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Inspection on 10/10/07 for Longton Nursing & Residential Home

Also see our care home review for Longton Nursing & Residential Home for more information

This inspection was carried out on 10th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The registered manager wrote on the home`s self-assessment, "Improvements have been made by introducing a named nurse system so that individualised care is better promoted and so that people living at the home form closer bonds with staff and their key workers. The care planning process has improved following introduction of care planning audit. Staff training has been increased, covering health and safety, basic food hygiene, customer care and moving and handling and an improved system has been introduced for end of life care". When asked what has improved since the last inspection, the registered manager wrote on the self-assessment, "Improvements have been made by introducing a named nurse system so that individualised care is better promoted and so that people living at the home form closer bonds with staff and their key workers. The care planning process has improved following introduction of care planning audit. Staff training has been increased, covering health and safety, basic food hygiene, customer care and moving and handling and an improved system has been introduced for end of life care". The overall handling of medications had improved since the last inspection. All nurses responsible for giving medications were taking and recording the pulse rate prior to the administration of Digoxin and two staff members were witnessing unwanted medicines being disposed of in the drug waste bin. When asked what has improved since the last inspection the registered manager wrote on the home`s self assessment, "Improvements have been made by revising and improving the menus, in accordance with residents` preferences. Film afternoons have been introduced, with DVD`s of residents` choice and due to popularity of the home`s pets a second dog has been acquired. Service users were provided with a nutritious, well-balanced lunch so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. When asked what improvements had been made since the last inspection, the registered manager wrote on the home`s self-assessment, "Following the introduction of new training package regarding safeguarding adults staff have become more vigilant and more understanding of the procedures in place. Training has also been provided to ancillary staff as well as care staff". Five comment cards received from relatives showed that they were always kept up to date with important issues affecting people living at the home, but the other four felt that they were not always informed about matters concerning their relatives. One person wrote on the comment card, "There have been two occasions recently when I believe I should have been consulted but was not. I am rarely, if ever contacted by the home" and another added, "Senior members of staff are not forthcoming with information unless we make a point of asking. Other members of staff pass on snippets of information about my relative. We were not informed of a visit by an external professional and were therefore unable to be present" and a third said, "I have only recently been involved in some decision making after proactive exploration on my part. There have been instances where no personal contact has been made when my relative has had falls and one admission to hospital. However, when I Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 9raised concerns with the home they did take time to listen to my concerns and we agreed a protocol for future admissions".

What the care home could do better:

The management of medications was in general satisfactory. However, any hand written annotations on the Medication Administration Records could have been signed, witnessed and countersigned and photographs of residents could have been attached to the medication records for identification purposes. Although instructions on the plans of care had been followed in day-to-day practice, the recording of these actions could have been better, particularly in relation to dietary and fluid intake. Although some activities were provided in the home, a number of residents said that there was not much going on and that it could sometimes become boring because there was nothing to do. When asked how the service could improve, one relative wrote on the comment card, "All rooms have to be decorated the same, with similar fixtures, but people are different and want their own colour schemes. After all it is their home. It can appear like a hospital rather that a home (just an observation)". The home could continue to work towards 50% of the care staff achieving a National Vocational Qualification at level 2 or above so that enough care staff are adequately trained in order to deliver appropriate care. When asked how the service could improve, one relative wrote on the comment card, "To carry on doing a good job, as they (the staff) all seem to be doing at present", and another stated, "Just by being more welcoming and friendly. Being more open to discussion and more proactive in communication. I have no real complaints about my relative`s care, but it would be good to have much better communication and a warmer approach to people", another relative said, "The laundry process could be improved, particularly in relation to residents having their own socks, rather than a shared stock and this person suggested that a clothing inventory be conducted at the time of admission with regular reviews, which might ensure that less things are lost or misplaced.

