Inspection on 16/10/06 for Longmore Nursing Home

This inspection was carried out on 16th October 2006.

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

Longmore Nursing Home 24/09/08

Longmore Nursing Home 17/02/06

Longmore Nursing Home 12/10/05

Longmore Nursing Home 17/02/05

Longmore Nursing Home 17/08/04

Longmore Nursing Home 03/12/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Longmore Nursing Home 118 Longmore Road Shirley Solihull West Midlands B90 3EE Lead Inspector Elizabeth Mackle Unannounced Inspection 16th October 2006 09:30 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 Longmore Nursing Home DS0000004559.V310478.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. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longmore Nursing Home Address 118 Longmore Road Shirley Solihull West Midlands B90 3EE 0121 733 6595 0121 733 3159 None None Mr & Mrs Grant 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) Mrs Lynne Margaret Buckle Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May provide day care for up to 5 older people. May provide accommodation for up to 22 service users in 14 single bedrooms and 4 double bedrooms, (increased from 20) The existing staffing must be increased to provide the following minimum staffing levels over a 24-hour period: RGN 8am - 2pm 1 staff 2pm - 8pm 1 Staff 8pm-8am 1 Staff Care Assistant 8am - 2pm 4 staff 2pm - 8pm 3 Staff 8pm-8am 2 Staff Catering, laundry and other ancilliary tasks are in addition to the care / nursing staff hours and must be reflected as such on the staffing rota. Staffing levels are continuously reviewed to reflect the changing needs of service users resident in the home. Students are not to be classed as part of the staffing establishment. The manager of the home is contracted to work a minimum of 35 hours per week and is super numerary to the staffing hours. May admit older people requiring personal and nursing care, on a respite care basis, within the overall total of 22 service users. 17th February 2006 4. 5. 6. 7. 8. Date of last inspection Brief Description of the Service: Longmore is a purpose built, two story, detached building, set in a residential area of Shirley. Located close to all local amenities and with a good public transport system, which services the area. There is a large garden to the rear of the property with patio areas and designated car parking spaces at the front of the building. The home provides accommodation and care for up to twenty-two elderly and elderly physically disabled people and may make provision for up to five-day care residents. At the entrance to the home there is a small foyer with a lounge directly opposite. The home has four double bedrooms and fourteen single bedrooms; there are two single bedrooms providing en-suite facilities. The passenger lift is centrally located and travels to all floors. Accommodation for residents is located on the ground floor and first floor. There is a large lounge on the ground floor, which leads directly into a large Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 5 conservatory, which is used as a sitting and dining room. Level access is provided for wheelchair users. There is a passenger lift to the first floor and throughout the home there is good access for people whose mobility may be limited. The scale of charges at the home ranged from £575 - £850 per week Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the fieldwork visit taking place a range of written information was gathered which included notifications received from the home and a completed pre-inspection questionnaire, which gave a variety of written information about the home. One inspector carried out the visit to the home over the course of one day in October 2006. This was the home’s key inspection for the inspection year 2006-2007. During the course of the visit a tour of the premises was undertaken, the health care records of three residents were sampled, together with three staff files and a range of other documents. The inspector spoke with the manager, deputy manager, domestic, cook, activities organiser, and two care staff as well as three residents and two relatives. Time was also spent in direct and indirect observation of life in the home on the day of the visit. What the service does well: The home provided residents with a good standard of accommodation, which is comfortable and homely. Prospective residents were able to visit the home and spend time there to assess the facilities. Residents at the home were very satisfied with the service they were receiving at the home. Comments received included: “The food is marvellous – first class”. “I have plenty of visitors.” “It’s good here – we all fit in”. “They respect me – I respect them”. There were no rigid rules or routines in the home and residents were able to spend their time as they chose. A variety of activities were on offer if the residents wished to take part. There were no restrictions on visitors to the home and they were observed to come and go throughout the course of the fieldwork visit; this helps residents to stay in touch with friends and family. Residents and relatives spoken with were very happy with the standard of food and the variety available to them; this helps ensure that the dietary needs of residents are being met. The home had flexible arrangements that allowed relatives to have a meal with residents if they wished, and this was appreciated by residents and relatives. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 7 Many of the staff had worked at the home for considerable periods of time and this was good for continuity of care of the residents. Relationships between staff and relatives appeared to be particularly strong, with good lines of communication. A large number of cards and letters had been received from families expressing their thanks and complimenting staff on the service received. The home had robust systems for dealing with complaints, and for ensuring that lessons were learned from complaints received, and this helps ensure that residents are protected. What has improved since the last inspection? What they could do better: The home needed to take prompt action to address a number of requirements that were outstanding from previous inspections. A number of documents and policies needed to be revised and updated so that all the information is up to date and accurate. The assessment of prospective residents needed to be more comprehensive to ensure that all their needs can be met by the home. Care planning needed to be more systematic and robust to ensure that all health needs were properly planned for and documented in the care plan, and risk assessments needed to be carried out in a more thorough way, so that the needs of residents can be fully met. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 8 The “Handling of Abuse Allegations” policy needed to be urgently updated to ensure that it complies with current good practice and guidelines on the protection of vulnerable adults. A small number of improvements were required to enhance the quality of facilities available to residents, including grab rails in first floor toilets and replacement of the floor covering in the lift. 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. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 9 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 Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 10 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): 1, 3, 5 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Prospective residents have the information they need to make an informed decision about whether they wish to live in the home. The pre-admission assessment procedure needed to be developed further to ensure that all the needs of residents were known to staff before admission. Prospective residents and their families were encouraged to spend time in the home before making a decision to move there; this enabled them to have some knowledge of what life in the home was like. EVIDENCE: The home’s Statement of Purpose and Service User Guide were generally informative and comprehensive. The Service User Guide was produced in a format that was easier to understand, making it accessible to the residents of the home. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 11 All prospective residents had their needs assessed by a senior member of the home’s nursing staff to ensure that their needs could be met by the home. Staff followed a structured approach to assessing needs using the home’s own pre-admission assessment documentation. The assessment process was comprehensive in relation to the physical needs of the residents, for example, covering mobility, personal care needs and equipment/aids required. However there was no evidence that the psychological needs of residents, or their spiritual/religious and cultural needs were assessed; this needed to be addressed in order to ensure that all the needs of residents were assessed and that the home would be able to meet all the needs of prospective residents. The home offered prospective residents and their families opportunities to visit the home before coming to a decision. The arrangements for such visits were flexible and tailored to the wishes of the person involved, and could range from attending for lunch through to attending for a whole day. One resident spoken with confirmed that as he had been unable to attend personally for a preadmission visit, a relative had visited the home on his behalf and had given him a favourable report. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 12 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, 10, 11 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The health needs of residents were well met; there was evidence of close working between staff and other professionals to achieve the best outcomes for residents. The systems for the administration of medicines were good ensuring that residents’ medication needs were met. Support to residents was offered in such a way as to promote and protect their privacy, dignity and independence. EVIDENCE: The health care records of three residents were viewed, including those of one person recently admitted to the home. Each resident had an individual care plan. There was evidence that pre-admission assessment had been carried out, and of the involvement of relative/carer in the assessment. Nursing staff in the home encourage relatives to discuss any matters relating to care with the responsible nurse. The residents’ preferred mode of address was clearly documented. A number of improvements were noted in relation to care plans: they were signed and dated by the person planning the care; they were being reviewed regularly, usually every month, and where possible relatives were Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 13 involved in this, and residents’ weight were being recorded in their care records. Within the Care Plans viewed the care needs recorded were long-term in nature. Although the care plans viewed showed a description of the care need, goal and nursing action required, in some cases the actual nature of the care need was not apparent, and there was a lack of detail about the nursing action required. Examples included lack of detail about a pressure ulcer when it was recorded “sore on sacrum and toe” without further information. More detailed information about pressure ulcers and their treatment were being stored separately. Other examples include where insufficient information was available in the care plan related to catheter care and use of oxygen therapy. The absence of more detailed information could result in staff not having sufficient information to ensure that