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Inspection on 19/08/05 for Longueville Court

Also see our care home review for Longueville Court for more information

This inspection was carried out on 19th August 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

Training is organised by the Clinical Tutor and the Head of Care. The built environment is of a high standard and is very spacious and allows service users to enjoy adequate private and communal space. The memory Lane unit is located downstairs and has 40 bedrooms all with ensuite facilities, 4 bathrooms, a dining room incorporating a kitchen and a large lounge with an additional dining area. The unit is designed as a spacious H layout with long corridors. Memory Lane has its own main entrance doors although these are not currently used as the main entrance to the unit. The manager of Memory Lane sets practical and high standards and leads by example. She is a valuable asset to the unit as are the care staff who work on the same unit. The manager is dedicated to improving the unit and to ensuring that service users enjoy a high standard of care and can enjoy a good quality of life. Her approach is especially person centred and understanding of individual needs. She has worked many extra hours in addition to her contracted hours and has consulted not hesitated to consult with GPs and a CPN about the changing care needs of service users. Care staff showed an approach to their work that was based on respect. All staff reflected a person-centred approach to care, despite differences in confidence and abilities of staff to communicate with service users.

What has improved since the last inspection?

A new manager has been appointed in Memory Lane unit who is very enthusiastic and committed to improving the quality of care and life to service users. She was observed to lead a hands-on approach to work that was pragmatic and considered as good practice that sets and example for staff working in the unit. Some of the care workers within the Memory Lane unit displayed good communication skills, were able to empathise with service users and showed a willingness to engage with service users. The previous Clinical Tutor has become Head of Care. An acting manager for the home has been appointed to replace the previous registered manager who has been promoted to a senior position within the organisation. The acting manager has applied to the CSCI to become the registered manager.

What the care home could do better:

The registered person must reconsider the range of differing physical, psychological and mental health needs of the service users resident in Memory Lane. Similarly, there must be reconsideration of the increasing dependency of all service users that has occurred within the unit in regard to meeting their changing needs. Care planning, staffing formulas and staff skills mix, staff training and the organisations quality assurance systems must address a need to urgently increase staffing levels in the Memory Lane unit. Mealtimes are just one period when there is a need for additional staff to assist service users. An assessment of the risks associated with 12-hour shifts worked by care staff in relation to the European Work Time Directive should be arranged with evidence of staff having been consulted. Improvements to the equipment and fittings in the four bathrooms located in the Memory lane unit are needed. Arrangements for an assessment by a Mental Health Occupational Therapist of the environmental and of the equipment and facilities in Memory Lane unit should be arranged.Memory Lane unit must arrange for their induction programme to include dementia care training and should encourage and enable staff to participate in subsequent in-depth training in Dementia care as part of their professional development. An induction programme for all staff employed within the home that includes training in protecting vulnerable adults from abuse must be arranged. Further training delivered by, or recognised by Greater Peterborough Primary Care Partnership (GPPCP) that emphasises the reporting procedures for allegations of abuse, must be arranged for all staff. Staff should be facilitated to increase the inclusion and involvement of service users in their daily routines and be allowed to create and maintain activities centred on meeting their interests and life skills. Emphasis and planning should be placed on raising the profile of Dementia Care based on a person centred approach to meet the needs of the current service users and to anticipate future demands in relation to the demographic needs of elderly service users affected by dementia.