CARE HOMES FOR OLDER PEOPLE Longton Nursing & Residential Home 11 Marsh Lane Longton Preston Lancashire PR4 5ZJ Lead Inspector Vivienne Morris Unannounced Inspection 10th October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Longton Nursing & Residential Home DS0000025570.V347131.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. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longton Nursing & Residential Home Address 11 Marsh Lane Longton Preston Lancashire PR4 5ZJ 01772 616144 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) MPS (Investments) Limited Mrs Joyce Hindle Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (6) of places Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the overall total of 58 a maximum of 58 service users requiring either nursing or personal care who fall into the category OP - Old age, not falling within any other category. Within the overall total of 58 a maximum of 6 service users requiring either nursing or personal care who fall into the category PD - Physical Disability aged 60 - 65 years. Within the overall total of 58 a maximum of one named male service user in the category of PD (Physical disability) aged 27 years and above requiring either nursing or personal care. This condition will no longer apply should the service user no longer reside at Longton Nursing and Residential Home. 6th March 2007 2. 3. Date of last inspection Brief Description of the Service: This service is located in a quiet residential area of Longton, close to local amenities and main bus routes. The grounds are landscaped with a large lawn to the rear of the building enabling people living at the home to enjoy the pleasant surroundings. Longton nursing and residential home is registered to provide both personal and nursing care for the elderly, although a small number of places are available for people who have a physical disability. Accommodation is provided on two floors served by a passenger lift. The majority of rooms are single, however a number of double rooms are available for those who wish to share facilities. Some en-suites are available, comprising of wash hand basin and toilet. Meals are served in the spacious dining rooms, although people can eat in the privacy of their own bedrooms, should they prefer to do so and those living at the home are able to entertain their visitors in the communal areas or within their own bedrooms if they wish. The fees at the time of the site visit ranged from £310 - £570 per week. Additional charges were incurred for hairdressing, chiropody, magazines/newspapers and transport for trips. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced site visit, which formed part of a key inspection, was conducted over one day in October 2007. During the course of the visit to this service, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from fifteen people involved with the service and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. Some of this information forms part of this inspection report. The inspector ‘tracked’ the care of three people living at the home, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at Longton Nursing Home. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which was referred back to the provider for investigation under the home’s complaints procedure. What the service does well: When asked what the home does well, the registered manager told us that the plans of care are clear, detailed and concise and are developed from information gathered before admission. Care plans are drawn up with involvement of residents or their relatives, they are reviewed monthly, reflecting current needs accurately and a variety of external professionals are involved in care of people living at the home. Specialist equipment is provided to improve comfort and a variety of assessments are carried out in relation to health and safety. Residents are able to self-administer medications, within a risk management framework. All residents are treated with respect and their rights to privacy and dignity is upheld in accordance with company policies. The information gathered before admission was detailed, providing staff with a clear picture of individual needs, so that the home was able to determine how the staff team could meet the assessed needs of people. The plans of care were well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a regular basis and any changes in the needs of people was accurately reflected. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 6 A relative of a resident whose care was ‘tracked’ wrote on the comment card, “I am very happy with mum being at Longton”, and a relative of another person, whose care was ‘tracked’, stated, “They (the staff) are doing a reasonably good job regarding the care of the elderly people who are unable to fend for themselves, owing to their various infirmities”. A variety of external professionals had been involved in the care of people living at Longton Nursing Home to ensure that their health care needs were being appropriately met. A range of risk assessments were in place at the home to ensure that systems were in place to protect the health and safety of anyone on the premises. When asked what the service does well, one relative commented, “The presence of dogs, cats and the fish tank is a homely touch. The vases of flowers are pleasing and there are no unpleasant odours. Some people are taken out to a coffee morning in the village each week. This gives my relative a change of scenery” and another stated, “We feel that the care home establishes a welcoming feeling and we like the way animals are allowed in the home. The food is, according to my relative, very good. We think that overall the care home does a good job in caring for our relative and he seems very happy there”. One person indicated that their relative was happy living at the home because his spiritual needs were being met and another relative said, “All the staff care for the residents and are very friendly and welcoming to visitors”. Relatives spoken to were happy about how visitors were received into the home and they informed the inspector that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how did they could make a complaint should they so wish. The policies and procedures in relation to safeguarding adults were in accordance with the Department of Health guidance ‘no secrets’, so that people knew the procedure to take should an allegation of abuse be received by the home. The home was tastefully furnished and pleasantly decorated to a high standard and the premises, both internally and externally were well maintained providing those living at Longton Nursing Home with a safe, clean, comfortable and homely environment in which to live. Effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 7 Staffing levels were calculated in accordance with the assessed needs of people to ensure that adequate care was delivered. Robust recruitment procedures and financial arrangements were in place at the home, which demonstrated that those living at Longton Nursing Home were adequately protected. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently skilled to meet people’s assessed needs. The registered manager holds relevant qualifications, has a lot of experience and is appropriately trained to manage the care home. Residents, relatives and staff thought highly of her and they all felt supported by the management of the home. Systems were in place to ensure that the quality of service provided was closely monitored so that any shortfalls identified could be promptly addressed. The health, safety and welfare of residents were protected by the policies, procedures and practices of the home so that any hazards, which could pose a potential risk, were minimised or eliminated. When asked what the home does well comments received from relatives included, “The personal care and attention shown to my relative by all members of staff provides as near as possible to a homely atmosphere”, “I am pleased to say that Longton Nursing home has been able to provide the best available care under what are always difficult circumstances”, “My relative seems to be well looked after, always clean and tidy, as is her room. Any problems always seem to be addressed quickly and sorted out. The staff are caring and thoughtful with the residents”, ”Good day to day care for vulnerable people, gives my relative security, companionship and they (the staff) look after her needs as best they can. I have no complaints”, “I don’t know what they do well – nothing has struck me as being particularly good” and “The fact that my relative has regular access to a physiotherapist and he is encouraged to develop his mobility shows it is a good service”. When an external health care professional was asked what the service does well, the comment received was, Longton nursing home looks after the patients in a holistic, safe, friendly and effective manner. If I needed a nursing home for a member of my family, this is the one I would choose”, What has improved since the last inspection? The registered manager wrote on the home’s self-assessment, “Improvements have been made by introducing a named nurse system so that individualised care is better promoted and so that people living at the home form closer bonds with staff and their key workers. The care planning process has improved following introduction of care planning audit. Staff training has been Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 8 increased, covering health and safety, basic food hygiene, customer care and moving and handling and an improved system has been introduced for end of life care”. When asked what has improved since the last inspection, the registered manager wrote on the self-assessment, “Improvements have been made by introducing a named nurse system so that individualised care is better promoted and so that people living at the home form closer bonds with staff and their key workers. The care planning process has improved following introduction of care planning audit. Staff training has been increased, covering health and safety, basic food hygiene, customer care and moving and handling and an improved system has been introduced for end of life care”. The overall handling of medications had improved since the last inspection. All nurses responsible for giving medications were taking and recording the pulse rate prior to the administration of Digoxin and two staff members were witnessing unwanted medicines being disposed of in the drug waste bin. When asked what has improved since the last inspection the registered manager wrote on the home’s self assessment, “Improvements have been made by revising and improving the menus, in accordance with residents’ preferences. Film afternoons have been introduced, with DVD’s of residents’ choice and due to popularity of the home’s pets a second dog has been acquired. Service users were provided with a nutritious, well-balanced lunch so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. When asked what improvements had been made since the last inspection, the registered manager wrote on the home’s self-assessment, “Following the introduction of new training package regarding safeguarding adults staff have become more vigilant and more understanding of the procedures in place. Training has also been provided to ancillary staff as well as care staff”. Five comment cards received from relatives showed that they were always kept up to date with important issues affecting people living at the home, but the other four felt that they were not always informed about matters concerning their relatives. One person wrote on the comment card, There have been two occasions recently when I believe I should have been consulted but was not. I am rarely, if ever contacted by the home and another added, Senior members of staff are not forthcoming with information unless we make a point of asking. Other members of staff pass on snippets of information about my relative. We were not informed of a visit by an external professional and were therefore unable to be present and a third said, “I have only recently been involved in some decision making after proactive exploration on my part. There have been instances where no personal contact has been made when my relative has had falls and one admission to hospital. However, when I Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 9 raised concerns with the home they did take time to listen to my concerns and we agreed a protocol for future admissions”. 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 Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 10 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 11 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 Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Sufficient information was gathered before people were admitted to the home so that the staff team were confident that individual needs could be adequately met. EVIDENCE: Four comment cards were received from people who lived at the home, which showed that they had received enough information about the services provided before they moved into Longton Nursing Home, although one person felt that more could have been provided. The registered manager told us that people wishing to move into the home were provided with a lot of information about the facilities available and they were able to stay for a trial visit, if they wished, to help them make an informed choice about moving in and so that they could see what life was like at Longton Nursing Home. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 13 We were also told that detailed pre-admission assessments were conducted to ensure that the staff team could adequately meet the needs of those wishing to live at the home and that prospective residents were given the time to discuss their needs and expectations prior to admission in order to ensure a smooth transition process. The manager said that information gathered before admission was then used to compile the plan of care. At the time of the site visit the inspector ‘tracked’ the care of three people living at the home. The care records seen showed that detailed information had been obtained prior to admission and that the needs of people had been thoroughly assessed, to ensure that the staff team could meet the individual needs of everyone moving into the home. The detailed assessments had been retained on residents’ files so that those working at the home were aware of individual assessed needs. The assessed needs of those admitted to the home were consistently recorded within the care plan therefore staff were provided with detailed information as to how service users’ needs were to be met. Staff spoken to knew about the needs of people and how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 14 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the home were being consistently met and their privacy and dignity was always respected. EVIDENCE: The care of three people living at Longton nursing home was ‘tracked’ during the course of the site visit. Comment cards were received from nine relatives, who all indicated that, in general, care and support was provided as was needed and that the different needs of people living at the home were usually met. One relative wrote, “Everyone seems to be treated equally in the home” and another stated, “My relative has now been assigned a male named nurse and is much happier with receiving care from the male staff members”. A comment card was received from an external health care professional who confirmed that the home always responded to the different needs of people living there and that resident’s health care needs were always met by the care Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 15 service, as the home sought advice, as required, and acted upon this to improve peoples health care needs. Relatives felt that, in general staff had the right skills and experience to look after the people living at the home and this was supported by comments also made by the health care professional. One person stated, “My relative has complex needs, so it takes time for care staff to learn how to handle her”. All three plans of care had been developed from the information gathered prior to admission, so that staff were aware of the assessed needs of people living at the home. The care planning process was very good and information recorded was person centred and consistently detailed, providing staff with clear guidance as to how the assessed needs of the individual residents were to be met. Residents or their relatives had been given the opportunity to be involved in the care planning process, so that they could have some in put into the care provided. The plans of care had been reviewed regularly and any changes in the needs of people had been accurately reflected. The plan of care for one person was extremely detailed, showing that the dietary and fluid intake needed to be recorded and supplementary nutrition should be given. Although it was established that this person’s nutritional needs were being met, the fluid and dietary record could have been better to show exactly what the individual’s intake was. Records showed that a variety of external professionals were involved in the care of people living at the home to ensure that their health care needs were being appropriately met. A specialised nurse was at the home, providing health care support, during this site visit. Comment cards received showed that everyone was treated equally and the majority of people felt that they received medical support when needed. Appropriate pressure relief was being delivered and specialised equipment was provided to make the lives of people living at the home as comfortable as possible. A variety of assessments were in place so that the health and safety of people living in the home was protected within a risk management framework. Staff spoken to felt that sufficient staff were allocated to meet the needs of people living at the home and residents spoken to at the time of the site visit said that their needs were being met. One person commented, “I get the best care and wouldn’t like to move anywhere else”, and another said, “The staff are all very kind and they treat me with respect”. The management of medications had, in general, improved since the last inspection. However, hand written entries on the Medication Administration Records had not been signed, witnessed and countersigned in order to reduce the possibility of any transcription errors and photographs of residents were not attached to the medication records for identification purposes. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 16 Staff were observed speaking to people living at the home in a respectful manner and knocking on bedroom doors before entering to ensure that privacy and dignity was consistently maintained. A written policy was in place and available to staff, which demonstrated that those living at the home were supported to maintain their privacy and dignity at all times. Induction records showed that staff had been instructed to treat service users with respect and care records demonstrated that the wishes of people were respected in relation to maintaining privacy and dignity when giving personal care. One person living at the home said, “The staff are all lovely. I have no complaints about any of them. They all respect my privacy and dignity at all times” and another said, “Staff always knock on my door before they come in and they always have a cheery smile”. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 17 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social and recreational activities were provided, but did not meet everyone’s expectations, but the rights of people were upheld, enabling them to make informed choices. The quality of food served was satisfactory and people received adequate a good nutritional intake. EVIDENCE: The registered manager told us that there was an activities co-ordinator employed at the home and that a range of activities were provided for people living there. Information about what was going on in the home was displayed in the reception area and included within the service users’ guide, so that people had the opportunity to plan their days according to their wishes. We were also told that people were encouraged to maintain contact with family and friends, who were able to visit at any time and who could order meals for themselves, if they wished to dine with residents. Family gatherings and birthday parties were catered for and a varied and balanced diet provided, with a choice of menu and a bar service at no extra cost. The information provided to us showed that people helped to exercise choice and control over their lives by choosing how their room was decorated and by Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 18 bringing personal possessions to the home, including pets, if they so wished. However, one relative stated on the comment card, “All rooms have to be decorated the same, with similar fixtures, but people are different and want their own colour schemes. After all it is their home. It can appear like a hospital rather than a home (just an observation)”. The bedroom of a younger adult was viewed, which was decorated in accordance with this person’s choice of colour scheme and interest of angling. Comment cards were received from five people living at the home, all of whom said that staff listen and act upon what they say. All of these people felt that suitable activities were sometimes provided for them to join in. The home had conducted excellent social care assessments about each person’s interests and hobbies, including their life history, so that a clear picture could be developed of each individual, which could be used to match up residents with key workers, who share similar interests. The home employed a person to be responsible for the organisation and provision of activities and we saw people being offered choices throughout the course of the day. Those spoken to said that some people attended coffee mornings in the village each week, a few trips out were provided and manicures were done for those sitting in the lounges. However, most residents spoken to said that there was not much going on and that there was a tendency to get bored. Staff spoken to felt that there were sufficient activities provided, but quite often those living in the home did not wish to participate. At the time of the site visit a younger adult living at the home was attending a gardening course, every week, at college with a staff member, as this was one of his interests. His bedroom also contained a lot of electrical equipment, to suit this younger age group. Comment cards were received from nine relatives, all of whom, in general, felt that people living at the home were helped to keep in touch with their relatives and friends and were supported to live the life they choose. One relative wrote on the comment card, My relative can no longer live the life she chooses. However, at Longton she is well cared for and encouraged to participate in activities as much as possible and as near to her choice as possible, and another said, “My relative lives the life that she is capable of”. The registered person told us that policies were in place in relation to equal opportunities, which included an explanation of the six principals of care, including rights, fulfilment, independence and choice, showing that all those living at the home were given the same opportunities to make decisions and informed choices. The plans of care showed that people’s choices had been taken into consideration and they included information about the leisure interests of residents so that staff were able to provide activities in accordance with Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 19 people’s preferences. The care plans recorded people’s social histories well so that staff could get a clear picture of each person’s life, interests and hobbies. One person confirmed that religious ministers visited the home regularly to conduct services and the statement of purpose supported this information. Plans of care had been written in relation to individual religious beliefs, showing how people could be supported in meeting their spiritual needs. A visiting policy was in place at the home and information relating to visiting was also included in the statement of purpose and service user guide to ensure that all interested parties were aware of the visiting arrangements of the home. Relatives were seen to be visiting people in private and visitors spoken to felt that they were made to feel welcome to the home at any time and that a friendly environment was provided for both residents and visitors. Personal possessions adorned individual rooms, where appropriate to create a homely environment and audits of service users’ belongings had been conducted on admission to protect the safety of individual’s personal possessions. People living at the home were able to manage their own finances, if they so wished and if they were capable to do so, showing that they were able to have some control over their lives. Information provided to us showed that two people living at the home were using an advocate to help them in making decisions. Leaflets were freely available in the home informing people how to access advocacy services, should they wish to do so. We were told that the management of meal times had been changed since the last inspection and that the changes were for the better. The dining rooms were found to be relaxed areas for people to eat in, with well-presented tables and unhurried atmospheres, so that those dining were comfortable and enjoyed having their meals in pleasant surroundings. It was pleasing to see some staff members dining with people living at the home, enjoying a chat and a bit of fun. Staff members were assisting people with their meal, as was necessary, in a pleasant, but discreet manner, sitting with them and providing words of encouragement as well as a joke or two. The four weekly menus were examined and were found to provide a choice of well-balanced meals to ensure that those living at the home received a nutritious dietary intake. The menu of the day was clearly displayed, so that people were aware of the choices they had been given for lunch, but records were retained of the choices they had made in case a gentle reminder was needed. Staff were seen offering people a variety of choices, during the lunch time period and one person living at the home confirmed that there were alternatives to the menu available if required. People were offered a wide Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 20 range of drinks, both during and after lunch, including an alcoholic beverage from the free bar. The food served at lunchtime was appetizing and well presented in order to aid nutrition. We noted that specialised utensils were provided to aid in independent eating and we saw one staff member explaining to a visually impaired resident, where the different foods were situated on her plate. People spoken to said that the meals had improved and were enjoyable and that the menu offered a range of choices, but that if they wished to have something different, then they were sure that the home would try to meet their request. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 21 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were well managed and people living at the home were adequately safeguarded. EVIDENCE: The registered manager told us on the home’s self-assessment that the complaints procedure was available in notice form around the home and was also included in the service users’ guide, so that people would know how to make a complaint, should they wish to do so. This information was supported by observation of the written policies and procedures. However, two of the nine comment cards received from relatives indicated that they did not know how to make a complaint, but those living at the home, spoken to at the time of the site visit and those residents who sent comment cards in, all said that they would know what to do if they were not happy about something, whilst living at the home. A system was in place at the home so that any complaints received could be recorded and any recurring patterns identified and regularly monitored. One relative said, We have only had cause to raise concerns once and I found that these were taken seriously. We had the opportunity to discuss our concerns with the senior staff and we were pleased that they took these on board and were responsive to our comments”. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 22 Policies and procedures were in place at the home in relation to safeguarding adults, which were in accordance with Department of Health guidance, so that people were fully aware of the action to take should an allegation of abuse be reported to the home. Staff spoken to confirmed that they had received training in relation to safeguarding adults and gave very positive feedback about this training, the training matrix seen supported this information. Staff were aware of what they should do if they had any concerns about the welfare of anyone in their care to ensure that appropriate action would be taken. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 23 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 and 26 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home provided a safe, well-maintained environment for people to live in, which was clean, pleasant and hygienic. EVIDENCE: A tour of the premises took place during the site visit when the home was found to be tastefully decorated and furnished to a high standard, providing a very homely and comfortable environment for people to live in. However, the furniture in one bedroom was worn and marked and in need of renovation of replacement, as was the bed base in this room. The communal lounges and dining rooms were pleasant and comfortable areas for people to sit in during the day, providing a homely environment for those living at the home. The building was fit for purpose and was maintained to a good standard of repair so that people living at the home were provided with a safe Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 24 environment. Odour control was effective so that the home was pleasant smelling. Residents spoken to were satisfied with the standard of private and communal accommodation provided. One person said, “I find my bedroom very comfortable and nicely decorated”. The laundry department was suitable for the needs of the residents and it was well organised, providing sufficient equipment, so that laundry was completed in a timely fashion. Detailed policies were in place at the home to ensure that the control of infection was being adequately met so that the health and safety of people living there was appropriately safeguarded. All comment cards received from residents stated that the home was always fresh and clean and this was evident at the time of the site visit. The registered person told us that the home was well maintained through a continuous refurbishment programme and that risk assessments of the environment were carried out annually. The grounds were extensive and well laid out, with disabled access to enable all residents to make use of the gardens. Specialist equipment was provided to allow people to maximise their independence. People were encouraged to bring in their own possessions and rooms could be laid out as bed-sits if required, and pets were allowed to move in with their owners. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 25 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff working at the home were skilled and in sufficient numbers to meet changing needs of residents. However, there were not enough care staff who were appropriately trained to fulfil the aims of the home. The recruitment procedures adequately safeguarded those living at the home. EVIDENCE: The details provided by the registered manager showed that the service promoted equality and diversity by the ethnicity mix of staff employed at the home. The three staff files examined supported this information. The registered manager told us that additional staff were brought in at peak times of activity, such as at meal times and this was supported by examination of the duty rota and by talking to staff, who felt that there were always enough people on duty to meet the assessed needs of those living at the home. The information provided to us showed that thirty-five care staff were employed, five of whom had achieved a National Vocational Qualification, which was equivalent to 14.3 , which indicated that there were not enough care staff who were appropriately trained to fulfil the aims of the home. The records of three staff members were examined, showing that people living at the home were protected by the recruitment policies in place, and it was Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 26 evident that all appropriate checks had been conducted, to ensure that those employed were fit to work with vulnerable adults. Staff had a training and development programme to ensure they were competent to do their jobs. Comment cards received from five people living at the home showed that in general staff were usually available when they were needed. At the time of the site visit there