CARE HOMES FOR OLDER PEOPLE
Longton Nursing & Residential Home 11 Marsh Lane Longton Preston Lancashire PR5 5ZJ Lead Inspector
Vivienne Morris Unannounced Inspection 9th February 2006 09:00 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.V280005.R01.S.doc Version 5.1 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.V280005.R01.S.doc Version 5.1 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 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 52 Category(ies) of Old age, not falling within any other category registration, with number (52), Physical disability (6), Terminally ill (5) of places Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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. 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. Within the overall total of 52 a maximum of 5 service users requiring nursing care who fall into the category TI - Terminally Ill. 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. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 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. 28th July 2005 2. 3. 4. 5. 6. Date of last inspection 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 lawn to the rear of the building 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 disabilities. Accommodation is provided on two floors served by a passenger lift. The majority of rooms are single, however a number of 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 DS0000025570.V280005.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day during February 2006. 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 received two complaints about this service since the last inspection, which were both referred back to the provider for investigation and which were found to be not upheld. What the service does well:
Those living at the home were treated with respect by the staff, ensuring that their rights to privacy and dignity were upheld at all times. The routines of daily living and activities made available were flexible and varied to suit service users’ preferences and capabilities. Mealtimes were well managed and people living at the home were provided with a good choice of nutritious food. Complaints were being appropriately investigated and adequate information had been provided to the relevant people to ensure that they were aware of the process in relation to making a complaint. The premises were clean and systems were in place to control the spread of infection, in accordance with relevant legislation and good practice guidance. Staffing arrangements within the home showed that a good balance of staff were on duty at any one time and that the ratio of care staff to service users was being calculated in accordance with the dependency needs of those living at the home to ensure that such needs could be adequately met by the staff team. Detailed induction programmes were in place for all new staff to ensure that they had been provided with sufficient information to enable them to carry out the duties expected of them. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 6 Procedures were in place and clear records were kept in order to safeguard service users’ money and valuables, which were retained by the home for safekeeping. What has improved since the last inspection? What they could do better:
A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented with records kept to ensure that the environment continues to be maintained to a good standard. The registered person should ensure that adequate odour control is maintained in order to provide a pleasant environment for those living at home. The home should be working towards achieving a minimum ratio of 50 of trained members of care staff with a relevant care qualification to ensure that new staff are adequately supervised by qualified care staff on a continuous basis. The registered person should implement an annual development plan for the home, based on a systemic cycle of planning-action-review, reflecting aims and outcomes for service users. This recommendation remained outstanding from the previous inspection, although the remainder of the standard was not assessed on this occasion. The portable electrical appliances must be appropriately tested to ensure that they are safe to use within the home in order to promote the safety of those using the equipment. The requirements and recommendations made in relation to the electrical installation must be appropriately addressed to ensure the continued safety of those living and those working at the home. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 7 All accidents recorded should be in accordance with the Data Protection Act 1998 to ensure that confidentiality is promoted and service users’ identities are protected at all times. A record should be retained of staff involved in fire drill training to ensure that all staff receive such training for the protection of those living in the home. The registered person should ensure that a qualified first-aider is on duty at all times to ensure that adequate first aid measures are put into place as required. 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 DS0000025570.V280005.R01.S.doc Version 5.1 Page 8 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.V280005.R01.S.doc Version 5.1 Page 9 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 the following standard(s): No standards from this section were assessed on this occasion. EVIDENCE: There were no outstanding requirements or recommendations relating to this section at this inspection. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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 the following standard(s): 9 and 10. Service users were supported to maintain their interests and leisure interests whilst living at the home. Service users were treated with respect and dignity, ensuring that their privacy was maintained. EVIDENCE: Standard 7 was not fully assessed on this occasion. However, the three recommendations made at the previous inspection were found to have been appropriately addressed. The care planning process had improved in relation to demonstrating how people were supported to maintain their hobbies and individual leisure interests. The care plans examined had been reviewed and updated to reflect changing needs of those living at the home to ensure that all assessed needs were being appropriately met. The pharmacy inspector assessed the management of medications at this inspection and found that in general they were well managed. A detailed report of the findings will be forwarded to the home with any requirements and recommendations made. The policies of the home demonstrated that service users rights’ to privacy and dignity were upheld and that they were offered choices in all aspects of daily
Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 11 living. Induction records showed that staff were instructed on how to treat service users with respect and the inspector observed staff knocking on bedroom doors before entering and speaking to people in a respectful manner. One visitor to the home spoke with the inspector stating,” my relative is always treated with dignity and privacy and is respected always.” Comments received by the inspector included, “The staff are really lovely. They will do anything for me. I just have to ask”, “Their (the staff) professionalism is second to none”, “I am more than satisfied with the care provided” and “The care is wonderful and excellent”. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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 the following standard(s): 12 and 15. Those living at the home were provided with a lifestyle, which suited their expectations and preferences, meeting their social, religious and recreational interests and needs. Service users were provided with a balance diet in pleasant surroundings. EVIDENCE: The home employed a member of staff who was solely responsible for the organisation and delivery of leisure activities within the home to ensure that people were encouraged and supported to maintain their interests and hobbies. Care records examined provided information in relation to service users’ social histories, interests and hobbies so that staff were aware of what people enjoyed doing before living at the home. Records were seen of activities provided, which included a variety of both group participation and 1:1 interaction, demonstrating that people were stimulated and assisted to continue their particular interests. The inspector observed a member of staff reading the daily newspaper and discussing various topics with one of the service users. Another service user was being taken on a fishing trip to ensure that his interests were being
Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 13 maintained. A variety of other one-to-one activities were seen to be taking place in accordance with service users preferences. A policy was in place at the home in relation to encouraging service users to maintain contact with family and friends and links with the local community. One relative confirmed that relatives of service users were encouraged to be involved in the daily lives of the people living at the home. The inspector established that the routines of daily living were flexible and varied in accordance with service users preferences and capabilities, ensuring that people were able to exercise choices, which were respected by staff. The inspector spoke with a number of service users who confirmed that they enjoyed the activities provided and it was established that clergy of various denominations visited the home to provide Holy Communion for those who wished to participate to ensure that individual religious beliefs were being met. The menu was seen to provide a good choice of meals, which were attractively presented in order to maintain appetite and nutrition. Alternatives to the menu were available as required and specialised diets were provided in accordance with service users dietary needs. Those spoken to confirmed that snacks and beverages were available at any time, including alcoholic beverages and that supper was provided in the evening. The inspector saw that a relaxed environment was provided at mealtimes and the tables were pleasantly arranged so that service users enjoyed the dining experience. Staff were seen assisting service users where necessary with their meals in a discreet manner, although independence was encouraged as far as possible. A relative said “an individual diet was prepared for my relative when health was poor”. One service users stated, “ the food is excellent and there is a good variety. Staff ask us each day what we would like for our meals” and another said, “The food is very good. I cannot complain about it”. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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 the following standard(s): 16 Complaints were being well managed. EVIDENCE: A clear policy was in place at the home in relation to the management of complaints, which informed readers of how they could make complaints and who would be responsible for dealing with them. This information was included within the service users guide and welcome pack to ensure that people were aware of the complaints process and that they could refer a complaint to the Commission for Social Care Inspection at any stage, should they so wish to do. A record was maintained of complaints received by the home, which included details of the investigation and any action which had been taken to ensure that each complaint was appropriately investigated and so that the receipt of complaints could be regularly monitored. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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 the following standard(s): 26 Service users lived in a safe and clean environment , although the home was not entirely odour free. EVIDENCE: Although standard 19 was not fully assessed on this occasion, the requirements and recommendations made at the last inspection were assessed. It was established that the requirement had been appropriately addressed. However, one recommendation remained outstanding. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented with records kept to ensure that the environment continues to be maintained to a good standard. At the time of the inspection the premises were found to be clean and tidy, although a slight unpleasant odour was evident in some areas of the home, which did not enhance the general environment. One service user stated, “I am quite content living in this home”. Laundry facilities were conveniently sited, which provided adequate equipment for the needs of the home to ensure that laundry was appropriately washed,
Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 16 dried and ironed and then returned to service users within an acceptable period of time. Policies were in place at the home to ensure that staff were aware of correct procedures to follow in order to promote infection control. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. The number of staff on duty was adequately meeting the assessed needs of those living at the home. Not a sufficient percentage of care staff had achieved a formal qualification to demonstrate that new staff were being adequately supervised by experienced and appropriately trained care staff. Robust recruitment procedures were in place at the home to ensure that those living there were adequately protected. EVIDENCE: The ratios of care staff to service users was being determined in accordance with the assessed needs of those living at the home and a system was being operated for calculating staff numbers required in order to ensure that the health and safety of service users was being maintained. At the time of the inspection there were 22 care assistants employed at the home, 8 of whom had obtained a care qualification, which did not demonstrate that a sufficient number of care staff had obtained a formal qualification in order to demonstrate that new staff were being adequately supervised by experienced and appropriately trained care staff on a continuous basis. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 18 The personnel records of three members of staff were examined at the time of the inspection when it was found that robust recruitment procedures were adopted to ensure that those living at the home were adequately protected. Staff training needs were being identified through the staff appraisal process to ensure that all staff received relevant training in accordance with their individual needs. Ongoing training was provided for all care staff in relation to meeting the needs of those living at the home and all new care staff had been guided through a detailed induction training programme, to ensure that they received sufficient information to enable them to carry out the duties expected of them. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38. The procedures adopted by the home ensured that service users’ financial interests were adequately protected. The health, safety and welfare of service users and staff was in general promoted and adequately protected. EVIDENCE: Standard 33 was not fully assessed on this occasion. However, the recommendation from the previous inspection remained outstanding. The registered person should implement an annual development plan for the home, based on a systemic cycle of planning-action-review, reflecting aims and outcomes for service users. Secure facilities were provided for the retention of money and valuables kept on behalf of service users and clear records were being maintained to ensure that safeguards were in place to protect the interests of those living at the
Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 20 home. Receipts were retained of any expenditure made on behalf of service users. However, these were not kept in an orderly fashion to demonstrate that a clear audit trail had been developed. The registered manager, in general, promoted safe working practices at the home to ensure the protection of the people living there. However, a record should be retained of staff involved in fire drill training, so that it can be easily identified if any staff members have not been regularly involved in such practices. Although registered nurses were on duty the registered person should ensure that a qualified first-aider is on duty at all times to ensure that adequate first aid measures are put into place as necessary. Although accidents occurring within the home had been accurately recorded, this information was not in accordance with the Data Protection Act 1998 to ensure that confidentiality was maintained and service users’ identities were protected. The registered manager ensured, in general, the health and safety of service users and staff. However, portable electrical appliances must be tested annually to ensure that they are safe to use within the home. The requirements and recommendations made in relation to the electrical installation must be appropriately addressed to ensure the continued safety of those living at and those working at the home. A variety of risk assessments had been conducted, demonstrating that strategies were in place to eliminate or minimise any hazards identified, to ensure the safety of those living at and those working at the home. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X 2 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 X X 2 X 3 X X 2 Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 16(2)(k) Requirement Timescale for action 31/03/06 2 OP38 23(2)(c) 3 OP38 13(4)(c) The registered person shall having regard to the size of the care home and the number and needs of service users keep the care home free from offensive odours. The registered person shall 31/03/06 having regard to the number and needs of the service users ensure that: - equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order, including portable electrical appliances. The registered person shall 31/03/06 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible and eliminated, including ensuring that the electrical installation is made safe. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 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 Refer to Standard OP19 OP28 OP33 OP35 OP38 Good Practice Recommendations A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented with records kept. A minimum ratio of 50 of care staff should obtain a care qualification. 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. Receipts of monetary expenditure on behalf of service users should be retained in an orderly manner. A record should be retained of staff involved in fire drill training. The registered person should ensure that a qualified firstaider is on duty at all times. All accident records should be retained in accordance with the Data Protection Act 1998. Longton Nursing & Residential Home DS0000025570.V280005.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 DS0000025570.V280005.R01.S.doc Version 5.1 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!
