Inspection on 15/10/07 for Longwood Lodge Nursing & Retirement Home

This inspection was carried out on 15th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Longwood Lodge Nursing &... 21/11/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Longwood Lodge Nursing & Retirement Home 61-63 Queens Road Oldham Lancashire OL8 2BA Lead Inspector Jenny Andrew Unannounced Inspection 15th October 2007 08:15 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 Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.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. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longwood Lodge Nursing & Retirement Home Address 61-63 Queens Road Oldham Lancashire OL8 2BA 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) 0161 627 5868 F/P 0161 627 5868 Eaglecrest Care Management Ltd Mrs Maureen Edith Ward Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (43) of places Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP; Physical disability: Code PD. The maximum number of people who can be accommodated is: 43. 21st November 2006 Date of last inspection Brief Description of the Service: There are 43 beds in total at Longwood Lodge; the home is registered to provide nursing and residential care. Longwood Lodge is a detached Victorian property that has been extended. It stands in pleasant gardens overlooking Alexandra Park. An open seating area at the front of the building allows service users to enjoy the view in a safe and peaceful environment. Accommodation is provided over two floors and consists of 31 single rooms and six double rooms, all with en-suite facilities. Access to the first floor is provided by two lifts. Within the home there are also a number of communal rooms in which service users can socialise, dine and participate in activities. Fees for accommodation and care at the home range from £330 to £553.16 per week. The price is dependent upon whether residential or nursing care is provided, the provision of double or single rooms and whether the person is being funded by the Local Authority or paying privately for their care, in which case higher fees are charged. Additional charges are also made for hairdressing and chiropody services, newspapers, dry cleaning and personal toiletries. Further details about the services the home provides are available in its statement of purpose and service user guide, both of which are provided on request and displayed in the reception area of the home. A copy of the most up to date inspection report is displayed in the reception area. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The visit lasted ten hours. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of some of the staff were also looked at to make sure the home was doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the service users, the manager/matron, deputy manager, social activity worker, three care assistants, the chef, administrator, a housekeeper, the handyman and two relatives were spoken with, as well as nine residents. Before the inspection, comment cards were sent out to service users, staff and relatives/carers asking what they thought about the care at the home. Three residents, 16 relatives/visitors and three care staff filled the cards in and returned them to the Commission for Social Care Inspection (CSCI) and this information has also been used in the report. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager needed to complete the form in more detail and further address the equality and diversity needs of the people living there. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The Statement of Purpose and Service User Guide had been reviewed and updated so that they showed the services and facilities offered at the home. A section on social needs had been added to the care plan but this was not always being completed. More of the staff team had attended training so they would know what to do if they felt a resident was not being treated properly. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.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 Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.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&3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Assessments were undertaken before people were admitted to the home, to ensure their needs could be fully met. Standard 6 was not assessed, as the home does not provide intermediate care. EVIDENCE: The Statement of Purpose and Service User Guide had been updated in line with a requirement made at the last inspection. The manager/matron said a copy had been given to residents and/or their relatives and one was also displayed in the reception area. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 10 Before coming into the home, all residents, whether they required nursing or residential care, were assessed by the manager/matron or one of the other trained staff. Evidence of this was seen on the files of three of the more recently admitted residents. In addition, if the person was admitted via Social Services, a full assessment document was received. The trained staff provided in-house training to the care assistants in order to raise their awareness so they would know how to care for individual residents. Examples of such training are dementia, peg feeds, skin and catheter care and resuscitation techniques. One relative, whose father had been admitted to the home the previous week, was spoken to. He said he had visited many other homes before deciding this home was the place for his father. He said his decision had been made in respect of how clean the home was, the welcome from the staff and the fact the residents living there looked well cared for. He particularly mentioned the manager, whom he said had been particularly helpful. He said the admission process had gone smoothly and that his father was beginning to settle in. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence, including a visit to this service. Some practices and lack of accurate documents could place residents at risk. EVIDENCE: All the residents appeared well presented, clean and comfortable and the men had received a shave. Relative feedback comment cards varied in respect of their satisfaction in this area. The following comments were made: “Usually a good standard of care is given but a lot of staff have left and this has impacted on the residents”; “When people are left in bed not enough checks are made on them”; “The staff give first class care to my mother”; “Health problems are dealt with promptly”; “They have weekly hairdresser and the home arranges optician and chiropody visits”; “They provide good care to the residents”; “Sometimes the younger carers appear to lack the necessary experience”; “The professional staff are competent and supportive but the quality of the support staff varies”; “Some members of staff are more conscientious and efficient than others”; “I sometimes feel our comments are dealt with in an Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 12 indifferent manner” and, “The nursing staff will always spend time with mum explaining things”. Three residents’ care files were looked at. Generally, the care plans detailed the individual health care needs of the residents and short term care plans were in place in respect of wound care, pressure areas, etc. However, several shortfalls were identified. One person’s care plan stated bed sides were fitted but this was not the case; another file showed a person had an allergy but this was not so and an incorrect label had been left on the front of the file. This was addressed during the visit. A nutritional assessment had not been amended since January 2007; there were two files without nutritional assessments, even though one person had lost weight; one care plan stated two staff were needed for moving/handling purposes but there was no moving/ handling assessment in place. In addition, the care plans focused mainly on the health care needs of the residents and did not always address their social/ emotional needs. Since the last inspection, when this was an identified shortfall, the manager/matron had introduced a section about social needs but this had not been included in one of the files. Risk assessments had been done to assess the risk of people getting pressure sores but there were no recognised tools in use for moving/handling or falls. As previously stated, one of the files did have a nutritional assessment in place but the others did not. Discussion took place about the need to introduce the Malnutrition Universal Screening Tool upon admission, for all residents and to use the tool for the people currently living at the home. The manager/matron said that one of the trained staff would be attending training on the use of this tool, which would then be cascaded to the other trained staff. Given the physical frailty of several of the residents, this tool, or the home’s own nutritional assessment should be implemented as soon as possible. Whilst nutritional assessments were not in place on two files, the residents were being regularly weighed and their care plans showed that appropriate action was being taken to address any weight loss, e.g., additional prescribed build-up drinks and high protein foods. A requirement made at the last inspection in respect of the implementation of nutrition and fall assessments had not been implemented. Pressure sore and wound care were being well managed. The matron/manager and another trained nurse were moving/handling facilitators and they trained staff in how to move/handle the residents. However, whilst the care plans set out how many staff were needed to assist people’s mobility and for transferring purposes, detailed assessments had not been done. This shortfall must be addressed as quickly as possible as the absence of moving/handling assessments can place both residents and staff at risk. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 13 One of the trained staff must undertake a full review of each person’s care plan to ensure it is a detailed accurate reflection of the person’s social, emotional and physical needs and includes all the relevant risk assessments. This will ensure their full needs will be met. A separate sheet in each of the care plan files was signed and dated to say that the care plans had been reviewed monthly, but given the shortfalls identified, staff responsible for updating care plans should do so more thoroughly. The manager/matron acknowledged there was room for improvement in the care planning process. She said that due to spending more and more time on the floor, providing care, she and the nursing team were struggling to find the time to devote to keeping care plan documentation up to date. Residents spoken to said they received visits from dentists, opticians and the podiatrist and the files contained sheets showing when health care professional visitors to the home had visited, together with the outcome of the visit. All those spoken to were satisfied with the way their health care needs were being met. Relative feedback from returned comment cards indicated they were generally notified when any changes in health were noted. One person commented that whilst they had been asked to provide a calendar for the resident’s room, so that staff could record routine appointments, this was not happening. According to information contained on the Annual Quality Assurance Assessment (AQAA) document, the home had medication policy/procedures in place. Only trained nursing staff gave out medication. The lunchtime medication round was observed and the person administering the medication was doing so safely. However, it was a very lengthy process, lasting one and a half hours, as the majority of the residents were on a lot of medication and some of them were in their bedrooms. She said that when there were sufficient carers on duty, a carer assisted in the process, which cut down significantly on the time taken. Procedures in place for controlled drugs and the disposal of medication were satisfactory. One person had been prescribed a build-up drink because of her weight loss. Whilst this was being given, it was only recorded as and when needed (PRN), rather than as prescribed which was at 11.00 and 15.00. All supplement drinks must be given as prescribed by the GP. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 14 Feedback from several of the people spoken to was that the night staff woke them up early to give them their medication. Upon making enquiries, it was determined the night staff were responsible for giving out the morning medication before they went off duty at 07.00. From checking the medication administration records, the timings of the majority of medication was recorded at 06.50 or 07.00 with only one or two being recorded between 06.15 and 06.30. This was clearly impossible, given the number of people receiving medication and the fact the staff went off duty at 07.00. This regime was about convenience for staff rather than good practice for the residents. Given the residents were not having breakfast at the time of receiving their medications, some were not being given it as prescribed by their GP, e.g., some medication needs to be given with or after food. The periods between giving out medication would also be too long in some instances, especially in respect of analgesics and antibiotics. The manager must ensure that all medication is dispensed as prescribed by the GP. Staff had a good understanding of the physical and emotional needs of people in respect of maintaining their privacy and dignity. Observations made included, staff knocking on doors, staff arranging for a visiting GP to see someone in the privacy of their bedroom and people being sensitively assisted to the toilet. All but one of the residents spoken with confirmed the staff’s attitudes were respectful. One person said she and other residents were “ordered around” but this was not felt to be the case by any of the other people spoken to. Arrangements were in place for people to have a telephone installed in their bedrooms and several had done so. A public pay phone was also provided. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users were encouraged to make daily choices and follow their preferred daily routines, as far as they were able. EVIDENCE: There were two social activity workers employed, working 16 hours per week each. Their start times of 12.00 midday meant that the first hour was usually spent assisting staff to give out lunchtime meals and this was seen on the day of the visit. The manager/matron should review this practice to ensure that all their designated hours are spent in arranging one to one or group activities. One of the workers had attended an Age Concern activity course and it was planned that the other would be undertaking the course in the future. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 16 From checking the activities book, it was evident that many of the residents enjoyed taking part in the planned programme. The weekly programme was displayed on a large whiteboard displayed in the home and the monthly entertainment programme up to February 2008 was also displayed. This showed a signer had visited in October, a Christmas shopping trip was to be organised in November, a vocalist in December, pantomime in January and another entertainer in February 2008. The group activities were held in one of the communal lounges and the activity worker said she always went around the home to check on whether people sitting in the other lounges wanted to take part. She confirmed that people in their bedrooms were also chatted to or given a manicure. Some residents were content and able to entertain themselves with reading, watching television and listening to music. They said they were not pressured to join in the activities. One resident enjoyed sitting in the dining room, watching the birds. A bird table and birdbath had been provided and she said she also liked to watch the squirrels. As highlighted in the care planning section above, the care plans should address residents’ social needs, which would assist in creating person centred social activities tailored to individuals’ preferences. Relative feedback was positive about the activities provided and the following comments were made: “My mother is encouraged to participate in all the activities”; “Plenty of activities are organised for the residents”, “There is daily therapy arranged”; “Hard working therapists”, “In-house activities Monday to Friday are excellent”. The more able people spoken to said they were able to make some choices in their daily routines, such as what to wear, when to get up and go to bed, whether to stay in their bedrooms or go into the communal lounges and meal choices. However, it was noted from the allocation file that the more dependent people were routinely assisted to bed at set times, such as 19.00 and 20.00 hours. As preferred rising and retiring times were not always recorded on people’s individual care plans, it was not possible to check whether these times were to suit the residents or the staff. The manager/ matron should ensure that everyone is consulted, preferred rising/retiring times recorded on care plans and the set routines changed as necessary to suit individuals. Also as highlighted in the above section, people were being awakened early so that the night staff could administer their medication. This was not a routine that the residents found acceptable. Residents’ religious needs were being met. Representatives of both the Roman Catholic and Church of England faiths were visiting weekly. One of the newer residents was a member of a different church group and arrangements were in place to arrange visits to the home. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 17 Relatives spoken to and feedback from returned questionnaires indicated they felt they were made welcome and no restrictions on visiting were imposed. One person said, “Visiting is pleasant and my two young grandchildren are happy to visit the home”. Another said, “The staff are always welcoming”. Facilities were provided in the reception area for visitors to make themselves a drink. Arrangements had also been made for the wife of one of the residents to visit the home and have a meal with him. Four weekly menus were in place, which were rotated. The menus were varied, nutritious and choices were offered at each meal. Whilst small menu sheets were displayed, these would not be able to be read by many of the residents and the manager/matron may wish to introduce large menu boards which could be changed daily. Some residents seemed unsure as to whether there was a choice but others confirmed there was and staff were seen during the inspection, asking people what their choices were for the following day. The Chef knew individuals’ likes/dislikes and portion sizes and also their dietary needs. The service users spoken with were fairly positive about the food stating “Its’ fine”, “Satisfactory”, “Very good”, “Nice” and, “Really good”. On the day of the visit, the lunchtime choices were, cottage pie or fish pie with carrots and green beans followed by ginger sponge and custard or ice cream. We sampled the dishes, which were tasty and hot. The vegetables were soft but not overcooked. Teatime choices were egg and chips or sandwiches followed by jelly and cream. Any special dietary needs of new clients coming into the home were passed to the chef so he could cater appropriately. Cooked breakfasts were provided on a daily basis and several people were seen to enjoy these. The atmosphere during lunch was pleasant and relaxed, with staff helping residents discreetly. Dining tables were attractively set with flowers, condiments and cups and saucers. The good practice of staff serving vegetables from individual tureens was also noted which enabled people to have more choice about portion size. Individual gravy boats were also used. Residents confirmed that they were offered hot drinks regularly throughout the day and jugs of juice were available in all the lounges. Fluid and dietary charts were utilised as and where needed. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which service users were familiar with and staff training and good recruitment practices ensured that, as far as possible, residents were protected from abuse. EVIDENCE: The home had a satisfactory complaints procedure. Residents said that if they had a complaint they would speak with the manager and were confident that any issues would be dealt with properly. The relative questionnaires also confirmed they were clear about how to make a complaint. One person said, “The matron is always happy to listen without prior appointments” and another said, “The senior nursing staff are clearly experienced and respond in a calm and professional manner when concerns are raised”. Examination of the complaints record indicated that complaints had been investigated and responded to appropriately but the complaints book had only recently been introduced. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 19 Over the last 12 months, we have been notified of two incidents where the protection of vulnerable adult proceedings had been followed. Oldham MBC had investigated them in line with the authority’s policy. One of the investigations had been concluded and the allegations were not proven. Two recommendations were made, however, and these had been implemented. The second investigation was still in progress. As this dated back to March 2007, the manager should chase this up with the investigating officers so that it can be concluded and an outcome determined. Since the last inspection, more staff had done abuse training. As there was no overall training matrix in place, it was difficult to establish exactly how many staff had done the training. The manager said she had done the training together with the deputy manager and 12 of the staff. Two of the staff spoken with confirmed they had recently received letters confirming they were on the Oldham MBC vulnerable adult training course and the manager said a further four would also be attending. Staff were going on all available courses as and when they were held. The home had a safe recruitment and selection policy, which meant that staff did not start working at the home until the necessary checks had been undertaken. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The home was well maintained and decorated and it provided a safe, clean and homely environment for the people living there. EVIDENCE: Observations made, from walking around the home, showed it to be clean, tidy and in a good state of repair. A handyman was employed and, from checking the maintenance book, it was seen that all his repair jobs were up to date. Rooms were redecorated as they become vacant, prior to the next resident moving in. On 16 February 2007, an Environmental Health Officer had done an inspection at the home. The report was seen and it said, “Good standards maintained”. No requirements or recommendations were made. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 21 Since the new smoking regulations had been introduced, the manager/matron had ensured there was a designated smoking area for the residents who smoked. There were only two people who were smokers. The staff had to smoke outside the laundry. One of the housekeepers was spoken to. It was clear she took pride in her work and demonstrated good practices in respect of using different coloured cloths and buckets for cleaning different areas. Resident feedback indicated they were satisfied with the standard of cleanliness and décor throughout the home. Those spoken to were happy with their rooms and said they had been encouraged to personalise them with photographs, ornaments and mementos. Privacy screens were provided in the double rooms. All the bedrooms had the facility of en-suite wash hand basins and toilets. Relatives were also extremely satisfied with the cleanliness throughout the home, commenting as follows: “The accommodation is very clean and bright”; “Everywhere is kept very clean and good hygienic practices”; “The whole place is scrupulously clean and has a bright welcoming ethos”; “The home has a handyman who we can approach if anything needs doing in residents’ rooms”; “Cleanliness is of a good standard and the dining rooms are pleasant”; “My mum’s room is always spotless” and, “The cleanliness and hygiene are good”. Only one person made a negative comment, which was, “There is sometimes an odour near the entrance”. This was not evident on the day of the visit. Communal space included three lounges and three dining rooms. These rooms were cosy and comfortable, reflecting a normal home environment with a range of styles of armchairs to suit different residents’ needs. The choice of lounges enabled people to move from one room to another if they chose to do so. Suitable aids and adaptations were available throughout the home. Residents were assessed upon admission to see if they needed any additional aids in their en-suite toilets. Since the new owner had taken over, full checks had been made of the water system in the home to ensure it complied with health and safety regulations for the prevention of Legionella. Additional work had also been undertaken in respect of fire safety. The AQAA stated that further improvements to be made were to have the car park resurfaced, to replace the double glazed unit in the conservatory and to replace some soft furnishings. