Inspection on 11/12/07 for Longview House

This inspection was carried out on 11th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Longview House 13/03/06

Longview House 03/05/05

Longview House 13/12/04

Longview House 20/07/04

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

CARE HOME ADULTS 18-65 Longview House 215 - 217 Longview Drive Huyton Knowsley Merseyside L36 6ED Lead Inspector Mr Mike Perry Unannounced Inspection 11th December 2007 10:00 Longview House DS0000021468.V356524.R01.S.doc Version 5.2 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 House DS0000021468.V356524.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 Adults 18-65. 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 House DS0000021468.V356524.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longview House Address 215 - 217 Longview Drive Huyton Knowsley Merseyside L36 6ED 0151-489-4334 0151 480 2521 lvmanager@2care.rsl.org.uk 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) 2 Care Peter Thomas Sinnott Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20) of places Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to Include up to 20 (MD) Date of last inspection Brief Description of the Service: Longview House is a purpose built building, which accommodates up to 20 residents with mental health problems. It is situated in the Huyton area of Knowsley close to a variety of shops. The care home was registered with the Commission in 2002 and is owned by 2 Care. The Registered manager is Peter Sinnott. The care home offers stays of varying length and works towards assisting residents to live and work independently. The care home is divided into three units; the main part of the building, a unit to encourage independence and a separate, attached house for other residents. Longview House concentrates on a model of care providing short-term stays for adults requiring a period of help prior to returning to live independently. The current fees for the service are £575 - £1075 per week. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the core standards the home is expected to achieve. The inspection took place over a period of one day. The inspector met with residents and spoke with 2/3 in more depth. The inspector also spoke with members of care staff on a one to one basis and the manager and deputy manager. Prior to the inspection the home was sent a form to fill in called the Annual Quality Assurance Assessment [AQAA] which details information about the service and is completed by the management team. Information from this is used in the report. Service user comment cards were also sent to the service some time prior to the actual site visit to try and gain more views as to how the home is run and what it is like to live there. 14 of these were returned. Comment cards were also sent to staff working in the home so that their opinions could be sought and 6 of these were returned. As part of the site visit the inspector was also joined by an ‘expert by experience’. This is a person who has had some experiences of care services as a user and spends time in the care home talking to residents and staff and eliciting their views which are then fed back to the inspector. A tour of the premises was carried out and this covered all areas of the home including some of the resident’s rooms [not all bedrooms were seen]. Records were examined and these included two of the resident’s care plans, staff files, staff training records and health and safety records. What the service does well: The care files seen evidenced that an assessment is undertaken by the home prior to residents being admitted. The assessments are detailed and cover aspects of risk and rehabilitation. There are also social worker and health care professional assessments that are part of the referral of residents. The final say is the residents in the home who ‘vote’ any new resident in at one of the community meetings. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 6 Residents have a full plan of care and residents stated that this is drawn together following discussion with themselves so that personal rehabilitation goals are agreed and recorded. Staff were clear about the care for each resident and how this related to future planning and aspirations. For example one staff member described how a particular resident had great anxieties around visiting the dentist and how she had supported the resident through the process of booking an appointment and then attending. The resident is now able to mange this without support. Residents are encouraged to take part in the home rather than being passive receivers of services. There are regular community meetings, a ‘food’ group and leisure groups. Residents interviewed described the daily chores expected of them and how this contributed to community life. One resident commented, ‘the rules here are a bit strict, for example you’re expected not to stay in bed, but that’s good because it helps to get you going again’. Residents interviewed spoke about the structure of the home and how this supported them in choices to lead and more individual lifestyle. This includes the acceptance and management of individual risk. It was clear from the care files that this is managed well and residents can be more independent. Residents are encouraged to be healthy and active. For example one resident talked about the use the local leisure centre and go swimming. Another was encouraged to stop smoking and had recently done so. That resident was also being supported to give up drinking alcohol. Most people said that they had generally been quite well while at Longview House and that it is easy to get appointments with GPs. Residents can attend appointments alone or with the support of a staff member if required. There is a complaints procedure available in the home and complaints are recorded and responded to. Those residents spoken to understand who they would access if they had a complaint although none had had to do this. Staff where observed to be interacting with residents and residents spoke in very positive terms regarding the staff’s ability to support them. Some of the comments received were that the staff at Longview House are very approachable. Several people thought the staff are ‘great’. One commented ‘they are good and helpful, but sometimes rushed off their feet.’ What has improved since the last inspection? Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 7 The management have addressed some of the requirements and good practice recommendations from the last inspection in October 2006. For example the security of the medicines in the home has been improved as there is now only one set of keys and one person designated responsible for medicines at any given time. There have been changes to the paper work and regular auditing so that all documents are now signed and dated and the standard is more consistent. Care staff have continued to attend training around safeguarding and abuse issues and this training is ongoing although there is still a recommendation to improve the quality of this by attendance at local social services led training events. All staff in the home are now enrolled on NVQ training courses and 50 already possess this qualification which shows that staff have the necessary background skills to carry out their work. All staff now have a Code of Conduct from the General Social Care Council [GSCC] issued and have some understanding of the values behind this, which can help define their caring role. Since the last inspection the home have a manager registered with the Commission for Social Care Inspection [CSCI]. What they could do better: The issue of resident involvement in the running of the home was discussed in general terms with the manager who felt that the home encourages all sorts of input by residents. The concept of residents getting involved in staff recruitment has not been considered however and could be a future development. Medication management is generally satisfactory although some recommendations were made. Currently there are 5 residents self medicating to some degree but it was noted that the home do not have a concise record of the risk factors accociated with individulas managing there own medication and this would be advised. A ‘risk assessment’ tool should therfore be devised. Some handwritten entries on the records were not signed by staff. It is good practice for two staff to sign a handwritten entry on the record as this reduces the risk of an error in copying a prescrition. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 8 During discussion is was noted that the current medication training is all in house by peers with no external professional input. Some staff reported attending training by pharmacists but this is not universal. The current training should be ‘acredited’ and this needs to be considered. The input of a pharmacist, as part of the overall training is strongly recommended. Staff reported they had received company led training in safeguarding of adults and abuse but felt that training from social services would enhance the existing provision and this remains a recommendation. The provision of suitable accommodation has been a factor on the last two inspections and is the main issue that is letting the home down in terms of minimum standards. The company have spent some money on improving certain areas but the overall feel to the home is on of neglect. The observations of inspectors are listed in the report and fall under the headings of poor cleanliness and hygiene, lack of privacy and separation of areas in terms of male female access and general lack of space in the home for meetings / privacy. A recent audit by the company has actually highlighted some of the issues and made recommendations for improvement. Given this fact and previous CSCI inspections making requirements, yet standards remaining poor, the managers must look at their own timescales and overall planning to achieve the results they would wish. The number of staff on duty has actually been reduced since the last inspection and the absence of domestic cover is particularly notable in terms of standards around hygiene. Staff spoken with feel that whilst the general philosophy is right [that residents should involve themselves in the running of the home] there is a trade off around maintaining quality of input into other areas of care. One staff commented, ‘the number one improvement would be a cleaner. We can’t get round to all the cleaning that needs doing’. Also there are no administrators in the home and staff interviewed were concerned at the amount of routine administration that took up resident / staff interaction time. Given the evidence of the inspection overall it would appear that the home is running on minimal staffing currently and this is affecting the homes ability to maintain adequate standards in some areas. Some of the issues could perhaps be addressed by giving the home managers more autonomy to make in-house decisions. Staff generally felt that whilst the company ethos is strong it is very much led by the centre and local decisionmaking is not supported. This includes, for example, issues such as the choice of décor, which has to be approved by central office making the process over burdened. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 9 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. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Assessments are carried out prior to admission, which are detailed and include health and social care assessments by professionals so that a full picture of the resident is gained. EVIDENCE: The care files seen evidenced that an assessment is undertaken by the home prior to residents being admitted. The assessments are detailed and cover aspects of risk and rehabilitation. There are also social worker and health care professional assessments that are part of the referral of residents. The homes own assessment document is completed over a series of visits to the home by the resident. If residents are not matched to the home or the home can’t meet needs then this is discussed at an ‘in day’ with all concerned. The final say is the residents in the home who ‘vote’ any new resident in at one of the community meetings. The staff interviewed were able to give a very clear picture of the needs of the residents. One staff commented: ‘referral information is very thorough. It includes day visits and overnight stays, risk assessments and rehabilitation plan prior to admission’. