Inspection on 10/08/05 for The Langholm

This inspection was carried out on 10th August 2005.

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

The Langholm 08/08/08

The Langholm 22/08/07

The Langholm 31/10/06

The Langholm 11/01/06

The Langholm 10/03/05

The Langholm 01/11/04

The Langholm 19/02/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Langholm Care Home 14/16 High Bondgate Bishop Auckland County Durham DL14 7PJ Lead Inspector Paul Emmerson Unannounced Inspection 10th August 2005 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 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. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Langholm Care Home Address 14/16 High Bondgate Bishop Auckland County Durham DL14 7PJ 01388 450149 01388 450149 mitch.langholm@tiscali.co.uk www.alphacareservices.com Alphacare Services (UK) Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs. Michelle Sandu LLoyd CRH 31 Category(ies) of OP Old age (19) registration, with number DE(E) Dementia - over 65 (12) of places Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10th March 2005 Brief Description of the Service: Langholm is a well-established care home, which has been extended to provide a semi-independent unit for people with dementia. Langholm is registered to accommodate up to 31 older people, including up to 12 people with dementia. The accommodation for people with dementia is at single-storey, ground floor level with access to the homes enclosed gardens. The original building, which accommodates older persons, has a choice of single and double bedrooms over three-floors. There is a large combined lounge/dining room and a separate lounge on the ground floor, and a separate lounge on the second floor. A vertical passenger lift is provided. The home is located close to Bishop Auckland town centre with its many shops, post office, pubs, bus station etc. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. CSCI has a statutory obligation to inspect all care homes at least twice a year. This unannounced inspection was carried out in accordance with this obligation. The inspection took place over 7 hours, on the morning and afternoon of Wednesday 10th August 2005. In line with current CSCI policy on ‘Proportionality’, the inspection focused upon a number of key standard outcomes for service users. The key standard outcomes not inspected on this occasion will be assessed during the next inspection of Langholm. The inspection also looked at any issues raised in the last inspection of the home. The inspector looked around the building and a number of records were examined. 8 service users, 3 visitors, the manager and 8 members of staff were spoken to. What the service does well: What has improved since the last inspection? Some redecoration work has been carried out, for example to the front windows. There is a continued commitment to staff training, for example a number of staff have been enrolled to commence a dementia care training course at a local college. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 6 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. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 Admissions to the home are appropriately managed. EVIDENCE: More recently admitted service users and some of their relatives were spoken to. One service user said, “They are really nice to us”. A relative said, “It couldn’t be better”. Langholm has its own assessment and care plan documents. Recently admitted service users’ care plans were examined. These showed initial assessments had been conducted, which were informing the delivery of the people’s care. These documents are being appropriately developed in to longer-term records of the care required and being provided by the home. Where service users are admitted through care management arrangements, assessment / care plan information is also obtained from the Local Authority Social Services Department and / or via Hospital discharge arrangements. Subsequent to admission, reviews are arranged appropriately. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 9 The home’s assessment and care plans are prepared under various headings. These reflect a range of needs, goals, objectives and lifestyle preferences and are generally appropriate for most service users. For example, mental health needs are considered, together with the actions required of staff. However, issues relating to challenging behaviour require some further consideration. Care plans should also be regularly reviewed and made available to staff at all times to ensure that, in addition to these documents forming a record of the care provided, they also inform the delivery of the care provided. Service users considering a move into Langholm would be welcome to visit with their relatives, have a meal and stay overnight if necessary. In this way, service users can get to know the home before moving in. Any move into Langholm is on an initial trial basis. Approximately six-weeks after admission a formal review meeting is held to consider permanency. The home has a Statement of Purpose and Service Guide to inform service users and prospective service users about the home’s facilities and services. However, these should be reviewed to ensure that they contain all the information required to be in them under Regulations 4, 5 & Schedule 1 of The Care Homes Regulations 2001. For example, the number and size of rooms in the home should be included. It should also be noted that in April 2004 the previous registration authority – the NCSC – ceased to exist. Any reference to the NCSC in the home’s Statement of Purpose, Service Users Guide or other documentation should be amended to refer to the Commission for Social Care Inspection (CSCI). Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these outcomes / standards were assessed on this occasion. They will be examined during the next inspection of the home. However, as highlighted above, issues relating to challenging behaviour require some further consideration within care plans. Care plans should also be regularly reviewed and made available to staff at all times to ensure that, in addition to them recording the care provided, they inform the delivery of the care provided. It should also be noted that, although it is acknowledged that senior carers administer medication, medicines should be administered by appropriately trained staff. The training for care staff should be accredited and include: basic knowledge of how medicines are used and how to recognise and deal with problems in use; and the principles behind all aspects of the home’s policy on medicines handling and records. EVIDENCE: N/A Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Social needs are recognised and provided for. The home has open visiting arrangements. Service users’ rights are respected and choice is provided. Meals provided are of a good standard. EVIDENCE: An activities co-ordinator is employed for 10 hours per week. People spoke positively about organised games of bingo and the entertainer who comes to the home once a month. It is also acknowledged that care staff provide activities wherever possible, and staff were seen by the inspector to engage with service users in social interaction. However, due to the layout of the home and the need for care staff to carry out personal care tasks and support, it is suggested that more could be done in this area. Additional social activity / activity co-ordinator hours should be provided. Langholm has open visiting arrangements. The inspector spoke to three visitors who provided positive feedback. Visitors are welcomed. One visitor said, “When I come in it’s like home from home, they make me coffee and Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 12 sometimes a sandwich”. Another visitor said, “I can go home at night and not worry”. Service users’ rights are respected, a number have solicitors acting on their behalf. One service user has a pet dog. Another service user said, “I can come and go as I please. They look after us well, but they don’t treat us like kids”. Food served was seen to be of a good standard. A four-week, rotating menu is used. One service user said, “We’re well looked after and are well fed”. Another person said, “The food is champion, no complaints about that”. However, it was noted that the main lunchtime meal is a set meal. Although it is acknowledged that kitchen staff get to know people’s likes and dislikes, and alternatives are available if requested, wherever possible meal choices should be offered to service users. Records in the home confirmed that service users’ nutritional needs are considered and recorded in care plans. Specialist diets are provided and where necessary assistance is given. The inspector observed lunch being served in the dementia care unit. Where service users required assistance, it was seen to be provided in a kind and caring manner. However, the meal was somewhat hurried and chaotic, with service users becoming impatient and staff trying to perform a number of tasks at once. It is suggested that available staffing resources should be reviewed to make better use of the people available in the home at mealtimes. For example, if all staff and management made themselves available to provide assistance, the main mealtime would become a less hurried and more dignified social occasion. It was also noted that only semi-skimmed milk is used in the home. Where service users are losing weight or require a higher calorie intake, it is recommended that the use of full fat dairy products as a food supplement should be considered. Further, although it is acknowledged that tinned fruit is served, fresh fruit should also be made available. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these outcomes / standards were assessed on this occasion. They will be examined during the next inspection of the home. EVIDENCE: N/A Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 Outstanding maintenance and redecoration detract from the homely nature, comfort and character of the home. EVIDENCE: Langholm is a well-established care home, which has been extended to provide a semi-independent unit for people with dementia. The original building has a choice of single and double bedrooms over three-floors. There is a large combined lounge/dining room and a separate lounge on the ground floor, and a separate lounge on the second floor. A vertical passenger lift is provided. The accommodation for people with dementia is at single-storey, ground floor level with access to the homes enclosed gardens. Much of the character of the original building and setting has been retained. Service users’ bedrooms were seen to be personalised with service users’ own furniture and other personal belongings. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 15 The inspector looked around the building, which was found to be generally clean and tidy. However, although action is being taken to reduce odours, some areas, for example the dementia care unit, require further cleaning or in some cases renewal of carpets. The home’s bathrooms are appropriately situated. Nevertheless, they would benefit from upgrading. It is also suggested that a shower room would be a useful addition. To ensure that Langholm can meet the future needs of service users coming into the home, bathroom upgrade costs should be considered within any future business plans for the home. However, the provision of WCs to disability standards requires more urgent consideration. As highlighted in previous inspection reports, additional WCs must be provided in appropriate areas for service users: 1 WC to disability standard on the top floor; 1 WC to disability standard on the middle floor; 1 WC to disability standard on the ground floor (old building); and 1 WC to disability standard in the extension. Although some areas have been redecorated, outstanding maintenance and redecoration generally detract from the homely nature, comfort and character of the home. For example, as highlighted in the previous inspection report, external window frames, doors and other woodwork to the rear of the premises are in urgent need of repainting / refurbishment. The state of this disrepair is heightened by a leaking overflow to the rear of the building, which in addition to nuisance dripping is causing a potential slip hazard outside the laundry below. The leaking overflow must be repaired. Langholm provides a generally safe environment for service users. All radiators have been guarded or have low surface temperatures. Where specialist equipment, such as pressure relieving mattresses, is required, it is obtained. Where bed rails are provided, risk assessments are prepared. However, a number of window restrictors fitted to upper floor windows are either damaged or inadequate to prevent opening. Risk assessments relating to window openings on upper floors should be carried out and regularly reviewed. Where necessary, more suitable window restrictors should be fitted to prevent injuries. Where unrestricted windows are in individual bedrooms, risk assessments should also consider risk to other service users who might wander into the room. Any changing needs of individual service users, for example as a result of infections, should also be considered when care planning arrangements are reviewed. Hot water temperatures must also be monitored and where necessary, hot water regulators adjusted / repaired to maintain safe supplies of hot water. An action plan showing repairs and redecoration works intended and timescales for completion should be forwarded to CSCI. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these outcomes / standards were assessed on this occasion. They will be examined during the next inspection of the home. EVIDENCE: Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these outcomes / standards were assessed on this occasion. They will be examined during the next inspection of the home. However, reports required under Regulation 26 of The Care Homes Regulations 2001 must be forwarded to the Commission. Copies of these reports must also be provided to the registered manager. Further, as highlighted in previous inspection reports, the registered manager should obtain NVQ level 4 in Care and Management (or equivalent) by 2005. EVIDENCE: N/A Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 19 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 21 Regulation 23(2)(j) Requirement As highlighted in previous inspection reports, additional WCs to disability standards must be provided in appropriate areas for service users. As highlighted in the previous inspection report, external window frames, doors and other woodwork to the rear of the premises are in urgent need of repainting / refurbishment. The leaking overflow must be repaired. Hot water temperatures must also be monitored and where necessary, hot water regulators adjusted / repaired to maintain safe supplies of hot water Some areas, for example the dementia care unit, require further cleaning or in some cases renewal of carpets. Reports required under Regulation 26 of The Care Homes Regulations 2001 must be forwarded to the Commission. Copies of these reports must also be provided to the registered manager. Timescale for action Overdue 2. 19 23 1 September 2005 3. 26 23 1 September 2005 1 September 2005 4. 37 26 Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 1 Good Practice Recommendations Statement of Purpose and Service Guide documents should be reviewed to ensure that they contain all the information required to be in them under Regulations 4, 5 & Schedule 1 of The Care Homes Regulations 2001. For example, the number and size of rooms in the home should be included. It should also be noted that in April 2004 the previous registration authority – the NCSC – ceased to exist. Any reference to the NCSC in the home’s Statement of Purpose, Service Users Guide or other documentation should be amended to refer to the Commission for Social Care Inspection (CSCI). Issues relating to challenging behaviour require some further consideration within care plans. Care plans should also be regularly reviewed and made available to staff at all times to ensure that, in addition to them recording the care provided, they inform the delivery of the care provided. Medicines should be administered by appropriately trained staff. The training for care staff should be accredited and include: basic knowledge of how medicines are used and how to recognise and deal with problems in use; and the principles behind all aspects of the home’s policy on medicines handling and records. Additional social activity / activity co-ordinator hours should be provided. Wherever possible meal choices should be offered. Available staffing resources should be reviewed to make better use of the people available in the home at mealtimes. For example, if all staff and management made themselves available to provide assistance, the main mealtime would become a less hurried and more dignified social occasion. Where service users are losing weight or require a higher calorie intake, the use of full fat dairy products as a food supplement should be considered. Fresh fruit should also be made available. Risk assessments relating to window openings on upper floors should be carried out and regularly reviewed. Where necessary, more suitable window restrictors should be B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 21 2. 3&7 3. 9 4. 5. 12 15 6. 19 Langholm Care Home 7. 31 fitted to prevent injuries. Where unrestricted windows are in individual bedrooms, risk assessments should also consider risk to other service users who might wander into the room. Any changing needs of individual service users, for example as a result of infections, should also be considered when care planning arrangements are reviewed. As highlighted in previous inspection reports, the registered manager should obtain NVQ level 4 in Care and Management (or equivalent) by 2005. Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection No 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Langholm Care Home B54 S45114 The Langholm V241061 100805 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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