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Inspection on 22/04/09 for Longueville Court

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

This inspection was carried out on 22nd April 2009.

CQC found this care home to be providing an Adequate service.

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

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

What the care home does well

The expert by experience’s summary stated: ‘from what I witnessed at lunch in the Kingfisher unit, there were no grounds to believe that residents were anything but lovingly and compassionately cared for and assisted at all times throughout the meal. Of the 17 people spoken to, all were satisfied with the choice and quality of meals.’ And, ‘staff were observed in positive and empathetic interaction with residents at all times’. Three people who were spoken to at lunchtime by the expert by experience ‘all agreed that they were happy enough at Longueville Court, the staff on the unit were respectful and treated them with dignity, and there was plenty to do’. One ‘resident (J) in the Kingfisher said, “I don’t think it’s any worse than anywhere else I could live.’’ She said of herself and her fellow resident friend, “we feel at home here,” qualifying this by telling us that her friend had settled down here at once on his arrival. She said the food was better lately and she quite enjoyed it.’ A visiting daughter-in-law was very positive about all aspects of the home, particularly commending the lack of any offensive odours, and the staff awareness of her mother-in-law’s swallowing difficulty. The home ensures that adequate information about the fees and provision of care is available to all prospective people who are considering moving into the home. The home has set itself as a provider of a valuable nursing resource to facilitate hospital discharges and to provide a range of care that should meet Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 the different needs of people who are affected by dementia, physically disability and physical ill-health. The environment is spacious and very well maintained. It is of a hotel status and attention to ensuring the home is clean and of excellent appearance has been consistently maintained since the home was built. Care plans were extensive documents that included appropriate records of the elements of care. All staff that we met were polite and professionally helpful. They demonstrated an attentive and caring approach to their work, which was seen to be carried out in an efficient manner.

What has improved since the last inspection?

The three requirements in relation to care planning and safe recruitment that were outstanding at the Random inspection on 05/09/2008 have been met. Staff awareness and attentiveness was noticeably good throughout all units of the home. Both inspectors and the expert saw that staff communicated well, were respectful and maintained a focused approach. This was noticed throughout the home and particularly by staff in the Memory Lane unit where it was observed that all staff maintained a professional approach, despite the strain of working with less than adequate numbers of staff. The home has implemented an hourly regime for offering fluid to the person whose care plan indicated this was needed. Care planning for social development and accessing the wider community had been recorded in some people’s care plans. Activities are now arranged by three activity co-ordinators employed by the home. Recruitment records included the details expected by the Care Home Regulations 2001.Longueville CourtDS0000024316.V375047.R01.S.docVersion 5.2

What the care home could do better:

The expert’s summary was: “ In conclusion it was found that there are a great many concerns resulting from lack of staff. Many complaints centred on this one issue, the most common of which were the lack of drivers for and use of the minibus and the risk of poor personal care. Of the 13 residents and four relatives spoken to, 12 expressed concerns about shortage of and poor communication with staff.” Shortages of staff were observed in the Memory Lane unit where two inspectors saw that the more dependent people had to wait to be assisted with their personal care in the morning. They then had to wait for their breakfast and their medication and also to have to wait to be assisted with a lunchtime meal. Whilst staff made every effort to communicate and assist people and were aware that people were waiting to be assisted, there was a limit to the number of people they could help at one time. This shortage of staff is a serious issue that must be corrected, as the level of fees charged by the home should guarantee a better service than that currently experienced by some of the extremely dependent people living at the home. The task of roistering care staff should be reviewed, so that people’s best interests are served. Care planning for social development and accessing the wider community should be planned for people wanting to do this and especially for people with physical disabilities living in the Robin Unit. People had been consulted for their preferences and activities, although their personal and social development was not satisfactorily recorded as an element of their care planning. It is acknowledged that this may be partly an issue about what care has been commissioned. Related to the above issue is the lack of a regular and useful arrangement for a driver of the home’s two vehicles. People do not have regular use of this facility and cannot plan their life without this assistance. People should be facilitated and encouraged by care staff, or by the activities co-ordinators to use the gardens as an element of care and social experience. The non-use of the gardens was noticed during this inspection and has been noticed on previous inspections and should be addressed. There is an institutional expectation for the elderly people living in Memory Lane to remain indoors. This appears to be due to the lack of numbers of support staff that people might need, plus the less than obvious way that people have access to the two gardens from Memory Lane. In either case, there is a lack of a plan for people to enjoy the benefits of sunshine and natural daylight.Longueville CourtDS0000024316.V375047.R01.S.docVersion 5.2It is recommended that a record is kept of the frequency and regularity of the checks made on any person, when it is known they are unable to summon help. Management should promote safeguarding more significantly than it has been. In the light of the number of allegation made about care an informative approach to this subject should be promoted, so that people are better protected and staff are better enabled to respond to any concerns they might witness.