residents could always be cared for fully and safely, for example, if staff did not know the residents well were on duty. The short-term care needs of residents were recorded in the daily evaluation sheets rather than the care plan. Examples of care needs that were not reflected within the care plan included the management of a urinary tract infection, and the management of a chest infection. The daily entries were informative and, as well as referring to short-term care needs, contained a general statement about the condition and care of the resident. The care plan needs to contain all the relevant information about the care needs of an individual resident, and the practice of not including short-term care needs in the care plan means that it would be difficult to care for an individual resident fully and safely from the care plan alone. A number of issues relating to care planning had been identified during previous inspections, and although some improvements had been made, it is recommended that staff receive training in order to improve the overall standard of care planning. There was evidence that risk assessments were being carried out, for example, risk assessment for the use of bedrails, nutrition, falls and handling and safe movement. The standard of risk assessment was variable. The risk assessment documentation in relation to use of bedrails did not demonstrate that all risks of using/not using bedrails had been considered before reaching a decision about whether bedrails were to be used. In one assessment regarding safe movement there was no conclusion about the size of sling required by that resident; this could potentially place residents at risk of injury. Residents were reviewed regularly by their general practitioner, who visits the home at least once a week. Some residents had their dental care from a local private dentist who visited the home by arrangement, or residents could be seen at his surgery if they choose. The manager reported that at times it had proved difficult to obtain an NHS dentist for residents and there was often a long waiting list. Optical services could be accessed when needed, and a chiropodist visited the home on a regular basis. These arrangements help ensure that all the health needs of residents are met. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 14 Existing systems within the home for the management of medication were robust. Times for the administration of medication were flexible, taking account of the individual preferences and needs of residents. The home had enjoyed good working relationship with a local pharmacy, which had provided all pharmacy services to residents. However, the GP for the home was, in the coming months, moving into a new health centre, and a pharmacy service was to be incorporated into this. This would involve changing to a monitored dosage system and staff were optimistic that the service to residents would be further improved. Staff were observed to be interacting with residents and relatives in an appropriate, respectful and caring way. One resident said, “They respect me, and I respect them”. During the course of the inspection all the indications were that the privacy and dignity of the residents was being respected. Residents who wished to spend time on their own, in their rooms were able to do so. There was a payphone available for residents’ use in a private area of the home. The home had developed a policy on care of the dying, and was also participating in the Gold Standards Framework for Palliative Care; staff felt this had enhanced their knowledge and care practices in dealing appropriately with people who were suffering from terminal illnesses. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 15 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, 15 The quality in this outcome area is good. This judgement has been made using available evidence, which included a visit to the service. There were no rigid rules or routines in the home. Residents were able to take part in a range of activities of their choice, and to spend time with their families/friends, which enhanced their quality of life. Residents were generally satisfied with the standard of catering provided in the home, which enabled them to receive a well balanced and varied diet ensuring that their dietary needs were met. EVIDENCE: The home continued to have the services of an Activities Organiser in the home four days a week. Each resident was consulted about their preferred activities, and these were accommodated as far as possible. Residents who may be cared for in their bed or bedroom also had opportunities for suitable activities. Residents also enjoyed visiting entertainers on a frequent basis. A local priest held an inter-denominational church service once a month. A hairdresser visited the home weekly and this appeared to meet the needs of residents. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 16 There were no restrictions on visitors to the home. Relatives were observed to be visiting freely in a relaxed manner, and to be on friendly terms with staff members. It was pleasing to see a number of young children visiting residents. The relatives of one resident present said they were very happy with the care their relative was receiving. They found the atmosphere within the home “like a family, and that the children were always made welcome and offered treats such as ice-cream at mealtimes”. Visitors confirmed that they were always welcome to eat with their relative if they wished, and that there was no charge for this; one relative stated “it makes it all so pleasant”. Residents were able to exercise choice in how they spent their time. One resident said “they invite me for activities every day, but I like TV”. The kitchen area was viewed, and discussions held with the cook. Standards of hygiene within the kitchen were found