CARE HOME ADULTS 18-65
Longrun House Longrun Lane Bishops Hull Taunton Somerset TA1 5AY Lead Inspector
Kathy McCluskey Unannounced Inspection 14 November 2006 09:15
th Longrun House DS0000065092.V314072.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 Longrun House DS0000065092.V314072.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. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Longrun House Address Longrun Lane Bishops Hull Taunton Somerset TA1 5AY 01823 272633 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) Cream Residential Care Mr Jonathan Peter Basil Trevarthen Care Home 15 Category(ies) of Learning disability (0), Physical disability (0), registration, with number Sensory impairment (0) of places Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the home`s maximum registered numbers of 15, one service user between the age of 16 - 17 years. NA – new service Date of last inspection Brief Description of the Service: Longrun House is a large detached converted farm house which is at the end of a private lane, conveniently situated just behind the Somerset College of Arts and Technology in Taunton. The home benefits from a very private, peaceful location and is surrounded by views of the countryside. The home has been suitably adapted and has been furnished and decorated to an exceptionally high standard. All bedrooms are for single occupancy and are fitted with en-suite facilities. Longrun House is registered with the Commission for Social Care Inspection to provide personal care for up to 15 service users, between the age of 18 and 65 years, in the categories of learning disability, physical disability and sensory impairment. The home is not registered to provide nursing care. The registered provider is Cream Residential Care. The responsible individual is Mr Steve Petts. The registered manager is Mr Jon Trevarthen. The home’s current fees range from £1400 & £2250 per week. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s first inspection since being registered by the Commission in May of this year. This Key inspection was carried out in line with the Commission for Social Care inspection (CSCI) framework ‘Inspecting for Better Lives 2’ (IBL2). It should be noted that, in line with the IBL2 methodology as this is the home’s first inspection, the quality in outcome groups cannot be judged higher than ‘good’. This unannounced key inspection was conducted over one day (5.75hrs) by CSCI Regulation Inspector Kathy McCluskey. The registered manager Mr Jon Trevarthen was available throughout the inspection. At the time of the inspection 13 service users were living at the home. The inspector was able to meet with some service users and staff. As part of this key inspection, the commission sent comment cards to all service users, relatives, healthcare professionals and GP’s. At the time of this report, completed comment cards were received from a GP, 10 relatives and 5 healthcare professionals. Comments have been included throughout the report. A tour of the premises was carried out where communal areas and a number of bedrooms were seen. Records were examined relating to service users, staff, medicines and health and safety. The inspector would like to thank service users, staff, and the registered manager for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 6 What the service does well:
Service users benefit from a relaxed, enabling and homely environment, which has been suitably adapted, furnished and decorated to an exceptionally high standard. The sizes of bedrooms and communal space exceed those recommended in the National Minimum Standards. The registered person should be commended for his obvious commitment to providing a very high standard of living for service users. The commission sent out comment cards to relatives and healthcare professionals and comments received included; ‘Longrun House is an exceptionally beautiful home full of lovely people both staff and service users alike’, ‘They provide an exceptional service which goes that little bit further for both residents and relatives’, ‘The home offers a wow factor second to none’, ‘I am impressed with the very high standard of the environment’. Service users have access to appropriate aids and adaptations according to their assessed needs. The home ensures that prospective service users and their representatives have the information they need to enable them to make an informed decision about moving to the home. The home has plans to produce the Statement of Purpose and Service user guide in symbol format for service users. All service users are fully assessed prior to a placement being offered. The home ensures that service users, their representatives and relevant professionals are fully involved in this process. The home’s care planning systems are good and can be further improved by producing care plans in a format which is more accessible to service users. Care plans examined demonstrated the involvement of appropriate care professionals and/or family. CSCI comment cards from relatives and healthcare professionals were very positive. Comments included; ‘Clear care plans in place & the key worker system working well’, ‘I am very pleased with the standard of care that my client receives’, ‘Staff communicate well with the service user, each, other and myself’, ‘Staff always keep me fully informed of any changes in the health care plan’, ‘the care of my relative is excellent and I am very pleased with the placement’, ‘the home provides an excellent service that goes that little bit further’, my relative ‘is in the best of care’. Since opening, the home has done well in accessing appropriate leisure activities for service users. The home has a range of transport available to Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 7 service users whatever their disability. The home has two new people carriers, one of which can accommodate wheelchairs, and a car. An indoor heating swimming pool is due to be built in the grounds of the home. Longrun House work on a high staff/service user ratio to ensure that suitably qualified staff are available to support service users access leisure facilities. This is felt to be very