CARE HOME ADULTS 18-65
Longlast Thorpe Road Carlton Stockton-on-Tees TS21 1DR Lead Inspector
Neil McKenzie Key Unannounced Inspection 8 and 23rd June 2006 09:30
th Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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 Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Longlast Address Thorpe Road Carlton Stockton-on-Tees TS21 1DR 01740 631391 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) Annfield Care Mr Kevin Paul Teasdale Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of persons shall not at any one time exceed 9 adults with learning disabilities 15th November 2005 Date of last inspection Brief Description of the Service: Longlast is a nine bedded home which is registered to provide care to people with learning disabilities. The home is situated in a rural setting, on the outskirts of a village. Accommodation for the residents is provided in spacious single bedrooms, two of which have en-suite facilities, and there are three lounges/day rooms offering ample shared space. The building has been converted to enable it to offer spacious accommodation for the residents, and is set in its own grounds, with a large enclosed garden at the rear of the house. Transport is provided by the Proprietors, which enables residents to use the amenities of the village, as well as those further a field. The transport is also used for residents to experience regular outings and outside activities. The current scale of charge falls between £462.00 and £986.00 per week. There are additional charges for hairdressing, chiropody, personal items and petrol for travel. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home was contacted 24 hours before the inspection. The inspection lasted for 7 hours and this included 2 visits to the home. The reason for the inspection was to see how good a job the home does in meeting the National Minimum Standards set by the government for Care Homes. During the visits the inspector spoke to residents and staff to find out what their views were about living and working at Longlast. The inspector also spent time speaking to the new Home Manager and the person responsible for supporting the new Home Manager and a Care Manager who supports two residents living at Longalst. The inspector spent some more time watching how staff and residents are with each other. A tour of the home took place and records looked at included staff recruitment and training, resident care plans and how the home handles medication and money for residents. There was also questionnaire’s sent to the home, residents and relatives and these were looked at to help decide how good a job the home does in meeting the National Minimum Standards. What the service does well:
The home on the whole does a good job in meeting the National Minimum Standards. The two questionnaires returned from relatives showed they were pleased about the home and residents said a lot of good things about living at Longlast. For example one resident stated how comfortable she was with staff, ‘I love talking to staff, they listen’. A Care Manager working with 2 residents living at Longlast stated, ‘both are doing really well’. The inspector also noticed how relaxed staff and residents were with each other and how they helped each other with the shopping and looking after the home. Residents’ who live at Longlast appear to get involved in things happening at the home. The residents live in a pleasant home that is well looked after and kept clean and tidy. Residents also have bedrooms that have lots of their personal belongings as well as plenty of communal space to spend time in. This includes large gardens that are well maintained. The home is good at working with residents and relatives to find out what their views are on living at Longlast. The home not only finds out what these views are but also takes action to make things better. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 6 The home is also good at working with other people to look at ways of making things better for residents living at Longlast. This includes staff having ongoing training with other professional people to help them support residents in new and different ways. As one professional who works with 2 residents living at the home stated, ‘Manager and staff are very positive and open to new ideas’. What has improved since the last inspection? 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.
Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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 Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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 The quality in this outcome area is good as residents’ benefit from comprehensive assessment of needs and care plans. This judgement has been made using available evidence from resident plans of care and care records. EVIDENCE: Care plans and care records examined contained detailed assessments of the residents’ original needs by qualified professionals and these original assessments contained evidence of updating as the residents’ needs change. At the time of the inspection two of these updates on the original needs assessment that is held every 12 months were not available on the resident files. However, these had been requested by the home and this was confirmed by a Care Manager who stated, ‘Care Plan reviews had been done but not posted’. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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): 6,7 and 9 The quality outcome in this area is good. Residents’ wellbeing is promoted by their detailed plans of care. This judgement has been made using available evidence from resident files, discussion with staff and observing staff interacting with residents. EVIDENCE: Evidence was in place in the files examined that relatives and residents had been consulted about the content and in particular any risks for a resident that may require actions by staff. As one resident stated, ‘ I get involved with my care plan records’. Each care plan also included detail on how best to support a resident with information on, for example, how to assist with any difficult changes in behaviour. For example, staff receiving specific training from specialist and qualified professionals to help them support residents in different ways. As one staff member commented, ‘ we have just done two day training with Behavioural Team, end product is to try to help a resident get more involved in the community’.
Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 10 There is evidence from records in care plans that show the home also works hard to reflect the wishes of residents and to help them make choices about their care, diet and activities. For example, eating and drinking ‘likes and dislikes, diet plans, daily activity plans and wearing cloths that they have chosen for themselves. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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): 12,13,15,16 and 17 The quality outcome in this area is good. Residents are supported to take part in a wide range of activity in the home and further a field. Resident’s dietary needs and choices are well catered for and relatives and friends are encouraged to maintain contact. EVIDENCE: The manager provided the inspector with a summary list of the range of activities undertaken by residents at the home. Opportunities for activity are available not just at the home but further a field. This is helped by residents’ having access to two people carriers that provides more choice when planning an activity. Individual cultural activity is also promoted with one resident attending a temple every month and a local cinema that regularly shows films from his country of origin. These activities include different holidays for different residents with one resident going on holiday to his country of origin. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 12 Discussion with the new manager and a Care Manager involved with 2 residents at the home suggested that there could be more structured activity for some of the residents. This structured activity could help the home meet some of the specific needs of residents as well as introduce them to some new skills. Questionnaires returned by family members said they are made welcome in the home and able to spend time privately with their relatives. Evidence was available in residents’ bedrooms and care files of family involvement with activities and holidays. There is a lot of evidence from records in care plans that show the home works hard to reflect the wishes of residents and to help them make choices about their care, diet and activities. Interviews with staff and observation during the inspection demonstrated that staff is good at observing and noting resident preferences when they were expressed. For example, residents and staff had returned from shopping and the shopping trip involved residents and included items that residents had chosen to eat. Staff also stated with regard to personal care that residents have a choice as to which staff member they have to help, ‘they are always allowed to go to the person most comfortable with’. Records demonstrate the specific dietary needs are included in resident care plans as well as their likes and dislikes. On one visit the inspector joined in for lunch and this was a very tasty chicken and mushroom casserole followed by fresh baked apple and raisins. This meal is part of a rolling menu programme that according to staff the residents chose. As one resident said, ‘I like the food and helping cooking and shopping’. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 13 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, 19 and 20 The quality in this outcome is good. Residents receive high levels of support based on individual needs with health care improved by the use of personal health ‘green monitoring’ cards and specialist health workers. Residents’ well being is promoted by effective storage and administration of medication. EVIDENCE: It was observed that staff work hard at meeting the emotional and physical needs of residents and this is reinforced by the use of ‘green monitoring’ cards to help residents keep their health appointments. Records in files looked at and discussion with the manager referred to specialist health professionals for support and advice. This involves specialist staff training by health professionals to help residents cope with some of their complex behaviours in a better way. As one staff member commented, ‘ we have just done two day training with Behavioural Team, end product is to try to help a resident get more involved in the community’. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 14 During the inspection the home’s arrangements for receiving, storing, administering, recording and returning resident’s medication were examined and discussed in depth with the manager. At the time of the inspection visit, medication was seen to be correctly stored with accurate records for the medication held. The manager was able to show and describe how medication is received and disposed of and how this is recorded. The manager said that staff who administer medication only do so after completing a safe handling of medication course. Staff files looked at contained certificates to show that they had undertaken the training. Individual residents’ medication record sheets contain photographs of the person to help ensure that residents receive the correct medication. Whilst the home is also good at looking after resident’s medication and making sure that they get the right medication this would be better if the home had an up to date medical book called the ‘BNF’. This book is for staff to look at when they need to find out more about medication for residents. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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 The quality outcome in this area is good. This judgement was based on evidence provided by interviews with staff and relative survey and sampling resident financial transactions. Staff understood adult protection issues and relatives confirmed they know how to make a complaint; and this protects residents. EVIDENCE: Staff interviewed presented as clear about adult protection, and they said they had received training in adult protection and knew how to access policies and procedures. One staff member stated that ‘recently completed Protection of Vulnerable Adults Training’. This was also documented in staff training files with certificates to verify that staff had done the training. Relatives confirmed in their questionnaire that they know how to make a complaint. This was encouraged by the home with pictorial complaints procedure displayed in the home and kept in resident files. There have been no complaints and or investigations with regard to Adult abuse since the last inspection. A random sample of resident’s personal allowances and records were examined and there were no discrepancies with the balance stated on the transaction sheet and the actual amount contained in the individual money envelope. The transaction is made more robust by ensuring that there are two signatures recorded on the transaction sheet.
Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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 and 30 The quality outcome in this area is good. This judgement was in part evidenced by a tour of the premises and the pre-inspection questionnaire. EVIDENCE: A tour of the home showed residents living in a pleasant, comfortable home that is well looked after and kept clean and tidy. Maintenance and associated records requested by the inspection completed as up to date in the preinspection questionnaire by the manager. Residents also have bedrooms that have lots of their personal belongings as well as plenty of communal space to spend time in. In addition resident’s benefit from large gardens that are also well maintained. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 17 Although the home is on the whole a safe place for residents to live in, it must be made safer by making sure that the risk of residents walking into the unlocked laundry room and scolding themselves on the hot water tap is made good. Also the gas tanks in the garden need to be noticed by residents and visitors as a possible danger. The home presented as clean and hygienic. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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): 32,34 and 35 The quality outcome in this area is good. Residents are supported by a welltrained staff team and made safe by good recruitment practice. EVIDENCE: The recruitment files of 3 staff were looked at. All files contained application forms that were backed up by two written references. Evidence was in place to show that Criminal Records Bureau disclosures at Enhanced level had been received for the staff members prior to them starting work in the home. Staff training files contained evidence that new staff members receive an in house induction and certificates showing that staff receive training specific to resident needs. As one staff member said,‘ we have just done two day training with Behavioural Team, end product is to try to help a resident get more involved in the community’. At the time of the inspection 62 of the staff had completed National Vocational Qualification (NVQ) in Care. The 3 staff files looked at contained certificates in NVQ. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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): 37, 39 and 42 The quality outcome in this area is good. This judgement has been made using available evidence including discussion with the manager, the internal monthly audit, business plan and the pre-inspection questionnaire. The home has a new manager who is in the process of registering with Commission for Social Care Inspection (CSCI). Residents’ views are sought after by monthly meetings and promoted by an annual relative survey. Health and safety records are up to date. EVIDENCE: During the inspection the new manager demonstrated her knowledge of the home and its operation. This is helped by the new manager who has worked prior to her appointment in the same home and is now in the process of registering with CSCI and is to start a NVQ in care at Level 4. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 20 The home has a system in place to seek the views of residents and their families about the running of the home. This was documented by monthly meetings involving residents and surveys returned and completed by relatives of residents. Information from these surveys is used in the home’s business plan. All residents who returned the CSCI survey said they were made aware of the inspections of the home and have access to the reports. Health and Safety records completed by the new manager in the pre-inspection questionnaire were documented as up-to-date. Longlast DS0000000010.V299632.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 22 No 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 YA24 Regulation 13 (4 Requirement The home must make sure that the laundry room is made safe as residents could scold themselves from hot water and the gas tanks in the garden are noticed by residents as a potential hazard The home must ensure the new manager registers as responsible and fit person with Commission for Social Care Inspection Timescale for action 23/06/06 2. YA37 8 (1) 30/07/06 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. 2 Refer to Standard YA20 YA13 Good Practice Recommendations The home should ensure that staff have access to an up to date BNF dictionary on medication to refer to The home should explore more structured day activity for some of the residents Longlast DS0000000010.V299632.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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