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 12 Residents talked about how they had been introduced to the home and had visited and spent some time getting to know staff and other residents. They felt that staff had taken time to explain how the home worked. All residents receive a file that has information about the home so that they can refer to this if they wish. The manager explains further developments planned regarding the admission process through the pre inspection information given to the inspector [AQAA]: ‘We will be reviewing the timescales for referrals.Crisis plans for out of borough residents are clear, accurate and reliable. These to be confirmed in writing prior to service users moving in by the care team and relevant crisis team. Day programmes (day centres/ college courses/ work placements) to be set up prior to move-in in order to help the person experiencing complacency and low motivation during the settling in period. Develop a networking group to ensure a well-rounded and diverse service user group Action all points highlighted by most recent Service User Satisfaction Survey’. This shows that the service is constantly developing with residents needs in mind. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards and standard 8. The quality in this outcome group is excellent. This judgement has been made using available evidence including a visit to this service. Care planning has been devised so that a full picture of the resident is made available and residents can feel involved in the way care is managed including risk factors associated with resident’s choice of lifestyle or behaviour so that residents feel supported in activities they choose. EVIDENCE: The care files seen showed that residents have a full plan of care and residents stated that this is drawn together following discussion with themselves so that personal rehabilitation goals are agreed and recorded. Staff were clear about the care for each resident and how this related to future planning and aspirations. For example one staff member described how a particular resident had great anxieties around visiting the dentist and how she had supported the resident through the process of booking an appointment and then attending. The resident is now able to mange this without support. This approach extended to cooking skills which would enable the resident to live a more Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 14 independent life outside the home in the future. The care plans are highly individualised with set rehabilitation goals that are evaluated regularly. Residents are encouraged to take part in the home rather than being passive receivers of services. There are regular community meetings, a ‘food’ group and leisure groups. Residents interviewed described the daily chores expected of them and how this contributed to community life. Any limitations to contribute are acknowledged. One commented, ‘the rules here are a bit strict, for example you’re expected not to stay in bed, but that’s good because it helps to get you going again’. There are morning meetings each day, at which residents can plan their day’s activities. They are reminded of any appointments, given any mail etc. Everyone is expected to attend and they are seen as a useful step in helping people move forward. They are also seen as a very good help in structuring the day. Every Tuesday there is a community meeting. At this people decide on things that affect all the residents. For example, the venue for trips out is decided here, any problems that have arisen can be discussed here, other activities people want to get involved in are decided, and people feedback on activities they have taken part in. One person spoken with felt that rules are very much set by staff and that residents should have a bigger say in the rules and running of Longview House. This was discussed in general terms with the manager who felt that the home encourages all sorts of input by residents. The concept of residents getting involved in staff recruitment has not been considered however and could be a future development. Residents interviewed spoke about the structure of the home and how this supported them in choices to lead and more individual lifestyle. This involves the awareness of risk and there are risk assessment documents in care files that assess areas such as fire risk for smokers, self harm risk and risk around medical care. This means that staff highlight and discuss [for example] the risk of non-compliance with medication and how this could affect future discharge plans and maintaining future well being in the community. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. The quality outcome for this area is good. This judgement has been made using available evidence including a visit to this service. As much as possible residents are encouraged to contribute to activities and therefore feel part of the external and internal community of the home but the management need to be aware of further developments needed to support residents in safe relationships in the home. EVIDENCE: The philosophy of the home is summed up in the pre inspection information: ‘We believe that creating an active day programme is essential to the rehabilitative service which 2Care provides. Service users have access to a variety of opportunities: work placements, direct work, volunteer, college and distance learning. Staff supports service users to access the above, as well as offer support with benefits/finance problems. Service Users are encouraged to carry on with an established day programme prior to move in, where feasible. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 16 These are reviewed in daily progress reports All support plans rely on access to external resources as well as internal. When starting to use the service, service users are given handbooks which provide information on local amenities and community groups’. [AQAA]. The evidence from the inspection generally supported this. Several residents reported regular visits to the local shops and café and found this an enjoyable activity. One resident said they know some of the girls who work there and was friendly with them. Several people also go into Liverpool from time to time to the cinema or to go shopping. Public transport seems to be quite good and reliable. Most people have free travel passes. One person discussed the advantages of having an advocate and finding this very useful at meetings such as case reviews. Most people felt that taking part in cleaning a good idea. Also doing the dishes, budgeting and learning to manage their own medication were really helpful in getting ready for moving on to an independent life, even if t might be ‘a bit of a struggle’ at times One resident attends a local college and is doing maths and English lessons there. One resident attends an educational programme nearby called ‘Alternatives’ that offers a wide range of activities. Two people reported they were in loving relationships, one with another resident. They felt that Longview House was suitably supportive of these relationships. For example one person could have a partner ‘staying over’ from time to time. Again this is evidenced in the manager’s philosophy: ‘Service users are supported to maintain social relationships. Family and friends are treated as partners in service delivery, and the service user invites whom they choose to review meetings. Service users may invite whom they choose, as well as arrange overnight visits 24 hours in advance’. [AQAA] The manager was able to produce an overall policy statement on sexuality and intimate relationships however and reported that this is currently being considered. Meals are generated by residents depending on individual programmes and personal choice following planning in the ‘food group’ for example. Residents were observed to be involved in cooking in the kitchen. Not all views were positive and the management should be aware that some residents felt that there is an inequality of expectation with some residents ‘not pulling their weight’ with chores and that standards of hygiene were not maintained sometimes [see ‘environment]. Also some people would be happier if the women’s bedrooms were in one part of the building, rather that scattered around. Another couple of people felt that Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 17 the current balance between men and women, about two to one, was not appropriate. They believe if numbers were more equal the atmosphere would be better. As half the women residents live in the annexe, the balance in the main building often feels even less even. These points raise further issues around privacy, dignity and safety, which are highlighted under the ‘environment’ section of the report. Some staff reported that due to much support having to be given to cleaning areas of the home including communal areas this left less time to spend in supporting residents in other areas such as social skills and activity outside the home. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. The quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Personal and health care is offered on an individual basis including regular liaison with referring agencies and health professionals so that residents are supported but there needs to some recommended developments regarding medication policy and training. EVIDENCE: Residents spoken to were satisfied with the way staff approached issues around personal care and support. Residents are physically capable of attending to their own self care and interventions are geared around the need to encourage and monitor levels of self care and attention to personal hygiene. Care planning documentation supported this and showed that staff regularly talk to residents and encourage responsibility in this area. For example one key worker entry said ‘ spoke to X about self care today and how he needs to improve and could do a lot better in this area’. Residents are encouraged to be healthy and active. For example one resident talked about the use of the local leisure centre and go swimming there. The same resident also took regular walks. Another was encouraged to stop Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 19 smoking and had recently done so. That resident was also being supported to give up drinking alcohol. Another resident was trying to lose weight, though they had had an appointment with a dietician, some further follow up and back up would have been appreciated. One resident who had deeper issues around eating was to attend an eating disorder clinic. Most people said that they had generally been quite well while at Longview House and that it is easy to get appointments with GPs. Residents can attend appointments alone or with the support of a staff member if required. All resident s have a key to their bedrooms and stated that staff respect their privacy and do not enter rooms without invite/ permission. There were entries in all care files recording the input from health care workers and appointments with GP’s and hospital appointments. Residents on the Care Programme Approach [CPA] were undergoing regular review with psychiatric services and these are clearly recorded. Medication administration was reviewed. The AQAA complted by the manager states: ‘Staff fully support and supervise a service users’ progression to self medicating and ensure this happens at a pace suitable to the individuals needs. Regular spot checks are carried out on those who are self medicating in order to identify any difficulties as soon as they occur. Written consent from the consultant psychiatrist is obtained prior to an individual beginning the process. Staff spend time outlining the process and explaining the various medications and possible side effects’. Currently there are 5 residents self medicating to some degree [ this is less than the previous inspection]. The records and interviews support the above practice but it was noted that the home do not have a concise record of the risk factors accociated with individulas managing there own medication and this would be advised. A ‘risk assessment’ tool should therfore be devised. The administration records were generally clear in that medicines given were recorded appropiately in terms of times and frequencies. Some