CARE HOMES FOR OLDER PEOPLE Longueville Court Village Green Orton Longueville Peterborough PE2 7DN Lead Inspector Don Traylen Announced 19th & 22th August 2005 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. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Longueville Court Address Village Green Orton Longueville Peterborough PE2 7ND 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) 01733 230709 01733 230716 Longueville@barchester.com Barchester Healthcare Homes Limited To be appointed Care Home 105 Category(ies) of Dementia - over 65 years of age (39), registration, with number Old age, not falling within any other category of places (101), Physical disability (24), Physical disability over 65 years of age (1), Terminally ill over 65 years of age (101) Dementia – under 65 (1) Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 (one) named male over the age of 65 years with Physical Disabilities Date of last inspection 12/01/2005 Brief Description of the Service: Longueville Court was opened in 1995 as a modern, purpose-built, spacious care home 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, Robin, Skylark and Kingfisher. The home 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. Longueville Court has attractive and orderly rear gardens plus a secure inner central courtyard leading from the Memory Lane and Robin units. The Memory Lane unit is located downstairs and has 40 bedrooms all with en-suite facilities, 4 bathrooms, a dining room incorporating a kitchen and a large lounge with an additional dining area. The unit is designed as a spacious H layout with long corridors. Memory Lane has its own main entrance doors that are being considered for use as the main entrance to the unit. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection concentrated on the Memory Lane unit of the home. An aim of this inspection was to assess the level of care needed by service users and to assess the quality of care provided in the Memory Lane unit. The inspector visited the home over two days; the 19 & 22 August 2005. Observations totalling 4 hours were made during both inspection visits. The inspector had conversations with individuals and with groups of service users and with 9 staff, the Unit Manager, the Head of Care, the Acting Manager, the Regional Operations Director and the visiting Community Psychiatric Nurse (CPN). The Head of Care, who was previously the Clinical Tutor for the home, provided information about the planning and content of staff training. The CPN provided information regarding the nine service users he is regularly involved with and his relationship with the home as a trainer for mental health, provided through the Greater Peterborough Primary Care Partnership. What the service does well: Training is organised by the Clinical Tutor and the Head of Care. The built environment is of a high standard and is very spacious and allows service users to enjoy adequate private and communal space. The memory Lane unit is located downstairs and has 40 bedrooms all with ensuite facilities, 4 bathrooms, a dining room incorporating a kitchen and a large lounge with an additional dining area. The unit is designed as a spacious H layout with long corridors. Memory Lane has its own main entrance doors although these are not currently used as the main entrance to the unit. The manager of Memory Lane sets practical and high standards and leads by example. She is a valuable asset to the unit as are the care staff who work on the same unit. The manager is dedicated to improving the unit and to ensuring that service users enjoy a high standard of care and can enjoy a good quality of life. Her approach is especially person centred and understanding of individual needs. She has worked many extra hours in addition to her contracted hours and has consulted not hesitated to consult with GPs and a CPN about the changing care needs of service users. Care staff showed an approach to their work that was based on respect. All staff reflected a person-centred approach to care, despite differences in confidence and abilities of staff to communicate with service users. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The registered person must reconsider the range of differing physical, psychological and mental health needs of the service users resident in Memory Lane. Similarly, there must be reconsideration of the increasing dependency of all service users that has occurred within the unit in regard to meeting their changing needs. Care planning, staffing formulas and staff skills mix, staff training and the organisations quality assurance systems must address a need to urgently increase staffing levels in the Memory Lane unit. Mealtimes are just one period when there is a need for additional staff to assist service users. An assessment of the risks associated with 12-hour shifts worked by care staff in relation to the European Work Time Directive should be arranged with evidence of staff having been consulted. Improvements to the equipment and fittings in the four bathrooms located in the Memory lane unit are needed. Arrangements for an assessment by a Mental Health Occupational Therapist of the environmental and of the equipment and facilities in Memory Lane unit should be arranged. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 7 Memory Lane unit must arrange for their induction programme to include dementia care training and should encourage and enable staff to participate in subsequent in-depth training in Dementia care as part of their professional development. An induction programme for all staff employed within the home that includes training in protecting vulnerable adults from abuse must be arranged. Further training delivered by, or recognised by Greater Peterborough Primary Care Partnership (GPPCP) that emphasises the reporting procedures for allegations of abuse, must be arranged for all staff. Staff should be facilitated to increase the inclusion and involvement of service users in their daily routines and be allowed to create and maintain activities centred on meeting their interests and life skills. Emphasis and planning should be placed on raising the profile of Dementia Care based on a person centred approach to meet the needs of the current service users and to anticipate future demands in relation to the demographic needs of elderly service users affected by dementia. 