Inspection on 24/09/08 for Longmore Nursing Home

This inspection was carried out on 24th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Longmore Nursing Home 16/10/06

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 09/02/2009.

CARE HOMES FOR OLDER PEOPLE Longmore Nursing Home 118 Longmore Road Shirley Solihull West Midlands B90 3EE Lead Inspector Lesley Beadsworth Unannounced Inspection 24th September 2008 11:30 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.V372497.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.V372497.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 longmore@live.co.uk 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) Ms Julia Ann Bryant Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) 22 The maximum number of service users who can be accommodated is: 22 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 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. Longmore Nursing Home DS0000004559.V372497.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 the people who use this service experience adequate quality outcomes. The inspection included a visit to Longmore Nursing Home. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a selfassessment and a dataset that is filled in once a year by all providers. It should inform us about how providers are meeting outcomes for people using their service. Ten surveys were sent to service users. Eight were completed and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The manager and deputy manager were absent at the time of the visit although discussion took place with the deputy manager after the visit. Subsequent visits to meet with the manager were not possible due to further absences. The inspection process also consisted of a review of policies and procedures, discussions with the nurse in charge, staff, visitors and residents. The inspection visit took place between 11.30am and 8pm. What the service does well: All prospective residents are assessed by the home to establish if the home could meet the person’s needs or not. A new format that covered all the necessary headings had been implemented. There was evidence that health care needs were being met, with records of visits by the GP, optician, chiropodist and psychiatric nurse being available in the care files looked at. Further evidence of this was seen in the surveys Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 6 returned to us when all eight people who responded said that they received the medical support they needed. Interaction between staff and residents was respectful and friendly and observations of staff practices found staff responded promptly and sensitively to the needs of residents. Residents spoken to said that staff respect their privacy and confirmed that they knock before coming into their rooms. In the surveys returned to us all respondents said that they ‘always’ or ‘usually’ enjoyed the meals and included positive comments about the food at the home. People living at the home were offered ample opportunities to join in stimulating activities and occupation, with a designated activity organiser in post. Special occasions were recognised and entertainers were hired to perform at the home. Visitors said that they were made welcome and it was seen that they had a friendly rapport with staff. All those spoken with made positive comments about the care at Longmore. People living at the home had choices in their daily lives such as when to get up and go to bed, what to eat and what activities they did or did not want to take part in. Instructions regarding special diets were available for kitchen staff. The home had complaint and safeguarding policies and procedures in place. Bedrooms seen had been personalised with the occupant’s belongings such as houseplants, pictures, photos and soft toys. These made the surroundings look more homely and more familiar to the people living there. Disposable towels and soap dispensers were provided in all communal areas staff and residents hand washing areas, thereby assisting with maintaining infection control. A suitably qualified and experienced person manages the home. What has improved since the last inspection? The Handling of Abuse Allegations (safeguarding) policy had been updated to reflect current guidelines. Staff had undertaken training related to safeguarding in order to protect residents from abuse. Grab rails had been fitted to the first floor toilets to safeguard residents’ safety. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 7 The floor covering in the lift had been replaced, improving the appearance and safety of the lift. A note at the bottom of the rota stated, “Staff laundry hours 2 hours per 24hours” in response to a previous requirement to indicate how many care assistant hours was taken away from time with residents to carry out laundry tasks. There was nothing to evidence how this figure had been estimated. The domestic sluice sink in the laundry had been effectively cleaned and no longer posed a hygiene risk. The registered providers had provided more detailed monthly reports that showed that they were monitoring the service in order to enable growth and improvement. The AQAA informed us that some profile beds, bed tables, bed linen, a new hoist and recliner chairs had been provided in the last 12 months. What they could do better: The assessment format had been revised to ensure that all care needs, including spiritual, religious and cultural needs had been incorporated but preadmission assessments viewed did not cover all these needs. Care plans had some shortfalls with specific needs not being included. There was a risk therefore that these needs would not be met. Some guidelines in a care plan were