Inspection on 12/06/08 for Longmead Court Nursing Home

This inspection was carried out on 12th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 but made no statutory requirements on the home.

Other inspections for this house

Longmead Court Nursing Home 22/05/07

Longmead Court Nursing Home 12/06/06

Longmead Court Nursing Home 07/03/06

Longmead Court Nursing Home 26/09/05

Longmead Court Nursing Home 22/02/05

Longmead Court Nursing Home 20/07/04

Longmead Court Nursing Home 30/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Longmead Court Nursing Home London Road Braintree Essex CM77 8QQ Lead Inspector June Humphreys Unannounced Inspection 09:30 12 & 26th June 2008 th 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 Longmead Court Nursing Home DS0000015357.V367194.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 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. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longmead Court Nursing Home Address London Road Braintree Essex CM77 8QQ 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) 01376 344440 F/P 01376 344440 Dovecote Care Homes Limited Mrs Jane Alison Billingham Care Home 54 Category(ies) of Dementia (54), Dementia - over 65 years of age registration, with number (54), Mental disorder, excluding learning of places disability or dementia (54), Mental Disorder, excluding learning disability or dementia - over 65 years of age (54) Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged between 45 - 65 years, who require nursing care by reason of dementia (not to exceed 54 persons) Persons, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 54 persons) Persons of either sex, aged between 45 - 65 years, who require nursing care by reason of mental disorder (not to exceed 54 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of mental disorder (not to exceed 54 persons) The total number of service users accommodated in the home must not exceed 54 persons 22nd May 2007 Date of last inspection Brief Description of the Service: Longmead Court is located in a cul-de-sac off the main Chelmsford to Braintree Road. It is close to local shopping facilities and a large shopping complex. It has good access to bus routes and there is car parking at the home. There are close links to the A120 and M11 motorway. The home is a two-storey building and the majority of rooms are single. There are several communal lounge/dining areas. The home is registered to provide nursing care for up to 54 people with dementia and mental disorders, who are over the age of 45 years. The home is predominantly for older people. The home had a range of information for prospective residents and their representatives. At the time of inspection, in May 2007, the fees ranged from £700 to £775. Additional charges are made for toiletries, hairdressing and private chiropody. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This routine unannounced inspection visit took place over two days on 12th and 26th June 2008. This was a thorough inspection covering all the key National minimum standards. The inspection process included talking to residents with dementia where possible, observations of staff talking to residents, information given to residents about the home before they came to live there, and most importantly how information is given to staff who provide care for the residents in the home. The manager completed the Annual Quality assurance Assessment form (AQAA) which is a self assessment which indicates how the home considers it is meeting the National Minimum standards, and what improvements they will make in the next 12 months. Information from this document is used within this report. A tour of the building was undertaken, looking at the facilities and the environment where residents live. A sample of documentation maintained in the home was looked at to ensure the health and safety of residents is considered at all times. Twenty surveys were received from staff, residents, relatives and professionals who know the service. Some residents had help to complete the surveys by both staff and family. The information in the surveys was helpful, and some comments have been used in the report. Eight staff was spoken to, and discussions were held with the deputy, and the manager. What the service does well: The home provides care for residents with high complex needs. There are currently forty-three residents over the age of sixty-five, and three residents under the age of sixty-five. They all suffer from some form of dementia, and have a range of different needs. There was clear evidence that peoples nursing and health needs are met within the home. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 6 Initial assessments are completed prior to admission, and the home only admits people if they can meet their needs. The home involves prospective residents wherever possible and also relatives in the assessment process. The day activities offered within the home are a real strength, and a varied and interesting programme is offered, including arts and crafts, music related films and activities, reminiscence work, discussions and games. The complaints procedure is on display in the home; staff listen to any concerns or complaints and they are properly investigated and responded to by the manager. The home is a secure environment offering a safe place for residents suffering from dementia to live. The home has received a number of compliments, and several surveys from relatives and residents commented that the “Manager and staff were always helpful and considerate”. “They appear to care very much for the residents, and mum appears very happy every time I visit” Medication is reviewed every 3 months by the G.P, and residents’ need for sedation and anti-psychotic drugs is reduced wherever possible. What has improved since the last inspection? The management of medication has improved. Frequent medication audits are now carried out. Additional staff training has also been undertaken. The initial assessment has been updated, and now addresses the requirements within the Mental Capacity Act, with greater involvement of residents in the care that will be provided. The home has quarterly, and planned social commented “I gained greater relative involvement. Relative meetings are held the newsletter has been restarted which provides information on activities that they can join in. Residents like this and one see more of my daughter now, it’s good”. The home received a silver award from Braintree Council, environmental health department after an excellent inspection of the home’s kitchen. The home has redecorated the majority of residents bedrooms, ten rooms have also had new furniture, wardrobes etc. A storeroom has been converted into a staff room. Two full time maintenance workers have been employed to ensure the home is kept well maintained, and any repairs are recorded, and dealt with effectively. All qualified staff has had appraisals completed by the manager and deputy. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 not applicable). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be assured that prior to admission a full assessment will be completed, which will take into consideration individual personal preferences and needs; and a placement will only be offered if their needs can be met. EVIDENCE: Initial assessments are completed prior to admission, and contained detailed information regarding the specific needs of the potential resident. The manager stated in the completed annual quality assurance assessment that “we have expanded our assessment to include and address the requirements within the Mental Capacity Act. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 10 Two assessments seen as part of the inspection verified that the prospective residents are involved wherever possible, and where this was difficult due to the person’s high, complex needs the relatives were consulted to obtain necessary information to ensure “Longmead” was the right placement. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident who lives at Longmead Court has an individual care plan which outlines the health care needs, action and intervention required, but this does not always reflect the care that is given and does not adequately consider the person as a whole; meaning that residents are sometimes limited in the amount of stimulation, and interaction that they receive. EVIDENCE: Three care plans were sampled during the visit to the home. These had been devised directly from the initial assessment information. The care plans contained basic information regarding the support needs of the resident concerned, and mainly focused on either the persons nursing needs, or the assistance they require with personal care. This has been an on going difficulty, and raised at the previous inspection. Care plans are not holistic, and therefore residents’ social and emotional needs are not always adequately met. From observation this means that staff are often task orientated i.e. assist people to use the toilet, ensure everyone has a drink. Staff was seen to Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 12 interact with residents, but this was often only to enable them to undertake the task that required completion. On the first day of the inspection after lunch in the Waters unit upstairs, two staff assisted residents to use the toilet, but whilst this was happening this left one member of staff with the remaining 10 residents. The toileting process took 50 minutes and during this time residents either sat, or wandered around the unit. The member of staff did engage with some residents, but from observation the task was just to ensure residents safety. It was of concern to note that one resident continually stood up, and the staff member sat them down, communication was limited. They then turned over the dining table, which was heavy, and could have hurt them. At that point the staff member did attempt to reassure the resident, and called out for assistance from another member of staff. The resident was quieten/comforted and a drink was offered to the person. Two staff surveys stated that information was not always made available about residents. One staff member said, “The service could do better if they can continue to up date all care staff, so that staff will be aware of how to deal with the clients they are looking after”. Clarification was sort from the staff member and this relates to care plans being updated, and information not always being passed on. Another Staff member said” We do not always have time to read the updates in care plans”. The healthcare needs of residents were well met. There was clear, recorded evidence of district nurse visits, health checks, and chiropodist visits, GP interventions, emergency services being called when required and opticians visit. Three medication files was examined as part of the inspection. Medication profiles, resident photos for identification purposes and PRN (as and when required) protocols were in place. All boxes and bottles were dated when opened, and the majority of medication was in blister packs and was seen to be correct. There were no gaps witnessed on the MAR sheets. The manager has introduced a regular audit of medication, which is undertaken by the deputy manager. The manager stated in the AQAA that “We continue to have a good relationship with local GP’s who review medication every 3 months and we continue to reduce the need for sedation and anti-psychotic drugs wherever possible”. Ten residents were spoken to as part of the inspection, of which several were unable to say if the service met their needs, or if they liked living in the home, due to their level of dementia. The six that were able to, were generally positive. One person said, “they are a bit slow, but the staff always help”. Another person said, “It’s good here, they try to help me”. Two surveys from professionals also stated “the manager and staff treat clients as individuals and try to engage, and occupy to reduce social isolation”. The other said, “Staff are Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 13 approachable, and have a sound knowledge of dementia, enabling them to relate to clients” Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunity to take part in some daily activities is available, but residents do not always benefit from staff that adequately socialise/engage with them, which means that residents emotional needs are not always fully met. Residents are offered a range of well -balanced meals, but sometimes there is a delay in people receiving the assistance they require resulting in residents not fully enjoying the food offered. EVIDENCE: The day activities offered within the home are a real strength, and a varied and interesting programme is offered, including arts