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Inspection on 28/07/05 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 28th July 2005.

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

The inspector 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

The registered person had promoted and maintained service users` health and personal care needs, ensuring access to health care services in order to ensure adequate health care was being provided. Visitors were made to feel very welcome and service users were encouraged and supported to maintain contact with family and friends. The use of the local advocacy service was facilitated for service users as necessary to ensure that they had access to independent advice if they so wished. The policies and procedures of the home showed that those living there were adequately protected from harm. The home was maintained to a good standard of cleanliness and in general was well maintained. The manager of the home is qualified, competent and experienced to manage the service.

What has improved since the last inspection?

The home had started to use new pre-admission and care planning documentation, which was much improved and the information obtained prior to admission now clearly enabled the home to determine if the assessed needs of those wishing to live there could be adequately met. The care plans provided more detailed guidance as to how the needs of individuals were to be met. Effective systems had been implemented so that the home could monitor the quality of service provided.

What the care home could do better:

Service users` leisure interests should be promoted and the care planning process should consider how those living at the home could be encouraged and supported to continue to maintain their leisure interests. The requirements made by the fire service must be appropriately addressed to protect the safety of those living and working at the home and the recommendations made by the environmental health officer should be attended to in order to promote good hygiene and infection control. The recruitment procedures must be improved to ensure that all relevant checks are conducted prior to the employment of any member of staff.

