Inspection on 30/10/07 for Longueville Court

This inspection was carried out on 30th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Longueville Court 12/04/10

Longueville Court 22/04/09

Longueville Court 12/08/08

Longueville Court 13/02/07

Longueville Court 20/02/06

Longueville Court 19/08/05

Longueville Court 12/01/05

Longueville Court 13/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Longueville Court Village Green Orton Longueville Peterborough PE2 7DN Lead Inspector Don Traylen Unannounced Inspection 30th October 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longueville Court Address Village Green Orton Longueville Peterborough PE2 7DN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01733 230709 01733 230716 peter.barlow@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Peter Nigel Barlow Care Home 105 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (39), Old age, not falling within any other of places category (101), Physical disability (24), Physical disability over 65 years of age (1), Terminally ill over 65 years of age (101) Longueville Court DS0000024316.V353824.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 13th February 2007 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 is decorated to a high standard and provides en-suite facilities in all rooms except one. It has an atmosphere of spaciousness and comfort. The company claim, to have created places that are not at all clinical or institutionalised, in their ‘Welcome to Barchester Healthcare’ pamphlet. The home has attractive and orderly rear gardens plus a secure inner central courtyard. The home attracts enquiries 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 and the previous CSCI inspection report. The CSCI inspection reports are also available from the CSCI website. Fees charged are between £789 to £1000 per week and represent nursing care costs. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this inspection that started at 10 am and finished at 6 pm. Methods used included: • case tracking the care arrangement of four people • observations of interactions between care staff and people living at the home • observations during a mealtime • assessing the recruitment records of two care staff • assessing the training records • assessing medication administration records • assessing the systems used by management to assure quality • a number of service users were spoken to during the inspection for their views and experiences of their care. Two visitors of two people who were case tracked were asked for their experiences of the care provided by the home. The home completed and Annual Quality Assurance Assessment and supplied the written training records for some of their care staff. Feedback of the inspection findings were given to the Head of Care as the registered manager was on leave on the day of the inspection. What the service does well: 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. They have started to refer any interested parties to an expert advocacy agency for information about funding and care arrangements. There are positive aspects to the written care plans that are focused on needs and are direct and clearly written and well presented. Complaints are responded to and are listened to by the manager. People have been protected from abuse by the actions of staff and their awareness and willingness to report a suspicion of abuse. The home’s actions have been appropriate to and have supported staff when they have raised concerns. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 6 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. The home has set itself as a provider of a valuable resource to facilitate hospital discharges and to provide a range of care that should meet the different needs of people affected by dementia and people who are physically disabled and people with a range of nursing needs including terminal illness. Management have developed a system of regular audits to assess and action any identified improvements. What has improved since the last inspection? What they could do better: • • • • • • Care plans must be current and include up to date reviews and be rewritten where necessary so that care is always reflective of current needs. Medication records must be accurately maintained. Medication must be administered in safe and manner. Individual lifestyles and choices and diversity should be better upheld. Activities should be arranged that are direct responses to consultation. Bathroom number 4 in Memory Lane unit should be considered for it’s current use or be maintained in a suitable condition. Staff recruitment must include a complete employment history and records must show accurate starting dates. DS0000024316.V353824.R01.S.doc Version 5.2 Page 7 Longueville Court • • • • • Staffing levels in Skylark unit must be maintained to at least the previous staffing deployment of a unit manager and two nights care assistants and three daytime care assistants. Induction plan/ arrangements should be clearly set out so that care staff can be directed through their induction stage. Staff training in NVQ level 2 awards that are cited in National Minimum Standard 28 for Older People have not been met and are short of reaching this Standard. The deployment of the activities co-ordinators should be made to be more effective so that more people receive their support. Management of audits and checking systems. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6, Quality in this outcome area is good. People are assured of being comprehensively assessed prior to moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The requirement made at the last inspection concerning Standard 2 has been responded to and people receive a breakdown of their fees in their revised Service User Guide. Two people who live on Robin unit said they could not recall having been given contracts and were not aware of what services they were paying for. The full contract was not assessed and this may be assessed at a future inspection. Standards 1, and 3 continue to be met by adequate PCT Care Management information or by assessment undertaken by the home for all people intending to move into the home. Standard 6 was not applicable. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Quality in this outcome area is poor. People are not assured of all their needs being set out in a plan of care and are not sufficiently protected by the home’s procedures to safely administer medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans for two people who were resident in the Skylark part of the home were assessed. The plans were well presented and contained clear and plainly written information about giving aspects of care. However, some aspects of the care plans were absent. The family and person had not been consulted or shown the care plans and did not know what they contained. The care plans for one of these persons showed that a significant event had occurred in early September 2007 that resulted in the person being admitted to hospital and in major changes to her care. Her care plan had not been fully reviewed and omitted various elements of her care. The elements missing related to a range of her needs that had changed and to a lack of inclusion of tasks or instructions about giving care. In addition there were new areas of risks for both persons that had not been identified or assessed. These risks Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 11 were to do with falls, that had not been updated since 07/05/2007 and for a moving and handling risk assessment that also had not been updated. The lady’s Waterlow risk assessment was not updated, despite her being confined to bed and at risk of pressure sores, a fact that was recorded on the skin inspection dated the 27/10/2007. A nutrition and hydration risk or plan had not been updated and there was no eating or feeding plan and this was notable because of the person’s associated and potential related aspiration risks. There were other significant risks related to her husband’s dementia that had not been re-assessed. All of these issues were discussed at length with the Head of Care during the feedback given by both inspectors at the end of the inspection. The care plans for five people inspected on the Robin unit included specific issues to do with gender, sexuality and relationships (CP 12); hopes and concerns (CP13) and social interests and hobbies (CP14). Two people’s plans had details about CP14 that were inadequate, but there was no information for any of the other areas on any of the files. The unit manager was not on duty but the senior nurse in charge said that files were being updated, but even on those that had been updated, the information was not sufficient. Two care plans for two people living on the same unit provided good information although other plans were badly written which made interpreting them difficult. For example, for one person’s assessed needs under gender, sexuality and relationships it was written: “X has special taste to the opposite sex”. The nurse in charge believed this meant that X did not want a male carer. Some risk assessments had been completed but on one file a falls assessment completed on 26/6/07 showed a small risk, but another, undated assessment showed a moderate risk. It was therefore not clear which assessment the unit should be working to or how staff should be assisting. Medication administration record (MAR) charts on Skylark for the two people whose care was tracked showed missed entries when medication should have been administered and they were without an explanation and had not been picked up on an audit or had been noticed or questioned by the person who next signed the MAR chart. Medication was observed being administered in Robin unit during lunchtime and was considered unsafe. Several issues were found. The nurse responsible for administering medication left the trolley containing the medication unlocked and open when she went across the dining room to administer medication to one person. The MAR sheets for one person had not been signed for the morning medication. The explanation given was that the tablets had been administered, but the person had another medical issue that made it difficult for her to swallow and the nurse had taken time to assist her but had forgotten to complete the MAR sheet. This same lady had been given her lunchtime tablet to take with her to an appointment she had with the hairdresser. The nurse explained that she would go to the lady to Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 12 check if she had taken it and would then complete the MAR sheet. Asked if the person could self-administer her medication and if she had a risk assessment regarding this and her other medication the nurse replied that the lady could not self-administer because of her problems with swallowing. This information was fed back to the Head of Care. The same nurse was asked about the medication for another person and she showed the inspector a blister pack where the medication was not being given for the correct day. The explanation was that the medication had been brought in when the person arrived for a respite break and the pack had been started on the wrong day and this was continued. The nurse also said that the lady was not given one of the tablets from the blister pack as they gave her severe headaches. There was no confirmation