positive. The home’s arrangements for visitors are very good. Visitors are made welcome and many spend all day at the home and can enjoy meals with their relative. Ten completed CSCI comment cards were received from relatives and all indicated that they could visit their loved one in private and that they were always made to feel very welcome at the home. Some comments received included; ‘It is always a delight to visit and we are always made to feel very welcome’, ‘You are always made welcome and there are no restrictions on visiting’. Service users benefit from a wholesome and varied menu. Service users can enjoy meals in a relaxed atmosphere. The registered manager confirmed excellent links with healthcare professionals. All service users are registered with a GP and a local GP and other healthcare professionals make weekly visits to the home. A CSCI comment card was received from a GP and responses to the questions were positive. All service users have an allocated care manager who liaise closely with the home. As part of this key inspection, CSCI comment cards were sent to all care managers/healthcare professionals. At the time of this report, five have been returned to the commission. Comments were very positive and include; ‘The staff are professional, committed to their work and consistent in their approach’, ‘clear care plans in place and key worker system working well’ ‘impressed with the quality of the staff and senior management’, ‘Staff always keep me fully informed regarding any changes in health care plan’ The home’s procedures for the management and administration of service users medication are robust and well managed. Service users benefit from a high ratio of staff who have been appropriately trained. Staff spoken with expressed no concerns about staffing levels at the home. All completed CSCI comment cards indicated that there were always sufficient numbers of staff on duty. Staff are well supported. Staff morale is high and this has a positive outcome for service users. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 8 Service users are protected from the risk of harm or abuse by the home’s robust staff recruitment procedures. The home is effectively managed by Mr John Trevarthen. Mr Trevarthen’s application to be registered manager of the home was approved by the commission in August 2006. Positive comments about the management of the home were identified in completed CSCI comment cards from healthcare professionals and relatives; ‘The home is exceptionally run and all the staff are efficient in their jobs and very approachable’, ‘Very impressed with the senior management and their understanding’, The provider ‘and his staff team provide a high quality of care’. The registered provider maintains close contact with the home and the registered manager and staff confirmed that he visits the home several times a week. The registered provider submits copies of his monthly reports to the commission. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors. What has improved since the last inspection? What they could do better:
No requirements were raised at this inspection. The home have confirmed that they are in the process of developing some records in symbol format to ensure that they are accessible to all service users and that, as appropriate, service users can be fully involved in their care planning process. Progress will be followed up at the next inspection. Two recommendations have been raised. These were discussed with the registered manager at the time of the inspection. The inspector recommended that the home develops a missing person profile for service users and that the home’s whistle blowing policy is updated to include more detailed information and the contact details of the commission. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 9 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. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 10 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 Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 The quality for this outcome group is good. Service users and their representatives have the information they need to make an informed choice about moving to the home. The home’s arrangements for ensuring that the assessed needs and aspirations of service users can be met are very good. EVIDENCE: The home has produced a Statement of Purpose and Service user guide, which clearly set out the aims and objectives of the home and services offered. These documents are made available to service users, prospective service users and their representatives. As the majority of service users have communication difficulties, the home have plans to reproduce the service user guide in symbol format. Copies of the Statement of Purpose and Service user guide were seen in the care records examined at this inspection. The inspector was able to see evidence that service users were assessed prior to moving to the home. Five service user care plans were examined and each contained pre-admission assessments, assessments from other professionals and detailed ‘transitional’ plans. Records demonstrated that relatives and care professionals were fully
Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 12 involved in the assessment process. The inspector was also able to see evidence that service users had benefited from visits from staff and visits to the home. The home ensures that admission only takes place once all parties are sure that the assessed needs and aspirations of the individual can be met. Service user care plans examined contained a contract/statement of terms and conditions and had been signed by appropriate representatives. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 The quality for this outcome group is good. The home’s care planning systems are good and can be further improved by producing care plans in a format which is more accessible to service users. Service users are supported to take risks in line with their agreed plan of care. EVIDENCE: Five service user care plans were examined at this inspection and all contained detailed information regarding the assessed needs, abilities and preferences of service users. Comprehensive risk assessments were in place for those with an assessed need. Service users are supported to take informed risks within their agreed plan of care. It was recommended at this inspection that the registered manager completes a missing person profile for each service user which includes a recent photograph. From the records examined, the inspector noted that service users experienced difficulties with communication. Care plans contained information on how to
Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 14 communicate with individuals and how they should be supported to express their needs/wishes/choices. The registered manager confirmed that it was there intention to reproduce individual care plans in symbol format to enable service users to be more involved in the care planning process. Progress will be followed up at the next inspection. Care plans examined demonstrated the involvement of appropriate care professionals and/or family. CSCI comment cards from relatives and healthcare professionals were very positive. Comments included; ‘Clear care plans in place & the key worker system working well’, ‘I am very pleased with the standard of care that my client receives’, ‘Staff communicate well with the service user, each, other and myself’, ‘Staff always keep me fully informed of any changes in the health care plan’, ‘the care of my relative is excellent and I am very pleased with the placement’, ‘the home provides an excellent service that goes that little bit further’, my relative ‘is in the best of care’. The registered manager also stated that the home were in the process of developing a communication board for service users which will include pictures of staff and other information to enable them to make more informed decisions. All records examined were appropriately stored in accordance with the Data Protection Act 1998. All staff at the home have received training/information in confidentiality. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 The quality for this outcome group is good. Since opening, the home has done well in accessing appropriate leisure activities for service users. The home has a range of transport available to service users whatever their disability. The home’s arrangements for visitors are very good. Service users benefit from a wholesome and varied menu. Service users can enjoy meals in a relaxed atmosphere. EVIDENCE: The home has been pro-active in ensuring service users have the opportunity to be part of the local community. Various local leisure activities have already been sourced and service users are able to access these with staff support. The home has two new people carriers, one of which can accommodate wheelchairs, and a car. An indoor heating swimming pool is due to be built in the grounds of the home.
Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 16 Longrun House work on a high staff/service user ratio to ensure that suitably qualified staff are available to support service users access leisure facilities. This is felt to be very positive. On the day of this inspection service users were benefiting from various activities. During the morning service users were observed enjoying a music session. A music therapist visits the home on a weekly basis. Other service users were observed spending quality time with staff taking part in activities of their choice. Some service users went shopping, some went out for a walk with staff support and one was assisting staff with the home’s recycling. Other regular activities include, bread making, swimming, bike rides, shopping, and trips to the park. On the day of the inspection, the atmosphere in the home was very relaxed and inclusive and it was apparent that service users were supported to choose how and where to spend their day. Service users are able to move freely around the home and the spacious environment, both inside and out, has a positive outcome for service users. In the garden, there are a range of swings and a trampoline. The home liaises closely with relatives/carers and, in line with the wishes/assessed needs of service users, the home supports service users to maintain contact with their family. The inspector was informed that visitors are made welcome and many spend all day at the home and can enjoy meals with their relative. Ten completed CSCI comment cards were received from relatives and all indicated that they could visit their loved one in private and that they were always made to feel very welcome at the home. Some comments received included; ‘It is always a delight to visit and we are always made to feel very welcome’, ‘You are always made welcome and there are no restrictions on visiting’. Meals are prepared by staff at the home and the menu appeared wholesome and varied. The inspector was able to see lunch being prepared, a vegetarian choice was available and the meal made good use of fresh vegetables and meat. The home had a good supply of brand named foods, fresh fruit and vegetables. Mealtimes at Longrun House are flexible to meet the needs and preferences of service users. Snacks and drinks are available to service users whenever they wish.
Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The quality for this outcome group is good. The home ensures that the personal and healthcare needs of service users are met in line with their agreed plan of care and individual preferences. The home’s procedures for the management and administration of service users medication are robust and well managed. EVIDENCE: Care plans examined contained information on the assessed needs and preferences of service users relating to personal care needs. Care plans also included individual’s moving and handling needs and equipment required. All bedrooms are fitted with spacious en-suite bathing facilities, which have been tailored to meet the needs and preferences of the service users occupying them. Examples include a Jacuzzi bath and overhead hoist tracking. The registered manager and staff confirmed that service users choose what time to go to bed and what time they get up. Staff support service users to choose what they would like to wear. All service users are allocated a key worker.
Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 18 The registered manager confirmed excellent links with healthcare professionals. All service users are registered with a GP and a local GP makes weekly visits to the home. A CSCI comment card was received from a GP and responses to the questions were positive. All service users have an allocated care manager who liaise closely with the home. As part of this key inspection, CSCI comment cards were sent to all care managers/healthcare professionals. At the time of this report, five have been returned to the commission. Comments were very positive and include; ‘The staff are professional, committed to their work and consistent in their approach’, ‘clear care plans in place and key worker system working well’ ‘impressed with the quality of the staff and senior management’, ‘Staff always keep me fully informed regarding any changes in health care plan’ Service users have access to a dentist and an optician, physiotherapist and chiropodist visit the home on a regular basis. A hairdresser visits the home weekly. The registered manager confirmed that there were currently no service users able to manage their own medication. Prescribed medicines are managed and administered by appropriately trained staff at the home. The home’s systems for the management and administration of medicines were examined at this inspection and were found to be well maintained. Medicines were seen to be securely stored with no excess stocks. Medication Administration Records (MAR) were examined and were found to be appropriately completed. Photographs of service users were in place to aid identification. The home has a policy relating to the management and administration of medicines which was submitted to the CSCI pharmacist inspector at the time of registration. CSCI comment cards received from the GP and healthcare professionals all confirmed that the service user medication was being managed appropriately. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The quality for this outcome group is good. The home has a complaints procedure in place which will be further improved to ensure that it is accessible to service users. The home takes appropriate steps to reduce the risk of harm or abuse to service users. The whistle blowing policy would benefit from further information. EVIDENCE: The home has produced a complaints procedure which is in the process of being reproduced in symbol format for service users. The complaints procedure includes the contact details of the CSCI. The inspector was informed that the home have not received any complaints since registration. CSCI comment cards from GP, healthcare professionals and relatives, all indicated that they had not made or received any complaints. The home has a whistle blowing policy which is written in accordance with the Public Interest Disclosure Act 1998. The inspector discussed with the registered manager the need to ensure that this also includes information on abuse and reference to Somerset’s policy on Safeguarding Vulnerable Adults and the Department of Health ‘No Secrets’ guidance. The whistle blowing policy should also identify contact details of appropriate external agencies including the Commission. The home’s robust staff recruitment procedures reduce the risk of harm or abuse to service users.
Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 20 The home’s arrangements for the safekeeping/management of service user’s money were examined at this inspection. The registered manager stated that currently there were no service users able to manage their own finances. Service users have their own bank accounts and where required/requested, small amounts of monies are managed by the home. Monies were found to be securely stored. Receipts are obtained for purchases and balances are checked on each shift change. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 The quality for this outcome group is good. Service users benefit from a relaxed, enabling and homely environment, which has been suitably adapted, furnished and decorated to an exceptionally high standard. The spacious environment and spacious single bedrooms have a positive outcome for service users. EVIDENCE: Longrun House has been converted and extended to an exceptionally high standard by the registered provider Mr Steve Petts. Longrun House is a converted farm house which is at the end of a private lane, conveniently situated just behind the Somerset College of Arts and Technology in Taunton. The home benefits from a very private, peaceful location and is surrounded by views of the countryside. To enable service users to live in smaller groups, the home has been divided into two parts. Longrun House accommodates up to ten service users. It has four bedrooms on the ground floor and six on the first floor. Access to the first
Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 22 floor is via stairs. There are two very large lounges, conservatory and dining room. The main kitchen and offices are also situated in the house. A door, fitted with a keypad, gives access to Longrun Lodge. All accommodation is situated on the ground floor thus giving easier access to those with mobility difficulties. Longrun Lodge has a total of five bedrooms, which conveniently lead out into the very large lounge area. All bedrooms have doors which open out onto their own private patio area. There is a generous sized dining room with small kitchen where service users can be supported to cook and make drinks as appropriate. Throughout the home there are large corridors and seating areas (in addition to lounges) which enables service users to move freely around the home and to choose where they wish to sit and relax. All bedrooms are very spacious and exceed sizes recommended in the National Minimum Standards. All bedrooms benefit from spacious en-suite facilities which are fitted with a toilet, wash basin and bath with overhead shower. Bathing facilities in bedrooms were agreed with the current service users to ensure that needs and preferences were met. For example, one ensuite/bedroom has been fitted with overhead