CARE HOMES FOR OLDER PEOPLE
Longueville Court Village Green Orton Longueville Peterborough PE2 7DN Lead Inspector
Don Traylen Unannounced Inspection 10:15a 13 & 26 February 2007
th th 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 Longueville Court DS0000024316.V330425.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. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Longueville Court Address Village Green Orton Longueville Peterborough PE2 7DN 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) 01733 230709 01733 230716 peter.barlow@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Peter Nigel Barlow Care Home 105 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (39), Old age, not falling within any other of places category (101), Physical disability (24), Physical disability over 65 years of age (1), Terminally ill over 65 years of age (101) Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 1 (one) named male over the age of 65 years with Physical Disabilities Dementia (DE) 1 - The one place for one person under 65 years is for a named individual only Dementia DE = 1 female, is for a named person for the duration of their residency only 20th February 2006 Date of last inspection Brief Description of the Service: Longueville Court was opened in 1995 as a modern, purpose-built, spacious care home on two floors, providing nursing and personal care for up to 105 people over the age of 65 years. The registration was varied in November 2004 for the home to provide care for up to 24 persons with physical disabilities in a dedicated unit within the home. Longueville Court is owned by Barchester Healthcare Homes Limited and is situated overlooking the quiet village green of Orton Longueville, approximately two miles from the centre of Peterborough. The building is a country house style, built on two levels and divided into four units: Memory Lane and Robin unit are on the ground floor and Skylark and Kingfisher unit are on the first floor. Memory Lane provides care to elderly persons who have dementia related care needs. Robin provides care to people under 65 years of age who have physical disabilities, whilst Skylark and Kingfisher provide nursing care. Longueville Court is decorated to a high standard and provides en-suite facilities in all rooms except one. It has an atmosphere of spaciousness and comfort. The company claim, “to have created places that are not at all clinical or institutionalised”, in their ‘Welcome to Barchester Healthcare’ pamphlet. The home has attractive and orderly rear gardens plus a secure inner central courtyard. The home attracts enquiries and potential service users from an area greater than it’s immediate PCT locality. The home informs all interested parties by providing their ‘Welcome to Barchester’ pamhlet, their Service User Guide and Statement of Purpose and the previous CSCI inspection report. Fees charged are between £789 to £1000 per week and represent nursing care costs. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The last key inspection was carried out on 20th February 2006 when nine requirements were made. On the 4th January 2007, a random and themed inspection was conducted to assess four National Minimum Standards that focus on the home’s admissions procedures, their contracts, fees and management of any complaints. Two requirements were made as a result of the thematic inspection, one of which has been carried forward and shown in the requirements made in this report, although it was not assessed durinng this inspection. This key inspection consisted of two visits to the home; one on the 13th February at 10:15 am, by one inspector and another during the night of 26th February 2007 at 21:00 pm, by two inspectors. The reason for carrying out this second visit was to assess the night care provision and documentation because of concerns found during the first visit to the home on the 13th February 2007. During the two visits a number of service users and staff were spoken and one visiting relative. Care Plans and supporting documentation of care routines, training arrangements and admissions procedures were assessed and observations were made during a lunchtime meal. Seven requirements have been made in this report, four of which are new. What the service does well:
Longueville Court has been purposely built to provide a spacious and generous environment for service users. Throughout the home, all corridors, communal areas and individual rooms are spacious enough to accommodate service users who use wheelchairs. The environment is well maintained, clean and has comfortable and modern furniture and high quality fixtures and fittings. The home admits only service users who have been comprehensively assessed and whose needs the home confidently expects to meet. The home’s procedures and history of reporting allegations or suggestions of abuse has been prompt and consistent. The approach by staff and managers has created an open and transparent practice in these matters that has been demonstrated to be in the best interests of service users. In general, the home’s range of policies and procedures provide the basis for good practice guidance to staff and to unit managers. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
During the inspection visit of the 13th February 2007 there were serious concerns around nursing practices for very dependent service users. Fluid intake records maintained for two service users who were considered at risk of insufficient fluid intake, indicated long overnight periods of between 11 to 14 hours when they had not consumed any fluids. Records of turning people who were cared from their beds showed varying periods of being turned, that were not explained. There were periods between 1am and 6am or 7am, when no service user was recorded as being turned. The inference was that night staff who commence work at 8pm through to 8am are poor at record keeping and are failing to provide adequate care. The registered manager agreed to immediately investigate and take action to remedy these concerns. A second inspection visit to assess the quality of night time care on 26th February 2007, revealed that these concerns had been addressed and that adequate attention to considered pressure prevention was in place and that the night nurse’s considered judgements about fluid intake was appropriately planned. However, these professional judgements about turning and about fluid intake must be recorded in the appropriate charts used by the unit. Staffing levels on the two nursing units must be increased to a level that allows staff to ensure that service users who require assistance to feed and encouragement to eat at mealtimes are given this care. Staff must be available in sufficient numbers, or alternative meal patterns should be arranged to ensure that each service user who requires assistance to feed and encouragement to eat receive their care in a timely and dignified manner. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 7 The catering arrangements have been found to be good in previous inspections. However, during the visit on 13th February it was found that food had not been properly cooked and a sweet was served whilst it was frozen. Two service users and a visiting relative complained about this lack of attention to food. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 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 Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5, Quality in this outcome area is good. Previous good admission processes remain in place and are regularly applied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has previously been assessed as having good admission processes and these remain in place and are regularly applied. The random inspection conducted on 4th January 2007 found that the admissions process and assessments of three service users were rigorous and that comprehensive information was obtained. A recent application to vary the home’s registration was further evidence by the home to ensure they had sufficient information about a prospective service users when they had re-assessments conducted to determine whether they could adequately meet the known needs. A length of time was given to consider these changing needs and a visit to the home by the prospective service user was used to decide whether the home could provide the type of care required.
Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 10 Standard 2 was not assessed but an outstanding requirement, relating to this Standard that was made during the thematic inspection on 4th January 2007, has been included in this report as the timescale had not been reached at the time of this inspection. Standard 6 was not applicable, as intermediate care is not provided. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10, Quality in this outcome area is good. Care planning and the delivery of care was considered thorough despite some of the differences in the records that were found. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection visit of the 13th February 2007 there were concerns around nursing practices for very dependent service users. Fluid intake records maintained for two service users considered at risk of insufficient fluid intake indicated long overnight periods of between 11 to 14 hours when they had not consumed any fluids. Care plans indicated two hourly turns being needed although less frequent turns were given during night periods from 8pm and 8am. Records of turning people who were cared for in bed, showed varying periods of being turned that were not explained. There were periods between 1am and 6am or 7am, when no service user was recorded as being turned. The inference was that night staff, who work from 8pm through to 8am, are either poor at record keeping or
Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 12 are failing to provide adequate care. The registered manager was informed of these findings and agreed to immediately investigate and take action to remedy these concerns. A second inspection visit to assess the quality of nighttime care on 26th February 2007 revealed that adequate attention to considered pressure sore prevention was in place and that turns had not been made because they were not essential and the person was sleeping. The unit manager’s (a registered nurse) considered judgements were accepted by the two inspectors. The concern about fluid intake was also judged on the same criteria and that sufficient fluids had been consumed during the daytime. However, these professional judgements about turning and fluid intake, must be recorded in the appropriate charts used by the unit and that more effective communication between night nurses and day time nursing managers should be achieved, to ensure that all of these professional judgements make a consistently delivered care plan. As a consequence, it is necessary that care plans are amended to include a very accurate instruction for recording these care topics for both daytime and nighttime. The records of one service user with postural hypotension, whose blood pressure readings showed dramatic differences, should include a record of her bodily position and the time when her blood pressure is read. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15, Quality in this outcome area is adequate. The standard of meals and the management of mealtimes are not carried out in the best interests of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels during the daytime on the two nursing units showed that staff are struggling to meet the needs of service users at mealtimes. Kingfisher has two student nurses on placement who were working on the day of inspection. Despite the two nursing students, it was observed that care staff were not in sufficient numbers to assist all service users who required help with feeding or encouragement to eat. There were 5 or 6 service users who are cared for from their beds and needed assistance to feed and drink and encouragement to consume sufficient fluids. Service users seated in the dining room of the Kingfisher unit also required supervision, or encouragement and some assistance and this was observed to be missing. One service user’s partner visits the home every day to assist his partner to help feed and eat, a role that relieves care staff of this task. Staff informed the inspector that meal times were a long process and this was observed by the inspector, who saw service
Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 14 users in their beds, who were still eating when the dining room was being cleared and others who were awaiting staff to help them. The inspector sat with two service users in the Skylark unit and observed that the potatoes were undercooked and still hard and that a cheesecake offered to both Skylark and Kingfisher units, was still frozen. The inspector asked to speak to the head chef (who was absent), but spoke to the acting head chef who tasted the food and agreed these findings. Two service users stated that they could not always understand the terminology used on the choice of food that was written as a restaurant menu and displayed on each table. They requested that plain English is used so they could understand what the food was. It is recommended that service users should be consulted in a respectful and dignified approach about their choices of food and meals that should be representative of their wishes. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 15 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): 16,18, Quality in this outcome area is good. Further attention and listening to service users concerns is anticipated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Complaints about meals and mealtimes must be recorded and comments about meals should be encouraged and also recorded and used to improve the quality of meals and mealtime experiences. Although staff did have a book that was used to record complaints about the food and was intended to be used to inform the kitchen, there were only two recordings and none of the concerns raised on the day of inspection had been recorded or acted upon until raised by the inspector. The home has consistently approached any suspicion or allegation of abuse in a very appropriate manner and has reported these concerns immediately to the adult protection social workers, or the Police. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 16 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): 19,21,22,23,24,25,26, Quality in this outcome area is good. Service users live in a very comfortable and clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment was clean and very well maintained apart from a toilet seat that was broken and had been broken at the previous inspection in February 2006 and had apparently been refitted and had become loose again. This indicates either a lack of awareness of the broken seat, or a lack of reporting as broken and unsafe for service users. A new bath had been installed in one bathroom in Memory Lane unit. This means the home has two useable bathrooms in Memory Lane unit and one bathroom is used as a storage room.
Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is adequate. An increase in staffing number would benefit service users at busy periods. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing numbers at mealtimes in the Kingfisher unit were not adequate to meet the needs of the unit’s very dependent service users. There were four permanent care staff, the unit head (a registered nurse) and two student nurses on placement. Service users were unable to be fed when the food arrived and had to wait for assistance. It is required that the registered manager will ensure the needs of service users are met at mealtimes. Staff training records were in the process of being overhauled by the recently recruited training manager. Not all the records of previous training achieved had been collated for each member of staff. However, the records were neatly presented and showed a comprehensive training plan for all staff for the year 2007. A new and full induction programme based on Skills for Care Standards has been introduced for new staff. All staff receive training in the Protection of Vulnerable Adults from Abuse in the early period of their induction. The home’s recognised ‘Key Practitioner’, who is the Head of Care, provides this training. On the evening of the 13th February 12 senior staff attended a training session on ‘Documentation- The Legal aspects’, provided by an HM Coroner.
Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 18 Less than 50 of care staff had achieved NVQ level 2 awards in care and it is expected that more staff should be enabled to achieve these awards NVQ level 2 awards in care. Recruitment procedures are thorough and are backed by the home’s recruitment policy. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,38, Quality in this outcome area is good. The management of the home is sound and operates to improve the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 31 remains unchanged since last inspection. Service users’ best interests are promoted. Their views are sought through an annual customer satisfaction survey. The home adheres to Cambridgeshire County Council’s Adult Protection Procedures and Protocol and has a range of policies designed to provide quality led care. Because of the discrepancies found in the Care Plan records already referred to in this report, plus the concerns about the staffing levels at mealtimes and
Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 20 service user satisfaction with their food, a quality assurance system to assess these concerns must be made. Appropriate safety and health checks are in place, as is emergency lighting, hot water temperature controls, fire drills and fire safety training. Hoists and wheelchairs are regularly serviced. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X X X 3 Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5(1)(bb), (bc,)(bd) & 5A(2)(b), & 17(1)(a), (2), & Schedule3 & Schedule4 Requirement The contractual details that relate to individual fees and terms and conditions, must contain clear details of the financial arrangements made of who is representing the service user’s financial interests and what arrangements are in place to pay their fees and by whom, and how service users receive their money or personal allowances. These details must be acknowledged as an element of each service user’s overall care plan. Timescale not reached and has been carried forward. The registered manager must ensure that unnecessary risks to the health of service users are avoided by ensuring that care plans relating to service users’ needs for minimum fluid intake and for regular turning, if they are confined to bed, are adhered to and that accurate records are maintained of these elements of care. The registered manager must ensure that food is served at
DS0000024316.V330425.R01.S.doc Timescale for action 31/03/07 2 OP7 15(2)(b) 01/04/07 3 OP15 13(4)(c) & 16(2)(i) 01/04/07
Page 23 Longueville Court Version 5.2 4 OP19 13(4)(a) 5 OP27 18(1)(a) 6 OP28 18 (1)(c)(i) 7 OP33 24(1)(b) 26(4)(b) safe temperatures. The registered manager must ensure that all hazards are avoided in bathrooms in the Memory Lane unit by fitting secure toilet seats. The registered manager must ensure that there are additional staff in sufficient numbers working in the Kingfisher unit at mealtimes to ensure that service users needs are adequately met. Training in NVQ level 2 awards must be promoted to enable more care assistants to achieve this award. Timescale not met and has been extended. Quality Assurance system(s) to assess Care Plan records, staffing levels at mealtimes and service users satisfaction about meals must be made to ensure the home has quality assurance checks in place to address these aspects of care. Timescale not met and has been extended. 01/05/07 01/05/07 01/05/07 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations The professional judgements about turning and about fluid intake made by night time nurses should be included in the appropriate charts used by the unit and more effective communication between night nurses and day time nursing managers should be promoted to ensure that all of these judgements make a consistent care plan. The records maintained for service users’ blood pressures should also record their bodily positions at the time. Residents should be consulted in a respectful and dignified
DS0000024316.V330425.R01.S.doc Version 5.2 Page 24 2 3 OP8 OP14 Longueville Court 4 5 OP27 OP28 approach about their choices of food and meals that is representative of their wishes. Staff should be enabled to develop skills in dementia related care and provided with training opportunities to do so. More staff should be encouraged to achieve NVQ level 2 awards in care. Longueville Court DS0000024316.V330425.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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