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 22 There was a comprehensive infection control policy in place and usual practice was to undertake screening of new people being admitted to the home to detect whether or not they had MRSA which can be passed to other people. Good practice was observed throughout the visit. Staff changed into protective tabards to serve food, there were plentiful supplies of disposable gloves and aprons and paper towels and liquid soap were provided in all bedrooms, bathrooms and toilets. The sluices were kept clean. The laundry was in the basement and the manager said there were plans to increase the size of it. There were sufficient washers and driers for the size of the home but only one industrial washer was provided. The owner had promised to replace some of the equipment as part of the laundry upgrading. Some problems were being experienced in respect of missing clothes but the manager was tackling the problems as they occurred. This was witnessed during the visit. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 23 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. This judgement has been made using available evidence, including a visit to this service. At certain times of the day, staffing levels were insufficient to meet the individual needs of the people living at the home. EVIDENCE: Information contained in the AQAA showed there was a good age and ethnicity mix of staff. Over the past 12 months however, there had been a very high turnover of staff. This was said to be as a result of the new owner changing their terms and conditions of working. Clearly, this had impacted on the residents in respect of losing carers with whom they had built up long and trusting relationships with. The use of agency staff over this period had also been high but now the team had stabilised which meant the manager was no longer employing agency staff. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 24 From checking staff rotas, it was evident the home was being staffed to the minimum standards. This meant that if a nurse or carer rang in sick, the home was under-staffed, resulting in the manager/matron or trained staff having to cover carers’ duties. The manager said that approximately 60 of her time was spent covering the floor, either in a nursing or caring capacity which had impacted on her management duties. Other staff spoken to also confirmed this was so. Relatives’ returned questionnaires highlighted concerns in this area. The following comments were made: “Whilst I don’t have any complaints about the care, I do have concerns about the staff turnover”; “There needs to be more settled staffing and consistency at carer level”; “There are not enough staff to cater for the number of residents”; “The home needs to employ more experienced carers and maintain a stable team”; “There are insufficient staff for the dependency of the residents”; “When people are left in bed there are not enough checks being done”; “New staff need more training before they see to the residents’ needs”; “Staff numbers are insufficient”; “A lot of staff left earlier in the year and they still seem short”. From checking the rotas, it was noted that care staff varied from five or six on in a morning together with the trained staff to a nurse and four carers in the afternoon/evening up until 21.00 when the night staff came on duty. This meant on the later shift, they had to work in pairs for moving/handling purposes whilst the trained staff attended to people’s nursing and medication needs. This level of staffing meant there were periods of time when lounges were left unattended which could impact on the safety of the residents. Care practices were also being undertaken to fit in with the rotas rather than around the needs of the residents. Feedback about the overall care given was very positive, with many good comments being made as highlighted in the summary at the front of this report. It was evident from discussions with three of the staff that they felt they worked well together as a team and that staff morale was good. All had been employed within the last 12 months. They felt they worked hard and provided a good standard of care to the people they looked after. One carer said, “I treat residents as I would want my own family to be cared for”. An effective communication system was in place and the handovers were thorough. As the manager/matron and trained staff frequently worked alongside the carers, they could ensure that care standards were being maintained. An allocation book was in place, which recorded exactly what duties each member of the team would be responsible for. The home was divided up into three areas and staff allocated accordingly. This system did mean that people in their rooms were not neglected, in respect of being turned, given fluids and meals. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 25 The manager/matron held trained staff meetings but did not hold full staff meetings with the carers. She said she was aware of this shortfall but just did not have the time to arrange them. Due to the high turnover of care staff, many of those who had previously achieved NVQ level 2 training had left. This meant that the home had not achieved over 50 of trained care staff. The current percentage of staff trained in NVQ level 2 or above was 26 , although another six were currently doing the training. Staff files were examined and each contained job application, references, start date and up-to-date Criminal Record Bureau checks and POVA firsts. One file contained only one written reference but the manager said she had received a verbal one and was awaiting written confirmation. When verbal references are received, they should be recorded and placed on the file. A notification had been received this year about a staff disciplinary issue. Records showed that the manager/matron had followed the correct disciplinary procedures and was monitoring staff performance. A recently recruited carer was interviewed and she described the process she went through to gain employment. This included completing an application and attending for interview, she provided two references and documents for completion of the criminal record check and POVA first. She had been allocated a mentor (one of the trained staff) and had worked alongside an experienced member of staff until she had learnt the job. She confirmed she was in the process of completing her Skills for Care workbook and had done inhouse training in respect of moving/handling. Whilst each member of the team had a training file in place, there was no overall training matrix, which showed exactly what training each carer had undertaken and when refresher training was due. The manager/matron and another trained nurse were moving/handling facilitators and undertook all inhouse moving/handling training. It was evident from speaking to staff and checking individual training records that not all staff had done infection control training. Information contained on the AQAA showed that only ten staff in total had done this training. This shortfall must be addressed. Good practice in food hygiene was done during induction but full courses were not attended. The manager said this was because they had catering staff, all of whom had undertaken the training, and the staff were only responsible for giving out suppers. As the home had trained nurses, the carers were given in-house training in resuscitation Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 26 New staff were undertaking Skills for Care training but this was not being completed within the first 12 weeks of employment. The Oldham MBC Skills for Care induction training courses were being accessed but as these were not always held at the times needed, new carers’ training was being excessively prolonged. Two carers who had started work at the home in February and March 2007 had only attended the Skills for Care two-day training course very recently, which had meant their training had taken in excess of six months. In the interim, they had completed the home’s in-house induction and undertaken several in-house training courses such as fire evacuation, first aid, health and safety, moving/handling and dementia. Another new carer who was spoken to had started working at the home in September but her name had not yet been submitted for the Skills training. She had, however, undertaken the in-house induction training which included moving/handling and had attended a lecture on dementia. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 27 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was not being effectively managed which had impacted on some health and safety outcomes for the residents. EVIDENCE: Since the last inspection, the Commission for Social Care Inspection had approved the former deputy manager to be the registered manager of the home. Whilst she had many years of senior nursing experience and had been deputy manager for the previous owners of the home, she was not as experienced on the management side. She had therefore enrolled on a “Key Skills for Managers” course, which should have started in May 2007 but had been cancelled until September 2007. Following this, her intention was to enrol on the Registered Manager’s Award. She kept herself abreast of current Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 28 practices by reading journals and care magazines. Whilst she was aware of the issues in respect of the Mental Capacity Act, she had not yet reviewed care plans to take account of this legislation. Since her appointment as manager, she and her senior nursing team had had many issues to contend with. Many of the staff had left as a result of the home changing hands, staffing levels had been reduced to the minimum required and new policies/procedures and practices had to be implemented due to the new company taking over. All of these had contributed to the manager/ matron having to spend more and more time on the floor, filling in for staff sickness and annual leave. When staff rang in sick at the last minute, the current minimum staffing levels left the home short on the floor which meant she was having to provide the cover needed to meet the residents’ needs. She was committed to ensuring that the residents did not suffer as a consequence of staff shortages. Clearly, this has impacted on the time she has been able to spend on her management duties and she was very honest and upfront about this. It is to her credit that the home has been managed as well as it has over this period of time. The home accommodates many very frail, dependent and vulnerable people and the owner must liaise with the manager/matron and trust her judgment in respect of the staffing of the home. The staffing levels must allow her the time needed to spend on the management tasks that are having to be neglected such as auditing of care plans, implementing risk assessments for nutrition, moving/handling and falls, reviewing medication times, holding resident meetings, arranging regular staff training and full staff meetings. Feedback from the staff spoken to was positive about the manager. She was described as being “approachable” and “supportive”. One carer said, “If I have any problems I have the opportunity to discuss things with the manager”. Relative feedback was also good about her approach both to themselves and the person they visited and comments included, “The home is well run by the matron and staff” and, “The home runs efficiently and concerns are dealt with promptly”. At the last inspection, it was reported the company was developing an audit system to ensure the quality of the service provided by the home could be monitored. This had still not been implemented although the manager was continuing to send out a selection of satisfaction questionnaires to residents, relatives and health care visitors to the home. These were then collated to show the survey results. The manager said any comments or ideas were implemented if at all possible. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 29 The system in place for the management of residents’ finances was checked and all three residents’ monies were correct. The administrator kept all receipts, including those for the hairdresser. She reported that the families of most of the residents in the home assisted with their finances, although Oldham MBC dealt with the personal allowances of seven people. The money for these people was paid into a separate bank account specifically set up for this purpose. Invoices were available for all transactions and sundry expenses were paid for by the company in advance and an invoice then sent to the family. A clear audit trail was evident. Information from the Annual Quality Assurance Assessment (AQAA) showed that all maintenance and other checks of the building and equipment were up to date to ensure the health and safety of the staff and residents. The handyman was responsible for keeping all fire checks up to date and the fire book showed the last checks had been done on 12th October 2007. The AQAA showed there was no restraint policy in place or a policy in respect of voluntary workers. The manager said she would ensure these were written. As previously stated, without checking every staff personnel file, it was difficult to determine exactly which staff had received the mandatory training and when refresher trainer had been done. A notice stating that fire training would be taking place shortly was displayed in the home. The manager said that all staff received in-house moving/handling but that food hygiene was only covered on the basic induction due to staff not having to make or prepare food. A trained nurse was always on duty and would be able to provide emergency first aid if needed. Infection control training had only been done by ten of the care staff and the manager was aware of this shortfall. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.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 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 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 X X X X X X 3 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 2 X 2 X 3 X X 2 Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 15 Requirement The manager must review all the care plans to make sure they accurately reflect each person’s needs in respect of personal, health and social care and this should be done in consultation with the residents and/or their relatives. This will ensure that each person will receive the right care. (This requirement was made at the last inspection and the timescale of 31/01/07 has not been met. The manager must ensure that unnecessary risks to the health or safety of residents are identified and, so far as possible, eliminated so they will be safe. This refers to risk assessments for nutrition, moving/handling and falls. Apart from the moving/handling, this requirement was made at the last inspection and the timescale of 31/01/07 has not been met). Timescale for action 31/12/07 2 OP8 13 02/11/07 Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 32 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. 3 Standard OP9 Regulation 13(2) Requirement Timescale for action 02/11/07 4 OP27 18(1)(a) 5 OP38 18(1)(c) (i) All medication must be given as prescribed by the doctor with specific reference to special instructions such as “with, before or after food” and be given at intervals as specified so the residents’ health will not be at risk. The provider must liaise with the 09/11/07 manager/matron to agree on safe and sufficient staffing levels on all shifts, taking into account the number of people being accommodated, their dependency needs and the layout of the building. This will ensure the people living there have all their needs fully met and the manager has the time needed to devote to her managerial duties. All staff must receive training in 31/12/07 infection control to raise their awareness of best practices to follow to reduce the risk of infections spreading within the home. Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 33 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 OP8 OP14 Good Practice Recommendations The Malnutrition Universal Screening Tool (MUST) should be implemented for all residents. Residents should be given more choice about their daily routines in respect of when they want to go to bed or get up and their preferences should be recorded in their individual care plans so that all staff will have this information. The manager should contact the Oldham MBC Social Services Department to determine the findings of an outstanding safeguarding investigation. The registered person should ensure that the dependency of residents is considered when determining any changes to the current staffing levels. At least 50 of care staff working at the home should have achieved NVQ level 2 or above training. When verbal references are given, they should be recorded until the written document is received. A training matrix should be in place showing when and what training each member of the staff team has completed, so that it can be easily seen when refresher training is due. Skills for Care training should be completed by all new staff within the first 12 weeks of their employment. The organisation’ audit system to measure the quality of the service offered should be implemented. 3 4 5 6 7 OP18 OP27 OP28 OP29 OP30 8 9 OP30 OP33 Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Longwood Lodge Nursing & Retirement Home DS0000067233.V350864.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. 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