tracking to enable the use of a hoist, some bedrooms have showers and one service user requested a Jacuzzi bath. The home has been furnished and decorated to an exceptionally high standard. Large plasma televisions are available in lounges and bedrooms and service users have access to satellite TV. The home provides an enabling and very homely environment for the service user group and the registered provider should be commended for his obvious commitment to providing a very high standard of living for service users. A selection of bedrooms were seen at this inspection and it was evident that service users are encouraged and supported to personalise their private space. The exceptionally high standard of furnishings and décor continues in bedrooms and bedrooms are fitted with plasma TV’s and satellite connection as requested. Very positive comments were received from healthcare professionals and relatives. These included; ‘Longrun House is an exceptionally beautiful home full of lovely people both staff and service users alike’, ‘They provide an exceptional service which goes that little bit further for both residents and relatives’, ‘The home offers a wow factor second to none’, ‘I am impressed with the very high standard of the environment’. On the day of this inspection, the atmosphere of the home was very relaxed and inclusive. Service users were observed moving freely around the home and Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 23 staff were observed interacting with service users in a kind and respectful manner. The home takes appropriate steps to reduce the risk of the spread of infection. Staff hand washing facilities were found to be appropriately sited throughout the home. The registered manager advised that, due to the needs/risks to service users, liquid soap and paper towels were not appropriate in all areas. The inspector therefore recommended that the registered manager provides staff with an appropriate hand cleansing gel. The registered manager confirmed that he would address this. At the time of this unannounced inspection, the home was warm and the standard of cleanliness in the home was high and there were no malodours. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 The quality for this outcome group is good. Service users benefit from a high ratio of staff who have been appropriately trained. Staff are well supported. Staff morale is high and this has a positive outcome for service users. Service users are protected from the risk of harm or abuse by the home’s robust staff recruitment procedures. EVIDENCE: All staff at the home have been issued with a job description and staff spoken with confirmed that they were clear about their responsibilities and the roles of others. Pre-inspection information supplied by the home indicated that 14 of the 33 care staff had obtained a minimum of an NVQ level 2 in care. This equates to 42 . This is just below the 50 recommended in the National Minimum Standards. The registered manager confirmed that further NVQ training was planned as the home was in the process of registering some staff to become NVQ internal verifiers. Progress will be followed up at the next inspection. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 25 The home works on a high staff/service user ratio, which has a positive outcome for service users. Days are usually covered by 8-10 care staff and nights are covered by 4 waking staff and 1 sleep-in staff. This is for the current service numbers of 13. The inspector was informed that staffing levels are adjusted as required to meet the assessed needs and social preferences of service users. Staff spoken with expressed no concerns about staffing levels at the home. Staff morale appeared high. All completed CSCI comment cards indicated that there were always sufficient numbers of staff on duty. Staff meetings are held monthly. The minutes of the most recent meeting held on 6th November were made available to the inspector. The inspector examined the home’s procedures for staff recruitment. Five staff recruitment files were seen and the inspector concluded that the home was following robust recruitment procedures. All information, as required in Schedule 2 of the Care Homes Regulations 2001, was in place. Enhanced criminal record checks (CRB) and protection of vulnerable adults checks (POVA) had been obtained prior to the staff member commencing employment. The inspector was able to see evidence that staff had signed contract/statement of terms and conditions of employment. All staff at the home have completed, or are in the process of completing the Learning Disability Awards Framework (LDAF). LDAF is a set of qualifications appropriate to people who work in learning disability services. Each LDAF qualification consists of units on particular topics. Each unit is a list of things that staff should know about that topic. Staff gain credits by proving their learning and understanding through short assignments or tasks for each unit. When successfully achieved these assignments or tasks can be combined and collected to make up a full qualification. Training records examined indicated that staff had also received up to date training in first aid, fire safety, moving and handling, Somerset Total Communication (STC) and intensive interaction, safe handling and administration of medication, Protection of Vulnerable Adults (POVA). Staff have either completed or are in the process of completing NAPPI training. NAPPI stands for; ‘non-abusive psychological and physical intervention’. The training focuses on the Assessment, Prevention and Management of confused, predictable and aggressive service users. NAPPI training is accredited by the British Institute of Learning Disabilities. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 26 All staff spoken with were positive about the training they had received. Staff indicated that they had received appropriate training to enable them to meet the needs of service users. Staff receive formal supervision sessions at least six times a year. Comments identified in CSCI completed comment cards from relatives and healthcare professionals included; ‘ all the staff are efficient and very approachable’, ‘very impressed with the senior management and their understanding and very impressed with the quality of the staff and the standard of care’, ‘I have found the staff professional, committed to their work and consistent in their approach’. In addition, all comment cards received from healthcare professionals confirmed that staff demonstrated a clear understanding of the care needs of service users. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43 The quality for this outcome group is good. The home is effectively managed and comments received from other stakeholders were very positive. The home takes appropriate steps to ensure the health & safety of service users, staff and visitors to the home. EVIDENCE: In August of this year, the commission approved an application for Mr Jon Trevarthen to be registered manager. Mr Trevarthen is very much a ‘hands-on’ manager and has over 15 years experience in caring for service users with a learning disability. He has achieved an NVQ level 4 in management and is currently registered on the NVQ level 4 award in care. Mr Trevarthen has completed various relevant training courses. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 28 Staff spoken with were positive about the management style at the home and stated that they were well supported. Positive comments were identified in completed CSCI comment cards from healthcare professionals and relatives; ‘The home is exceptionally run and all the staff are efficient in their jobs and very approachable’, ‘Very impressed with the senior management and their understanding’, The provider ‘and his staff team provide a high quality of care’. The registered provider maintains close contact with the home and the registered manager and staff confirmed that he visits the home several times a week. The registered provider submits copies of his monthly reports to the CSCI. The registered manager stated that the home is still in the process of developing a quality assurance programme. This being the case, progress will be followed up at the next inspection. The home has developed a range of appropriate and up to date policies and procedures. All records examined at this inspection were well maintained and stored in accordance with the Data Protection Act 1998. The following records were examined relating to health and safety: FIRE SAFETY – The home has an up to date fire risk assessment which had been completed by an external company. In-house weekly checks are being conducted on the home’s fire detection systems and fire fighting equipment. Records indicated that the last test was conducted on 09/11/06. Emergency lighting is checked monthly. The last check was 10/11/06. The home has an installation certificate from an external company dated 09/08/06. Staff training records indicated that all staff had received up to date training in fire safety. ELECTRICAL SAFETY – The home has an up to date electrical hardwiring certificate dated 25/04/06 which is valid for 3 years. Portable appliances were checked on 21/06/06 and will be due again next year. EQUIPMENT SERVICING – Up to date servicing records were seen for the home’s two hoists dated 27/06/06 & 16/08/06. One service user has an profiling bed which was serviced on 16/08/06. HOT WATER OUTLETS AND SURFACES – All hot water outlets have been fitted with thermostatic controls. Weekly checks are conducted by the home to
Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 29 ensure that temperatures do not exceed upper limits as recommended by the Health & Safety Executive (HSE). Hot water outlets checked at this inspection were within acceptable limits. The home has oil fired central heating and low heat surface radiators are fitted throughout the home to reduce the risk of burns. REDUCING THE RISK OF LEGIONELLA – The home has completed a risk assessment which indicates that all water outlets not regularly used will be flushed weekly. CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH (COSHH) – All hazardous materials were seen to be appropriately stored. A range of information sheets were available for the cleaning materials in use, though these are stored in the office. The registered manager agreed to ensure that records would be made available in all areas where cleaning materials are stored. This will be followed up at the next inspection. MANDATORY TRAINING FOR STAFF – Staff training records examined at this inspection indicated that all staff had received up to date training in moving and handling, food hygiene health and safety and first aid. The environmental health officer (EHO) carried out a health and safety inspection of the home on 07/08/06 and a copy of the report was made available to the inspector. The inspector was able to see evidence that the recommendation raised had been fully addressed by the home. The home has a range of up to date environmental risk assessments dated 11/07/06. The home has up to date employers liability insurance which expires 11/04/07. Longrun House DS0000065092.V314072.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 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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 3 28 4 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 3 3 3 3 Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 31 NA 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA9 YA23 Good Practice Recommendations The registered person should ensure that a missing person profile is developed for each service user. This should include a recent photograph of the individual. The registered person should update the home’s whistle blowing policy to include information on abuse and reference to Somerset’s policy on Safeguarding Vulnerable Adults and the Department of Health ‘No Secrets’ guidance. The whistle blowing policy should also identify contact details of appropriate external agencies including the Commission. Longrun House DS0000065092.V314072.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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