Key inspection report CARE HOMES FOR OLDER PEOPLE Longueville Court Village Green Orton Longueville Peterborough PE2 7DN Lead Inspector Don Traylen Key Unannounced Inspection 22nd April 2009 10:00 DS0000024316.V375047.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Longueville Court DS0000024316.V375047.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 Barchester Healthcare Homes Ltd Manager post vacant 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.V375047.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 12th August 2008 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 less than 65 years of age who have physical disabilities, whilst Skylark and Kingfisher provide nursing care. Longueville Court 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 secure inner courtyard garden and a sensory garden. The home attracts enquiries from an area greater than it’s immediate PCT locality. The home informs all interested parties by providing their ‘Welcome to Barchester’ pamphlet, their Service User Guide and Statement of Purpose. The CQC inspection reports are available from the CQC website. Fees charged are between £789 to £1100 per week and represent nursing care costs. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is “ one star”. This means the people who use this service experience adequate quality outcomes. The last Key inspection was on the 12 & 13th August 2008 and has been published. A further Random inspection was carried out on the 5th September 2008. The reason for the Random inspection was to assess compliance with the one immediate requirement concerning the provision of care and care records made as a result of the key inspection on the 12th August. The outcome of the Random report was that the immediate requirement was met and a further two requirements were made in relation to care plans which required more detail in the plans for giving oral hygiene and showing the frequency and amount of fluids offered and consumed by people where this had been stated in their care plans. This inspection started at 09:45 am and ended at 19:00 pm on the 22nd April 2009. Two inspectors and an ‘expert by experience’ carried out the inspection. Methods used during the visit included: • Case tracking one person’s care arrangement. • Assessing other care plans • Observations of the interactions between care staff and people living at the home • Observations of a mealtime in two of the home’s four units. • Assessing the recruitment records of two care staff • Assessing the training records • Assessing the administration of medication • Assessing the systems used by management to assure quality • Asking people for their views of living at the home and experiences of their care. • Asking visitors for their experiences of the care provided by the home. We looked at people’s care plans who were living in the Memory Lane unit and we spent from 10:00 am to 15:00 pm in this unit observing the routine and interactions between people and staff and the breakfast and lunchtime arrangements. During this period the administration of medication was assessed and two inspectors had lunch with people in this unit. We observed mostly from the dining room and the adjacent lounge where the majority of people living in this unit were. We visited people in their rooms who were receiving care in bed, as well as spending time with people who were not confined to their beds. We looked at care plans and associated records. We spoke to people, their visiting relatives and to care staff and to the acting manager and to the recently appointed Clinical Manager. Records that were read included staff rosters and staff files that included supervision and Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 6 disciplinary notes, recruitment details and training records. Fire drills and fire alarm testing records were checked. The expert by experience focused on people’s experiences of living at Longueville Court and observing the care provided and had lunch with people in the Kingfisher unit. She spoke to seventeen people who were resident in the four different units of the home. The home completed an Annual Quality Assurance Assessment (AQAA) prior to the inspection that gave us statistical and operational information about the home. Since the last key inspection, the home has been the subject of allegations of abuse and complaints that have been investigated by NHS Peterborough (Peterborough Primary Care Trust) Safeguarding Team. As a result of these concerns, the Trust suspended placing people at the home on 22/12/2008. The Trust resumed placing people at the home on 20/03/2009, after they had completed a review of the service. What the service does well: The expert by experience’s summary stated: ‘from what I witnessed at lunch in the Kingfisher unit, there were no grounds to believe that residents were anything but lovingly and compassionately cared for and assisted at all times throughout the meal. Of the 17 people spoken to, all were satisfied with the choice and quality of meals.’ And, ‘staff were observed in positive and empathetic interaction with residents at all times’. Three people who were spoken to at lunchtime by the expert by experience ‘all agreed that they were happy enough at Longueville Court, the staff on the unit were respectful and treated them with dignity, and there was plenty to do’. One ‘resident (J) in the Kingfisher said, “I don’t think it’s any worse than anywhere else I could live.’’ She said of herself and her fellow resident friend, “we feel at home here,” qualifying this by telling us that her friend had settled down here at once on his arrival. She said the food was better lately and she quite enjoyed it.’ A visiting daughter-in-law was very positive about all aspects of the home, particularly commending the lack of any offensive odours, and the staff awareness of her mother-in-law’s swallowing difficulty. The home ensures that adequate information about the fees and provision of care is available to all prospective people who are considering moving into the home. The home has set itself as a provider of a valuable nursing resource to facilitate hospital discharges and to provide a range of care that should meet Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 7 the different needs of people who are affected by dementia, physically disability and physical ill-health. The environment is spacious and very well maintained. It is of a hotel status and attention to ensuring the home is clean and of excellent appearance has been consistently maintained since the home was built. Care plans were extensive documents that included appropriate records of the elements of care. All staff that we met were polite and professionally helpful. They demonstrated an attentive and caring approach to their work, which was seen to be carried out in an efficient manner. What has improved since the last inspection? The three requirements in relation to care planning and safe recruitment that were outstanding at the Random inspection on 05/09/2008 have been met. Staff awareness and attentiveness was noticeably good throughout all units of the home. Both inspectors and the expert saw that staff communicated well, were respectful and maintained a focused approach. This was noticed throughout the home and particularly by staff in the Memory Lane unit where it was observed that all staff maintained a professional approach, despite the strain of working with less than adequate numbers of staff. The home has implemented an hourly regime for offering fluid to the person whose care plan indicated this was needed. Care planning for social development and accessing the wider community had been recorded in some people’s care plans. Activities are now arranged by three activity co-ordinators employed by the home. Recruitment records included the details expected by the Care Home Regulations 2001. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 8 What they could do better: The expert’s summary was: “ In conclusion it was found that there are a great many concerns resulting from lack of staff. Many complaints centred on this one issue, the most common of which were the lack of drivers for and use of the minibus and the risk of poor personal care. Of the 13 residents and four relatives spoken to, 12 expressed concerns about shortage of and poor communication with staff.” Shortages of staff were observed in the Memory Lane unit where two inspectors saw that the more dependent people had to wait to be assisted with their personal care in the morning. They then had to wait for their breakfast and their medication and also to have to wait to be assisted with a lunchtime meal. Whilst staff made every effort to communicate and assist people and were aware that people were waiting to be assisted, there was a limit to the number of people they could help at one time. This shortage of staff is a serious issue that must be corrected, as the level of fees charged by the home should guarantee a better service than that currently experienced by some of the extremely dependent people living at the home. The task of roistering care staff should be reviewed, so that people’s best interests are served. Care planning for social development and accessing the wider community should be planned for people wanting to do this and especially for people with physical disabilities living in the Robin Unit. People had been consulted for their preferences and activities, although their personal and social development was not satisfactorily recorded as an element of their care planning. It is acknowledged that this may be partly an issue about what care has been commissioned. Related to the above issue is the lack of a regular and useful arrangement for a driver of the home’s two vehicles. People do not have regular use of this facility and cannot plan their life without this assistance. People should be facilitated and encouraged by care staff, or by the activities co-ordinators to use the gardens as an element of care and social experience. The non-use of the gardens was noticed during this inspection and has been noticed on previous inspections and should be addressed. There is an institutional expectation for the elderly people living in Memory Lane to remain indoors. This appears to be due to the lack of numbers of support staff that people might need, plus the less than obvious way that people have access to the two gardens from Memory Lane. In either case, there is a lack of a plan for people to enjoy the benefits of sunshine and natural daylight. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 9 It is recommended that a record is kept of the frequency and regularity of the checks made on any person, when it is known they are unable to summon help. Management should promote safeguarding more significantly than it has been. In the light of the number of allegation made about care an informative approach to this subject should be promoted, so that people are better protected and staff are better enabled to respond to any concerns they might witness. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 10 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.V375047.