from any qualified medical source that this was acceptable but had been started because of the intervention of the person’s daughter. On looking at this person’s file there was no care plan at all. The nurse informed the inspector that she was a regular respite person and that the information should have been on file. She was not sure if the information was updated at the start of each visit. This was discussed with the Head of Care. Discussions with people revealed they felt they were respected and treated with dignity and this was also mentioned in survey forms returned to the Commission. Observations showed that staff spoke to people in a polite manner that showed respect. In discussion with several people on Robin unit there was a consensus that staff treated people with dignity and respect. However, one person said that she had to remind staff to knock on her door and wait to be invited in, as at times this had not been done. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. People who live at the home do not always experience the lifestyle they expect, or maintain contact with the local community as they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On speaking to people in Robin unit they said that they do not always have a choice in what time they get up and go to bed. On speaking to the nurse in charge she said that in general people do have a choice but that they sometimes change their mind and then staff are busy. Those living on Robin unit said they were bored and frustrated most of the time. Trips out are limited by staff numbers and are provided on a rota basis that includes all people resident at the home. A few people said they managed to get out on their motorised scooters in the local area. Some people said that computers had been donated to the home and that a course had been promised so that they could begin to use them. However, the course had been cancelled several times and although a new timescale of Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 14 ‘before Christmas’ had been verbally given they felt that this might not go ahead. One person is completing a computer course, which she is hoping will enable her to be involved in some voluntary work within, or outside of the home. This person expressed her strong interest in becoming a representative of people living at the home and to be a contact to liaise with the Commission when and if appropriate. A lunchtime meal was observed in Robin unit and the following was found: People arrived at the table from 11:50 onwards. Soup was served at 12:10 and the main course arrived from 12:30 onwards. There appeared to be no consistency over who was served first. For example, one person who eaten her soup was immediately served with the main course, but others who had been waiting since 11:50 received their main meal much later. One person was assisted with her soup, but when the carer moved away she managed on her own and was clear that she could have managed all along. Her care plan was seen after the meal and this showed that she should be given minimal assistance and prompting. This same person was given a drink during the morning but in a cup that was not appropriate for her. The explanation given was that appropriate cups were in the wash. This meant she required the staff member to assist her instead of being independent. Most staff spoke to people they were assisting to eat, but some talked over the person or gazed around the room. One member of staff gave people in the dining room serviettes, which were taken away minutes later by another care assistant who put bibs on them. Although staff were heard to ask some people if it was “OK”, it was done in such a way that did not anticipate a negative response. One person was given a drink but in a cup that was not appropriate for her. The explanation given was that appropriate cups were in the wash. This meant she required the staff member to assist her instead of being independent. All those spoken to said the food was hot and tasty. They had a choice of Pizza or Lasagne, accompanied by peas, sweet corn and potatoes. Dessert was Italian ice cream, or tiramisu. Staff were knowledgeable about people on Robin unit and were able to say how people who had communication problems showed whether they liked or disliked something. They were also knowledgeable about the medical issues of residents. There were visitors during the morning and afternoon who were spoken to and said they were made welcome. It was remarked by people living at the home that it was their relatives who were often the ones who took them out from the home. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. People are protected by the home’s actions and responses to concerns of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken to on Robin unit knew who to speak to if they were not happy but felt that even then there were times nothing was done. They said there are meetings that they attend but some things take a long time to be sorted out, although they did understand that some issues required a more senior person in the company to deal with it. Staff had completed training in safeguarding adults and were able to say what constituted abuse. However, some were not sure about reporting abuse if caused by one resident to another resident. The home has responded appropriately to concerns and allegations of abuse and has consistently reported these to the PCT adult protection team. Records show that staff have acted responsibly and professionally by reporting their concerns when they judged it was necessary. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24,25,26, Quality in this outcome area is good. People enjoy a spacious and a well maintained home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is spacious and well maintained. People had their personal belongings, bowls of fruit, pictures, books computers and other things to make them pleasant. The furnishings were very comfortable and there were ample chairs and tables for visitors. Visits were seen to be private affairs that were conducted in people’s rooms. The rooms were large and accommodated wheelchairs and other specialist equipment. In the Memory Lane unit there was an odour of stale urine in one area of the corridor near to the managers office and the lounge/dining area. The Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 17 bathroom, number 4, in Memory Lane was in need of some minor repairs to the bath panel and was used as a storage room for lifting hoists and incontinence pads and other items and should be reconsidered for its use. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is adequate. The home’s recruitment processes do not consistently safeguard people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A management audit carried out included a signed (by the manager) ‘Action Plan’ dated 27/07/2007 indicated a shortage of care staff to assist with activities. This was at a time when there were three activities co-ordinators employed full time. This suggests that the activities co-ordinators may need assistance, or that care staff might wish to be involved in organising activities and that staffing levels do not allow this. It has already been stated in this report that there is a shortage of meaningful activities and concerns raised of boredom and lack of anything to do by some people living at the home. Therefore, there is an issue about the suitable deployment and management of staff. The staffing levels appeared disproportionate to the needs of people on the Skylark unit. When one person had a serious fall the explanation quoted as given to the family was, “there were not enough staff on duty”. On one night the staffing roster showed only the unit manager and one care assistant working rather than the usual two care assistants and unit manager. This referred to the unit nurse manager who described the situation as a “shortage of staff”. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 19 People spoken to on Robin unit said there were times they felt there were not enough staff on duty especially to take part in activities or assisting them to get out of the home on trips. They also felt there was an issue about communication in the language spoken by care staff and this made it difficult to be understood. Staff spoken to on the unit supported this view. The Head of Care is aware of this and said that some staff are undertaking English language lessons either through Skills for Life, or have arranged them privately at local colleges. Two recruitment records were read for two care staff who had been recently recruited from China through a recruitment agency. Both staff had been allowed to commence employment prior to receiving a satisfactory CRB disclosure, but apparently on the same day that a POVA First check had been received. Both records were misleading and incomplete. There was no clear date that could be determined exactly when either person had commenced employment. Staff rosters were unable to confirm an actual start date. One file showed a start date earlier than the POVA First clearance, although this was possibly inaccurate because the initial induction programme started after the POVA First check, but prior to a CRB being disclosed. The references in both cases were addressed to a recruitment agency and not to the home. The work history of one employee was not complete on the application form and did not show a history since 2005. There was a letter of an offer of employment to only one of the two people, in February 2007. There were no instructions about when to start work or what the formal process would be and no information for a foreign worker starting employment. There were ‘employee guidelines’ and ‘working under POVA’ recorded on both files signed by the employee and employer. There was no record of any assessment of their spoken or written English language. There was no record of any plan to structure their induction or allocate a mentor or supervisor. However, staff spoken to confirmed they had completed a 2-week induction although this is not supported by evidence of learning. It is considered that the recruitment and induction of overseas care staff is not well managed. The induction programme recorded showed a brief induction. The initial induction is conducted over 2-3 days and included policies and procedures as well as training in Moving and Handling and Adult Protection. There was no recorded evidence or assessment of the competencies that induction is based on the ‘Skills for Care’ set of Standards. Staff spoken to on Robin unit said they had received a two week induction covering the statutory courses, followed by 2 weeks when they shadowed more senior carers before they undertook care roles by themselves. After induction, the training was not demonstrated to be individually planned or systematic. There were various training and professional development course opportunities listed by the home, although it was uncertain if these were enough for the numbers of care staff employed, should a majority of the Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 20 staff need to, or wish to attend. The home has sought external training courses and carries out a training needs questionnaire for staff comments. Training records for staff employed on the Robin and Skylark units had received appropriate training in mandatory topics. Training was not consistent