not being followed. To maintain security and confidentiality the medical room should be locked when unoccupied. The medication keys should be held only by the person in charge of medication at the time and need to be separate from general keys to avoid the risk of them being held by inappropriate people. There should be a procedure for as required (PRN) medication to enable staff to know when this should be offered/given. Some residents had regularly refused some PRN medication and the supply was being kept in the medicine cupboard, without a ‘carry over’ total on the Medication Administration Record Sheets. The GP’s advice should be sought with regard to whether the prescription should be repeated or not. A record should be maintained of medication stored in the medicine cupboard that will enable appropriate auditing. A sample of the signatures of staff responsible for medication should be available for monitoring, auditing and inspection purposes. The kitchen had a few shortfalls in cleanliness and the storage of food, that is, dirty extractor fan casing, worn and peeling cutting boards, poorly wrapped food items in the freezer, uncovered tea bags and sugar canisters and dirty Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 8 worktop under these canisters, which had the potential to be hazardous to the health and welfare of the people living and working at the home. Our address included in the Whistle Blowing policy continued to be several years out of date and we cannot be contacted there. The sitting areas were not spacious with residents sitting close together. There were very limited dining facilities, due to lack of space, for residents to eat at a table, the majority taking their meals in their armchairs with an over bed table. The only table was worn and unsightly and place mats used were of poor quality and past their best. Bathrooms were in need of tidying and some worn boxed-in areas needed repainting. Toilets in the home had stained u-bends, which were unsightly and unpleasant. There were only two assisted baths for twenty two residents but staff said that no more than two people would be assisted to bathe in the same period. Items continued to be stored on the corridor adjacent to the top of the emergency exit staircase. At the time of the visit these included a hoist. Advice should be sought from the fire service about the safety of storing items in this area. The home looked in need of redecoration in order to provide more comfortable surroundings. Some bedroom furniture was looking very worn and in need of repair or replacement and this included rusty patches on some commodes that could be unhygienic. Most of the bedrooms viewed were in need of a second armchair to accommodate visitors comfortably and bed linen was creased and looked unattractive. 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.V372497.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.V372497.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): 3 Quality in this outcome area is adequate. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met but there are shortfalls in recording social and religious needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three resident care files were looked at as part of the case tracking process. Each had an assessment that had been carried out by the home in order to establish whether the home could meet the person’s needs. Pre-admission assessments had been carried using a format that includes all the necessary headings and sufficient detail to decide if the home could meet the person’s needs or not. The AQAA told us that assessments had been revised to ensure that all care needs, including spiritual, religious and cultural needs had been incorporated. However there continued to be some shortfalls Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 11 in this, which could create the needs of the residents not being met. For example, an assessment included brief details about a resident’s religion but omitted important information that would impact on the person’s day-to-day life in the home; the pre-admission assessment of a resident recently admitted to the home had very limited information regarding their interests. This could lead to these needs not be included in the care plan and not being met. The assessment of a person who had been living at the home for five years did not refer to the person’s nutritional needs or wishes and the nutritional screening had not been completed. Information shared verbally with us about the same person and their assessed needs was not reflected in the recorded assessment. Relying on the memory of staff creates the risk of needs not being known by everyone. Longmore Nursing Home DS0000004559.V372497.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 Quality in this outcome area is adequate. There are shortfalls in care plans that carry the risk of residents’ needs not being met. Residents have access to health care professionals and are cared for in a respectful manner. The medication process generally safeguards residents’ health and welfare but there are shortfalls that could mean a risk to maintaining security and confidentiality. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are devised in order to give the staff the information required to provide the appropriate care. The home had very recently revised the care plan format and had introduced a system that they had purchased. Whilst all care plans had been transferred to the new system this had been completed only a short time before the visit. The nurse in charge advised that they were aware that the plans needed further information to be transferred from the previous care plan system and the deputy manager confirmed this later during a telephone conversation. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 13 The care files of three residents were looked at as part of the case tracking process. Each contained a care plan that was based on the resident’s assessment. Whilst the care plans were well presented and easily readable they had some shortfalls that could result in needs not being met. Care plans looked at failed to give staff any information or guidance about how to meet some assessed needs including those related to mental health, a diverse religion, repeated urinary tract infections and what side effects could arise, skin soreness and difficulty in swallowing. There was no body map to indicate the extent and location of the soreness of the resident. One care plan stated that although the person fed themselves there was a risk of spillage of food and drink that staff needed to watch for but it was seen that the person was left alone to manage a drink that subsequently led to the whole beaker being spilt. Each of the care files also included a life history, which helps staff to know the person they are caring for. One life history of a person who had been at the home several years had not been completed, although it was clear that staff knew a great deal about her. As this person also had difficulty in speaking it would be beneficial, if the person agreed, for this information to be recorded. Residents on going health care needs were being met with evidence visits by the GP, optician, chiropodist and Psychiatric Nurse being identified in the care files looked at. Visits from health care professionals were recorded separately and were to easy to track and to cross reference. Daily records in one care file showed that a person had suffered from soreness for some weeks but there was no record to show that this had been referred to the GP when it had not improved. The nurse in charge told us that all the people living at the home have the same GP, who visits the home weekly and when asked to visit. When asked the nurse added that if a person wanted to keep their own GP and that GP agreed this would be arranged. Surveys completed by or on behalf of residents asked the question, “Do you always receive the medical support you need?”. All eight responses to this question were “Always”. Comments added included, “I see the doctor, chiropodist, dentist.” “I tell them (staff) I want to see the GP and he always sees me.” “I have my feet done every 6-8 weeks. I had my eyes tested last week.” Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 14 Completed risk assessments for nutritional risk screening and a manual handling risk assessment were also in place. These would help to minimise any risk in these areas. However the action required to minimise a risk in one moving and handling assessment had not been included in the appropriate care plan. Records for falls, pressure areas, weight, bathing and nail checks were in place within the files looked at, although the personal hygiene records had not been completed on a daily basis in any of the files looked at. Preventative measures such as pressure relieving mattresses and cushions were in use. The home has a medication policy that had been signed by all registered nurses to show that they understand it and agree to comply with it. The deputy manager was responsible for the ordering and receipt of medication. Prescriptions are completed by the GP and received at the home for them to be checked against what was ordered, prior to being taken to the pharmacist for dispensing. Medication is received monthly and stored in a secure place until in use. There were appropriate procedures for the disposal of medicines, including controlled drugs. Controlled drugs were stored safely in a suitable drugs cupboard and had been administered and recorded correctly. The Primary Care Trust pharmacist visits the home at regular intervals and reports made available to us by the home showed that there had been significant improvement in the medication system in the home in the last months. We were also advised that the PCT pharmacist keeps the home up to date with changes related to medication. The medication administration process was observed and medicines were given and recorded appropriately. However there were occasions when the nurse administering the medication left the unlocked trolley out of her line of vision whilst ensuring people, in the same room, were taking their medicines. This could jeopardise the security of the contents of the trolley. Medication keys were kept with the general keys and although the person in charge only held these there was the chance that they could be passed on to others. It was therefore suggested that the medicine keys were kept separately from the general keys. The deputy manager confirmed after the visit that this would be addressed. The medical room was unlocked throughout the visit and we were told that this was usual practice. It was suggested that this door be locked in order to safeguard the contents and maintain confidentiality. The deputy manager confirmed that this would also be addressed. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 15 The home did not have any ‘as required’ (PRN) protocols to give staff guidance as to when these medicines should be given. Medication Administration Record Sheets (MARS) were looked at and these were in good order with no inappropriate gaps or codes. However some PRN medication was being refused on a regular basis. The GP should be consulted for advice as to whether the prescription needs to be repeated or not. The total held by the home was kept in a cupboard rather than in the trolley used at each medication round. The amount remaining was not shown on the MARS, making it difficult to audit. A random audit of tablets was carried out. There were no errors found with all actual tablets remaining being the amount calculated. This indicated that the correct medication was being given to the correct people. A sample of the signatures of the people responsible for medication was not available at the time of the visit. It was later confirmed that these were with the policies and procedures. All interaction between staff and residents showed that they were cared for in a respectful manner. Conversations between staff and residents were respectful whilst including friendly banter. Terms of preferred address were on the residents care plan and heard to be used by staff. Observations of staff practices found staff responded promptly and sensitively to the needs of residents. Residents spoken to said that staff respect their privacy and confirmed that they knock before coming into their rooms. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided but there are shortfalls in the dining facilities available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activity organiser for four days a week. Staff said that this person was popular with residents and surveys and discussion with residents confirmed this with such comments as, “I enjoy the activities and get on well with the organiser.” The staff spoken with said that residents are asked what they want to do and an activity schedule was in place and included darts, skittles, card games, quizzes and bingo. Crafts also take place, with residents’ birthdays being recognised by residents assisting with card making and all residents signing the card. Residents have also assisted with the planting of hanging baskets and potting bulbs. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 17 Professional entertainers are organised approximately two monthly and a notice displayed in the home informed everyone of a forthcoming sing along that was to be led by an accordionist. The home’s AQAA told us that they were looking at how transport for trips out could be viably purchased. The visit took place on the rest day of the activity organiser. An outside contractor visited the home to provide the residents with Music to Movement in the morning but no other organised activity was seen during the rest of the day. A caged budgie lives in the conservatory and residents were enjoying talking to and interested in watching the bird. Comments from residents in response to the question, “Are there activities arranged by the home that you can take part in?” in the surveys returned to us said, “I like to watch the squirrels in the garden and the birds. I like to watch the activities.” “I always join in.” “I enjoy playing cards and talking to the budgie.” “I like dominoes, skittles and quizzes.” There is ‘open’ visiting with one resident spoken with saying, “It is good that visitors can come at any time.” The home’s AQAA identified ‘open visiting’ and ‘encouraging families and friends to stay for meals and to help if they wish’ as things that they did well. There were several visitors during the day, some of whom were spoken with. The following comments were made by them, “Everything is fine here.” “They always have a drink close by, which is good.” “They’re well looked after here. Very happy with the care.” “No concerns at all.” “This is a good home. My (relative) is happy here.” Visitors also said that they were made to feel welcome and this was apparent, with staff chatting with visitors and a friendly rapport seen between them. Observations made and discussion with residents and visitors showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat and whether to join in activities or not. Choices about where to spend their time could also be made although this was limited to the lounge/conservatory areas or their bedroom. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 18 The majority of the people living at the home took meals in the sitting areas. Dining facilities consisted of a large and worn laminated top table and a few dining chairs in the middle of the conservatory. Whilst this would be useful for the activities it was inadequate to be able to cater for all the residents sitting at the table for their meals. Staff said and residents and visitors spoken with said that they were happy to eat from their armchairs but in reality they had little choice. Each person had an over bed table at their armchair which were also used as occasional tables for jugs of drinks and personal bits and pieces. These tables were set at lunchtime with appropriate crockery, glasses and cutlery, although tablemats were poor quality and past their best. Menus were varied, offered a choice and meals looked appetising and nourishing. A menu was displayed on the notice board in reception but was not the current one. The main meal that day was pork in cream with mashed potatoes, leeks, cabbage, carrots and peas and was well presented. Surveys returned to us said that the people who had responded either ‘always’ or ‘usually’ enjoyed the meals at the home and comments included, “I love the food.” I know what I like and staff will get me the meals I like.” “The food is good. I like the porridge and cooked breakfast.” There was a large variety of hot and cold drinks available including a large choice of good quality fruit squash. The kitchen was located in the basement and although generally clean there were some shortfalls, storage of sausages, chicken and fish in the freezer were inadequately wrapped; sugar and tea bags were stored in open canisters; the worktop under and around the canisters was dirty; cutting boards were badly scored, worn and peeling; some cooking trays were old and worn. A