Inspection on 20/07/08 for Longridge Court

This inspection was carried out on 20th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Longridge Court 01/08/07

Longridge Court 02/05/06

Longridge Court 29/09/05

Longridge Court 04/04/05

Longridge Court 12/10/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Longridge Court Bull`s Cross Stroud Gloucestershire GL6 7HU Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 20 and 21st July 2008 10:30 th Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longridge Court Address Bull`s Cross Stroud Gloucestershire GL6 7HU 01452 814341 01452 810712 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) Voyage Ltd Ms Elsa Lister Jones Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2007 Brief Description of the Service: Longridge Court was first registered in July 2004 to provide accommodation to 14 service users with a learning and/or physical disability in two separate dwellings. It has since been refitted to provide additional accommodation for up to three people in a self contained flat. It is owned and managed by Voyage Ltd. People living in the main house may have high care needs, such as wheelchair dependence, auditory and visual impairment, autistic spectrum disorder or epilepsy. People living in Almartom (the annexe) may have additional low level challenging behaviour. People living at The View (the flat) may have a learning disability and associated challenging behaviour. Situated near to the village of Painswick, Longridge Court is in a rural location and has easy access to the neighbouring towns of Stroud, Cirencester and Gloucester. 7 people live in the main house and 3 people may live in the flat. Almartom accommodates 3 people. (This has been reduced from the initial registration for 4). All three residences are self-contained with single rooms that have en-suite facilities. The house has a lounge, music room and dining room, whereas the other residences have a combined lounge/diner. Almartom has a sensory room. There are substantial grounds around the property. People living at the home have access to three vehicles. The fees at the home range from £1,412 to £1,746. The Statement of Purpose and Service User Guide are displayed in the hallway to the main house, further copies are available from the office. Longridge Court DS0000060822.V360907.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 2 star. This means the people who use this service experience good quality outcomes. This inspection took place in July 2008 and included two visits to the home. The first visit took place over the weekend. Because people with learning disabilities are not always able to tell us (The Commission) about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing three people who live in the home for two hours and recording their experiences at regular intervals. This included their state of wellbeing and how they interacted with staff members, other people living in the home and their environment. Two inspectors visited the home on the second day and they looked at a range of records including care plans, staff files, medication systems and health and safety documents. Staff were spoken with during the first visit about the care they provide. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. She was present on the second visit to the home. Surveys were returned from seven relatives, one healthcare professional and one member of staff. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 6 Eleven requirements issued at the last inspection had been complied with. One requirement was partially met and it was evident that the registered manager and Milbury/Voyage were addressing ways in which they could ensure that all staff have access to mandatory and other training on a regular basis. All people had been given revised copies of the service user guide. Fences in the garden had been erected providing privacy and safety for people in the main house. Access to activities for some people had improved and plans were being put in place to offer regular activities to all people living in the home. People were having regular access to dentist appointments. Systems for the administration of medication had improved. Staff had received training in basic food hygiene. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Satisfactory admission arrangements are in place that include an assessment of people’s needs. Ongoing re-assessment of people ensures that the service is continuing to meet their changing needs. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed since the last inspection. All people living in the home had been given a personal copy of the service user guide that provided them with information about the service they receive and that there were no additional costs to them. Information about fees had not been provided in these documents. There had been no new admissions to the home since the last inspection but two people had been supported to move to new homes which could better meet their needs. The registered manager said that several people were showing an interest in moving into the home and that visits would be arranged. Voyage have a central admissions department who complete initial assessments and collate pre- admission information from placing authorities and previous placements. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are being involved in developing their care plans that reflect their aspirations and needs. Risks are being managed safeguarding them from possible harm. EVIDENCE: A new person centred support plan was being introduced at the home. A sample of a draft copy was available for examination. Until these plans were in place the home was continuing to use the old style care plans and risk assessments. Plans provided a holistic analysis of people’s physical, intellectual, emotional and social needs. The care for three people was case tracked which included reading their care plans, discussing their care with staff and observing the care provided. Their financial and medication records were also examined. Each person had a person centred plan plus additional care plans and risk assessments that clearly linked with each and had been reviewed regularly. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 10 Any changes to these documents were summarised on a cover sheet that indicated the frequency of review. This is good practice. Key workers were keeping a monthly summary of each person’s care needs, appointments and activities. A selection of monitoring records was in use such as body and fluid charts, transfer and moving and handling charts. The registered manager said that some annual reviews were taking place with placing authorities and that others were being arranged. For the two people case tracked there did not appear to have been an annual review since 2006. Parents commented, “better communication on issues such as reviews” is needed, and “we are due an annual review to review last year and amend and add to plan if needed.” All people should have an internal annual review. New daily notes had been introduced and were being revised to include space for night staff to record any observations. These provided a summary similar to the monthly reports but also including people’s diet, medication and general wellbeing. Staff spoken with had a good understanding of people’s needs and were observed following people’s care plans. The AQAA stated, “service users are involved in the running of the home where possible and the development of their support/care plans and risk assessments.” People were observed being given choice about what they would like to do, what they would like to eat and where they would like to spend their time. Staff used objects of reference to offer choice to people so that they could indicate their preference by pointing to the object. A total communication approach was being put into place using photographs and symbols to enable people to make real choices. The AQAA indicated, “a menu board will be implemented in picture format to allow service users to help with creating more choice”. Risk assessments provided a guide for staff in minimising hazards identified in care plans and were being put in place as a result of unforeseen incidents and accidents. Accident forms were being used as well as critical incident forms that were being monitored by Voyage. Missing person information including a current photograph had been put in place for all people living in the home. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have the opportunity to participate in social, educational, cultural and recreational activities that reflect their personal expectations. Although for some people these may be affected by staffing levels. People are supported to maintain contacts with families and friends. People are offered a healthy and nutritional diet. EVIDENCE: Each person has an activity schedule in place that indicated a range of opportunities for social, educational and leisure activities during the week. These had recently been reviewed. Daily diaries for the people being case tracked were sampled for the month of July. For two people the majority of their time was spent at home, one liked to go for drives and had recently started going to a day centre for sensory activities twice a week. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 12 The registered manager said that another person would choose to spend all their time in their room and so were encouraged to spend time with others in the lounge and gardens. For them a different type of day care was being explored initially for half a day and hopefully increasing to two days a week. The third person had a range of activities scheduled such as swimming and plans for sailing but these were occasionally cancelled. Staff said that any cancellations would be due to inadequate staffing levels. (See also Standard 33) During the first visit to the home, most of the people in the house and annexe were at home for the day. Staff said they had all been out the day before to a local show and there were indications that people were tired. People in the house were observed listening to music, helping cook lunch, playing games or listening to a story being read. Two people were visiting relatives and people in the annexe were spending time in the garden. During the second visit to the home people went swimming, for a drive, to a day centre and spent time in the garden or lounge. People have hand massage and music therapy on a regular basis and also go to the theatre, garden centres, out for lunch and shopping. Whilst the range of activities had increased there was still capacity for further improvement to make sure that all people living at the home have the opportunity for access to regular community based activities. Staff said that having an additional vehicle that was accessible to wheelchair users had made a significant improvement. The AQAA stated the home would “review our rota to ensure that there is more flexibility in activities” and “implement more structured activities especially at weekends.” Comments from parents and a relative indicated, “key workers support her to join in and undertake planned activities” and “…….. appears to participate in all the areas she enjoys.” Staff continued to support one person to do a paper-round and to find appropriate work experience. Others were being supported to explore opportunities at local colleges for the new term in September. People have the opportunity to help with meal preparation, recycling, gardening, cleaning and their laundry where appropriate. Rooms have keypads and some people were observed accessing their rooms using these, others require the support of staff. People have regular contact with their families. Two people were visiting relatives at home at the time of the visit. Comments from parents and relatives confirmed that they are made welcome when visiting the home. Some people maintain contact over the telephone. One parent commented “I feel very happy with the care ……… receives. It is like one big family at the home.” Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 13 Staff follow a four-week roll over menu plan. People are offered alternatives to the main meal. People in the main house require support from staff to eat their meals. This was observed being done respectfully at their pace and giving them full attention. Their care plans provide guidelines for staff. Meals are nutritious in content with a range of fresh ingredients being used. Budgets were examined and found that one month the provisions budget may be overspent but the next month was under spent. Dry goods were being purchased in bulk and fresh vegetables, eggs and meat sourced locally. At the time of the first visit on the weekend there were very limited amounts of fresh vegetables and staff said that they had used frozen vegetables for the Sunday lunch. Staff confirmed that on occasions at weekends fresh produce might be very limited. On the second visit homemade soup was provided. People were offered fresh fruit on both occasions. Financial records for two people indicated that at times they had paid for a meal when out and had purchased a meal or drinks for staff. This was discussed with the registered manager and she said that replacement meals during the week would normally be paid for out of the activities budget and that people would not pay for staff. These had been an oversight and had been processed when she was away. Clear guidelines need to be in place for staff about the financing and processing of meals for people in the home and staff meals or drinks when supporting people. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are being met helping them to stay well. There are some improvements in the administration of medication that need to be implemented to safeguard people from the risk of error or possible harm. EVIDENCE: The way in which people would like to be supported with their personal care needs was clearly identified in their care plans. There appeared to be flexibility around times for getting up and going to bed. The AQAA stated “Individual care/support plans include preferred times and flexibility, same gender where possible and any adaptations or aids which are needed.” A parent commented “they support every need of my daughter” and another parent said “they treat ……..with respect and as an adult.” Care plans evidenced that concerns about people’s weight were being monitored and the registered manager confirmed a dietician had been involved. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 15 During the first visit people were observed being weighed in the dining room and their weights recorded. Perhaps greater privacy might have been more appropriate. Additional guidance had been provided for staff, which included the use of photographs showing how, sleep systems and bedsides should be used. Risk assessments were seen to be in place. People had been assessed by healthcare professionals for the use of other specialist equipment such as standing frames and chairs. There was evidence in daily records that these were being used. During the first visit a person was observed to have a nosebleed, possibly caused by self- harm. Staff did not notice this for some time despite several walking past her to another room. When we pointed this out to them they took immediate action. Daily notes made reference to the nosebleed. A range of healthcare professionals was supporting people and there was evidence of regular appointments with their Doctor, Dentist, Chiropodist and Optician. Each person had a full record detailing the appointment and the outcome. Health action plans had not been put in place. The registered manager said that the home continues to work closely with the local Community Learning Disability Team. Records on files confirmed this. Staff were maintaining a range of monitoring forms for the team including Red, Amber, Green charts observing behaviour and moving and handling transfers. Systems for the administration of medication were observed and found to be mostly satisfactory. A new copy of the British National Formula had been obtained. Staff had completed training in the safe handling of medication. It was noted that night staff had not completed medication training apart from the administration of midazalom. The registered manager said that this was now available via Elbox learning. Information in the home confirmed this. A member of staff had completed regular medication audits and had identified some of the following issues which we noted: • • All staff dispensing medication must have current training in place Some handwritten entries had not been countersigned by two members of staff • Large stocks of some medication were noted which appeared not to be used in date order • The homely remedies list needed reviewing. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable complaints and concerns to be raised by people using the service or on their behalf. Systems are in place that safeguard people from possible harm or abuse. EVIDENCE: The home had a complaints policy and procedure entitled “Letting us know what you think” which had been made available to all people living at the home and their relatives. Copies of this as well as information details about us were available in the hallway of the main house. The DataSet indicated that five complaints had been received by the home since the last inspection of which three had been dealt with by the home and two were cascaded to Voyage by us to deal with. We had also received an expression of concern. Full records were maintained within the home with a copy of the outcome of the complaint or concern. The AQAA indicated improvements to the current process would include “facilitation of house meetings to offer another arena for service users to express their concerns/views” and “provision of an accessible version of ‘letting us know what you think’.” Training records confirmed that staff had completed Protection of Vulnerable Adults training and the registered manager had completed Mental Capacity Act Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 17 training. She had an easy read version of the Act ready to give staff to read. The registered manager discussed situations when she may use an Independent Mental Capacity Advocate. The home also had a copy of ‘No Secrets’. Staff spoken with had an understanding of how they would safeguard people living in the home and how to recognise possible abuse. Some staff had training in 2004-2006 in CALM (Crisis and Anger