to be high. A board was displayed in the kitchen showing information about special diets, and residents’ likes and dislikes. At the time of the visit there were no residents requiring special ethnic or religious diets, but the manager was confident that these could be provided if required. The menu operated on a four week rolling programme, and demonstrated that residents receive a wholesome and varied diet. The chef also consulted regularly with residents about their likes and dislikes. The food was cooked on the premises and fresh fruit and meat bought locally. Supplies were plentiful, with evidence of home baking such as egg custard and apple crumble. Traditional puddings on the menu included: baked Alaska, rice pudding, chocolate sponge, and trifle. Breakfast was a substantial meal, which varied daily and included cereal, sausage, toast, tomatoes, poached eggs, bacon, fried eggs, and bread and butter. Residents had a choice of main meal. The home did not have a dedicated dining room, and residents were able to choose to eat at dining table in the pleasant conservatory area, or to have a small individual table provided in the conservatory on lounge. A small number of residents preferred to eat in their rooms. Lunch was observed and consisted of beef and mushrooms, potatoes and mixed vegetable. A choice of baked vegetables was available. The meal was attractively served, with portion sizes to suit the needs of the individual. A selection of drinks was available. There were sufficient staff on duty to enable assistance to be given as required, and this was provided in a discreet and sensitive manner. One resident said, “The food is marvellous – first class”. The evening meal consisted of soup, and a choice of sandwiches or items such as pork pie salad, omelette, and beans on toast, followed by a pudding. Longmore Nursing Home DS0000004559.V310478.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, 18 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Arrangements were in place to ensure that complaints were addressed thoroughly and promptly to ensure that residents were protected. The home’s policy on Handling of Abuse allegations requires updating to ensure that staff respond appropriately in the event of any allegation, in order to ensure that residents are fully protected. EVIDENCE: The home had received one complaint since the last inspection and another complaint had been received by Social Services who carried out an investigation. No complaints had been received by CSCI since the last inspection. The recording of complaints was clear and comprehensive, showing the name and address of the complainant, the date the complaint had been received, a summary of the complaint, together with details of the investigation, the outcome, and whether the complainant was satisfied. There was evidence that findings and recommendations arising out of complaints were discussed at staff meetings. The home’s complaints procedure needed to be updated to include that the registering body was now CSCI, their address and telephone number and that they can be contacted at any stage of the complaints procedure by the complainant. This is an outstanding requirement from the last inspection. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 18 The home had a policy on Handling of Abuse Allegations, which was last reviewed earlier in 2006. A copy of this was available together with Department of Health’s “No Secrets” document, Solihull Social Services “Guidelines for managing suspected abuse of vulnerable Adults”, (April 2005), and the home’s Whistle blowing policy. The home’s policy on Handling of Abuse Allegations requires urgent updating to state that in the event of any allegation of abuse, staff must not initiate an investigation, must make a referral under “adult protection” to Social care and Health and also inform CSCI. The statement “if suspected victim does not want issue to be taken further, their wishes must be respected” must be deleted from the policy. Discussion with staff revealed a lack of clarity about how to respond in the event of an allegation of abuse. Staff require training/awareness of adult protection issues to ensure they know how to respond appropriately in the event of any allegation of abuse. The home’s Whistle blowing policy was clear and user friendly, but information regarding how to contact CSCI needed to be updated. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 19 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, 22, 24, 26 The quality in this outcome area is good. This judgement has been made using available evidence including to a visit to the service. The home provided residents with a pleasant, well maintained and homely environment, which helped ensure that residents were comfortable, secure and safe. EVIDENCE: There had been no changes to the layout of the home since the last inspection. Communal areas within the home were clean, generally well maintained, comfortably furnished and homely. Improvements were noted since the last inspection in the general decoration and quality of carpets throughout the home. Curtains and bed fabrics were in good condition. During a tour of the home a sample of residents’ bedrooms were viewed, and found to be clean, comfortable, well furnished and had been personalised with family photographs and other personal items. Residents had access to a Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 20 lockable facility within their rooms. Drinks were available for residents within their rooms. On the first floor, the landing area adjacent to the stairway, which is also an emergency exit, a variety of items were being stored. Although the staircase was not directly obstructed the manager was advised that the area should be cleared so that in the event of an emergency the maximum space would be available. Of the three communal