Inspection on 01/11/05 for Longview

This inspection was carried out on 1st November 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Longview 29/04/08

Longview 27/04/07

Longview 31/07/06

Longview 12/05/05

Longview 17/01/05

Longview 04/10/04

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 Longview Little Gypps Road Canvey Island Essex SS8 8HG Lead Inspector Ann Davey & Vicky Dutton Unannounced Inspection 1st November 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Longview DS0000018105.V252244.R01.S.doc Version 5.0 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. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Longview Address Little Gypps Road Canvey Island Essex SS8 8HG 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) 01268 682906 01268 510155 longview@runwoodhomesplc.com Runwood Homes Plc Mrs Johanna Maureen Fitzgerald Care Home 65 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (65) of places Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Personal care to be provided for up to 65 older people aged 65 years and over. Personal care to be provided for up to 32 older people aged over 65 years who have dementia. Total number of service users for whom personal care can be provided must not exceed 65. 12/5/05 Date of last inspection Brief Description of the Service: Longview is registered to provide care and accommodation for 65 older people. Thirty two beds are registered for residents with dementia and three beds are reserved for residents on a respite placement. One part of the site is used to provide day care. Longview is a 2-storey building and is nearby to local shops and community amenities. The home has access to local bus routes. All bedrooms are single occupancy and most have ensuite facilities. The home has a courtyard garden/patio area and other grassed areas surround the building. There are adequate parking facilities to the front of the home. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of 9 hours. As there were two inspectors, this equated to 18 hours input. The inspection mainly focused on the progress the home had made since the last inspection and the situation found on the day. A partial tour of the home took place. Staff and residents were spoken with. Records were selected at random and various elements viewed. A notice was displayed in the main entrance area advising all visitors to the home that an inspection was taking place with an open invitation to speak with an inspector. On arrival to the home, it quickly became eveident to the inspectors’ that staff were upset and unhappy about an apparent recent decision to reduce the number of staff on duty for all posts and shifts. The weekend had been a particularly difficult time for the home. The home had operated on staffing levels at the weekend, which could not possibly have provided adequate holistic care for residents. It would appear that considerable and significant misunderstanding had taken place between the registered provider’s apparent directive and the local management interpretation and subsequent actions to reduce staffing levels over the 3 days prior to the inspection. The inspectors were not able to form a clear picture of what actually happened or what had been said, because of varying reports/accounts from different people. The inspection also coincided with the registered manager’s holiday and therefore an Operational Manager attended the home for the majority of the inspection. The inspectors’ were assisted in the main by one of the home’s senior Care Team Manager’s. The Operational Manager took responsibility for resolving the difficulties regarding the staffing issues and by the end of the inspection, the inspectors were assured that the situation was in hand and adequate staffing cover would be provided with immediate effect. It was understood that senior management were to attend the home on 3/11/05 for a meeting with staff to try and resolve the difficulties. Although this swift action was efficient and commendable, it is of concern that the matter arose in the first place. Because of the unexpected situation, the inspection process was at times frustrated and fragmented and did not cover as many standards as planned. A full and detailed ‘feedback was provided at the end of the inspection to the Operational Manager and Care Team Manager with opportunity for further discussion and/or clarification. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: 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. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 7 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 Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Documentation associated with pre admission assessments is adequate. The home must continue to develop systems to ensure that staff receive appropriate training to meet the assessed meets of all residents. EVIDENCE: Admission assessment documentation viewed at random was appropriate in detail and content. It is however very important that the home ensures that all pre admission assessment documentation is completed in full. The level of awareness training within the home to meet the assessed needs of residents has improved, but this must also include how to meet the specific needs of those with sensory impairment. One resident has specific care needs associated with a sensory impairment, but no staff have received any awareness training. The home does not provide intermediate care. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 The care plan documentation system needs to be further developed to ensure that information is accurate and covers all assessed care, medical and social needs. Staff need this information to ensure that the right care is provided. Health/clinical needs are facilitated and medication is safely managed. EVIDENCE: It was evident that the home has reviewed and improved on a number of care practice issues since the last inspection. This was encouraging to note. Although there has clearly been some improvement, the care plan recording system requires further development. One some identified records, information was missing, was disjointed, had no ‘follow up’ and/or did not cross reference with other related documentation. Within the care planning system, the home operates two assessment tools i.e. ‘mental status questionnaire’ and ‘barthel score’ (based on physical care needs). The ‘scoring’ from these documents is at variance and does not provide a ‘holistic’ outcome. This also has crucial implications on the way the home determines staffing levels, as current levels tend to