CARE HOMES FOR OLDER PEOPLE
The Langholm 14/16 High Bondgate Bishop Auckland Durham DL14 7PJ Lead Inspector
John Trainor Unannounced Inspection 31st October 2006 10:30 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.V305733.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. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 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 665914 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.V305733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th January 2006 Brief Description of the Service: The Langholm is a well-established care home, which has been extended to provide a separate unit for people with dementia. The home 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. At the time of this inspection fees charged ranged from £364.50 to £398.50. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included gathering information from the home prior to a site visit which was unannounced. The site visit lasted 6 hours during which there was a tour of the building and people were spoken to about the home including people resident, staff and the manager. Records were inspected including some policies and procedures, health and safety records and care records. There was also an unannounced Random inspection conducted on 24th August 2006 due to concerns raised with the Commission for Social Care Inspection. Some deficits were found and requirements to improve were made. The home had been expected to improve infection control measures and staff recruitment procedures both of which had been addressed by this inspection. The home also was required to ensure all people had an assessment of need documented before they moved into the home. All files inspected at this time had pre admission assessments. What the service does well: What has improved since the last inspection?
Some refurbishment had been completed both inside and outside the property though the standard of the re-decorating was generally poor. Other areas still needed attention. Improvements had been made to the recruitment of staff following a Random inspection earlier in the year and there were now procedures to follow to make sure all staff were recruited safely. Infection control measures and pre admission assessments had also been improved following the Random Inspection. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 6 One of the double rooms had been fitted with an additional sink to enable people to have their own washing facilities when sharing a room. The second room had a sink waiting to be fitted and this was scheduled. Training on Nutritional needs for kitchen staff had been completed. 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. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 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.V305733.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People did not have all the information they needed to make an informed choice before they moved into the home. EVIDENCE: People were given the service user guide and statement of purpose before they moved into the home. These documents were reviewed and revised by the manager when necessary. All files inspected had pre admission assessments including assessment by professionals where appropriate. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 9 When the local authority was funding care, people did not have written terms and conditions or confirmation that the home was able to meet their needs before moving into the home. The home did not provide intermediate care. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had their health and personal care needs met in a planned way. EVIDENCE: All files inspected had care plans detailing care people needed including how this was to be delivered. There was evidence of access to Doctor, District nurse and other health professionals to show people had their health care needs met. Staff were seen to move and handle people safely using equipment when necessary though some people were being transported without footrests on their wheelchairs which can cause accidents and injury The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 11 Staff were seen to treat people with dignity and respect and people said the staff were very kind when delivering care. Medicines were administered and recorded well though improvement to storage would be made by having a drug trolley. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 12 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People had some choice of activity and diet. EVIDENCE: Relatives and friends could visit when they wished and staff were seen to actively engage with relatives during the site visit. People liked the food and menus were varied though the chef did not use fresh vegetables, frozen were used as a matter of course because of time constraints. The main cooker was also out of commission though this did not seriously impact on people’s dietary intake as steamers were being used and there was a separate oven. Staff were trained or were receiving training in nutritional needs. People had some activities and progress was being made to tailor these to individual requirements though this area still needed some improvement.
The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s concerns were listened to and acted upon though improvements to adult protection training were necessary to ensure people would be protected in the event of abuse. EVIDENCE: There was a complaints policy and complaints were recorded. There was an adult abuse policy which reflected the local multi agency strategy. Staff needed training on POVA and adult abuse issues. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People lived in a clean home which needed some refurbishment and redecoration. EVIDENCE: Some redecoration had taken place though of poor quality. Flooring throughout the home was poor and the majority of carpets needed replacing. The odour problem in the dementia unit had improved though some of the rooms in the home did still have odour problems.
The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 15 Windows on the top floor at the rear had window restrictors fitted though these had been left unscrewed by the handyman for decoration rendering them useless. Windows at the front of the house still needed replacing. No change had been made to disabled toilet access in the home. Improvements were needed. Infection control measures had improved with paper towel and liquid soap in all toilet and bathroom areas. The exterior rendering to the building was coming away in several places leaving the house unsightly. There had been a leak in the ceiling of the dementia unit and they were waiting for this to dry out to refurbish. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples needs were met by a group of committed staff with some training. EVIDENCE: Staff were deployed in sufficient number to meet the residential forum guidance. People said the staff were kind. Staff were seen to treat people well. The home was committed to staff training though changes in staffing meant the level of staff trained to NVQ 2 or above had dropped below the required 50 . Recruitment procedures had been improved and were fit for purpose. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 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 managed safely though improvement to mechanisms for ensuring supervision and adequate staff training were necessary. EVIDENCE: Service user monies were recorded and managed well so people could be assured their money was safe. Legionella checks were taking place to ensure people were not at risk.
The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 18 Staff recruitment was now managed safely. Health and safety issues were in the main managed well though window restrictors on the top floor at the back were unscrewed and a carpet outside the lift on the ground floor needed to be made safe. Staff were not receiving sufficient formal supervision to make sure practice was current and of good standard. Mandatory training was not taking place at the required level for fire safety and there were not sufficient people trained in first aid to deploy one on each shift. The manager did not have a process in place for identifying and managing training and supervision of staff in the home and needed to develop this area to ensure training was delivered as needed. An at a glance training matrix would be of benefit. The manager’s NVQ 4 was not completed and needed to be finished. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 1 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 X 1 The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 Requirement Timescale for action 31/12/06 2. OP21 23 (2(j & n)) 3. OP19 23 4. OP19 23 Each service user must be provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). Bathrooms on the middle and 30/09/07 top floor require remodelling to allow for improved disabled access and to enable people to be assisted. (Previous timescale of 30/09/06 not met.) As highlighted in the previous 30/09/07 inspection report, external window frames, doors and other woodwork to the rear of the premises are in urgent need of repainting / refurbishment. (Previous timescale of 1st September 2005 not met.) Windows at the front of the house need replacing. Carpets throughout the home 30/04/07 were in poor condition and needed replacing. In particular the carpet outside the lift on the ground floor was a trip hazard and needed attention. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 21 5. OP19 23 6. OP33 24 7. 8. OP36 OP38 18 13(4) 9. 10. 11. OP38 OP38 OP38 13(4) 23(4) 13 (4) A programme of routine maintenance and renewal of the fabric and decoration of the premises must be produced and implemented with records kept. An effective quality assurance methodology must be introduced which makes sure the views of service users inform quality improvements. Staff must be formally supervised at least 6 times per year in line with this standard. One bed in the dementia unit was fitted with bed rails but did not have bumpers fitted for use. Bed rails must only be used within a risk assessment framework and must include the use of bumpers. Window restrictors on upper floors must be maintained in working order. Fire training and refreshers must be conducted in line with current advice from the fire officer. Footrests must be used when people are transported in wheelchairs. 30/09/07 31/10/07 31/10/07 31/10/06 31/10/06 30/04/07 31/10/06 The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 22 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. 3. 4. 5. Refer to Standard OP9 OP18 OP31 OP26 OP38 Good Practice Recommendations Medication should be stored and transported in a locked medication trolley. Staff should receive training in POVA and adult abuse. The manager should obtain the NVQ 4 in care management before June 2006. It is recommended odour control is more robustly managed to identify where there are odour problems and introduce measures to rectify the problem. The manager did not have a process in place for identifying and managing training and supervision of staff in the home and needed to develop this area to ensure training was delivered as needed. An at a glance training matrix would be of benefit. The Langholm DS0000045014.V305733.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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
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