bathrooms on the first floor it was noted that only one had grab rails fitted to toilets. The manager stated that residents seldom used these toilets as they preferred to have a commode in their bedrooms at night. Nevertheless, these toilets should have grab rails fitted to ensure they are suitable for frail residents who may wish to use them at any time. The rubber floor covering in the lift was noted to be “bubbling” in places, and this could pose a hazard for residents and staff; the manager confirmed that this was in the process of being replaced. The laundry area was viewed, and some improvements noted since the last inspection. Protective covers had been fitted to ventilation vents, and soap and towels were available for staff hand washing. The washing and drying machines were in working order. Each resident had an individual named basket for his/her personal laundry. Care staff deal with residents laundry as part of their general duties; although the system appears to work well it means that no one person is responsible for standards of hygiene and maintenance within the laundry. The sink for mop sluicing was still badly stained and may need to be replaced if it cannot be cleaned. This is an outstanding requirement from the previous inspection. The home had good level access throughout making it accessible for people who use a wheelchair and for people with limited mobility. The home was clean and free from malodours at the time of the inspection. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 21 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, 30 The quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. A stable staff team was maintaining appropriate staffing levels. New staff received appropriate induction training, which ensured they knew what was expected of them in their roles. Recruitment procedures were robust, helping to ensure that residents were protected. EVIDENCE: The home had a stable staff team with little turnover of qualified nurses, which was good for the continuity of care of the residents. Agency staff, mainly care assistant grade, are used occasionally. Duty rosters and discussions with the manager evidenced that there were adequate numbers and skill mix of staff on duty over the 24-hour period. The manager had the flexibility to increase the numbers of staff in the home when resident numbers or dependency levels increased. Care staff deal with residents’ laundry as part of their general duties, and the manager reported that this system worked very well in the home. It will be necessary to quantify the time spent in laundry duties in order to ensure that the number of hours available for the personal care of residents is not compromised. This is an outstanding requirement from previous inspections. Three staff files were sampled and demonstrated robust recruitment practices. Files viewed contained a completed application form, photographic identification, copies of contract of employment, two references (including last Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 22 employer), evidence of enhanced Criminal Records Bureau checks and immigration status documentation. The manager reported that an audit of practice within the home had recently been carried by the Criminal Records Bureau, and the home’s procedures were found to be in order. The home also required staff to sign a declaration form stating details of any other employment; this enabled the home to help ensure that residents were not placed at risk by staff working excessive hours. All nurses had current registration with Nursing and Midwifery Council. The home had a comprehensive induction programme, which included the home’s philosophy of care, and the manager reported that they were at present planning further improvements to programme Training records were viewed and confirmed the home’s commitment to ensuring that staff receive statutory training. Staff receive fire training in the form of lectures and Drills, Safe Moving and Handling, and Control of Infection. Training in food hygiene had been scheduled for early November. A number of staff were being supported to undertake “distance learning” with a local college in subjects such as Nutrition, Health and Safety and care of people with Parkinsons Disease. The home was also participating in the Gold Standards Framework for Palliative Care. More than 50 of care staff had achieved NVQ Level 2 or above. Two staff members commented that they had good access to training and felt well supported in their roles. Staff files viewed evidenced that they had received an annual appraisal and there was also some evidence that formal supervision was being carried out. The manager said they were aiming to carry out supervision a minimum of six times a year. She later confirmed that all staff received formal supervision a minimum of six times a year; this was not verified at the time of the inspection. Longmore Nursing Home DS0000004559.V310478.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, 32, 33, 35, 36, 38 The quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. The manager ensured the smooth running of the home in a competent manner. The health and safety of residents and staff was well managed. Systems were in place to ensure that the views of residents, relatives and staff were sought and considered, and this ensured that residents and staff felt valued. EVIDENCE: The manager of the home had substantial experience of caring for elderly people and the managing of a nursing home. She was supported by two deputy managers who job-shared a full-time post. Throughout the inspection the manager demonstrated a good knowledge of the residents in her care. There were clear lines of accountability within the home, and relationships between the manager, staff and residents appeared to be good. Residents, Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 