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. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 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 standard(s) 3,4,5,6, Service users’ needs are fully assessed prior to moving into the home. EVIDENCE: The Statement of Purpose (p23) states that ‘ prior to admission a preadmission assessment is carried out to ensure that the home is able to meet the needs of residents presenting themselves for admission to the care home’. Service users files contained pre-admission assessments carried out by a commissioning authority’s Care Manager, as well as additional and extensive assessment detail collated by the home after admission. This additional detail built upon the amount of information contained in the pre-admission assessments. The home operates a policy of allowing prospective service users, or their representatives, to visit the home before deciding whether to live there. There is usually a 6-week period until the commissioning authority carries out a review to confirm the placement. For privately funding individuals the home offers a 4-6 weeks trial period before making a permanent contract. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 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) 7,10,11, Care Plans and care needs are adequately recorded and changes in need have been identified. EVIDENCE: The unit manager described how she intends to restructure the existing Care Plans to make them person-centred in style and presented in a modified format to show that realistic aims are coupled to a full description of how these aims might be achieved. Care Plans identified a range of needs amongst the service users in Memory Lane unit. The range of needs of service users in the unit includes bed-bound nursing care for three people. The physical needs of these five service users demands the use of a hoist for manoeuvring. Most service users require incontinence care. No service user has any pressure sores and no service user is known to have MRSA. Intensive social and psychological intervention by staff are necessary to meet the mental health needs of service users. All service users need assistance to function by being reminded or encouraged with their daily routines. Encouragement to eat and drink is a feature of care necessary for most service users living in Memory Lane. Most have very limited mental capacity and some service users do not have the capacity to manage their selfLongueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 11 care. Reassurance and management of agitation, anxieties, depression and distress are essential aspects of dementia care on the unit. Confusion, disorientation and disrupted neurological pathways are symptoms of dementia manifest in most of the service users. In general, there are a group of service users with a range of progressive needs who require a mixture of intensive social and psychological interventions and physical nursing interventions by skilled staff. Care Plans revealed an increase in dependency levels for nearly all service users and this was confirmed with the unit manager and with the visiting Community Psychiatric Nurse (CPN) for the nine service users he is professionally involved with. The home has a tool for regularly assessing each service users’ dependency levels and these showed a gradual increase over the last year for most service users. The CPN reported that nine service users whom he regularly visits have all shown increases in dependency and need physical nursing and medium to intensive individual psychological intervention by staff. Five of these nine service users scored the highest possible level for ‘challenging behaviour’. The CPN considered that one service user who requires constant general nursing and due to her advanced dementia could be cared for in a different care unit of the home. All staff who spoke to the inspector used the word “challenging” when asked about their perceptions and experiences. The same staff expressed their strong desire to work with the service users in Memory Lane. No member of staff expressed any desire to work elsewhere, or was critical of their jobs. Observations were made of their often gentle and polite approaches and effectively engaging in verbal communication with service users. Staff who were observed to engage with service users in this attentive and considerate manner should be commended and recognised for their contribution to the unit. Observations were made over two days of the actions and interaction between service users and between service users and staff. On the days of inspection there were 36 service users in Memory Lane. Observations were carried out between 12 noon - 1pm and between 3pm – 4.30 on one day and 4.30 pm5.30 pm and 8.30 pm and 10 pm on another day that included one lunchtime meal and one evening meal/supper being served. Whilst one member of staff explained to the inspector they operated a system organised to serve food and assisted service users, there were not enough staff to help all service users when they needed assistance, or when they required encouragement or reassurance about their food. At other periods of the day staff were observed to be absent from communal rooms where service users were present, because they were carrying out tasks in other parts of the unit. Two staff are needed to assist with the nursing care for the five service users requiring physical nursing. When two staff were needed to assist with the care needs of service users this significantly reduced the availability of staff. The unit manager was observed to operate a pragmatic and therapeutic ‘hands- on’ approach to care. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 12 She displayed dedicated and effective good practice in her person-centred manner with one service user who expressed aggressive behaviour. According to the Care Plans and to the perceptions of the unit manager and the staff and the visiting CPN the behaviour and interaction of service users requires constant supervision. The unit manager stated the challenging behaviour expressed by some service users is a feature of care on the unit. Care Plans and records of events kept for Regulation 37 of the Care Homes Regulations 2001, have showed evidence of need for particular care and protection. The unit manager and the CPN stated the challenging behaviour of service users takes the form of physical aggression towards other service users and staff as well as causing destruction within the unit. Whilst the amount of monitoring and intervention was acknowledged as necessary by staff, the differing skill levels of staff does not ensure that effective monitoring is always carried out. The size and layout of the unit prevents total supervision of service users, as does the ratio of staff to the number of service users. The social environment was observed to be a source for triggering challenging behaviour during the lunchtime when one service users objected to the verbal expressions of another service user. It is significant to report that figures submitted by the home in the PreInspection Questionnaire, shows that 62 service users are considered to have dementia, 72 have mental health needs, 64 are incontinent of urine and 62 are incontinent of faeces and 66 require the use of a wheelchair. The overall analyses of the evidence from: • the observations of service users and staff interaction, including the unit manager, • the staff views and perceptions and the unit manager’s description of service users needs and behaviour, • the professional opinion of the attendant CPN • the Care Plans and service users’ dependency levels and Regulation 37 reports, all indicate that staff are struggling to meet the complex physical and mental health care needs of highly dependent service users affected by dementia and mental health difficulties. Care is compromised by a shortage of staff who are skilled communicators and able to spend time with service users so that they can engage in ordinary yet therapeutic conversations that will orientate, occupy, distract and stimulate service users and thereby help prevent risks and abuse. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15, Service users choices and the limited amount of control they have over their lives can be better facilitated. EVIDENCE: This section should be read in conjunction with the previous section entitled “Health and Personal Care”. Observations were made over two days of the behaviour and of the interaction between staff and service users. A lunchtime meal and one evening meal/supper were observed. Specific observations were made of the interactions and activity of service users on each visit to the home. Observation periods totalled some four hours. The inspector asked staff about their understandings of the needs of service users and their perceptions of working in Memory Lane unit. It was observed service users were spending long periods without the attention and involvement of staff. However, some service users are given extra social stimulation by the close attention and company of staff. The manager of the unit was observed to give essential one-to-one attention and encouragement to one service. Her level of person-centred care and methods and style of communication showed very good practice. Her intervention was intensive and lasted over three hours. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 14 Generally, the daily routines and activity of service users requires significant social stimulation and psychological encouragement by staff to meet their needs. Time is required to talk to service users and to assist them with many tasks and routines that they lack the mental capacity to carry out. Constant attention, re-assurance, encouragement and validation of their behaviour is a feature of the care needed by service users living in Memory Lane. Staff who were observed to give and maintain some amount of attention and who did engaged in verbal communication with service users were seen to provide stimulation and bring about immediate reactions in service users. Personcentred care, used as an activity based form of care, is recognised as essential in dementia care (Bradford University Dementia Care studies) to help maintain orientation, validate experiences and memories, to provide stimulation and meaningful activity, as well as preventing further agitation and raised anxieties. Observations during one mealtime indicated that more staff are required to assistant and encourage service users. Most service users who were seated in the dining rooms were observed to require some form of assistance during mealtimes. Assistance ranged from basic enquiries by staff to assistance with feeding. Two service users spoke to the inspector during one mealtime and stated they did not want the soup they had been given but could not attract the attention of any care staff. Whilst the staff explained to the inspector they had a system organised to serve food and other staff to assist service user there were not enough staff overall to notice and assist service users during mealtimes. One visitor was offering her relative chocolates, which she appeared to enjoy and was stimulated and encouraged to help herself to, an eagerness that subsided when her relative left and was not observed during the remainder of the inspection. None of the four activities co-ordinators employed by the home were observed in the unit over the two days of inspection. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18, The home has recently improved their protection of vulnerable service users. EVIDENCE: The home have regularly reported allegations of abuse and have responded to complaints in an open and transparent manner. The home has recently started to report incidents and concerns that had previously not been considered as allegations of abuse. Recent Regulation 37 reports have indicated risks to service users. The inspector discussed these matters in detail with the Head of Care at a recent investigation and again with the Head of Care and the acting manager during the inspection. A discussion with the Head of Care, prior to the inspection, clarified how these incidents must be reported. The home was asked to report any incidents of concern to the CSCI as expected by Regulation 37 of The Care Homes Regulations 2001, so that an open and transparent view of the circumstances within any part of the home may be used to inform and ascertain care planning and identify changes in service users’ needs. During the inspection the acting manager and the Deputy Manager and the Unit Manager were reminded by the inspector that by always reporting any such incidents, all service users may benefit from any subsequent strategies considered necessary by other agencies, intended to protect service users from the threat or potential of abuse. The acting manager was reminded that nonreporting of abuse would be regarded as institutional abuse, as well as a professional failing to maintain a code of conduct. Further prevention of abuse must be considered by the following; Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 16 • improving the induction training, as discussed with the Head of Care , include mandatory training in the protection of vulnerable adults from abuse and increasing staff numbers in the Memory Lane unit. This would ensure that more effective and preventative monitoring and engagement with service users can be better provided as a fundamental aspect of care, in relation to their social, psychological mental and physical health needs and providing continuous training about dementia care and to encourage and facilitate staff working on the unit to specialize in dementia related care. • • All complaints to the home had been responded to within 28 a day period timescale. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 17 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) 19,20,21,22,23,24,25,26, Service user would benefit from additional and specialist bathroom equipment and redesigned en-suite shower facilities. EVIDENCE: Previous reports have stated that the home provides a high quality built environment for their service users. This inspection concentrated on the Memory Lane area of the home where each service has an en-suite shower in their bedroom. The manager explained that some service users need to have a regular bath and that no service users can safely get into or out of baths. Only one bathroom has an assisted chair to lower service users into a bath. One bathroom has been fitted with a new deep bath that cannot be operated and remains unused. The two other bathrooms do not have any assisted seats to help service users into the bath. There was a lack of support rails for service user to hold in all bathrooms. All of the toilets are low and there are not enough grab rails or support bars for service users. There is only one hoist on the unit. It was stated by the unit manager that additional hoists are essential and that an alternative type of hoist is required. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 18 Showers in the en-suite rooms have only one grab rails for service users and there are no enclosed shower sides. Risks to service users of slipping off their chairs without anything near to hold on to and with only a shower curtain on one side were noticed and discussed with two members of staff. Two care staff stated that when they assist service user to shower there is nothing to prevent water from splashing their lower legs and feet. It was discussed with the unit manager how different designed bathrooms with specialist fitting and equipment and redesigned en-suite showers would benefit service users. The bathrooms were worn and one had a cracked toilet seat. Two bathrooms were used to store wheelchairs. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 19 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) 27,28,29,30, Improved protection of service users can be achieved by arrangements to provide apprpriate and continous or repeat training for staff. EVIDENCE: Evidence gathered about service users’ challenging behaviour, their social functioning and necessary stimulation, their frail mental health and their physical health nursing needs suggest that staff are working to their capacity. Staff informed the inspector the work is demanding and lengthy. Memory Lane can accommodate 40 service users. There are usually six care assistants and two registered nurses (including the unit manager) on duty during the daytime 8 am to 8 pm shift. During the 12-hour nighttime shift there are three care assistants and one registered nurse working. At the time of inspection there were no Mental Health trained nurses employed by the home. There are 21 registered nurses and 2 enrolled nurses employed. Staff from both shifts commented that higher staffing levels would help to improve the care for service users. During the inspection there were 36 service users living in Memory Lane. The level of co-operation between the daytime and the nighttime workers was difficult to assess. The combination of the recognised increased dependency levels of service users, their challenging behaviour (exhibited by some service users), the number of service users, the design and layout of the unit and the 12 hour working shifts patterns indicated that increased staffing levels must be applied to Memory Lane to meet the needs of service users. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 20 The home provides a well structured and extensive induction training and this was discussed with the Head of Care. She stated that induction training included the protection of vulnerable adults. The Skills for Care proposed new standards for adult social care induction arrangements, will expect staff to “recognise and respond to abuse and neglect”. It was discussed with the Head of Care that the home could anticipate this improved induction training and it was agreed that Longueville Court could promote more emphatically the protection of vulnerable adults by including this topic in the initial stage of induction training. Training provided by Greater Peterborough Primary Care Partnership (GPPCP) could still be arranged for all staff. The Head of Care has attended a 3-day training course with GPPCP that allows her to deliver this training to staff. The Head of Care and the Clinical Tutor decide whether courses are mandatory or optional for staff to attend. The Head of Care and the Clinical Tutor also give regular weekly training to care staff. The training matrix revealed that 2 induction courses, 2 manual handling courses, 2 falls prevention courses and 2 courses entitled “ Yesterday Today and Tomorrow are planned to be presented in October 2005 by the Head of Care and the Clinical Tutor. Other training written in the training calendar for 2005 included: Diabetes, Multiple Sclerosis, Fire Safety, Customer Care, Emergency Aid Supplement Feeds, Introduction to Dementia and Challenging Behaviour. Ongoing NVQ training is arranged for a variable number of staff employed by the home. The PMS project team set up by Greater Peterborough Primary Care Partnership offers direct general and mental health nursing training to staff in care homes and has provided the training to the home for ‘Dementia Awareness’ and ‘Challenging Behaviour’, although not all staff in the Memory Lane unit have attended this training. The unit manager stated that releasing staff to undertake training is another demand on the unit and is not always possible because there are not always sufficient numbers of staff. Staff expressed their interest to work with elderly service users affected by dementia and showed ability for engaging with service users. The needs of all service users in Memory Lane require dementia related care and some service users have enduring mental health issues. It was discussed with the Head of Care that preparing and enabling staff to understand dementia related needs and ensuring they are sufficiently skilled to provide the appropriate care that service users need, dementia care training must be included in the induction programme. It is recommended that the organisation encourage staff in their subsequent development, by providing additional and advanced professional training in dementia related care. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 21 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) 31,36,37, The management and leadership of the home are professionally conducted. EVIDENCE: The current acting manager has applied to the CSCI to become the registered manager. The line management structure of the home consists of a home manager, a Head of Care, a Clinical Tutor and four unit managers. Suitable and regular one to one supervision arrangements are made for all staff. The home have recently been reminded of the need to report all serious incidents that might be considered abusive through Regulation No 37 of The Care Home Regulations 2001. The Inspector and the Head of Care discussed this matter during the inspection and agreed this action. Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 22 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 3 COMPLAINTS AND PROTECTION 3 3 2 2 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x 3 3 x Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 23 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 7 Regulation 15(2) & 13(6) & 18(1)(a) Requirement Individual and collective care planning for service users in Memory Lane who have specialist mental health needs must be reviewed. The review must include: 1. consider adopting dedicated person cented approaches to care and 2. ensure there are sufficient staffing numbers with the skills and ability to provide this mental health care. Service users social and socioenvironmental needs must be met by person-centred approaches to their care so that they are offered regular opportunities to be heard and to make routine daily choices. All incidents where significant or intended harm has been identified must be reported to the CSCI and be reported as an allegation of abuse. Bathrooms in the Memory Lane unit must be fitted with suitable bath and toilet aids, equipment and adaptations to enable staff to meet the physical and Timescale for action 01/101/05 2. 12 & 14 12(3)(5) (b) 01/12/05 3. 18 37 01/09/05 4. 21 23(2)(n) 01/12/05 Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 24 5. 22 14(1)(a) personal care needs of service users. The home must arrange for a Mental Health Occupational Therapist to assess the four bathrooms and ensuite shower facilities for service users in Memory Lane. Staffing levels in Memory Lane must be increased to meet the known and acknowledged needs, including the risks presented by service users. Induction training must include training in the protection of vulnerable adults and must be delivered by a person who has been trained to cascade this training to other staff. Dementia care training must be included as part of the induction training for staff working in Memory Lane. 01/10/05 6. 27 18(1)(a) & 24 01/10/05 7. 30 13(6) & 18(1)(c) (i) 01/10/05 8. 30 18(1)(c) (i) 01/10/05 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 None Good Practice Recommendations Longueville Court I53 I03 S24316 LONGUEVILLE COURT V230743 190805 - STAGE 4.doc Version 1.30 Page 25 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE 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. 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