be based on the ‘lower’ score which is normally associated with physical care` needs. The Commission is aware that this current ‘scoring’ Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 10 system is used throughout the homes owned and managed by the same registered provider. It is also accepted that the registered provider is now aware of the shortfalls associated with the system and is currently reviewing it. As with other homes owned by the same provider, development work is required on risk assessments as documentation provides an ‘outcome’, but does not adequately demonstrate the process by which a decision is made i.e. to put bedrails in place. The home facilitates appropriate health and clinical care from outside agencies that visit the home on a regular basis. The medication recording system was in good order and the storage facilities for medication were clean and orderly. Staff who take responsibility for medication issues confirmed that they had received adequate training. From care practice observed on the day, the home respects and upholds residents rights of privacy and dignity. However, because of the situation as described within the summary and referred to in other parts of this report, staff were often noted to be leaving residents unattended for considerable periods of time whilst speaking with each other. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 The home is currently carrying out a residents survey to improve the catering service. Residents’ religious beliefs and values are respected. EVIDENCE: These two standards were not covered in full. Residents in general were positive about food at the home and it was encouraging to note that there is a survey currently being carried out to improve the menu. It was positive to note that since the last inspection when some poor practice issues concerning where residents could or could not eat, has been fully resolved. It was however disappointing to establish that there is no consistent process in place by which a daily record of food provided/chosen and eaten by individual residents is kept. It was positive to see on care planning documentation that the home respects individual residents religious beliefs and values and actively finds ways of meeting them. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 An established complaints procedure is in place. Systems are in place to protect residents from harm, but staff training on this must be developed. EVIDENCE: The homes complaint procedure is displayed on each floor. The home maintains a detailed complaints record system. It was positive to note the improvements in maintaining the system since the since inspection. Staff spoken with had an adequate basic awareness of adult protection procedures. However, it is important that senior staff especially should be provided with more in depth training to ensure that they are fully competent and confident to deal with any matter that should arise. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25 & 26 Generally the environment was clean, comfortable and pleasant, but some identified aspects need attention for the comfort, wellbeing and safety of residents. There is a lack of orientation and directional signage though out the premises. EVIDENCE: Residents’ bedrooms in the main were appropriately decorated, furnished and equipped. Many were very personalised, creating a warm homely atmosphere. Areas of any unpleasant odours were isolated and few. The home was warm and well ventilated. Although the standard of decoration is generally reasonable, it is now very important that the registered provider arranges a programme of redecoration, repair and maintenance for the near future. There is evidence of considerable wear and tear in some parts of the home and this should be addressed before the general standard falls any lower. This aspect was reported on at the last inspection but not addressed. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 14 The following aspects require attention/addressing for the comfort, wellbeing and/or safety of residents: Cleaning schedules/systems need review to ensure that wheelchairs, lifting/moving hoists (and slings) and baths are kept clean. Some shower heads were crusty with lime scale, wardrobes were not always secured to walls, a broken bath panel noted at the last inspection had not been repaired, there were no mattresses covers for the comfort of residents and the television picture in one of the main lounges was ‘fuzzy’. The home is registered to provided care for residents with dementia, but there was a lack of orientation/directional signage and/or colour coding to assist/help residents. The style/colour of decoration in the main corridors in particular provides little stimulation or visual interest to these residents. Items such as latex gloves, medical equipment casing, unattended hairdressing room and denture cleaning materials were noted to be fully assessable to residents. Many clocks in residents’ bedrooms did not advise of the correct time, which could lead to residents being further confused. One resident had specific care needs associated with a significant sensory impairment, but there was no evidence that the home had provided or had considered providing any aids/adaptations to make the identified bedroom and surrounding areas into a more suitable and safe environment. Call bells when tested during the inspection were not always answered promptly. Clothing is some wardrobes and drawers had been left by staff in an untidy manner. Bed blankets with other companies logos and names printed on them were found in use. Wheelchairs belong to identified residents were found in the wrong rooms. There was a lack of towels in residents’ ensuites. The long corridors in the home only have ‘dado’ style rails. Appropriate aids should be fitted in all corridors to aid and assist residents. Some bins were noted not to have lids and/or they were broken. Residents do not have direct access to a telephone. There is a practice of decanting cleaning fluids from one container to another which is then used without any means of identifying the contents. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 On arrival to the home, the presented staffing levels had not and were not adequate to provide care for 65 residents. Staff recruitment procedures and training opportunities have improved since the last inspection. EVIDENCE: Not all aspects of these standards were assessed. On arrival, the inspectors became quickly aware of the tension and upset amongst staff over what appeared to have been a recent directive from the registered provider advising the registered manager to reduce staffing levels. Levels had been reduced over the 3 days prior to the inspection. These levels could not have provided adequate care for 65 residents, many of whom have dementia care needs. The registered manager was on annual leave and there was general confusion amongst staff about who was ‘in charge’. One identified senior member of staff took responsibility for briefing and advising the inspectors of the situation. Staff on duty were clearly very disturbed by recent events and this was compounded by the general feeling that the home had been left without a clear local management structure in place. There was no clear documentation providing evidence of who was ‘in charge’. The home had notified the registered person that an inspection was in progress and by late morning an Operational Manager came to the home. The situation at that time was not clear as there were varying reports from different people involved. Morale was Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 16 very low, staff were noted to be around the home talking in small groups, this had a direct impact on the care which was being provided to residents. The Operational Manager was made aware of the situation and by 6pm had increased staffing to a more appropriate level. Staff morale was lifted slightly and it was noted that residents were receiving more attention. Amended staffing rotas were going to be prepared and copies sent to the Commission together with a full report on the inspectors’ findings. It was positive to note the improvements concerning staff recruitment files, but there was little evidence that the home operates a sound induction programme. Staff awareness training has improved but there is still a lack of dementia and POVA training. It was also disappointing to note that one resident had been admitted with a significant sensory impairment, but no member of staff had received any awareness training of this condition. Due to the situation found on the day, no other aspects of the above standards were fully assessed. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35 & 38 On the day of inspection, local management systems and structures were not robust. Residents’ personal monies are safeguarded. Some infection control and safety matters require attention. EVIDENCE: As detailed within the summery and the staffing section of this report, the local management structure on the day of inspection was inadequate and not in the best interests of residents. The situation is not satisfactory to the Commission. The registered provider is to provide a full report. On establishing the situation, the actions of the Operational Manager were swift, but the situation should not have arisen in the first place. There are some infection control and cleaning issues identified within the environment section of this report, which need to be addressed. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 18 The system whereby individual residents’ personal monies are kept and transactions are recorded was sampled. Documentation was in good order and monies in safe keeping equated with the stated amounts. It is good practice for all ‘outgoing’ transactions handled solely by staff to be documented using two signatures. It is also good practice for the home to obtain single rather than corporate receipts on behalf of residents. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X 2 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X 3 X X 2 Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP30OP3 Regulation 14 & 18 Requirement The registered person must ensure that all staff are suitably trained to meet the needs of all residents. This includes the specific care needs associated with a sensory impairment. The registered person must ensure that all residents have a comprehensive plan of care in place. This must include details of the care required, risk assessments, an adequate assessment of dependency level(s), care plan review and adequate daily records. Records must be kept in accordance with regulatory requirements and the NMS. The previous timescales of 17/1/05 & 12/6/05 to meet this standard has not been achieved, although some improvements were noted. The registered person must be able to demonstrate that all residents are provided with a balanced nutritional diet. Timescale for action 01/12/05 2 OP7 15 01/12/05 3 OP15 16 01/12/05 Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 21 4 OP20OP19 23 5 OP23 23 6 OP38OP26 OP25 23 7 OP28OP27 18 The registered person must ensure that all areas of the home used by residents or are accessible to residents are safe. Full details are within the report. The registered person must demonstrate that a full assessment has taken place and adequate arrangements made concerning the suitability of a bedroom which is to be used by a person with a sensory impairment. The registered person must ensure that the home is in a good state of repair and maintained in accordance with regulatory requirements and the NMS. The home is registered to provide care for residents with dementia. Adequate orientation and directional signage must be in place to assist these residents. Full details are within the report. The registered person must review and be able to demonstrate that sufficient staff are on duty at all times to fully meet the needs of all residents. Although a timescale has been set, this requirement is immediate and ongoing. 1 – The detail on the staff rotas immediate prior to the inspection indicated that that staffing levels were not sufficient to meet the needs of residents 2 – A full review of the home’s dependency level assessment tool(s) needs to take place. The result of this may have an impact of staffing levels. 3 – Evidence of staff induction must be made available. 01/12/05 01/12/05 31/12/05 30/11/05 Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 22 8 OP33OP32 18 The registered person must carry 30/11/05 out a full review of the inspectors’ findings on the day and provide a copy to the Commission. The home must be run and managed in the best interests of residents. Full details are within the report. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 18 Refer to Standard OP18 Good Practice Recommendations The registered person should review the level of adult protection training provided to ensure that all senior staff are fully aware of their responsibilities. Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Longview DS0000018105.V252244.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!