CARE HOMES FOR OLDER PEOPLE
The Langholm 14/16 High Bondgate Bishop Auckland Durham DL14 7PJ Lead Inspector
John Trainor Unannounced Inspection 11th January 2006 11:30 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 The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Langholm Address 14/16 High Bondgate Bishop Auckland Durham DL14 7PJ 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) 01388 450149 01388 450149 Alphacare Services (UK) Ltd Mrs Michelle Sandu Lloyd Care Home 31 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (19) of places The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th August 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. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and took 6 hours. It included a tour of the building, inspection of records and talking to people who live at the home, as well as staff, to see what the service is like. The registered provider was spoken to on the telephone. The detail of peoples care package was looked into to get a picture of what it was like to be cared for in the home. The representative of the home at the time of inspection was the registered manager Michelle Sandu Lloyd. What the service does well: What has improved since the last inspection? What they could do better:
Improvements were needed to the safe administration of medication to ensure people had the correct drugs at all times and avoid the risk of errors. Care plans would benefit from attention to mental health and social and occupational needs to ensure people had all of their needs met in a holistic way. Attention was needed to practices in the home to ensure people would be safe at all times. Doors were wedged open in contravention of fire regulations placing people at risk in the eventuality of a fire. Staff were seen transferring people in a wheelchair without footrests placing them at risk from catching their feet during transport. The fabric of the building needed improvement and some areas needed new carpets. Windows needed replacing or repair. There was a foul smell in the dementia care unit which was not nice for people who had to live there. Windows on the upper stories needed to be made safe in case someone fell into them and the home was required to do work to correct this.
The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 6 Procedures for what to do in case of adult abuse needed revision to ensure correct procedures were followed to protect people and one member of staff had not been CRB checked by the provider before starting work which must not happen again. The staff member was required to be CRB checked. 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 Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 6. People have sufficient information to make a choice before they move into the home. EVIDENCE: The statement of purpose had been reviewed following the requirement from the last inspection. The home does not provide intermediate care. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Though people’s health and personal care needs were met in a way which respected their individuality and dignity, improvements were needed to the safe management of medication. EVIDENCE: Care plans were in place on files inspected and included people’s health and personal needs. Some records were better than others in terms of the detail of personal preference and improvements were needed in recording peoples mental health and social needs to ensure consistency of approach from all staff and to be clear of risk and relapse management triggers. There was evidence of involvement of multi disciplinary health professionals and primary care teams. Some improvement to the storage and administration of medication was needed as a staff member was observed to dispense into multiple pots before administering medication. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 People’s dietary needs were met and there were activities for people which would be improved by individual social care planning. EVIDENCE: The manager was in the process of appointing an activities co-ordinator as recommended from the last inspection. Dietary needs were met with plans to introduce a new nutritional assessment tool in conjunction with local health professionals. Chefs were due to begin further training on the dietary needs of the elderly. Care planning did not have people’s social and occupational needs recorded. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People had a clear procedure for making complaints should they need to though adult abuse procedures were not robust enough to ensure protection in all eventualities and needed revision. EVIDENCE: There was an adequate complaints procedure and people spoken to felt their concerns would be heard and acted upon if they needed to complain. The adult abuse policy needed revision in line with “No Secrets” and the local multi agency strategy. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. Outstanding maintenance and redecoration detracted from the homely nature, comfort and character of the home. EVIDENCE: Some areas of the home required refurbishment and some carpets needed replacing. There was an odour in the dementia care unit noticeable from the moment you enter the door. Cleaning of carpets must be more robust to manage the odour problem which arises from people’s incontinence. Windows on the upper stories did not appear to have safety glass and were at a height where it would be possible to topple through so action was required to make these safe. Some window restrictors were also necessary to ensure safety. Some previous requirements had been actioned though further improvements were needed to the fabric of the building internally and externally. Previous requirements to provide disabled toilets on all floors had not been met. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 13 Upon inspection of the environment it appeared impractical to provide a disabled toilet on the top floor though adaptation to the bathroom on the middle floor appeared possible to improve disabled access and there was a passenger lift to all floors so people could access disabled facilities. The requirement has therefore been amended to reflect this and it is recommended people who need disabled access are house on a floor where there is disabled access. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Though peoples health needs were met by staff in sufficient numbers some practice was observed relating to medication which suggested people needed reminding of safe practice through supervision. Recruitment processes needed to be more robust to ensure safety of people. EVIDENCE: The manager had enough flexibility to deploy staff as needs demanded. Staff training was acceptable with evidence of induction signed off and all staff trained in health and safety issues including safe administration of medication though as previously stated reminders were needed as some unsafe practice was observed. Some staff files did not have the required two references and one person had been recruited without the manager applying for a new CRB check as they had recently had one done by another company (within weeks). This is not acceptable practice and CRB checks should be made by the provider before staff are confirmed in post. The manager was directed to recent guidance on the CSCI website. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Though the home was managed in a competent manner with the interests of service users at heart some improvements were needed to both the fabric of the building and practices in the home to ensure the safety of people in every eventuality. EVIDENCE: The manager had been in post for six years and had almost completed the NVQ 4 which she expected to finish within 2 months. Service user monies were managed in a safe way which ensured people were protected. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 16 Gas and electrical checks had been completed to ensure the installations were safe. However the hard wiring electrical certificate could not be found and Legionella checks could not be evidenced. This evidence was required to be forwarded to the CSCI. Fire safety, equipment and passenger lift checks were being conducted and staff were trained in health and safety food hygiene and first aid. Windows on the upper stories were unsafe and some unsafe practice was observed as has been noted earlier. Improvements were needed to adult abuse policy and recruitment. Some doors were wedged open contravening fire regulations. The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 1 1 The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 18 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 OP9 Regulation 13 (2) Requirement Timescale for action 11/01/06 2 OP18 13 (6) 3 OP21 23 (2(j & n)) 4 OP19 23 All staff should be reminded of safe practice in administration of medication and must administer safely. Storage of medication should be reviewed with the local pharmacist to explore better options than the one used currently. The adult abuse policy and 30/04/06 procedure must be revised in line with “No Secrets” and local multi agency policies and procedures. A copy of the multi agency strategy should be obtained form the local authority. The toilet in the bathroom on the 30/09/06 middle floor identified with the registered manager must be adapted for disabled access. Rooms with double occupancy should have two hand basins with suitable screening to allow for people to wash in privacy. As highlighted in the previous 30/09/06 inspection report, external window frames, doors and other woodwork to the rear of the premises are in urgent need of
DS0000045014.V266189.R01.S.doc Version 5.0 The Langholm Page 19 5 OP26 23 6 OP29 19 7 OP37 26 8 9 10 11 OP38 OP19OP38 OP38 OP38 23 13 (4(c)) 13(4(b)) 13 (4(a)) repainting / refurbishment. (Previous timescale of 1st September 2005 not met.) Some areas, for example the dementia care unit, require further cleaning or in some cases renewal of carpets. (Previous timescale of 1st September 2005 not met.) All staff must be CRB checked and have two references taken up and recorded by the provider prior to being confirmed in post. Current up to date guidance on CRB is available on the CSCI website and the manager should familiarise herself with this. 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. (Previous timescale of 1st September 2005 not met.) Doors must not be wedged open unless by devices approved by the fire officer for this purpose. Windows on the upper floors must be risk assessed and made safe. People must not be transported in wheelchairs without the use of footplates. Evidence of the safety of the electrical installation and of legionella must be made available to the Darlington office of the CSCI before 18th january 2006 30/09/06 11/01/06 28/02/06 11/01/06 11/01/06 11/01/06 18/01/06 The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 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 OP7 Good Practice Recommendations Care plans should be improved to account for mental health needs and social occupational needs. Where someone has a diagnosed mental health problem risk and relapse management plans should be obtained from the mental health team. The manager should obtain the NVQ 4 in care management before June 2006. 2 OP31 The Langholm DS0000045014.V266189.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Darlington Area Office 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
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