Care Home: Langdale House Care Home

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What the care home does well Langdale House caters for a small group of people who`s needs are met by a staff team, led by a qualified manager. The service provides a safe environment where people feel confident that their needs are met in accordance with their individual wishes. What has improved since the last inspection? The requirements set at the last key inspection have been addressed and implemented. No further requirements have been made as a result of this inspection. Some improvements have been made to the environment including some redecoration and purchase of curtains and floor coverings. Pre-admission assessment and care planning has improved to encorporate a more `person centred` approach. What the care home could do better: There are a number of areas where the environment could be further improved with regard to refurbishment and redecoration. The entry system to the service would benefit from having an intercom system installed in place of the current security measure that is in place. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Langdale House Care Home Grove Avenue Nottingham NG7 4BP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Starr     Date: 0 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Langdale House Care Home Grove Avenue Nottingham NG7 4BP 01159783822 F/P01159783822 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Bernard Okenwa Ogbakaeko,Mrs Cordelia Nwafor Ogbakaeko care home 12 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 1 12 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 Within the total number of residents accommodated, 1 may be within the registration category MD(E) Date of last inspection Brief description of the care home Langdale House Care Home is an adapted detached house on a private road, situated close to the shops and other amenities in Hyson Green and near to the tram route to Nottingham city centre, Bulwell and Hucknall. The accommodation is on two floors. Three bedrooms are on the ground floor with one shared bathroom. The remaining bedrooms and a shower room are on the first floor and there is a lift to these rooms. There is a small garden to the rear of the home, with a courtyard frontage. Car parking is limited to the courtyard and to the front of the building, on a narrow, private road. Care Homes for Older People Page 4 of 26 Brief description of the care home The home is not fully accessible for full-time wheelchair users, but a portable ramp is available on request, to provide access to the main entrance, which has four steps. Although registered for people of both sexes, the current occupants are all male. The current scale of charges is Three hundred and thirty six pounds 43 pence per week, which does not include the cost of haircuts, trips or new clothing. The Service User guide sets out the range of facilities provided, peoples rights and the complaints procedures. This is available on request, but also on display in the foyer of the home, together with the current Certificate of Registration and a copy of the last Inspection Report. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of Inspections undertaken by the Care Quality Commission is upon outcomes for people who use the services and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We ask managers to fill in a questionnaire called an Annual Quality Assurance Assessment, which tells us about how well their service provides for the needs of the people who use it and how they intend to improve their service. We received this back from the manager within the required timescale and the form was completed in a satisfactory manner, providing us with information to assist in planning our visit and deciding what areas to look at. Care Homes for Older People Page 6 of 26 We also reviewed all the information we have received about the service since we last visited on the 11th April 2008 and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking which involves us selecting a number of people who use the service and looking at the quality of the care they receive by speaking with them, observation, reading their records and asking staff about their needs. We also sent Have Your Say questionnaires to a random selection of people who use the service, some relatives and some staff members. The information provided in the replies we received, was also a contributory factor in the focus of our inspection visit. We spoke with 2 members of staff and 3 people who use the service to form an opinion about the quality of the service being provided. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who use the service. A copy of the latest inspection report can be found by visiting the Care Quality Commission web site at www.cqc.org.uk What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to live at the home have their needs assessed to ensure their needs can be met. People are given information about the service to assist them in making a decision about their choice of home. Evidence: The written information provided to us by the manager tells us We have reviewed and updated our service user guide and statement of purpose. We plan individual visits for people to spend time at the home and have lunch. We looked at the above documents and found them to be informative and comprehensive, providing people with useful information. These documents were all on display in the foyer of the home, along with the last inspection report. Care Homes for Older People Page 10 of 26 Evidence: We looked at the files for three people who live at the service, including the last person to be admitted. These files all contained a contract of residency, a pre admission assessment and care plans. Peoples individual needs, choices and wishes had been addressed within this process. The assessments were thorough and it was evident that some of the information had been obtained prior to a person moving to the home. We sent out ten questionnaires to people living at the home, ten to relatives and a further ten to staff. Six people who live at the service returned them and where we asked Did you receive enough information about the home before you moved in? all six replied yes and comments included I came here for a visit before I moved in. I love this home and dont think I will move to another place. I love to stay here for ever. Two staff responded and where we asked Are you given up to date information about the needs of the people you support? both replied Always. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare needs are assessed and provided for in a way which shows respect for the privacy and dignity of people who live at the service whilst meeting their identified needs. Evidence: The manager told us in the written information he provided Each Service User is supported to make his or her decisions and these are evaluated at regular intervals. Staff are trained to promote choice and empowerment, respect and dignity. On admission to the home, each person is assessed to see if they would be safe to administer their own medication and if appropriate, is then given the opportunity to do this. One person is currently self medicating and their care file contains an up to date risk assessment. We looked at the care plans for three people who live at the home, including the last person to be admitted. These were thorough and did provide us with evidence that the Care Homes for Older People Page 12 of 26 Evidence: person had been consulted and involved in this process. The care plans had also been reviewed regularly and any changes clearly documented, agreed and signed by the person. We found the healthcare needs of people living at the service are being assessed and there is clear evidence in the records that they are referred for specialist advice and treatment as needed. People who live at the service told us that the staff treat them with respect, The staff are very nice. I do whatever I want and I know the staff are good. The carers really look after me and comfort me. We observed staff knocking on peoples doors before entering and speaking with people in a respectful manner. A questionnaire returned from a member of staff said, The staff in the home give good care and support to the residents and we get all the information we need daily at report. We spoke with staff and they demonstrated a good understanding of the principles of respect and dignity. We looked at storage arrangements for medication and medication records. We found the records to be well maintained and the storage appropriate. Staff we spoke with who administer medication told us that they feel confident to undertake this task and have had training to do so. The training records we looked at confirmed that staff have had training to administer medication and that this training is regularly reviewed. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People mostly experience a flexible lifestyle which is in accordance with their needs, abilities and preferences. Evidence: The manager told us in the written information he provided We have completely open visiting arrangements and the people living here can meet with friends, relatives or professional visitors, undisturbed. People we spoke with told us that they do go out with staff and do shopping and some people told us that they have visitors who take them out. Records showed us that people had been on outings last year to Skegness and Newstead Abbey. These locations were chose by people at one of their residents meetings. The surveys we sent to people asked Are there activities arranged by the home that you can take part in? Four replies said Always and two said Usually. Comments include I decide on the activity I want and my wishes are respected. I do whatever I Care Homes for Older People Page 14 of 26 Evidence: want. Relax, watch television, play dominoes with the staff. Its very sociable here. Sometimes I go to the shop on my own and sometimes with staff. I prefer to stay in. I dont like people much. There was a programme of activities displayed in the dining room but people told us they prefer to do as they please. One person we spoke with said they prefer to spend time in their room, reading, watching television or going out with family. With reference to food the information tells us We offer three meals daily as well as snacks and drinks. Special diets are catered for, e.g. diabetic. A menu board in the dining room displayed the choices for lunch and we observed people being asked what they would like. People we spoke with told us that they really enjoy the food and have whatever they want. Ive put weight on since I came here. On the day of the inspection, some people had enjoyed a cooked breakfast. One person said that they have a take away sometimes or the staff will cook something special for them. Another person said that they had asked to have a particular meal on Good Friday and staff confirmed that this was being provided. Staff we spoke with on the day of the inspection demonstrated good knowledge of peoples choices, wishes and preferences. The care plans we saw did have information recorded about peoples previous hobbies and interests as well as current choices. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain and have confidence that any concerns would be acted upon and responded to. People living at the service are safeguarded from harm and abuse. Evidence: We looked at the services policy and procedure regarding complaints and protection and found it to be detailed enough to advise people how to make a complaint. The surveys that were returned to us from people who use the service all said that they know how to make a complaint and who to speak to if they are not happy. One person said that they had previously had cause to complain but the manager sorted the problem out straight away. People we spoke with told us that they would always tell any problems to the manager and another person said I have a mentor on the staff who advises me on procedure. In the entrance of the home there is a comments book where visitors are invited to record anything they wish to. The comments we saw recorded were quite positive. No complaints have been recorded since the last inspection. We discussed complaints and concerns with the manager and he told us that as soon Care Homes for Older People Page 16 of 26 Evidence: as anyone raises an issue he deals with it and that is why he does not get complaints from people. Previous records of complaints did show us that they are dealt with appropriately, are fully investigated and the outcomes shared with the complainant. Staff told us that they pass on any concerns that people raise with them and added that the manager is very proactive in sorting things out for people. As part of our case tracking process we looked at the files of three staff members. We saw evidence that the staff have had training in Safeguarding Adults and staff we spoke with demonstrated that they understood and worked within this. Safeguarding Adults is a process of identifying and reporting suspected or potential abuse of vulnerable people and provides a framework of consistency to protect those individuals at risk. People we spoke with told us that they felt safe I am alright here and safe and comfortable. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe comfortable and reasonably well maintained environment which meets their needs. Evidence: The manager told us in the written information he provided The home is clean, pleasant and hygienic. We maintain a safe environment and have a handyman who visits each morning to undertake any identified tasks. We conducted a partial tour of the home and looked at the communal areas, the bathrooms and some peoples bedrooms. The areas we saw were clean and well maintained and some benefitted from recent redecoration and new floor coverings. The environment smelled fresh and people we spoke with told us that the home is always clean and tidy. Maintenance records are kept and show that the handyman responds quickly to any problems that are identified and recorded by staff. There is a schedule in place to ensure that all areas are kept clean and tidy and these domestic chores are completed by care staff during their shifts. Care Homes for Older People Page 18 of 26 Evidence: Staff are responsible for doing peoples laundry and when we asked people if this is done to their satisfaction, they all replied Yes. The gardens were tidy and were planted with a variety of flowers and shrubs, providing a relaxing and pleasant area for people to enjoy. People we spoke with told us that they are very happy with the standard of accomodation and all liked their bedrooms. The ground floor bathroom would benefit from some redecoration and possible replacement of fittings. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by well trained staff in sufficient numbers to meet their needs. Evidence: We looked at the staff rota which showed us that there are always two staff on duty in addition to the manager, who works split shifts in order to be at the service at peak times. As well as carrying out care duties, staff are responsible for providing meals and doing the cleaning. Staff we spoke with said that these duties are achieved without compromising the quality of the care they are able to provide for people. This is due to the level of peoples independence and the fact that they are encouraged and empowered to retain as much independence as possible. People we spoke with told us They do whatever I need them to do. I like to keep myself to myself and am happy to get on with things. The surveys people returned to us told us The staff in this home are very good to me. All the staff are a friendly lot. The carers are doing their best. They give me all the care I need. As part of our case tracking process we looked at files for three members of staff. All three files contained evidence that the correct procedures had been followed when Care Homes for Older People Page 20 of 26 Evidence: they were recruited. This included, Criminal Record Bureau and Protection of Vulnerable Adult checks, two written references and where applicable, valid work permits. The training records we saw showed us that all staff have achieved National Vocational Qualifications level two and some at level three. All mandatory training has been completed and is up to date. This includes Food Hygiene, Moving and Handling, Administration of medication as well as Safeguarding Adults, Mental Capacity Act and managing Challenging Behaviour. Further training is arranged for the future and includes Deprivation of Liberty. Staff we spoke with demonstrated a good level of knowledge relating to the training they have undertaken. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well managed and is being run in the best interests of the people who live there. Evidence: The Annual Quality Assurance Assessment completed for us by the manager was returned within the required timescale and it contained useful information about the service. The manager has in excess of twenty two years experience in management and has achieved a high level of qualifications, including National Vocational Qualification Level four in Management and Care. Since the last key inspection the service have achieved a number of goals that were identified in the homes annual development plan. These include some refurbishment of rooms, improvement in the standard of pre admission assessment and care planning Care Homes for Older People Page 22 of 26 Evidence: to include a person centred approach and an activities programme based on the wishes of the people living at the service. Regular meetings are held where people are encouraged to discuss anything of concern or interest to them. The information gained at these meetings is recorded and used in the planning and development of the service. People we spoke with told us that they use the meetings to decide where they would like to go on outings as well as talking about any concerns they may have. Two people we spoke with commented that the manager is a lovely man and easy to talk to. Staff we spoke with said that they feel very well supported by the manager who is available whenever they need him. They told us that he is approachable and is dedicated to the home. A Quality Assurance Survey has been completed by the people living at the service and some relatives. We saw the results of this and the information that was gathered through this process has been analysed and any outcomes addressed. Staff files showed us that staff receive supervision two or three monthly and an annual appraisal. Staff told us that they find this useful to look at career development and progression but reinforced that the manager is always around if they have a problem. We found that the Health and Saftey testing and sevicing has been undertaken as required and staff told us that they consider their Heath and Safety is well protected as well as the people living at Langdale House. They told us they are up to date with all statutory courses and this was confirmed by training records. Records we saw showed us that seven accidents have occurred since the last key inspection. These were falls and one person had a nose bleed. Each of these accident records detailed the actions taken and the outcomes for the person. Risk assessments have been completed with regard to falls and are present in peoples care files. The Care Quality Commission have received one regulation 37 notice . (This is a regulatory process which informs us of any reportable incidents that occur at a service.) Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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