wallmounted piece of equipment, which appeared to be a large extractor fan, in the kitchen did not seem to be working and was very dirty; staff spoken with did not know what this equipment was. Whilst there was nothing to suggest that anyone had suffered as a result of these shortfalls there was the potential of hazards to the health and welfare of people living and working at the home. Up to date temperature records were available in the kitchen showing that the temperature of fridges and freezers and cooked foods were taken to ensure safe limits to protect the health and welfare of the people living at the home. There was a dry pantry adjoining the kitchen, which was well stocked with good quality foods. Further storage for dry foods was being used along the corridor from the kitchen but food items were being stored with incontinence Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 19 pads, hardware cleaning items, archiving, activity equipment and Christmas decorations. Food should be separated from these items. A list of special diets such as soft diets, vegetarian and thickened fluid, was on display in the kitchen to ensure that people were provided with appropriate meals. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents although these did not show our details correctly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure was displayed in the reception and included in the Service User Guide. The procedure seen continued to be without our details. Records are maintained of complaints made to the home and showed that there had been only one since the last inspection. This was related to the care of a resident’s clothing and was satisfactorily managed and resolved. No complaints had been made directly to us. The Safeguarding (adult abuse) policy had been updated to include the latest relevant guidelines, however the Whistle blowing policy continued to have our address from several years ago. As this office is no longer used by any of our teams we could not be contacted there. Staff had attended training related to safeguarding to give them the knowledge and skills to identify and to protect residents from abuse. The AQAA told us that this training would be continued into the following year. Notices displayed in the office showed that three sessions had taken place in recent months. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 21 All recruitment practices safeguard residents from the employment of unsuitable people. All financial records of money held on behalf of residents safeguarded their financial interests. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 22 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, 20, 21, 24, 25, 26 Quality in this outcome area is adequate. The home offers the people living there surroundings that are free of unpleasant odours, generally clean and adequately maintained but with some shortfalls related to décor and communal sitting area space and dining facilities. Outdoor space is attractive and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located on a residential road that is close to all amenities and bus routes. Accommodation is provided on two floors with communal space on the ground floor only. There is adequate parking at the front of the home. The entrance had a porch with a telephone entry system. This leads to a corridor that directly faced the lounge. A general office was sited in the reception area. The manager’s office, which was originally a bathroom, was off the reception corridor in between two bedrooms and with a sluice opposite. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 23 The sitting areas looked crowded with residents sitting quite close together in the lounge and along the two long walls. Most of the people in the adjoining conservatory were sitting very close together. There was one cay care service user in the home at the time of the visit and a second service user attends on other days for day care as well. The home’s registration conditions allows for five day care service users but it would add greatly to the already crowded living space if all places were used. The conservatory has fire exits at either end, which lead on to the attractive and well maintained garden that surrounds it. The conservatory was very warm during the visit. These areas were clean, apart from the lounge carpet needing vacuuming, and were free of any unpleasant odour. There was one large and worn laminated table in the conservatory with a few dining chairs in the middle of the conservatory. Staff said that residents like to take their meals in their armchairs but it was seen that the dining room furniture and space gave them limited choice. Ground floor toilets were very dirty and smelly on our arrival at the home with urine on the floors and badly stained u-bends in the WC. The floors and toilets had been cleaned later in the day and were odour free but, as with all toilets looked at, were still stained. The surfaces of the boxed-in pipes in the ground floor bathroom were very worn and could be unhygienic. The assisted bathroom on the first floor looked untidy with hoist slings on the floor and hung on the wall. The third bathroom, which was on the first floor did not have an assisted bath and was only used for the hairdresser’s visits. The hairdryer was used in the corridor. The home had less than the one assisted bath to eight residents suggested in the National Minimum Standards but staff told us that there were never more than two people bathed at the same time of day. A passenger lift was provided between the two floors giving residents access to these floors. it also enabled staff to access the basement. The floor covering in the lift had been replaced thereby improving appearance and safety. Grab rails had been added to the first floor toilets to assist people using these facilities. Most of the bedrooms viewed were small although a lounge on the first floor had been changed to two good-sized bedrooms with ensuite facilities before the last inspection in 2006. The doorframes of these two rooms were still in need of varnishing/painting. All bedrooms looked at had been personalised with houseplants, photos, pictures, and soft toys, making the residents private space more homely and familiar to them. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 24 The home had four shared bedrooms that had screening which provided adequate privacy if personal care was being provided for one or both occupants. There was no way of identifying which toothbrush and toothpaste belonged to which person in all the shared rooms viewed as they were stored together on shelves, were not labelled and were identical in colour and brand. This created the risk of them being used by other than the owner and of infection control not being maintained. The floor covering and décor in each bedroom was satisfactory. Bedroom furniture in the rooms looked at ranged from new and attractive to shabby and worn. There were also rusty patches on some of the commodes that could unhygienic and which were of a clinical design rather than domestic. There was only one armchair in most of the bedrooms, including those rooms that had room for a second armchair. It therefore would be difficult to provide adequate seating for visitors in the bedrooms. The bedrooms seen did not have a lock and key although previous reports showed that some bedrooms do have locks. When asked we were told that none of the residents had a key to their room but that if they asked for one provision would be made. All bedrooms viewed had a lockable space for valuables. Bed linen, including duvet covers, whilst in good condition was creased, which looked unattractive and uncared for. There was a hoist stored at the top of the emergency exit staircase, which was dirty in parts and were a hygiene concern, and had a broken buffer. The home should check with the fire service regarding the fire safety aspect of storing items in this area. On another corridor on the first floor another hoist and battery charger was stored safely but a commode was also stored in this area. This was unsightly and parts of it were dirty. Outside the fire exit stairs a broken chair, an over bed table and a headboard were awaiting disposal. The question, “ Is the home fresh and clean?” was asked in the surveys and four people answered “Always” and four people answered “Usually”. The comments made were, “Always clean” “Cleaners are there every day to clean the home.” Some redecoration would provide more comfortable surroundings for the people living at the home. The AQAA told us that some profile beds, bed tables, recliner chairs, linen and a hoist had been provided in the last year and that there were plans for more profile beds, linen and for a rolling programme of redecoration. The redecoration programme was not made available at the time of the visit. Laundry facilities, which were in the basement, were inspected and found to be well organised, clean and hygienic. There were two washing machines with appropriate disinfecting/sluicing programmes and two tumble driers. Hand Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 25 washing facilities and protective clothing were available in order to maintain infection control. The mop sink had been cleaned to remove previous staining. Dispersible bags were used to take soiled linen to the washing machines. The bags dispersed during the washing cycle so that staff did not need to be in contact with the soiled contents, further maintaining infection control. All communal areas where staff and residents were able to wash their hands had soap dispensers and disposable towels thereby assisting infection control. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 26 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 Quality in this outcome area is good. There are sufficient care staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The nurse in charge said that the usual staff cover was made up of the manager and/or deputy manager during the day on weekdays; one registered nurse and four care staff each morning; one registered nurse and three care staff each afternoon and evening; two care staff throughout the night; a cook each day and a kitchen assistant in the afternoon and evening; one domestic assistant each morning; a handyman/ gardener fifteen hours a week. Rotas looked at confirmed this apart from the absence of the manager and the deputy manager. The capacity in which some of the staff worked was not shown on the rota and had to be cross referenced with the staff list made available. The hours worked were not shown on the night staff rota. The actual hours worked and the designation of each member of staff should be shown on each rota. Three files of recently employed staff were looked at. All recruitment practices safeguarded residents from the employment of unsuitable people. The appropriate checks had been made prior to employing each member of staff. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 27 Evidence of staff supervision was seen in one of the files and all had evidence of appropriate induction training having been undertaken. The home’s AQAA told us that one of the improvements in the last 12 months was the implementation of induction training and a training schedule and the recruitment of a bank nurse to cover absences amongst the nursing staff. The home’s AQAA also told us of the home’s staff stability, which would provide the people living at the home with continuity of care. Fourteen of the eighteen care staff at the home had achieved National Vocational Qualification (NVQ) Level 2 in Care and one had achieved Level 3. This exceeds the required 50 of care staff to have NVQ. Staff with this qualification have been assessed as competent to do their job. Other recent training undertaken by staff included safeguarding, dementia care, infection control, food hygiene, and life support. The training planner showed that health and safety, fire safety and moving and handling training were due in the next few weeks. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 28 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, 35,36,38 Quality in this outcome area is good. A person with the appropriate qualification and who has previous management experience manages the home. There is a system for monitoring and auditing the service and practices to ensure that all services operate in the best interests of residents. Residents are protected by the home’s finance procedures and practices. The home is a safe place to live and work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager of the home is a registered nurse and has achieved the NVQ Level 4 in Management qualification. She was previously the deputy manager at the home and therefore had the appropriate experience and qualifications for the post, which she had held for a year. The manager was on holiday at the time of the inspection an the deputy was not on duty . A Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 29 qualified nurse was in charge of the home at the time. The registered providers should assess the need for sufficient senior staff when the manager and the deputy are not available. The AQAA returned to us was very brief consisting mainly of one-line responses telling us very little about the views of residents, what the home does well or what improvements had been made or were planned. There was not enough information to help us to fully understand how the home is meeting the outcomes for people living at the home. The Quality Assurance system shown to us showed audits of medication and finances. The AQAA told us that there was a new system in place but this was not available at the time of the visit. The registered provider had improved the monthly reports with more detail showing that he was monitoring the service in order to make any necessary improvements. Some money was kept for safe keeping for most of the residents. There were appropriate records of transactions made, and a random audit showed that cash balanced against these records. Money was kept in a secure location. The financial interests of these residents were safeguarded by the practices in place. Manager and deputy manager carried out staff supervision. The nurse in charge at the time of the visit said that supervision was on target. Some evidence was found in the staff files looked at. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. The AQAA showed us that policies and procedures had been revised in 2008. There was evidence from the home’s AQAA and from a random check of records, (that is Portable Appliance Testing, the gas boiler and gas fittings, the five year wire testing and the servicing of hoists), that equipment was regularly serviced and maintained, health and safety checks were carried out and that in-house checks on the fire system were up to date. Staff had undertaken training in health and safety related subjects and there were dates planned for further training in health and safety, fire safety and moving and handling in the next few weeks. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 30 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 2 x x N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 x x 2 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 x 3 x 3 3 x 3 Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 Requirement Assessment must cover all areas of need. This will ensure that they receive the appropriate support. Care plans must include sufficient details of the individual care required. This will ensure that residents receive person centred support that meets their needs. Timescale for action 30/11/08 2. OP7 15 30/11/08 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. 2. 3. 4. Refer to Standard OP9 OP9 OP9 OP9 Good Practice Recommendations The medical room should be locked when unoccupied in order to maintain security and confidentiality. The medication keys should be kept separately form general keys and be the responsibility of the person in charge of medication. A protocol for ‘as required’ medication should be in place. A sample of the signatures of all people who may administer medication should be available. DS0000004559.V372497.R01.S.doc Version 5.2 Page 32 Longmore Nursing Home 4. 5. 6. 7. 8. OP18 OP19 OP20 OP26 OP38 The home’s Whistle Blowing policy should be revised to show our current address and telephone number. The maintenance and décor tasks identified in the report should be included in the rolling programme and addressed promptly. Consideration should be given as to how sitting areas and dining facilities can be improved. Any solutions should be implemented. All issues related to cleanliness and hygiene including in the toilets, kitchen, the toiletries in shared rooms and rusty commodes should be addressed promptly. Advice should be sought from the fire service regarding any risk involved in storing items on the corridor adjacent to the side staircase. Longmore Nursing Home DS0000004559.V372497.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V372497.R01.S.doc Version 5.2 Page 34 - 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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