CARE HOMES FOR OLDER PEOPLE Longton Nursing & Residential Home 11 Marsh Lane Longton Preston PR5 5ZJ Lead Inspector Vivienne Morris Announced 28 July 2005 09:30 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 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 F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Longton Nursing & Residential Home Address 11 Marsh Lane Longton Preston Lancashire PR5 5ZJ 01772 616144 Telephone number Fax number Email 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 with Nursing 52 Category(ies) of PD Physical disability (6) registration, with number OP Old Age (52) of places TI Terminally Ill (5) Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the overall total of 52 a maximum of 52 service users requiring either nursing or personal care who fall into the category OP - Old age, not falling within any other category. 2. Within the overall total of 52 a maximum of 5 service users requiring either nursing or personal care who fall into the category PD - Physical disability aged 60 - 65 years. 3. Within the overall total of 52 a maximum of 5 service users requiring nursing care who fall into the category TI - Terminally Ill. 4. Within the overall total of 52 a maximum of one named male service user in the category 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 & Residential Home. 5. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 6. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. Date of last inspection 21 January 2005 Brief Description of the Service: Longton Nursing and Residential Home is located in a quiet residential area of Longton, close to local amenities and main bus routes. The grounds are landscaped with a large lawned area to the rear enabling service users to enjoy the pleasant surroundings. The home is registered to provide both personal and nursing care for the elderly, although a small number of places are available for people who are terminally ill or who have physically disability. Accommodation is provided on two floors served by a passenger lift for the less mobile. The majority of rooms are single, however seven companion rooms are available for service users who wish to share facilities. En-suite facilities are available, comprising of wash hand basin and WC. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one day during July 2005. The inspection process focused on the outcomes for people living at the home. During the course of the inspection service users, relatives and staff were spoken to, relevant records and documentation were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas and service areas were seen. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. What the service does well: What has improved since the last inspection? The home had started to use new pre-admission and care planning documentation, which was much improved and the information obtained prior to admission now clearly enabled the home to determine if the assessed needs of those wishing to live there could be adequately met. The care plans provided more detailed guidance as to how the needs of individuals were to be met. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 6 Effective systems had been implemented so that the home could monitor the quality of service provided. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Sufficient information had been obtained prior to admission to enable the home to determine if individual assessed needs could be adequately met. EVIDENCE: The care of two service users’ was ‘tracked’ during the course of the inspection. The home was using a new set of documentation for the preadmission assessment process, which was much improved and therefore the information obtained prior to admission enabled the home to determine if individual assessed needs could be adequately met. Those people living at the home, whom the local authority funded had been assessed by a social worker prior to admission and a copy of the assessment and care plan had been obtained by the home so that a clear picture of individual needs was available for staff reference. The home had also conducted an assessment of people’s needs before they were admitted to the home, to ensure that the needs of those coming to live at Longton Nursing Home could be adequately met by the staff team. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 9 The service users’ plans of care had been based on the information obtained prior to admission, therefore documented guidance for staff was provided to ensure that all assessed needs were being consistently met. One relative commented, ‘staff at the home make us feel very welcome’, and one service user stated ‘the staff are very kind and helpful. They were very supportive when I first came here’. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 The people living at Longton Nursing Home were receiving appropriate health and personal care in accordance with their individual assessed needs. However, they were not being encouraged or supported to continue with their preferred leisure interests. EVIDENCE: The care of two service users’ was ‘tracked’ during the course of the inspection. A new care planning process had been implemented since the previous inspection, which was much improved. The plans of care, in general provided clear, up to date instructions for staff as to how individual needs, in relation to personal and health care were to be met. Although individual leisure interests had been documented within the care files, some conflicting information was provided and residents’ interests were not recorded within the plan of care to show how people living at the home were encouraged and supported to continue with their individual leisure interests. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 11 The resident or their relative had been involved in the care planning process and relatives spoken to told the inspector that staff discuss the care plans with them. Care plans had not consistently been reviewed on a monthly basis to ensure that up to date information was provided. Staff spoken to were fully aware of the needs of the people living at the home and were seen to be anticipating individual needs well. External professional advice had been sought as required to ensure that health care needs were being appropriately met. Service users spoken to informed the inspector that they were satisfied with the care provided and felt that staff attended to their needs well. The risk assessing process had improved since the last inspection and a variety of risk assessments were in place, which showed how risks were to be minimised or eliminated. Although the management of medications was not fully assessed on this occasion, the requirement and recommendation from the previous inspection had been fully met. However, the inspector noted that the instructions on a number of medicine containers was illegible, which could potentially place those living at the home at risk. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 14 Visitors were welcomed to the home and service users were encouraged and supported to maintain contact with family and friends. Service users were able to exercise choice and control over their lives as far as possible. EVIDENCE: Visitors spoken to informed the inspector that they were always made to feel very welcome at the home and were encouraged to participate in the every day life of those living at the home. The policies and procedures of the home demonstrated that residents were able to receive their visitors in private if they so wished. Those spoken to confirmed this and the inspector saw visiting taking place in private. Strategies were in place to ensure that those living at the home were able to refuse visitors if they so wished. Therefore, it was evident that the home respected the wishes of service users in relation to receiving visitors. One service user commented ‘my relative is able to have a meal with me and drinks are provided for visitors’ and a relative stated ‘I have had meals here, the food is very good’. Service users and their relatives had been provided with information about how to contact the local advocacy service if they so wished and access to Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 13 personal records was facilitated as required in accordance with the Data Protection Act 1998, demonstrating that service users and their relatives were encouraged to be involved in the care provided. At the time of the inspection evidence was available to demonstrate that advocacy services were used as required. Personal possessions were observed in service users’ bedrooms in order to create a homely atmosphere, the extent of which had been recorded on admission to the home in order to protect individual’s personal belongings. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The policies of the home demonstrated that those living there were, as far as possible protected from possible abusive situations. EVIDENCE: Policies and procedures were in place at the home in relation to the protection of vulnerable adults, which included ‘whistle blowing’ and were in line with standard 18 of the National Minimum Standards for Care Homes for Older People to ensure that those living at the home were protected as far as possible. A policy was in place in relation to physical and verbal aggression displayed by service users to ensure that staff fully understood their role should such a situation arise. Systems were in place to demonstrate that the money and valuables of those living at the home were appropriately managed, ensuring that they were safely retained and protected. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The home was maintained to an acceptable standard both internally and externally. However, the safety of those living at and working at the home was not fully protected as there were items which had not been addressed from the Fire Officer’s report and Environmental Health Officer’s report. EVIDENCE: A tour of the premises was conducted during the course of the inspection, which was found to be clean, hygienic and pleasant smelling. One relative commented ‘the home is always spotless. The cleaner is excellent. The handyman is very friendly and attends to any maintenance problems immediately’. Although a programme of routine maintenance was not in place, it was noted that the home was maintained to an acceptable standard. The double-glazing units were in the process of being resealed to prevent condensation. The registered manager informed the inspector that some carpets were due to be replaced to enhance the environment. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 16 The external grounds were well maintained and a pleasant patio area was available to the rear of the building. Lancashire fire and rescue service had issued an enforcement notice at the time of their last inspection identifying some requirements and recommendations, most of which had been addressed. The remaining must be attended to as a matter of urgency to protect those living at and working at the home. The Environmental Health Officer’s recommendations were in the process of being addressed to promote good hygiene and infection control. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The number of staff on duty on the day of the inspection was not adequate to meet the needs of those living at the home. The home’s recruitment procedures were not robust enough to support and protect the service users. EVIDENCE: At the time of the inspection there were 49 people living at Longton Nursing Home. The staff rota was examined, which showed staff on duty at any time of the day and night and demonstrated that more staff were on duty at the busier periods of the day. The dependency levels of those living at the home should be taken into consideration when calculating the ratio of care staff to service users to ensure that needs are adequately met by the number of staff on duty. The inspector received 31 comment cards from those who use the service, their relatives and other professionals, a number of which felt that there were not always sufficient numbers of staff on duty. The records of three staff employed at the home were examined, which demonstrated that recruitment procedures were not adequate enough. References, Criminal Record Bureau disclosures and POVA checks had not always been obtained prior to the commencement of employment to ensure the protection of the people living at the home. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 18 All staff had received terms and conditions of employment and been issued with the relevant codes of conduct to ensure that they were fully aware of their responsibilities and roles within the home. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 33 The person in charge is fit to be the registered manager. The quality of care is monitored on a regular basis. EVIDENCE: The person in charge of the home is a first level registered nurse and holds a certificate in management, which meets the revised guidance in relation to the qualifications of the registered manager. She has managed the home for many years, therefore has gained a lot of experience in caring for the elderly. She has undertaken periodic training to update her knowledge and skills and is familiar with the conditions associated with old age. The registered manager has a job description, which enables her to take responsibility for her duties. Both staff and those using the service were very complimentary about the manager of the home. Comments received included ‘The manager is very supportive and approachable’, ‘The manager supports her staff, she is always Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 20 there for us and we can talk to her about any concerns we may have’ and ‘the manager is helpful and manages the home well’. Effective quality assurance monitoring systems were in place at the home, which were based upon feedback from those using the service, their relatives, staff and stakeholders within the community. Although an annual development plan was not in place at the home a variety of internal audit trails had been conducted reflecting the aims and outcomes for those using the service. The home had achieved a recognised external quality assurance award, demonstrating that the service was independently audited. A variety of meetings were held at regular intervals with minutes being retained, showing that open discussions about the service were encouraged and that views of those using the service, their relatives and staff working at the home were actively sought, the results of which were produced in graph format for easy reference for any interested parties. Written policies and procedures had been regularly reviewed and updated in light of changing legislation and good practice guidelines. Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x 2 x x x x x Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement Timescale for action 31.08.05 2. 19 23(4) The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must take 31.08.05 adequate precautions against the risk of fire, including addressing requirements made by the fire officer. The registered person must not employ a person to work in the care home unless the person is fit to work in the care home; he has obtained in respect of that person the information and documents specified in Schedule 2 and he is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person. 31.08.05 3. 4. 29 19(1)(a)( b)(c) Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard 7 7 7 19 19 Good Practice Recommendations The plans of care should demonstrate how service users would be encouraged and supported to maintain their leisure interests. The service users’ plans of care should be reviewed on a monthly basis. Service users’ records should not provide conflicting information. A programme of routine maintenance and renewal of the fabic and decoration of the premises should be produced and implemented with records kept. The registered person should ensure that the recommendations made by the environmental health officer are appropriately addressed. It is recommended that an annual development plan is produced based on a systematic cycle of planning – action – review, reflecting aims and outcomes for service users. 33 Longton Nursing & Residential Home F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 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 F57 F08 S25570 Longton Nursing Home V228621 280705 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!