Care Home: Langdale Lodge

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What the care home does well What has improved since the last inspection? Most of the requirements made at the previous inspection had been met. This resulted in improvements to information provided, care plans, and to the health and safety of people at the home. The range of activities provided had improved since the last inspection. People spoken with said they enjoyed activities such as bingo, music, and carpet bowls. A group of people were involved in a bowls league. A new gardening project was planned for the spring and summer. Staff spoken with were enthusiastic about activities and clearly enjoyed spending time with people at the home. Since the last inspection improvements had been made to the home, including new carpets, redecoration, and laminate flooring to the main entrance area and dining room. The refurbishment programme was ongoing with plans for more redecoration, carpets and a new bath for the first floor bathroom. What the care home could do better: Information could be provided for people in the home, their relatives, and staff about the Mental Capacity Act 2005. This would help to ensure that people`s rights were promoted and upheld. There were gaps in the staff recruitment procedures that potentially put people living in the home at risk. A fully robust recruitment procedure would ensure that people are protected. CARE HOMES FOR OLDER PEOPLE Langdale Lodge Selhurst Road Newbold Chesterfield Derbyshire S41 7HR Lead Inspector Rose Veale Unannounced Inspection 10th April 2008 09:25 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 Langdale Lodge DS0000067637.V362336.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. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langdale Lodge Address Selhurst Road Newbold Chesterfield Derbyshire S41 7HR 01246 550204 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) Miss Neemat Kassam Mrs Yasmin Nazir Kassam Vacancy Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th June 2007 Brief Description of the Service: Langdale Lodge is located in a quiet residential area of Chesterfield, approximately a mile from the town centre. Personal care and accommodation is provided for up to 23 older people. The home is modern and purpose built with accommodation and communal areas on two floors. There is a mature accessible garden to the rear and car parking at the front of the home. Information about the home, including CSCI inspection reports, is available at the home or from the provider. The fees range from £350 to £360 per week. The acting manager provided this information on 21st April 2008. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit was unannounced and took place over 6 hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 20 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The acting manager was available throughout the inspection visit. The area manager was available for most of the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. Most areas of the building were seen. The Annual Quality Assurance Assessment (AQAA) had been completed and returned prior to the inspection and information from this has been included in the body of this report. What the service does well: What has improved since the last inspection? Most of the requirements made at the previous inspection had been met. This resulted in improvements to information provided, care plans, and to the health and safety of people at the home. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 6 The range of activities provided had improved since the last inspection. People spoken with said they enjoyed activities such as bingo, music, and carpet bowls. A group of people were involved in a bowls league. A new gardening project was planned for the spring and summer. Staff spoken with were enthusiastic about activities and clearly enjoyed spending time with people at the home. Since the last inspection improvements had been made to the home, including new carpets, redecoration, and laminate flooring to the main entrance area and dining room. The refurbishment programme was ongoing with plans for more redecoration, carpets and a new bath for the first floor bathroom. 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. Langdale Lodge DS0000067637.V362336.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 Langdale Lodge DS0000067637.V362336.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, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a satisfactory needs assessment process and sufficient information provided so that residents were confident the home was able to meet their needs. EVIDENCE: The Statement of Purpose had been reviewed and updated since the last inspection and a Service User Guide had been produced and distributed to people living in the home. The Service User Guide included comments from people living in the home. The records of 3 people were seen. 1 person had been admitted as an emergency from hospital and there was no assessment information from their social services care manager, although there was assessment information from the hospital staff. The acting manager said she had chased up the information Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 9 from social services without success. The other 2 records included sufficient information from social services and hospital staff. Standard 6 did not apply to this home, as there were no people receiving intermediate care. Langdale Lodge DS0000067637.V362336.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. Improvements had been made in care planning so that residents received care and support to meet their individual needs and preferences. EVIDENCE: The 3 care records seen each included an individual care plan. The care plans covered all the assessed needs and were reviewed monthly. The care plans included some references to maintaining privacy and dignity and included some details of personal preferences. Care plans generally lacked detail of how people preferred care and support to be provided. However, staff spoken with were very knowledgeable about peoples individual needs and preferences. People spoken with were satisfied that their needs were met. The care plans were not signed by the person or their representative to indicate their involvement in care planning. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 11 There were records of visits from GPs, District Nurse, optician and dentist. People were referred promptly and appropriately for healthcare support. For example, District Nurses were asked to carry out continence assessments or to advise on the care of minor wounds. The records seen all included assessments of manual handling needs, continence, and the risk of developing pressure sores. The tool used to assed risk of developing pressure sores was the Norton Scale and there was no explanation of what action should be taken in relation to the scores noted. There was a keyworker system in place with records kept of regular review meetings between the keyworkers and people in the home. The notes of the meetings were signed by the person as well as the member of staff. Staff spoken with were knowledgeable about the needs and preferences of the people they were keyworkers for. People spoken with were aware of their keyworkers. Medication was stored securely and was administered by the senior care assistants who had all received appropriate training. The Medication Administration Records (MARs) seen were correctly completed. Staff spoken with were aware of correct procedures to follow to ensure safe handling of medication. People spoken with felt that staff respected the privacy and dignity of people living in the home. One person said, “the staff are very good – nothing is too much trouble”. Another person said that staff were “kind” and “cheerful”. It was observed that staff spoke to people in an appropriate and respectful manner. Langdale Lodge DS0000067637.V362336.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 good. This judgement has been made using available evidence including a visit to this service. People were consulted about their preferences so the lifestyle in the home generally met their needs and expectations. EVIDENCE: The range of activities provided had improved since the last inspection. People spoken with said they enjoyed activities such as bingo, music, and carpet bowls. A group of people were involved in a bowls league. A new gardening project was planned for the spring and summer. Staff spoken with were enthusiastic about activities and clearly enjoyed spending time with people at the home. People’s spiritual needs were noted in the care plans and there were links with local churches. Visitors spoken with said they were always made welcome at the home and that they were able to see their relatives in private if they wished. People were encouraged to make comments about the home in a comments / suggestion book and at the regular meetings for residents and their relatives. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 13 The notes of the meetings showed that action had been taken to address ideas and issues raised, for example, changes to the menu. People said they enjoyed the meals at the home. They were regularly asked for ideas for the menu by the cook and at residents meetings. The ground floor dining room was bright and pleasant. The lunch served on the day of the inspection looked appetising and was well received by people at the home. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. On the whole, staff awareness and the policies in place were sufficient to ensure people were protected and their complaints effectively dealt with. EVIDENCE: The complaints procedure was included in the Service User Guide given to all people at the home. Not all of the people spoken with were aware of the complaints procedure, but all said they would be able to go to staff or the manager with any concerns. People were encouraged to bring concerns or complaints to the meetings for residents and their relatives, and also to put any ideas / comments / complaints in a book left out in the main entrance area. There was a file for recording complaints, but there were no entries. The acting manager said that complaints were usually sorted out quickly because people would come directly to her. The Annual Quality Assurance Assessment (AQAA) completed before the inspection said that no complaints had been received. CSCI were aware of one complaint that had been made directly to the provider. The acting manager said that the provider had everything relating to this complaint, but there were no records available at the home. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 15 An anonymous complaint was received by CSCI before the inspection. Some elements of the complaint were followed up during the inspection and there was no evidence found to uphold them. Other elements of the complaint were referred to the provider to investigate. Staff at the home had all received training about safeguarding vulnerable adults. Staff were aware of what abuse was and of the procedures to follow in the care home. However, there appeared to be some gaps in knowledge about the local multi-agency procedures. Staff were not fully aware of the procedures that should be followed by senior staff if an allegation of abuse was made. If the correct procedures were not followed, people using the service could be at risk. The local authority multi-agency policy and procedures and the “No Secrets” document were not available in the home. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 16 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, 21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well maintained and clean so that people living there enjoyed a safe and pleasant environment. EVIDENCE: Since the last inspection improvements had been made to the home, including new carpets, redecoration, and laminate flooring to the main entrance area and dining room. The refurbishment programme was ongoing with plans for more redecoration, carpets and a new bath for the first floor bathroom. As at previous inspections, it was seen that most people chose to sit in the ground floor lounge and in the entrance area so the first floor lounge was Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 17 rarely used as intended. The first floor lounge was sometimes used by visitors and was used for staff training and meetings. People spoken with said the home was always clean and fresh. All areas seen during the inspection visit were clean and free from any offensive odours. Since the last inspection a new washing machine and tumble dryer had been provided in the laundry room. The acting manager said it was planned to replace the flooring in the laundry room. The garden was accessible and well maintained and there was a gardening project planned for people living in the home to be involved in. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 18 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. The staff training programme and staffing levels were satisfactory so that residents were protected and well supported. Although improvements had been made, the recruitment procedure was not fully robust to ensure people living in the home were protected. EVIDENCE: The current staff rotas were seen and showed that there were 3 care assistants on duty for the morning and afternoon shifts, covering the hours from 7am to 8pm. In addition, there was a cook, a housekeeper and a handyman. There were 2 care assistants working the night shift. People living in the home said that staff were available when needed. Staff spoken with said the staffing levels were sufficient for the current number and dependency of people living in the home. Staff induction included a period of shadowing an experienced member of staff. Staff had received training in manual handling, first aid, health and safety, infection control, equal opportunities, and fire safety. The AQAA said that over 50 of care staff had already achieved National Vocational Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 19 Qualification (NVQ) in care at level 2 or above, and that other care staff were working towards the qualification. Staff spoken with were pleased with the training provided. The records of 3 members of staff were seen. All 3 staff had Criminal Record Bureau (CRB) disclosures and POVA First checks. The employment history on 2 of the application forms did not include enough detail and information. 2 of the members of staff did not have references from their previous employer. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed and there were good systems in place so that the health, safety and welfare of residents was promoted and protected. EVIDENCE: The acting manager had been in post for approximately 18 months. She said she had recently started the application process to register with CSCI. People spoken with said the acting manager was “well organised”, “approachable” and “easy to talk to”. They said they had confidence in her to sort out any issues or problems. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 21 The acting manager was not fully aware of the requirements of Regulation 37 of the Care Homes Regulations to notify CSCI of certain incidents in the home. The quality assurance system had been further developed since the last inspection. There were meetings for people living in the home and their relatives with notes kept of the items discussed and action taken. There had been 3 meetings held in 2008 and the acting manager said it was planned for the meetings to be monthly if possible. Other quality assurance measures included internal audits by the acting manager, monthly visits by the provider (Regulation 26 visits), use of the comments / suggestions book, and feedback from the keyworkers. The area manager said there were plans to produce a newsletter for the home. Records were seen of personal money held for people living in the home. The records were well kept and up to date. The area manager carried out regular checks of personal money. The AQAA was returned by the due date and included all the information required. The AQAA showed that maintenance and health and safety checks were up to date. The fire logbook and accident reports were seen and were satisfactory. The home had not complied with the 2007 smoke free regulations. Following discussion with the manager, immediate action was taken on the day of the inspection visit to address this issue. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 23 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 OP16 Regulation 17(2) Schedule 4 Requirement Timescale for action 31/05/08 2 OP29 19(1)(b) 3 OP29 19(1)(b) 4 OP38 37 There must be a record of all complaints made about the home with details of the action taken. This will help to ensure that complaints are taken seriously. Previous timescale 11/07/07 There must be a full employment 31/05/08 history, with a satisfactory written explanation of any gaps, for all staff employed at the home. This will help to ensure that people living in the home are protected. For all staff employed there must 31/05/08 be a reference from the previous employer if the last period of employment involved work with children or vulnerable adults. This will help to ensure that people living in the home are protected. Notifications of death, illness and 31/05/08 other events as specified in the regulation must be sent to CSCI. This will help to ensure that people living in the home are protected. Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP7 OP7 OP19 Good Practice Recommendations Care plans should be devised in consultation with residents / their representatives and should include more detail to ensure that people’s needs are met in the way they prefer. There should be training for staff and information available about the Mental Capacity Act 2005 to ensure that people’s rights are protected and upheld. The use of the ground floor bathroom should be reviewed and consideration given to the provision of an accessible bath and / or shower. This would provide people with a choice of bathing / showering facilities. Staff should have supervision sessions 6 times per year. This would ensure people are assisted by competent and well supported staff. There should be information available at the home about the smoke free regulations introduced in 2007. This would ensure that the home complies with the regulations, and that people living in the home, their relatives and staff are aware of the regulations. 4 5 OP36 OP38 Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Langdale Lodge DS0000067637.V362336.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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