedroom had a pendant light fitting and the bulb had been removed. It was understood that the resident was not tall enough to put fingers into the fitting, which may be live. A thorough risk assessment of this should be completed and the Environmental Health department would be able to provide guidance concerning health and safety. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 17 The block floor of the dining room was in need of refurbishment. The kitchen floor should be replaced and it was understood that action was being taken to address this. The kitchen was of a commercial type and it may be possible to make some improvement, when dealing with the floor, in consultation with Environmental Health. The floor to the main toilets was also in need of attention, however the doors to the WC’s were not of the floor to ceiling type and consideration should be given to this. An adjoining part of the registered building not in current use had two selfcontained flats. One bathroom had leaking taps and one bath was badly stained and must not be used until the problem is resolved and the bath replaced or rejuvenated. Bedroom 3 within the main part of the home had suffered serious water damage and was undergoing extensive works. The problem had been solved and new plasterwork was drying. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 36 The home has exceeded the standard requiring qualified staff to support residents. Staff receive regular supervision. EVIDENCE: The standard concerning the qualification of staff with NVQ Level 2 or above had been exceeded by the home, the staff team had done well to achieve this. The current situation was as follows: 5 staff with NVQ Level 3; 3 staff with Level 2; 2 staff with level 4 and the acting manager was completing Level 4; 2 staff were due to start their NVQ in April and 1 had just started. The acting manager showed the Inspector the home’s staff training matrix to evidence the range of training staff were provided with, including future training. Two staff had unfortunately been away from the home due to lengthy sickness over the last twelve months however the staffing had become satisfactory and agency staff were not used frequently; there were no staff vacancies. Two staff files were read and found to contain the information required. Supervision notes were thoroughly recorded, though one had not been signed. Supervision was on an eight weekly basis. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39 The provider must ensure unannounced regulation 26 visits are undertaken to protect residents. A quality assurance system must be developed so that residents can be confident their views underpin self-monitoring and future practice of the home. EVIDENCE: The last regulation 26 visit to the home and submitted to the CSCI was dated 10/08/05. The acting manager was unable to locate a file of the visits, which must be available. The reports of the unannounced visits must be sent to the CSCI each month. The home, which is very small, has three offices. It is important to ensure that staff are very clear about where information they need is located. There was some difficulty in finding information on the day of inspection and it may help to review where documentation is held and of a simple referencing system so that anyone can be clear about location. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 20 The home needs to establish a quality assurance programme, which involves people who stay for respite, their supporters and others who are important. Meetings with residents were due to be established again on a regular basis and this would be a part of the process. A range of approaches must be taken to gather information, which must be analysed and reported back so that people can be fully engaged in the process. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X 3 X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 2 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X X X 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Longhouse Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X 2 2 X X X X DS0000032212.V272425.R01.S.doc Version 5.0 Page 22 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 YA41 Regulation 17 Requirement Maintain up to date, accurate and complete records concerning residents. Ensure residents are listened to and consulted on and participate, in all aspects of life in the home. The registered manager must ensure that complete and accurate records relating to the receipt, administration and disposal of medicines are always made on the Medication Administration Records and Medication Plans. (Previous timescale of 09/08/05 not met) Medication must be provided from the original container of origin Provide training for staff concerning adult protection. Ensure the environment DS0000032212.V272425.R01.S.doc Timescale for action 31/03/06 2 YA8 12 (3) 02/06/06 3 YA20 13(2) 31/03/06 4 YA20 13(2) 24/02/06 5 6 YA23 YA24 13(6) 23 02/06/06 02/06/06 Page 23 Longhouse Version 5.0 is in good order. 7 8 YA24 YA39 23 26 Ensure the premises are safe for residents. The provider to undertake monthly, unannounced visits to the home and complete a report, which is available at the home, with a copy sent to the CSCI. Provide an effective quality assurance and monitoring system. A matter of consent about medication must be followed up with an agreed outcome recorded. 24/02/06 03/03/06 9 10 YA39 YA20 24 13(2) 29/09/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations An up to date edition of the British National Formulary to be available in the home. Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Longhouse DS0000032212.V272425.R01.S.doc Version 5.0 Page 25 - 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. 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