CARE HOMES FOR OLDER PEOPLE
Longmead Court Nursing Home London Road Braintree Essex CM7 8QQ Lead Inspector
Diane Roberts Unannounced Inspection 26th September 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Longmead Court Nursing Home Address London Road Braintree Essex CM7 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 01376 330096 Dovecote Care Homes Limited Mrs Lone Quist Edwards Care Home 30 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Mental disorder, excluding learning of places disability or dementia (30), Mental Disorder, excluding learning disability or dementia - over 65 years of age (30) Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged between 55 - 65 years, who require nursing care by reason of dementia (not to exceed 30 persons) Persons, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 30 persons) Persons of either sex, aged between 55 - 65 years, who require nursing care by reason of mental disorder (not to exceed 30 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of mental disorder (not to exceed 30 persons) The total number of service users accommodated in the home must not exceed 30 persons Date of last inspection Brief Description of the Service: Longmead is located in a cul de sac off the main Chelmsford to Braintree Road. Its local is close to local shopping facilities and a large shopping complex. It has good access to bus routes and there is plenty of car parking at the home. There are close links to the A120 and M11 motorway. The home is two storeys and the majority of rooms are single. There are several communal lounge –dining areas. The home is registered to provide nursing care for people with dementia and mental disorders over the age of 55 years. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was undertaken as part of the planned inspection programme for this home. The inspection took place over a three-hour period. The care provision, staffing levels, staff training and the premises were inspected. It was possible to speak to 2 residents and 2 visitors during the inspection. A further nine comment cards were received from relatives regarding the home and the services provided. Due to the registration category of this home it is not always possible to speak to the residents at length. The Manager, Mrs Lone Edwards was present throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The home needs to improve further upon some of the recording systems, which relate to the provision of care. Overall healthcare provision in the home is good but work needs to be done to ensure that resident’s health care needs are fully met in all cases. Work needs to be done to further develop the activities programme. Longmead Court Nursing Home DS0000015357.V256733.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. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home has a good pre admission assessment system in place, which ensures they can meet the needs of new residents to the home. Standard 6 is not applicable for this home. EVIDENCE: Care records inspected show that residents had received a pre admission assessment. The home has a standard recording sheet, which has an emphasis on dementia care needs. Records were seen to be detailed and covered all the required areas. Records also showed that where appropriate the home had obtained copies of the Social Services assessment as well. Records show that the home is admitting residents appropriately, within their registration category. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Care plans are generally satisfactory but work is needed in some areas to bring them up to standard. Generally service users healthcare needs are met but work is needed with regard to ensuring that all needs are met. EVIDENCE: Care plans were inspected for both new and long-term residents. These were seen to be generally satisfactory and contained detailed information regarding the care needs and care provided. Care plans had evidence of regular review. Care plans, where possible, did not have input from the residents relatives. Social histories were seen to be in place and often relatives provide these. Daily notes are maintained which reflected how the resident was and how well they have eaten etc. The home uses a range of risk assessment tools. These were inspected and seen, in some cases, to not have been fully completed or reviewed regularly. Where risks had been identified there was no evidence of any action taken, subsequent outcome or link to plan of care. Dates need to be recorded on the risk assessments. The home needs to improve upon this area of their
Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 10 assessment and recording and to ensure that all the required risk assessments are completed. Records show that residents receive regular medication reviews from the General Practitioner, who visits one day every week and on an as needed basis. From the care plans it is clear that the home act in a proactive way when dealing with residents health and do call the General Practitioner when required. Records with regard to the provision of chiropody were poor and do not evidence that a satisfactory service is being offered. This was also reflected in the condition of a few of the resident’s toenails, although it is acknowledge that some residents do refuse this service. The home needs to ensure that where possible all residents are receiving chiropody services. Records show that residents are seeing the optician and dentist when required. Records show that where possible residents are being weighed monthly and where there are any concerns, these have been refereed onto the resident’s doctor or a dietician. The home has a satisfactory supply of pressure relieving equipment and this was seen to be in use around the home. Work is required on the risk assessments carried out for the prevention of pressure sores. Upon inspection of the home it was clear that the majority of residents had creams in their rooms, many of which had no rational for use and no link to a care plan. In some cases creams, not prescribed to the residents, were being used on them. This practice in the home requires review and addressing. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 The lifestyle of service users in the home is appropriate to their care needs but could be developed further with regard to social needs. EVIDENCE: From discussion and observation, the routines of the home are very resident led. Resident’s individual preferences and needs are taken into account. Staff are aware of residents individual behaviour patterns and where possible they organise the care provided around this. Relatives spoken to and who commented feel that the atmosphere at the home is relaxed, unrushed and that the care staff are patient and caring in their approach. Activities are provided but records show that at the current time these are basic. The manager is hoping to appoint an activities officer with more experience. The activities programme does not include any life skills which people with dementia can often find stimulating. The manager is aware of the need to develop this side of the care provision. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home has a complaints procedure in place, which ensure that complainants will be heard and complaints dealt with objectively. The home has systems in place to help ensure that residents are protected from abuse. EVIDENCE: The home has a satisfactory complaints procedure in place and this is available in reception. No complaints have been received since the last inspection. Cards of compliment to the home and staff team were seen from relatives. Relatives who commented were aware of how to make a complaint should the need arise. A new policy for the protection of vulnerable adults has been put into place. This was inspected and still found to require some review and ideally linking to local Social Services policy and procedure. Nearly all the care staff in the home, bar two have attended training on the Protection of Vulnerable Adults. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Residents live in a safe and well-maintained home. The home is clean and generally hygienic and free from odours. EVIDENCE: The home was inspected and seen to be in good order generally. The home employs a maintenance man and keeps up regular decoration of the home. Since the last inspection the following items have been purchased bed linen, commodes, beds, laundry equipment including a roller iron, washing machines and dryers. It was noted that some of the pillows and duvets were lumpy and this was raised with the manager. One shower room currently has a damp problem, which is creating an odour in this room. It is currently unusable but the home has plans to address this. The home was seen to be clean and no odours were noted apart from the one shower room. Communal use of skin creams for residents was noted in bathrooms again and is poor practice.
Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 14 The home has up to date infection control policies and procedures in place. It is recommended that they obtain local guidance and training from the Community Infection Control Team. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. The home provides suitable and competent staff for the current needs of service users. The home provides a training programme, which ensures that the staff are competent to do their jobs. EVIDENCE: Staff turnover at the home is low and minimal or no agency staff are employed with the homes staff covering any shifts that are vacant. The staff rotas for the previous weeks were inspected and found to be in order and showing that satisfactory staffing levels were being maintained. The manager reports that she reviews the levels regularly in relation to resident dependency levels with particular regard to the cover on night duty. Extra staff are provide for activities, escorts to hospital etc. and domestic duties. Domestic cover is reduced at weekends. The rota shows that on occasions nursing staff cover is over and above the required to help cover the documentation that is required. The home employs a training officer who works at the home one day a week. In addition to this the home accesses courses and study days provided by agencies outside the home. Records were inspected and show that staff have been attending medication training, dementia care training, challenging behaviour, protection of vulnerable adults, fire safety and manual handling. Nine staff have completed a course in person centred care for people with
Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 16 dementia and thirteen staff have completed the NVQ level 2 in care. Two staff have completed NVQ level 3 in care and other are in the process of completing NVQ courses. This means the home has over 50 of its staff trained to NVQ level 2 and above. The home is currently working on ensuring that staff are training in relation to health and safety. The maintenance man has also attended training on the PAT testing of small electrical items. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 The management of the home ensure that the home is run in the best interests of its residents. EVIDENCE: The home sends out an annual satisfaction questionnaire. These were seen to be positive as were the comment cards received by the C.S.C.I. The home have analysed the results and plan to develop their questionnaire further and repeat the survey in 2005. The home could develop its quality assurance programme further by using an internal audit system as well. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 18 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 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X X Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15 Requirement The registered person, where possible, must involve the resident or their representative in the care planning process. The registered person must ensure that all the required risk assessments are completed and reviewed where required. The registered person must ensure that residents receive an adequate chiropody service. The registered person must ensure that only prescribed skin creams are used for the identified person. The registered person must provide a suitable activities programme linked to the needs of residents. Timescale for action 28/02/06 2 OP7 15 28/02/06 3 4 OP8 OP8 12 12 14/01/06 01/01/06 5 OP12 16.2 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000015357.V256733.R01.S.doc Version 5.0 Page 20 Longmead Court Nursing Home 1 2 3 4 Standard OP18 OP19 OP26 OP33 The registered person should review the homes POVA policy and procedure. The registered person should review the provision of bed linen with regard to duvets and pillows. The registered person should ensure good infection control practices in the home with regard to communal skin cream use. The home should develop its quality assurance programme further by use of an internal audit system. Longmead Court Nursing Home DS0000015357.V256733.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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