were 55 people living at Longton Nursing Home. The number of staff on duty was being calculated in accordance with the assessed needs of people and records showed that a good skill mix of staff made up the staff team so that residents’ needs were being met. Equal opportunity policies were in place at the home to ensure that everyone applying for work was treated the same and was given the same job opportunities. Formal induction processes had been adopted by the home so that staff understood their role and were able to perform the duties expected of them. . The home’s self-assessment showed that a wide range of training was provided for staff so that people working at the home were competent to look after the people in their care. All staff completed mandatory core-training courses to ensure that there was a skilled workforce and that people had the necessary knowledge to meet the needs of the people they were caring for. Staff spoken to felt that a lot of training was provided to meet their needs and the training certificates available on staff files supported this. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 27 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed by a competent person, having effective systems in place for monitoring the quality of service provided. The health, safety and welfare of people living at the home were sufficiently protected. EVIDENCE: The registered manager of Longton Nursing Home has been in post for many years. She has the required qualifications and experience and is competent to run the home. During the time she has been in post she has worked hard to improve the service and to provide an increased quality of life for residents. She has the skills to operate the home efficiently and effectively for people living there. The manager had completed a variety of additional training courses and was resident focused. She leads and supports the staff team who have been appropriately recruited, so that those living at the home were adequately protected. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 28 A variety of surveys were being conducted annually so that the views of residents, their relatives and others involved in their care were obtained about how the service was performing. The information gathered was put together and produced to show interested parties the strengths and weaknesses of the service. A variety of meetings were held, with minutes kept, so that people were informed of any relevant matters. The home had been accredited with an external award, showing that it was audited on a regular basis by external professional bodies. The registered manager had put in place a variety of regular, detailed checks. This enabled her to identify and address any shortfalls within the systems in place at the home and closely monitor the quality of service provided. The registered person ensured that visits to the service were conducted at least every month, when a full report was made so that the service could be monitored. Systems were in place at the home to ensure that residents’ finances were adequately protected. The relatives of residents were often responsible for the management of their money. However, personal allowances for a small number of people were retained by the home, if residents were unable or did not wish to manage their own affairs. Clear records were kept of any money or valuables retained at the home on behalf of service users so that the possibility of any mishandling was reduced. A wide range of risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. Risk assessments had been conducted for those using bed rails and some people had been identified as not requiring bed rail protectors because they were unable to move in bed, but wanted the rails in place as they felt safer, when needing to roll from side to side during bed making. Information provided by the registered manager showed that all systems and equipment had been appropriately checked so that the health and safety of people living at the home was protected. This was confirmed by examination of a random selection of service certificates. Accidents occurring in the home had been accurately recorded so that the manager was able to audit and monitor the frequency of accidents. The environment was free from any hazards, which could pose risks to those living at the home. Fire drills had been conducted periodically to ensure that all staff were familiar with the fire procedure and evacuation plan within the home. However, a record was not retained of staff attendance so that the home’s fire warden could ensure that all staff were involved in a fire drill at least annually. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 29 Policies and procedures were in place at the home in relation to Health and Safety issues and Infection Control practices, so that staff were aware of the importance to ensure that the health, welfare and safety of people living at the home was consistently protected. Longton Nursing & Residential Home DS0000025570.V347131.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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Longton Nursing & Residential Home DS0000025570.V347131.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. 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 OP8 OP9 Good Practice Recommendations Record keeping in relation to dietary and fluid intake should be consistent with nutritional care being delivered in day-to-day practice. Any hand written annotations on the Medication Administration Records should be signed, witnessed and countersigned. Photographs of residents should be attached to the Medication Administration records for identification purposes. It is recommended that the registered person develops a programme of activities in accordance with an audit of what people want to do and then records if people prefer not to participate, so that the home can demonstrate that activities have been offered to the people living there. The furniture in the bedroom identified at the time of the site visit was worn and marked, so should be renovated or DS0000025570.V347131.R01.S.doc Version 5.2 Page 32 3. OP12 4. OP19 Longton Nursing & Residential Home 5. 6. OP28 OP38 replaced. The home should continue to work towards 50 of care staff achieving a National Vocational Qualification at level 2 or above. A record should be retained of staff involved in fire drill training. Longton Nursing & Residential Home DS0000025570.V347131.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Longton Nursing & Residential Home DS0000025570.V347131.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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