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5,6, People using the service experience good quality outcomes in this area. People are assured their needs are assessed prior to moving into the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Similar evidence to that found at the last key inspection prevails. All people are assessed either by the commissioning authority of the Primary Care Trust making the placement, or by the home for people who are privately funding their care. As the home provides nursing care and is frequently asked to admit people from hospital, there is an expectation for people who are self-funding, that the home ensures any potential nursing element of their care charge has been assessed by the NHS. Intermediate care is not provided and therefore Standard 6 is not applicable. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, People using the service experience good quality outcomes in this area. People are assured their care is planned and thoughtfully provided and their healthcare is attended to. However, not all people’s needs are assured of being met because of low numbers of staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: It is necessary to read the Daily Life & Social Activities and the Staffing groups of outcomes in relation to the care provided. We read care plans and case tracked people’s care in Memory Lane unit. The documents were well-written documents with an extensive range of care needs being recorded. They contained an abundance of information and a good description of tasks of care to follow. There was a progress evaluation and records of communication that showed these plans had been reviewed. They Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 13 included what the person “likes to” do and can do. This acknowledged the choices that were expected to be made by the person. Overall, the plans were comprehensive and informative records where effort has clearly been made to recognise the person. The plans were good and would inform a new reader. The documents contained a large photograph but did not have an index and had an excess of older information that we were told would be removed to make the files easier to handle. After discovering the minimal use of the gardens on the day of inspection (which was sunny and warm), we noted that there was an absence in care plans for exercise or walking, or for the benefits and risks of sunshine and natural daylight. We spoke to one person in her bed who was unable to summon help. She had a “fluid” chart and a “turn” in her room and a chair she uses when she sits in the lounge. Her care plans were very detailed and showed a clear record of risks and tissue viability and her nutritional needs. There was one issue about her wishes regarding her death that was recorded but did not indicate the source or record of this wish. Staff informed us they check her every hour, as they are aware she did not have a call bell that she could use. We visited one person in Robin unit and spoke to him and his father. His father spoke for him and stated he does not have an activity plan and this element of his care is not adequate. We read his care plan which showed there was no plan for relationships and activity and nothing under a heading ‘hopes for the future. His father told us that he takes his son to college every Monday as this cannot be managed by the home and is not a part of his care plan the home have written. He told us that the home’s two vehicles cannot be relied on because the home do not provide a regular driver, although the home has informed us there are five drivers within the home. His father felt he would not get out of his room if the family did not act. This matter raises an issue about the precise details of care to be provided. His father told us the family are planning to help their son move to another home. The expert by experience reported that she was told by (B) that she ‘was greatly concerned at the effect of staff shortages in her personal care. Previously, when a new member of the care team began duties, he or she would observe an experienced carer managing B’s needs. This would happen twice, then the new carer would perform the duties, supervised, before being considered competent to do so independently. Recently, however, the new recruit would be given just one demonstration, then expected to know how to cope unaided’. The expert was told ‘there had been two recent occasions when A had been left in bed with a soiled pad for over an hour, from 7.30-8.30am, having summoned a carer, who said she was busy and to wait until the day staff came on duty. She also felt her toileting needs were not being met and that it was difficult to summon assistance as staff were sometimes in other rooms where TV or radio prevented them from hearing the buzzer. No alarm bells in the dining room and lounge was another issue called into question. Pendant alarms would effectively resolve the problem of alarm/assistance bell Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 14 location and would give extra independence and confidence to appropriate residents, particularly those in the Robin unit’. The expert by experience also reported that she was told by person B, ‘there had been more than one occasion recently when her medication had been incorrectly dispensed: one time she received her pre-lunch medication at 2pm, which meant she could not eat until 3pm; another time, she reported, she had no food at all as medication did not arrive’. And was informed by person (G): ‘Resident G was in his room (still in the Robin unit), with his wife, who had arrived at 3pm to find a bowl of cold soup and another of