handwritten entries on the records were not signed by staff. It is good practice for two staff to sign a handwritten entry on the record as this reduces the risk of an error in copying a prescrition. All staff who administer medicines are trained inhouse and there is a ‘medication proficiency’ form for each staff member on file. During discussion is was noted that the current medication training is all in house by peers with no external professional input. Some staff reported attending training by pharmacists but this is not universal. The current training should be Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 20 ‘accredited’ and this needs to be considered. The input of a pharmacist, as part of the overall training is strongly recommended. Following requirments made on the previous inspection medication security has been addressed with only one set of medicines keys now being used with a designated care staff member. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure and concerns are acted on so that residents feel safe in the home and are protected. EVIDENCE: There is a complaints procedure available in the home and complaints are recorded and responded to. Those residents spoken to understand who they would access if they had a complaint although none had had to do this. The complaints book was seen. There has been a recent complaint of bullying. This was clearly managed well through community meetings and resident involvement producing a good outcome. The home have procedures in place to manage reports or allegations of abuse and staff are trained to respond appropriately. Staff reported company led training in this area and records evidenced that staff attend this. Some staff felt that training from social services would enhance the existing provision and this remains a recommendation. Most people reported no problems while out and about in the local neighbourhood. However, a couple of people reported occasional problems of name calling, usually from local children or youths. They felt that the staff at Longview House were supportive about such incidents. Some mentioned that there had been thefts at the home in the past but most people did not feel under any kind of threat within Longview House. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. standards around maintenance and basic hygiene are not being met and residents are therefore living in accommodation which does not meet their needs. EVIDENCE: The home is divided into three main sections, which fits in to the homes philosophy around rehabilitation so that there is a structured pathway in terms of developing more skills and independence. The building is over two floors with requisite day space. There is access to external gardens. The home is situated close to local shops and facilities. The last inspection was conducted over a year ago and requirements were made at that time around upgrading the environment as many of the furnishings and décor was run down and in poor condition. Since that time there has been some upgrading: Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 23 ‘The main part of the house has had major refurbishment in the last four months. The areas that have been modernised are the lounge, the dining area, the pool room and the downstairs corridor. The fire system has also been upgraded. Service users bedrooms are decorated in theraputic colours and are fully furnished by the project prior to the service user moving in’ [AQAA]. The inspection was therfore expected to find major improvements. Overall however, whilst some changes were noted, the impression is of a care home that is failing in its managment of a satisfactory and acceptable standard of accomodation. There are many examples of this but these are the more serious: • The home was found to have unaceptably poor levels of basic cleanliness and hygiene. The smoking room for example was very dingy and dirty. Walls and ceiling were badly stained with ashtrays overflowing on to the floor. A small table was stained and full of burn marks. The laundry room was very untidy and cluttered. Hoover and buckets stored so not able to get to the machines [lack of other storage space]. Laundry baskets were overflowing on to the floor and had been left from the previous night. All observed surfaces were dirty particularly the shelf underneath the sink. There was no sign of a cleaning rota. All bathrooms [4] were in a poor state. For example one upstairs bathroom had tiles missing and the bath panel broken. The seal around the bath was coming off so shower not usable. The toilet on the ground floor was stained and wet around the base of the toilet. There was a puddle on floor, which remained when checked after a few hours. The other GF toilet / bathroom was dirty with toilet paper over the floor which was badly stained at side of the toilet basin. The toilet appeared like it had not been cleaned for some time and was badly stained. A sanitary bin had a badly fitting lid and there was a foul smell apparent. There were no paper towels in holders in at least 2 of the bathrooms / toilets and no liquid soap available. The shower holder was broken in one bathroom. General areas were not clean – eg windowsills stained dusty, corridors had debris on floors. The main kitchen was very dirty. The cooker was stained with food from the previous day [s]. The grill not been cleaned for some time. The freezer was untidy with food just thrown in haphazardly. The floor was dirty. Two residents were involved in washing up and reported that ‘everybody helps themselves’ regarding breakfast. Shelves were very cluttered with rotten fruit in one bowl. The fridge was untidy and cluttered with food stored on top of other food. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 24 The Manager was seen about this and advised to clean the kitchen as a matter of urgency. [Following the inspection the environmental health department was alerted and has since visited the home]. Staff and residents feel that standards have slipped since the housekeeper has left and has not been replaced. There is no ‘deep cleaning’ and although residents get involved in the housework basic standards are difficult to maintain due a lack of consistency. • There were many examples of maintainance not been carried out in a timely fashion. Numerous small ‘tagging’ jobs were observed and some have already been mentioned. Others included cracked plaster around one bedroom door and lack of mainataince to a toilet door lock so that this was not functional. A resident reported that this has been reported for weeks. The manager reported that the home have a contract with an external firm for maintainance but that this relies on reporting necersary repairs rather than these being picked up regularly by, for example, a regular maintainance person. • The general feel to the home is rather institutional. The ‘expert by experience’ gave the following account of his first visit: ‘I arrived to the prospect of a very long wavy lap fence with a large building behind with ‘Longview House’ boards on it. I found it looked quite institutional. Nobody answered the door when I rang the bell. I went in as a resident came out’. Internally there is lack of homeliness with both main corridors lacking paintings on walls. There is no identification on bedroom doors. One resident commented that ‘it sometimes feels a bit like the hospital, because of the long corridors and ‘closed in’ nature of the place’. One person, now living in the three-bedroom annexe, felt that it was hard to get privacy in the main part of the building. In discussion with staff it was felt that there is marked lack of space for privacy and meetings. One staff commented that this is ‘embarrassing when social workers call, as they cannot meet any where apart from the office and the rehabilitation kitchen if not in use’. • There was some discussion with the manager around the layout of the home with respect to privacy. There are marked risk factors associated with mixing of female and male residents in any communal setting and these have been addressed in good practice reports in the past. The homes philosophy of getting residents to have more responsibility is good but this means staffing levels are not always high with resultant DS0000021468.V356524.R01.S.doc Version 5.2 Page 25 Longview House difficulties in monitoring residents. [This is particularly so at night with no waking staff]. Some comments from residents have been recorded earlier in this report regarding the need for more privacy and this could be achieved with, for example, attention being paid to the positioning of bedrooms and toilet / bathroom areas so that these are accessed by single sex residents. The manager should review good practice guidance such as the document ‘Safety, Privacy and Dignity in Mental Health Units’ [DOH 2000] which is available on the Department of health website. This good practice guidance can be used in conjunction with the development of policies around sexuality and privacy / dignity. The provision of suitable accommodation has been a factor on the last two inspections and is the main issue that is letting the home down in terms of minimum standards. A recent audit by the company has actually highlighted some of the issues and made recommendations for improvement. Given this fact and previous CSCI inspections making requirements, yet standards remaining poor, the managers must look at their own timescales and overall planning to achieve the results they would wish. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33,43,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are able to support residents in their care needs but are stretched in their role so that some standards in the home are not being met. EVIDENCE: For 19 residents the home was staffed at the time of the inspection with the deputy manager and one carer until 1030 am when more staff arrived including the manager. The inspector was advised that the usual staffing numbers for days is three carers. There are no other staff – no kitchen staff and no domestic cover. The philosophy is that residents take responsibility for much of the housekeeping work. These staffing numbers have actually been reduced since the last inspection and the absence of domestic cover is particularly notable in terms of standards around hygiene. Staff spoken with feel that whilst the general philosophy is right [that residents should involve themselves in the running of the home] but there is a trade off around maintaining quality of input into other areas of care. One staff commented, ‘the number one improvement would be a cleaner. We can’t get round to all the cleaning that needs doing’. Staff also felt that it was budgetary restraints rather than purposeful philosophy that has meant the domestic cover has been lost. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 27 Also there are no administrators in the home and staff interviewed were concerned at the amount of routine administration that took up resident / staff interaction time. Recommendations around the provision of ancillary support for staff on the last inspection seem to have been not considered. [This also extends to the provision of waking night staff although both residents and staff thought this to be of a less concern that previous]. Given the evidence of the inspection overall it would appear that the home is running on minimal staffing currently and this is affecting the homes ability to maintain adequate standards in some areas. Staff where observed to be interacting with residents and residents spoke in very positive terms regarding the staff’s ability to support them. Some of the comments received were that the staff at Longview House are very approachable. Several people thought the staff are ‘great’. One commented ‘they are good and helpful, but sometimes rushed off their feet.’ Staff files were seen and the manager ensures that recruitment processes are followed so that staff are not employed with out references or criminal records [CRB] and Protection of Vulnerable Adult [POVA] clearance so that residents are protected. Staff files contained training records and staff spoken to were able to list recent updates and training courses attended and stated that they felt training in the home was good and appropriate. The induction programme was discussed and is very thorough. All staff receive training in areas such as listening skills and mental health. Since the last inspection there has been an uptake for NVQ training and 50 of staff have been trained with other staff undertaking courses currently. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are appropriate management systems in place to ensure that the home is run in the best interests of the residents but there needs to be consistency in all areas including housekeeping so that residents are assured of good standards in all areas. EVIDENCE: Peter Sinnott has been the newly appointed Registered manager at Longview House since September his year. Peter has approximately 18 years experience in working in care services both as a carer and a manager. Over the 8 years Peter has worked with people with learning disabilities and people with mental health problems. Peter has been acting manager at Longview since March 2006 and prior to that he worked as the deputy manager at Longview House for 12 months. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 29 Peter is currently working towards the Registered Manager Award. He also said that he had recently undertook training by the company in The Mental Capacity Act 2005 and continuously updates his knowledge in good practise through internet access and publications. He is supported by a deputy manager who has worked at the home over a long period and has good experience. The managers have addressed some of the issues following the previous inspection but the core problem of the environmental standards in the home remain outstanding and current practices in terms of general upkeep of the home must be addressed. Some of the issues could perhaps be addressed by giving the home managers more autonomy to make in-house decisions. Staff generally felt that whilst the company ethos is strong it is very much led by the centre and local decisionmaking is not supported. This includes, for example, issues such as the choice of décor, which has to be approved by central office making the process over burdened. Staff overall feel their input is appreciated but sometimes consensus ideas such as those for more ancillary support, for example, are overridden. Residents and relatives are asked their views as to how the home should be run on a regular basis and service user surveys are given out and feedback sought. There are also regular meetings with residents so that they can feel involved in the running of the home and the service can keep up to date with resident needs and aspirations. There are also quality audits carried out by the company on a regular basis. For example the care services director carried out a service review annually and there is also an annual quality audit lasting 2 –3 days carried out by the companies Quality officer. This also covers health and safety issues. The home also has an ISO quality audit, which is an audit external to the company. The maintenance programme for the home was discussed and this should be actioned [see environment]. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23(2) Timescale for action All of the areas highlighted under 01/02/08 the ‘environment’ section of the report must receive urgent consideration and action by the managers of the home and specific timescales for improvement submitted to the Commission so that residents can be assured of living in a comfortable, homely and safe environment including: • • • Bathroom / toilet areas Décor of communal areas including corridors. Refurbishment plans for other areas of the home. Requirement [Last requirement date 1/12/06 not met] 2 YA30 23(1) d All parts of the home must be maintained in a satisfactorily clean state including all communal areas and kitchen facilities. There must be enough staff support in various roles to ensure that both care needs are being met and the home is able DS0000021468.V356524.R01.S.doc 01/01/08 3 YA33 18(1) a 01/01/08 Longview House Version 5.2 Page 32 to run smoothly and maintain standards around housekeeping. 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 Refer to Standard YA8 YA15 Good Practice Recommendations Consideration should be given to extending residents input into the running of the home by including them in the staff recruitment process. The managers should develop an overall policy statement and guidelines covering sexuality and intimate relationships. This should be tied in with the comments under ‘environment’ and reference to the document ‘safety, privacy and dignity in mental health units’ [DOH 2000] It is strongly recommended that all written instructions on the medication administration record are witnessed and signed by two staff members to help ensure accuracy. YA20 A self-medication risk assessment tool should be developed for use with those residents who self medicate. The current training package for staff who administer medication should have input from a pharmacist or have some form of external ‘accreditation’. 4 YA23 All care staff should attend local adult protection training to raise awareness of abuse and reporting procedures as planned. The manager should review good practice guidance such as the document ‘Safety, Privacy and Dignity in Mental Health Units’ [DOH 2000] which is available on the Department of health website. This good practice guidance can be used to develop the environment in the home in conjunction with the development of policies around sexuality and privacy / dignity. Longer term planning needs to make provision for both storage and improved day space. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 33 3 5 YA24 6 YA30 7 8 YA33 YA37 It is strongly recommended that in order to meet requirements under this standard that a house keeper is employed to both monitor and ensure standards of cleanliness are maintained. Consideration should be given to the provision of an administrator to compliment current staff balance. The company should consider the comments around the apparent lack of local management autonomy in some areas. Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. Extracts may not be used or reproduced without the express permission of CSCI Longview House DS0000021468.V356524.R01.S.doc Version 5.2 Page 35 - 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!