and crafts, music related films and activities, reminiscence work, discussions and games. The room that is the central hub of activities is well decorated, and welcoming. The three activity co-ordinators were observed at different times during the inspection, and were able to respond to a wide range of people who had varying levels of dementia. “The manager stated in the AQAA that the activity co- coordinators had received training this year on “meaningful activities and person-centred dementia care, and they have begun to record life history books with residents Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 15 and families.” Two life history books that had been started were looked at, and were really well put together. The coordinators also provide 1 to 1 time with residents with higher needs. This is often based in the residents unit, and less effective, as the environment is often noisy. It has been noted that the amount, and quality of activities has improved each time an inspection as taken place over the last two years. The numbers of residents has also increased, and there is a need to review the amount of staff working within this area to ensure residents can go out when they ask, and that stimulation, and encouragement to participate is offered to all residents. Surveys received provided evidence that staff do not always interact very well when working with residents. One person said, “They need to employ a few more staff for each shift so that carers will become more available to engage with residents”. Another person stated that “ I am concerned that for several English is not their first language, and this does impact on communication and understanding.” A number of staff have now received training in engaging, talking to people with dementia; but further work is required in developing staff skills, which was acknowledge (in the AQAA) by the manager who advised that ‘our programme for person centred dementia care will continue until all staff have attended’. Feedback from relatives indicated that they feel welcome in the home, and that the home keeps them well informed of any issues arising. People’s ability to manage their own affairs is respected, and supported wherever possible. Residents were able to bring their own possessions into the home with them; and several residents chose to spend time in their rooms, which was again recognised and respected. Over the two days of the inspection all four units were observed at meal times. In three of the units there are tables which have a number of chairs to offer the opportunity for residents to eat at the tables, should they choose to. In general the practice observed is that people who require assistance with feeding remain where they are seated and staff come to them. The outcome is a number of residents remain in the same part of the lounge must of the day which does not allow the person to be aware that it is lunch, or dinnertime until the food has arrived. In the Waters unit upstairs a high number of residents require assistance with eating. There was four staff available to provide help, which meant that some residents did have to wait sometime prior to eating. There is insufficient numbers of tables, and appropriate chairs to allow residents to sit at the table. One member of staff was observed feeding a resident. Half way through the task he was called to assist in finding a desert for another resident who had refused the main course and was becoming agitated because they wanted a dessert. It was observed that four residents had assistance with their main course but then waited to have a dessert, as the staff member went on to feed someone else a main course. It was also noisy, with staff talking to each other Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 16 across the room, and residents walking up and down. One relative survey stated, “Sometimes when we have visited at mealtime, we often help feed residents lunch as it seems somewhat haphazard. Carers do not always know who has been fed or not”. The residents in this particular unit have high complex needs, and there is a need to review mealtimes to ensure that the setting is congenial, and that mealtimes are unhurried with sufficient staff to ensure residents are supported at a level and pace appropriate to their needs. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be confident that any complaint, or allegations of possible abuse will be listened to and acted upon. EVIDENCE: The complaints procedure was on display within the home. As part of the inspection the complaints file was examined. Nine complaints have been received in the last 12 months. All of the complaints were responded to appropriately and were upheld. The service also demonstrated that they are aware of how to report safeguarding issues, and the manager showed an example that had been reported, and was being investigated. The manager stated in the AQAA that “all staff have had training in the protection of vulnerable adults, and work to these regulations”. The feedback from staff, residents/relatives was that the service maintains an open culture, where any concerns and complaints are sensitivity listened to. One resident said, “I am happy about the home, but would tell staff if I did not like it”. A relative said, “I have made a complaint, and was pleased to say that it was deal with immediately.” One member of staff spoken with stated that safeguarding was now included as part of the induction training for new staff which meant they were equipped to complete the required forms if necessary. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of residents who live at Longmead Court has high complex needs, overall the home provides a satisfactory standard of cleanliness and comfort, but this cannot be assured throughout the units at all times. EVIDENCE: The home was extended in 2006 with a new wing (Wilson) being added. The main lounge area in this unit is large in size, and since the last inspection effort has been made to purchase new furniture, and make it a more homely place for residents to live. The home is a safe place for residents to live with a keypad system in operation to alleviate possible falls on the stairs. Whilst this is an effective system, access in and out of doors is by key which staff holds. When opening doors the alarm system activates a noise to alert staff that someone is exiting. This does make for an institutionalised feeling, with the frequent noise of the Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 19 alarms. One relative stated that “the alarm is too loud, does it have to ring so loudly. After all staff needs to watch my mother anyway”. The home is generally well maintained, and any repairs are recorded and usually dealt with effectively. The manager stated in the AQAA that “ the home has an infection control training programme, and also that the kitchen was awarded a Silver award from the environmental health department due to an inspection and excellent report” However the Waters unit upstairs had an oddment of different furniture, of which a number of pieces of this furniture were seen to be in poor condition. A blue chair was torn, and dirty with food remains located in the creases of the arms of the chair. The carpet in the lounge was vacuum cleaned after lunch but still look stained in several places. A chair was placed against the wall, and was unstable. This was pointed out to staff, and removed immediately. One relative stated, “ dinning room tables are usually sticky and seats often missing from armchairs”, however the person also said “generally, mum is well cared for”. The concerns were discussed with the manager and it was stated that furniture is being slowly renewed throughout the home. The annual quality assurance assessment also stated “We can still improve further on the cleanliness of the home at times. Cleaning schedules may help, with daily, weekly and monthly tasks.” This demonstrates that the manager is aware of the short falls and looking at ways to improve. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate, but residents cannot be assured that their social and emotional needs will be consistently met. EVIDENCE: During the day the ratio of staff is one member of staff to three residents. At night there is two nurses, and four carers. The rotas were seen for a period of four weeks, and this confirmed that the above numbers of staff were usually on duty. At times staff sickness has impacted on the numbers of carers, and despite managers trying to get cover from permanent workers, or even agency cover this had not always been possible, and was evident from the rota. On day one of the inspection there was 9 carers, 3 senior carers, and two nurses to 47 residents. Both the manager, and deputy manager were supernumerary. On both days of the inspection when observing the Waters unit upstairs engagement between staff members and residents was limited. Three staff were working with the 11 residents, rather then four. On the second day a senior member of staff was completing paperwork, and therefore not included in the numbers. Staff was observed for a period of 35 minutes on the first day of the inspection, and 30 minutes on the second day of the Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 21 inspection. One day was over the lunchtime, and the other was mid afternoon. The residents in this unit require a great deal of support, and staff seemed very task orientated, although on the second day the atmosphere in the unit was much more ‘upbeat’ and staff did attempt to talk to residents whilst they were undertaking a task. This is in contrast to the Waters unit downstairs where on the second day of the inspection there was 3 staff to 7 residents. The layout of the room was also more ‘homely’ and staff was observed sitting chatting to residents. A review of the deployment of staffing levels within the four units is required. Six staff surveys were returned, and six members of care staff were interviewed as part of the inspection. The surveys provided a mixed response. Three surveys recorded that care was good, and staff work as a team. One person said, “the care is really good, the residents are well looked after, and all their needs met.” The other three surveys suggested that staffing levels were inadequate, and that the home was a very stressful place to work. One person said, “the staff manage to meet the needs of the individual but it is done on a stressful level (to the carers), maybe staffing levels should not run at a minimum”. Staff that was interviewed expressed concern in relation to the inconsistency of numbers of staff on duty, but also the skill mix and experience of the staff that were on the shift with. For example if three staff were on duty and one of them was fairly new, or an agency member of staff this would be more difficult, then three staff who had worked as a team for sometime. Two staff said that some staff “phone in sick or cancel their shifts late and agency staff cannot be found to cover”. This often was at weekends and the manager acknowledged in the annual quality assurance assessment that the home does experience “episodes of staff sickness, particularly at weekends. The manager is trying to recruit staff who prefer to work at the weekend, and is also considering offering an incentive for weekend work.” The response from the 13 relatives surveys received was overall positive about staff, and the care provided. One person said, “Mum is well cared for”. Another person said, “Management and staff actually care about the people under their care”. Several surveys stated that the quality of personal care was variable i.e. ”the grooming leaves a lot to be desired”. “I sometimes do it myself”. Two staff recruitment files were examined and all the required documentation was in place. The homes recruitment process is robust and thorough, and provides confidence that residents are safeguarded from potential harm. The home employs an experienced mental health nurse as a part time trainer for one day per week. The content of the induction programme for new staff was looked at, and provides a good level of information for new staff about the work that the service sets out to do. The induction programme has been broken down into modules, and staff often completes a module, which takes 2 to 3 hours as part of a shift. This is newly introduced since the increase in residents within the new wing, and ensures that staffing levels remain Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 22 constant. Staff said they were all right with this system, but unhappy that if there were staff shortages then the training would be cancelled. This one person, who also currently provides supervision, the majority of mandatory training, except manual handling. The staff team has grown, and a review of what can be realistically achieved by one person, in one day, must be re considered. However Staff was very positive about the training opportunities provided, and the manager reported that 50 of care staff are trained/ working towards N.V.Q 2 (or above) in health and social care. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37, and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager at the home has a clear understanding of the principles, and focus of the service provided, and is committed to reviewing and improving the service offered to residents. EVIDENCE: The registered manager is experienced in the care of older people and has completed the Registered Managers Award (RMA). The home is well managed, and systems and procedures have been organised and established regarding recruitment, training and supervision. The manager and deputy also continue to undertake periodic training to update their knowledge, skills and competences whilst managing the home. There is a clear management structure in place, which consists of a manager, deputy and Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 24 a team of qualified nursing staff. Feedback from residents and staff about the manager and deputy was positive; with comments received about them being supportive, approachable, and always available for advice. Observations, and feedback form relatives/residents and staff has highlighted a need for staff to evaluate their practice in terms of giving higher priority to residents social and emotional needs i.e. the quality of interaction between staff and residents. Evidence shown suggested that some work had been completed since the last inspection, particularly in regard to staff undertaking training in the area of dementia care. The manager stated, “It is her intention for all staff to undertake this training, as she had completed the course herself and felt residents would benefit from all staff having a clearer understanding of the impact of dementia”. The manager has devised a supervision matrix. The freelance trainer currently provides supervision to all care staff within the home. Notes of nine staff members were looked at, and insufficient evidence was available to prove that staff receives regular supervision. Notes were available for some sessions, and from my discussions with the supervisor he felt that a filing cabinet to store confidential information is required. A filing cabinet should be provided, but also it is an unrealistic expectation to expect one person to supervise the whole team, and provide both induction and mandatory training, when commissioned to work only one day per week. The arrangements for management of residents’ money were checked inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. Appropriate records for the health and safety of the residents and staff are maintained in the home, and staff follows the home’s policies and procedures. All the staff has training in moving and handling, fire safety, food hygiene and infection control as part of their induction. The manager stated in the annual quality assurance assessment that “there is a good attendance at staff meetings, and staff are willing to work extra shifts to help with the smooth running of the home. It was also stated that the home has “gained more relative involvement and we have started relatives meetings, and restarted the quarterly newsletter”. This demonstrates a clear commitment to seek residents/relatives views, and act on them. One resident requested “More decorations to look at around the home e.g. pictures etc”. this is a topic that could be discussed at the next residents meeting. Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 25 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 3 Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 26 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 15(1)(2) Requirement Care plans must be resident centred, and include information on individual abilities, emotional and social needs and not only with an emphasis on nursing care. A more holistic approach will improve outcomes for residents. (repeated requirement from the inspection on 22/05/07) Timescale for action 01/10/08 2. OP27 16(n) Sufficient numbers of skilled staff 01/09/08 must be available to interact, and subsequently provide stimulation, to ensure residents social and emotional needs are met. The manager must ensure that sufficient staff are available to enable mealtimes to be unhurried, with residents being supported at a level and pace appropriate to their needs; making mealtimes social and enjoyable. 01/09/08 3. OP15 (18) 1a Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 27 4. OP19 23(2) The manager must ensure that torn furniture is replaced, and dirty furniture and carpets are either cleaned or replaced, to ensure residents are living in a homely, clean and hygienic environment. Records in the home must comply with the Data Protection Act 1998 in order to maintain confidentiality. A filing cabinet should be made available for the storage of supervision/training records to protect staffs’ personal information. 01/10/08 5. OP37 17 01/09/08 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 OP12 Good Practice Recommendations Staff should have training in activities and social interactions/stimulation in order that they understand the range of activities that can benefit residents at all different stages of dementia on a daily basis. A review of the current level of day activities should be undertaken to enable all residents to benefit, regularly from this quality resource. A quality assurance programme must be developed that provides evidence of the actions being taken to review and improve services and care for residents. A copy of the quality assurance report and action plan must be sent to the Commission when it has been completed. This was a requirement in the last report - the timescale of The manger should ensure that all care staff receives 6 supervisions per year to ensure they are adequately supported and are equipped to meet residents complex needs. DS0000015357.V367194.R01.S.doc Version 5.2 Page 28 2. 3. OP12 OP33 4. OP36 Longmead Court Nursing Home Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Longmead Court Nursing Home DS0000015357.V367194.R01.S.doc Version 5.2 Page 29 - 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. 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