Limitation Management) although the organisation now advocates using NCI (Non crisis intervention) a low arousal approach to managing challenging behaviour. All staff now need to have either refreshers in CALM or training in NCI. The Operations Manager confirmed that this had been identified and that training was available for staff in September. Risk assessments and protocols provided guidance to staff about how they were to support people in the management of their emotions. Triggers and responses were clearly identified. A log of any interventions was kept. This indicated that physical intervention was rarely used. Staff also confirmed this. Most doors within the home have keypads and whilst people were observed accessing their own rooms there were times when they could not access the kitchen or doors leading to the gardens. Future care plans must take into consideration implications of the Deprivation of Liberty Act to be implemented in 2009. Peoples’ financial records were examined and robust records were seen to be in place with regular checks and cross-referencing with bank accounts. (See also Standard 17) Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: Longridge Court provides purpose built accommodation for people with a physical disability. Access throughout the ground floor of the main house and annexe (Almartom) is level and corridors and doorways provide sufficient space for people who use wheelchairs. All rooms have en suites that include a bath and/or shower. Overhead tracking is supplied to en suites in the main house. Other specialist adaptations have been put in place after consultation with occupational therapists. People have been supplied with easy chairs that specifically meet their needs. The registered manager confirmed that the home has access to a general maintenance person for day- to- day concerns and a system in place for Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 19 identifying longer-term refurbishments. One person had a new Jacuzzi style bath installed and assisted baths were being looked into for other people. At the time of the visits the home was clean and tidy. Good infection control measures were seen to be in place. Communal toilets and hand washbasins had liquid soap and paper towels. Food in fridges was labelled with the date of opening or preparation. Personal protective equipment was provided for staff but they were not observed wearing these in communal areas, which is good practice. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are met by a competent staff team, who have access to a training programme which is improving and will when fully implemented provide staff with knowledge about the diverse needs of people living at the home. Improvements in recruitment and selection procedures will ensure that people are being safeguarded from possible harm. EVIDENCE: There has been continued stability in the staff team over the past twelve months. New staff work through Milbury/Voyage induction programme, which follows the Common Induction Standards, as well as the home’s induction, and have access to the Learning Disability Qualification. Staff said that they then register for their NVQ Awards in Health and Social Care. The DataSet confirmed that 40 of staff have completed a NVQ Award and 13 of staff were completing their awards. Previously concerns were expressed about the impact of staffing levels on people’s access to activities and whilst staff still expressed some concerns Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 21 parents who responded to our surveys appeared to be happier. One relative had expressed concerns to Voyage and us and these were being dealt with to ensure access to activities for their relative was consistent. For others there still appeared to be some problems with activities being cancelled. One parent stated, “Obviously there are peaks and troughs in staffing levels throughout the year but in the main this past year has seen a more constant level”. The registered manager was feeling more optimistic about the ability of the home to maintain a schedule of regular activities for all people in the future. Changes to the staffing needs of people living in The View, which had previously impacted on the home would reduce pressures on staff working in the main house. There were currently five bank members of staff with a further two being appointed. During the visits there were sufficient staff on duty and rotas confirmed that any unfilled shifts were being identified and filled by either bank staff or permanent staff. Files were examined for five new members of staff. An agreement had been reached with Milbury/Voyage and ourselves that certain documents could be kept at a central location. Front sheets had been provided to record when documents such as CRB or references had been obtained. In most cases this information had not been completed in full particularly in relation to proof of identity. One file contained copies providing evidence of proof of identity and a photograph, others did not. Other concerns noted were: Professional references had been provided by several managers from their personal addresses and not from the home in which applicants had worked • Verification of the reason for leaving former positions working with adults or children was not being obtained There was evidence that a full employment history was being obtained for people where they had not provided it on the application form. The registered manager confirmed that if people were appointed without a CRB (but with a satisfactory PoVA first check and two references) then a risk assessment would be put in place detailing what they could and could not do. A training matrix was in place for April 2008 that indicated that some staff were managing to complete refresher training in most areas. Staff confirmed that they have had training in fire, food hygiene, first aid and the administration of midazolam and copies of certificates were on their files. Records confirmed that of the staff group of thirty, twelve still had food hygiene training to complete and thirteen had still to do moving and handling training. Staff said that they have been supplied with open learning packages for mandatory training but that finding time to do this was the main problem. The registered manager said that key staff had been identified to become trainers and would then cascade training to staff in the home. • Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 22 As noted in Standards 20 and 23 staff need to have training in the safe handling of medication and in Non crisis intervention. The registered manager had identified additional training which she would like staff to have access to including sexuality, Autistic Spectrum Disorder, Epilepsy, Diet, Equal Opportunities and Person centred planning. Requests to Milbury/Voyage identifying this were seen. All staff had been registered to complete the Learning Disability Qualification. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has a clear vision of the service that will be provided by the home. Effective quality assurance systems are in place involving people who live there. Satisfactory health and safety systems are in place providing a safe environment. EVIDENCE: The registered manager has considerable experience working with people with a learning disability. She has completed her registered managers award and NVQ Level 4 in Care. She maintains her continuing professional development through a Management Development Programme. She has a clear developmental plan for the home including making sure that a regular schedule of activities are provided for people, providing training for all staff and environmental improvements to meet people’s needs. Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 24 Milbury/Voyage have a quality assurance system in place that involves unannounced visits by the operations manager each month. This includes speaking to or observing the care of one person living at the home. An annual quality assurance report was produced last year. Milbury /Voyage senior management had recently visited the home and identified key actions for the year ahead. Key staff within the home conduct audits of medication and health and safety systems each month. Health and safety systems were inspected confirming that: • • • • • • A fire risk assessment was in place with each person having a personalised copy indicating their individual risks Fire equipment was being regularly serviced and checked at appropriate intervals First aid boxes were regularly checked Hot water temperatures were recorded Specialist equipment was being regularly serviced Fridge, freezer and hot food temperatures were being recorded regularly. Longridge Court DS0000060822.V360907.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(bb) Requirement Timescale for action 30/09/08 2. YA17 13(6) 3. YA20 13(2) 4. YA20 18(1)(c) Each person must be given information about the charges for the service they receive. This is so that they are aware of the cost of the service they are receiving. Clear processes and 30/09/08 procedures need to be in place for people being supported to have meals or drinks away for the home, the financing of these and staff. This is to safeguard people from possible financial abuse. Medication must be 30/09/08 administered to people safely, making sure that where homely remedies are used these have been recorded for each person and authorisation given by their Doctor or the Pharmacist. This is to protect people from possible harm. Night staff and staff 29/08/08 administering medication must complete training in the safe handling and administration of medication. This is to safeguard people from harm due to possible DS0000060822.V360907.R01.S.doc Version 5.2 Page 27 Longridge Court medication error. 4. YA23 13(6) Staff working with people who may present with challenging behaviour must have access to training in the use of physical intervention, with opportunities for annual refreshers. This is to safeguard people from possible harm. Where staff have previously worked with adults or children, written verification of the reason why they left that employ must be obtained. This is to protect people from possible abuse. Evidence that proof of identity including a current photograph had been obtained must be provided. This is to safeguard people from possible harm. Staff must be supported to gain the knowledge and skills they need to perform their roles. This is in relation to moving and handling and basic food hygiene training as well as other key training. (This is repeated from previous inspections although it was evident work is in action to remedy this). 30/09/08 5. YA34 19(4)(b) Sch 2.4 30/08/08 6. YA34 19(4)(b) Sch. 2.1 30/08/08 7. YA35 18(1)(c) 30/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations People should have an internal annual review to discuss with them and their representatives any changes to their DS0000060822.V360907.R01.S.doc Version 5.2 Page 28 Longridge Court 2. 3. 4. 5. 6. YA14 YA17 YA19 YA19 YA20 care plan. All people living in the home should have regular access to structured activities whilst at home and in the community. Careful planning and budgeting for provisions will make sure that fresh produce is available at all times within the home. Each person should have a Health Action Plan. When people should be weighed in privacy and not in communal rooms. Handwritten entries on Medication Records should be countersigned. The temperature of medication cabinets should be taken regularly and recorded. Stocks of medications should be managed and kept at reasonable levels. Put systems in place to make sure that any actions identified in the monthly audit of medication are followed through. Where people have restricted access and key- pads are in use, care plans should reflect this and be discussed and agreed in a multi disciplinary forum. Improvements in staffing levels should be maintained to make sure people have access to regular activities. Two professional references should be obtained. References should be obtained from the applicants place of work/care home and not personal addresses. 7. 8. 9. YA23 YA33 YA34 Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Longridge Court DS0000060822.V360907.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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