provided in topics such as Bereavement, Dementia, Diabetes, Nutrition, or Multiple Sclerosis, or Parkinson’s Disease, or in NVQ awards. The training manager stated and the AQAA verified that the home could improve the training of care staff in NVQ awards. Only 6 care staff have NVQ level 2 awards in care rather than the 50 expected under National Minimum Standard 28. A further 8 care staff were progressing with NVQ level 2 awards in care. According to the information returned in the AQAA, the home employs 78 care and nursing staff, most of whom are care staff. A total of 21 staff had left in the past year. These figures indicate there is a real potential for the home to achieve a greater percentage of care staff with NVQ level 2 awards in care. Staff employed as care assistants, who had been nurses in their country of origin, stated they were not able to complete the nursing conversion course whilst working at Longueville Court. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38, Quality in this outcome area is adequate. People’s best interests are not consistently promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The same registered manager is in post since the previous inspection and continues to lead by good example and by the organisation’s continuing concern to achieve good quality of care. The home’s policies and practices are extensively recorded and regulation 37 reports have been sent with regularity to the Commission. Staff supervision is regular and has shown evidence of staff being supported when they have appropriately reported suspicions of abuse. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 22 There has been a shortage of ensuring consultation with people and family about their care plans already referred to in section ‘Health and Personal Care’ in this report. People with physical disabilities who were spoken to in the Robin unit expressed a clear interest in wanting organised excursions and more opportunity to be outside of the home and for a life that is more expansive than life at the home. This is an area that people wanted the home to consult more with them, so their aspirations and needs can be planned and recorded in a shared manner and care is person-centred. There has been a lack of achievement in more staff completing NVQ level 2 awards in care, since the last inspection in February 2007. The management and quality audits have failed to ensure that there is a strong and thorough recruitment and induction process. Although the audits are varied and regular they have failed to address the issues of: • out of date care plans and risk assessments, • a lack of care plans, • reduced and low staffing levels, • less than satisfactory recruitment procedures. • the auditing of medication did not ensure that errors were always noticed. However, the home had carried out checks on medication that had revealed some mistakes and their regulation 37 notices sent to the Commission showed they had acted appropriately to deal with these. The fire alarm annual certificate was ambiguous and it was uncertain if the completed system had been inspected and assessed safe. The previous annual fire certificate was issued for the complete system in early 2006. Since then the system has been arranged to inspected and serviced in four separate stages throughout the year. Not all of these staged inspections had been carried out at the time of the inspection. The home has subsequently assured the CSCI that, “the fire alarm system currently installed is operating safely and correctly”. Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 23 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 3 Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15(2)(b) Requirement Care plans must be maintained by keeping them under review so that they are always up to date and include ways and methods to meet current needs based on consultation with the person or their representative so that people are assured they will receive the appropriate care they need. Risk assessment must be carried out as an aspect of care planning when needs have changed so that risks to people are not neglected but can be met in planned and measured response. Records of the administration of medicines must be accurate and complete. This will demonstrate that residents have received medicines prescribed for them. Medication must be administered in a safe manner so that people receive their prescribed medication. People who live at the home must be consulted for their expectations and capabilities and preferences regarding their care DS0000024316.V353824.R01.S.doc Timescale for action 01/02/08 2 OP7 14(2) 01/02/08 3 OP9 13(2) 17(1)(a) 01/12/07 4 OP9 13(2) 01/12/07 5 OP12 12(2)(3) 01/02/08 Longueville Court Version 5.2 Page 25 6 7 OP26 OP27 16(2)(k) 18(1)(a) and this must be recorded as an aspect of their care plans. The home must be kept free of offensive odours. The registered manager must ensure that there are sufficient numbers of care staff working in the Skylark unit at all times so that people are ensured their needs will be met at all times. 01/02/08 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP19 OP30 OP27 Good Practice Recommendations Bathroom number 4 in Memory Lane should be reconsidered for its use. The induction programme for new care staff should be clearly set out and staff should be assessed and signed off for their competencies. Staff should be enabled to develop skills in dementia related care and provided with training opportunities to do so. More staff should achieve NVQ level 2 awards in care. 4 OP28 Longueville Court DS0000024316.V353824.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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