24 relatives and staff conversed with felt confident that their opinions would be listened to and taken into account. Feed-back from both relatives and residents was very positive about life in the home. A number of people commented favourably on the quality of care, and the culture within the home, with more than one person describing life there as “like a family”. There were a large number of letters and cards from grateful relatives expressing thanks to the staff for the care their relative had received. Staff spoken with said it was a good place to work. One staff member said, “It’s so rewarding – it’s like an extended family – we all want to achieve the same thing.” Another staff member said, “It’s a caring place – I wouldn’t stay otherwise” The Registered Provider visited the home on a regular basis, and brief records of the visits were available. The reports of visits by the responsible individual needed to be more comprehensive in order to comply with the regulations, and to help ensure the welfare of residents. There were systems in place for monitoring the quality of the service offered in the home, including an annual Quality review using the Safe Standards and Practice Audit. Questionnaires canvassing the views of residents, relatives and staff were circulated twice a year, and information from these was collated, evaluated and action taken as appropriate. Staff did not manage residents’ monies, apart from a small amount of cash provided by families for the day-to-day expenses of residents. This was securely stored in a locked cabinet; access was limited to the nurse in charge, two signatures were obtained when cash was withdrawn, records kept and receipts required for any expenditure made on behalf of residents. The health and safety of the staff and residents was generally well managed. Separate accident books were maintained for residents and staff. Accident and incident reporting were seen to be satisfactory. Following the last inspection a trolley had been made available for the safe transporting of the oxygen cylinder within the building. There was evidence on site of the regular servicing of equipment and the water system had been checked for the prevention of legionella. Longmore Nursing Home DS0000004559.V310478.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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Longmore Nursing Home DS0000004559.V310478.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 OP3 Regulation 14(1)(d) Requirement The registered manager must review the assessment procedure to ensure all care needs are being identified. The assessment must include an assessment of the persons spiritual/religious and cultural needs. Guidance as stipulated in the care standard should be used in this review process. This is an outstanding requirement from previous inspections. The registered manager must ensure that the care plan for each resident includes all care required by the resident and that it is revised and renewed as the resident’s needs change. Requirements in relation to care planning were made at previous inspections 17/02/06 and 12/10/05. The registered manager must ensure that risk assessments carried out are sufficiently detailed and robust to inform the process of care planning and DS0000004559.V310478.R01.S.doc Timescale for action 14/12/06 2 OP7 15 Sch 3 (1)(b) 14/12/06 3 OP7 15 Sch 3 (1)(b) 01/01/07 Longmore Nursing Home Version 5.2 Page 27 practice. Requirements in relation to risk assessments were made at the last inspection – 17/02/06 The registered manager must ensure that the Complaints Policy is revised to inform complainants that they may involve the Commission for Social Care Inspection at any stage in the process, and to include the address and telephone number of the Commission. This is an outstanding requirement from the previous inspection 17/02/06. The registered manager must ensure that the “Handling of Abuse Allegations” policy is urgently updated to reflect current guidelines. The registered manager must ensure that staff receive training in relation to adult protection issues. The registered manager must ensure that the home’s “Whistle blowing” policy is revised to include up to date address and telephone number of CSCI The registered manager must ensure that the landing on the first floor adjacent to the stairway (emergency exit) is cleared of the various items being stored there. The registered manager must ensure that two grab rails are fitted in first floor toilets. This is an outstanding requirement from the last inspection 17/02/06. The registered manager must ensure that the floor covering in the lift is replaced promptly. DS0000004559.V310478.R01.S.doc 4 OP16 22(7) 01/12/06 5 OP18 13(6) 01/01/07 6 OP18 13(6) 01/04/07 7 OP18 12(10(a) 01/01/07 8 OP19 24(4)(5) 14/11/06 9 OP22 23(2)(n) 01/02/07 10 OP22 23(2)(n) 01/02/07 Longmore Nursing Home Version 5.2 Page 28 11 OP26 13(3) 12 OP27 17 &18 The registered manager must ensure that the badly stained mop-sluicing sink in the laundry is replaced if it cannot be cleaned. The registered manager must ensure that the time care staff spend on laundry duties is quantified and clearly shown on the duty roster. This is an outstanding requirement from previous inspections 17/02/06 and 12/10/05. The registered provider must prepare a more detailed written report on his visits to the home. This is an outstanding requirement from the previous inspection 17/02/06. 01/03/07 01/12/06 13 OP26 (1) (3)(4)(c) 01/12/06 Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations It is strongly recommended that staff receive training in care planning. Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Longmore Nursing Home DS0000004559.V310478.R01.S.doc Version 5.2 Page 31 - 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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