melted ice cream untouched by her husband. These had presumably been given at lunchtime, some two to three hours earlier. She had had to ask for a carer to remove them. Fortunately, G was not hungry, as he was recovering from a tummy upset. Mrs G reported, that G’s medication had been given incorrectly twice recently. Because of his condition, the timing of his medication was very important, but in one instance his 1pm dose had been given at 3.30pm and another time an agency nurse did not know about a fortnightly injection. Mrs G said there was a clear need for more, high quality nurses’. Am, or morning medication was observed still being given at 11am in Memory Lane unit. We discussed this with the nurse manager who was aware of the issue and informed us that that there would be an appropriate time span between each time medication is administered. Medication was accurately recorded and safely administered in the Memory Lane unit. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, People using the service experience adequate quality outcomes in this area. Whilst the general outcomes are good and the home has intentions to assure people they can participate in activities and are offered good food, people are not assured their choices are satisfactorily delivered and managed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Three activity co-ordinators are employed. The activities programme covers Mondays to Fridays and each co-ordinator works four days a week. The activities include taking people to a garden centre and to a shopping centre and to different parklands. Other activities were bingo; talking to people; a Baptist service; poetry; reminiscence; balloon games; quizzes; discussions; and helping with lunch’. Activities start at 10:30 am and continue to either 3:30 or 4pm. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 16 Through the discussions with one person and his father, already referred to in this report, the comments made by other people and the activity roster, we found that there were not enough drivers to take people on frequent or regular excursions and trips, apart from one co-ordinator who does take people shopping and to a local parkland. However, the home subsequently informed us that there are two activity co-ordinators, a trainer and two maintenance personnel who are able to drive the home’s two vehicles. When people were asked about how they were treated, it was reported by the expert by experience that: ‘Resident A complained that, since one of the four activity co-ordinators had left, the remaining three, although they tried, were not providing a good service, particularly with regard to use of the minibus, which residents use on a rota basis. Person A felt that the rota was not handled evenly and that more drivers were needed, as well as a replacement coordinator. This resident did not feel listened to, and was non-committal when asked about dignity and respect in care’. Mrs G informed us that, ‘Planned activities were often running late and sometimes didn’t happen at all. The rota for the minibus was well used and they could do with another one, or at least more drivers so the existing one could be used still more’. And ‘Mrs H felt more staff were needed to assist residents on a one-to-one or oneto-two basis during activities, in order to be more inclusive. H said the best thing about the home was the “peace and quiet and good company of living here”.’ We observed restriction on people living in Memory Lane who were observed to remain indoors all of the time on a day that was warm and sunny. There was no obvious way that people could independently access the gardens from the large lounge in Memory Lane, or find the exit to the enclosed rear enclosed garden that is a dedicated safe area for people in Memory Lane. For people who are disorientated through memory loss and dementia, as well as being physically frail, this situation does not encourage, or invite them to use the gardens and benefit from fresh air and sunshine. Whilst we did not specifically ask people if they wanted to use the garden, nobody living in Memory Lane was observed to use the gardens. The expert by experience observed lunch in the Kingfisher unit, where tables were attractively laid with cloths to tone with the general furnishings, and small vases of flowers. ‘I shared a table with three residents, D, E & F, who were already seated when I arrived. One said the food was fine and had no complaints, one said it hadn’t been very good this week, but did not give examples, and the third said it was sometimes better than others. In spite of this mediocre opinion, they ate with relish. Staff were attentive, offering extra gravy and checking everyone was managing. There was a good choice of menu. Meals were presented ready plated up and looked appetising, freshly prepared and appropriately presented, i.e. already cut up for F, who had difficulty’. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 17 ‘Residents at the next table were much more highly dependent. They were being fed one-to-one by clearly compassionate staff, who judged the timing well and encouraged them; they did not hurry or keep them waiting. Food was pureed for these residents. The chef made a point of asking if everything was satisfactory’. The experiences of people living in Memory Lane were different. Whilst some people could independently manage to eat their food, others need encouragement and others are totally dependent. Breakfast was still being served at 10:30 am in Memory Lane dining room where 12 people were seated. One person had uneaten toast in front of her and another person had a bowl of bananas uneaten and another person had a large amount of food on her plate and told us, “I couldn’t eat all that”. Initially there were no care assistants helping people to eat when we arrived, although staff later appeared and assisted people. A daughter who was visiting her mother was assisting her to eat. The lunchtime lasted from 12.30 to 2.30 pm and the two inspectors ate lunch with people there. People started to arrive in the dining room at 12 noon. There were nineteen people who ate, some with assistance, in the dining room and four who were given 1-1 help to eat in their bedrooms. At 1pm six people were eating independently, but no one was receiving any assistance, as no staff were available. Eventually one staff member came and cut up food for one person. People ate little of their food and those waiting for help put their drink in the meal, spilled their soup over the table or sat with food in front of them. There were disturbances from the phone ringing, one person who never stopped talking and a variety of other distractions. Four people sat in armchairs unaware that it was lunchtime and two others sat in chairs that made it impossible for them to reach the table. Another person sat in warm sunshine until staff drew the curtains to shade him. Three staff eventually assisted people in the dining room after they had helped people in their rooms. At 2pm staff were still offering deserts of trifle and rhubarb and custard to group of ladies seated together. Staff were expected to take their breaks around this period and before the unit manager was due to go on a training course that afternoon. However, another member of staff went in her place, thus further depleting staffing levels. In the afternoon the manager of the unit was asked to attend a meeting with the acting manager and this took her off the unit. Consequently, the unit was left with three staff and no nurse. Whilst staff made every effort to communicate and assist people and were aware that people were waiting to be assisted, there was a limit to the number of people they could help at one time. Whilst the activity programme showed, “helping people with lunch”, for on the day of the inspection, this was not observed to take place in Memory Lane unit where it was required. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, People using the service experience adequate quality outcomes in this area. People are protected by the homes policies and practices, although ensuring that people are safer would provide further assurance. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has an appropriate complaints and an abuse policy. A complaint log with details and outcomes had been recorded. Twenty-three complaints had been recorded since the last key inspection in August 2008. The expert by experience noted that, ‘a complaint by residents, B and C, was the intrusive noise of the television from the room above. Repeated requests had been made to turn down the volume and even a log set up to record each time such a request was made, but B reported that nobody came when asked to come and listen to it’. And ‘Mrs G said that relatives and residents alike were afraid of reprisals if they were to complain’. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 19 The home has been fully co-operative in all matters when concerns and complaints have been raised. The home has been the subject of a number of allegations and complaints that have been investigated by the Local Authority (Peterborough NHS) Safeguarding team. These have revealed specific issues that indicate staff need to be clear about how and when abuse must be reported, to ensure the well-being of those who live there. Safeguarding training has been provided to almost all staff, although this had not been provided by the Local Authority. When staff were asked about this topic they demonstrated they were not aware of the lead role of the Local Authority in safeguarding matters. Staff indicated they did not realise they could directly report abuse to the Local Authority, or how to do this. They did tell us that they would report abuse to the acting manager. One allegation of abuse investigated by the Peterborough PCT revealed that one event had not been timely, or appropriately reported. The acting manager has always immediately reported any concerns when she has known about these and has always co-operated when these have been investigated. To ensure people are safeguarded, it is recommended the home arranges to promote safeguarding to a higher level of understanding, so that all staff are aware of their responsibility to independently report an allegation of abuse, should they need to do this. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26, People using the service experience good quality outcomes in this area. People are assured of a clean and well-maintained home, but are not assured they can enjoy the garden. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is spacious comfortable and remains very well maintained. There were no noticeable offensive odours in any part of the home. People’s bedrooms were personalised and every room has a full en-suite facility with shower. There were additional bathrooms with specialized baths and these rooms were of a size to allow hoists to be manoeuvred. One person’s room in memory Lane unit was quite bare of any personal possessions and had scuff marks on the walls and what appeared to be a blood marked pad covering this Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 21 person’s bed rails. There were many rooms without names, or anything that would remind a person that it was their room. The sameness and repetitive style and colour of corridors and doors was noted. The exterior areas to the building are landscaped with well-kept shrubbery. There are two inner safe and secure courtyard gardens. The main inner garden can be accessed from Robin and Memory Lane units and from some of the private rooms in Robin unit that surround the garden. There was no obvious way that people could access the gardens from the large lounge in Memory Lane. Access to the other safe garden that is dedicated to Memory Lane is difficult to find, as the way out to it is through a side door marked ‘fire exit’. There were no signs to indicating show the way to the garden. The expert by experience noticed that, ‘The interior and environs of this large care home were impressively well maintained, and the décor throughout was clean, tidy and cheerful. Alcohol hand rub was strategically placed at the entry and exit points between units.’ Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, People using the service experience adequate quality outcomes in this area. People are assured staff are safely recruited but are not assured the numbers of staff working are sufficient. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: It has already been highlighted, in the personal care group of outcomes and in the daily life and social activity outcome groups, the staff shortages and the detrimental effects people have experienced because of this. We observed one care assistant helping people with their breakfast and others with uneaten food in front of them. We reported this and showed the situation to the clinical manager when she arrived on the Memory Lane unit at 10:20 am. We showed her there was one person administering medication and there were not any staff assisting people to eat because they were assisting people with personal care in their rooms. The clinical manager said she expected one care to assistant to help people with breakfast whilst three care staff helped people to get up. When we spoke to staff they stated they were given clear instructions from the unit manager about their roles and task before each shift. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 23 They stated that trying to complete all tasks and help is “a bit difficult”. The staff roster showed that the usual numbers of staff were one nurse and four or five care assistants between 8am and 8pm. At night time there was one nurse and two care assistants. There were 23 people living on this unit six of whom were admitted over the previous two weeks and eleven in need of two care staff to manoeuvre them by mechanical aids. A member of staff said, “we are short. There are a lot of people who need feeding. Some need two to hoist. About eleven or twelve need stand aid and hoist. Sometimes (X), needs 3-4 cares when he gets aggressive and very difficult”. These figures show that when two people who require two staff to assist and the nurse is administering medication, there is only one other, or no other staff available. A similar situation has already been described in this report about the lunchtime situation in Memory Lane and the shortage of staff that was observed. Although care staff competently supported people, there was not enough help available. The expert by experience found that: two people (B and C), ‘said some of the staff were particularly good, but there was no continuity and much too frequent change of faces, with no chance to forge relationship’. And that, ‘B was greatly concerned at the effect of staff shortages in her personal care’. And ‘Mrs G said morale among staff, residents and relatives was lower now than two years ago, due to so many staff and management changes and the great influx of non-English nationals to the care team. She said there were difficulties in understanding their halting, sometimes heavily accented English, as well as in their understanding of English’. And ‘Resident H and her mother felt the care was mainly good, but there were communication difficulties with non-English staff’. The acting manager reported that staff are offered English Language lessons where this is thought necessary. When staff were spoken to they stated, ‘they were happy in their work and felt that adequate training was offered and taken up. Two had been there for 13 years.’ Staff on Memory Lane reported they felt they worked well as a team and this was observed and demonstrated during the inspection. The recruitment details of two staff were assessed. One person had been employed as a nurse. His record indicated that the hand written references received were not authenticated by the organisation the referees worked for, or their status shown However, we saw copies of the letters requesting these references. Criminal Records Bureau disclosures and POVA First checks had been carried out. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 24 The induction records were a concern. There were records that showed inductions for The Skills for Care Common Induction Standards had been completed in one day for one person. There was no supporting evidence of how competency had been assessed. All of this person’s induction had taken place on one day including the initial Barchester induction and the Skills for Care Common Induction Standards. This element will be assessed in full at the next inspection. Most of the training is provided through Barchester, including Safeguarding training. Much of this training is through videos. It was not clear if safeguarding training is given by a Local Authority recognised ‘train the trainer’. Nobody in the home has this training provided by the Local Authority. When staff were asked, they demonstrated they were not aware of the lead role of the Local Authority in this matter. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38, People using the service experience adequate quality outcomes in this area. People’s best interests would be assured, if management arranged for sufficient numbers of care staff to be at work, so that people’s needs are met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has been managed by a temporary short-term manager and then by a permanent acting manager since August 2008. There have been management issue that needed to be addressed because the home was judged to provide poor personal care in October 2007 and adequate care in August Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 26 2008. Subsequently, issues relating to complaints and allegations had been investigated by Peterborough NHS who were concerned about aspects of personal care and the management of the home. The clinical manager had been appointed four weeks previous to the inspection. She informed us her role was to oversee the clinical side of care and this included carrying out weekly audits and monthly reports. Staff informed us that they have raised their concerns about staffing levels with management through staff meetings. The management expectations of staffing levels did not serve the best interests of all people, or provide value for money. The consequences of insufficient numbers of staff has already been commented on earlier in this report. It should be noted that the recent removal of the suspension of placements on 20/03/2009 by Peterborough NHS, allowed the home to start admitting people. The home increased the numbers of highly dependent people in Memory Lane unit, without increasing staffing levels in this unit. The deployment of staffing levels throughout the home has showed that the needs of some people in Memory Lane were being compromised. When we provided this feedback to the acting manager, she told us that she has arranged for more staff to be recruited to work in this unit. A requirement has been made in relation to staffing levels that is considered a quality management matter. We were informed by the acting manager and the unit manager that the task of rostering staff is an administrative function, overseen by the acting manager who stated that the home had already recruited more staff to work in the Memory Lane unit. The record of staff rosters for the 20/04/2009 showed there should have been five staff working in the afternoon, although only four were shown on the list. On the 22/04/2009 the numbers of staff working tallied with the expectation of five staff working. The expert by experience reported that B declared that the manager, “is a very nice lady, but she hasn’t got her finger on the pulse and is more a figurehead than a leader of people”. And ‘Both B and C commented that there had been many changes in management over the past year and that there had not been regular residents and staff meetings. They wanted to be involved in the life of the home and to know what was happening. Resident H and her mother were two more who said they missed the staff and residents’ meetings’. We were informed by the acting manager that the home has arranged more regular relatives meetings since October 2008 and minutes of these had been recorded and that one person residing at the home has agreed to be the chairperson for these meetings. People’s money is not managed by the home. Regulation 37 notifications have been sent regularly to the Commission and regulation 26 reports were stored at the home. Fire alarm testing and servicing is carried out at three monthly Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 27 intervals. Weekly fire alarms testing had been recorded. There is an MRSA management policy and care plan specification. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 28 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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 X X 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 2 X 2 X N/A X 3 2 Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 29 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 OP27 Regulation 18 Requirement The home must provide a better quality service by employing adequate numbers of staff, so they are able to meet people’s needs. Timescale for action 01/07/09 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 OP12 Good Practice Recommendations An arrangement for a driver of the home’s two vehicles should be made so that people can regularly use this facility and can plan their life with this assistance. People should be facilitated and encouraged to use the gardens of the home as an element of their health and social care and spiritual activity. Safeguarding should be further promoted to all people and all staff and information about safeguarding should be clearly stated and made accessible within the home. The home should ensure they provide good quality care and value for money by employing adequate staff to meet people’s needs. DS0000024316.V375047.R01.S.doc Version 5.2 Page 30 2 3 4 OP12 OP18 OP33 Longueville Court 5 6 OP33 OP37 Pendant alarms should be considered for use when people want to summon assistance. It is recommended that a record is kept of the regularity of the checks made of any person, when it is known they cannot summon help. Longueville Court DS0000024316.V375047.R01.S.doc Version 5.2 Page 31 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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