Care Home: Langford Park Care Home

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What the care home does well The home was clean and people living at the service appeared to be content and well cared for. All staff were polite, welcoming and helpful. There were plenty of drinks available and food was in plentiful supply. Care planning has improved since the last inspection but this improvement needs to be continued. The plans we looked at during this inspection included a pre admission assessment for a person admitted recently to the Home. This contained some very good information that would help staff meet their needs such as at what level their blood sugars normally ran if they were diabetic. Care plans also included detailed information about a persons` needs such as a nervous disposition and how to meet these needs. One care plan showed excellent would care recording and appropriate referrals to other relevant health care professionals. Another showed attention to a safe environment such as keeping the area clutter free and a call bell to hand. The Manual Handling plans were detailed and very personalised. Whilst the actual care plans were detailed, the daily records informing staff of how a person was doing were not so informative excluding wound care. We saw that Continence Care Plans were in place which provided guidance on how to manage individual continence needs throughout the day and night and there was evidence in the care plans we looked at of referrals to other professionals. Since the last inspection the manager has introduced fluid intake records for all people living at the home. We were told this is to ensure that people take enough fluids but also as an exercise to ensure that staff maintain these records. There was no evidence to suggest that, despite the considerable weight loss, this person had any problems with skin integrity and had no pressure sores. We discussed with the manager the need for more detailed guidance to be added to the care plan to ensure that the persons` weight continues to be closely monitored. The manager was very knowledgeable about individuals dietary intake needs such as one person had a very small appetite and only liked certain drinks. This information was not in the care plans but staff were also aware. The service had completed their own detailed assessments about continence promotion including 3 day diaries producing some good information for when people received their assessment. Staff knew when certain people were likely to need toileting and staff were aware of this too. One person had been referred to the speech therapist regarding their diet and this information was in the care plan. Care plans we looked at had identified those people who may be at risk of pressure damage to their skin and plans to manage these risks were being followed. There was evidence that four people, whose care we looked at in detail, were being monitored and getting the support they needed to maintain their skin integrity.We saw the care plan for one person and when we visited them in their room and we found evidence that their position had been changed regularly to ensure they did not suffer from pressure damage and they also had a pressure relieving mattress to further minimise the risk. The person looked comfortable their skin was being checked regularly to ensure skin integrity is maintained and had no pressure damage to their skin. All the above information was included in the person`s assessment and care plan. Care plans also included information about how wounds were treated. The positions of wounds were identified on a "body map", kept in individual care plans, and information of how the wound was being treated and the outcome of the treatment and any changes were recorded. We noted that people living at the service are encouraged to be as independent as possible given the limitations of their physical and mental health. During this visit we saw people walking independently around the home, saw staff anticipating individual needs and prompting some people including those who suffer from dementia, with most activities of daily living. There was evidence in care plans that the service seeks the advice and input of health care professionals. There was evidence in the four care plans we looked at in detail, of risk assessments, records of multi professional visits and daily notes to show that this home does consult other professionals and follow the guidance and advice given. We saw evidence that people living at the service are offered dental checks, `flu vaccination and are visited by the Chiropodist if they choose. All four care plans we looked at included a social care plan and one to one time with the activities co-ordinators. Since the last inspection the service has recruited an activities organiser and an activities assistant at the service. At the time of this inspection we saw staff engaging with people asking them if they would like to join in with activities and offering alternatives if they chose not to. The service has started to record social information about people living at the service and relatives and friends have also been asked to be involved in this. During this inspection we saw carers assisting people at the service and their approach appeared to be respectful. Plans looked at advises that staff should always explain what they are going to do before they provide care. Service users in general seemed well cared for and their choices of how they spent their day were being met. One person was having a lie-in and the service was helping them move to a home nearer their family. They were also able to self-medicate safely which was facilitated by staff. We spoke to one visitor who visited the Home regularly. They felt that their friend (a person living at the home) was very well looked after and always looked well kempt and that their room was tidy. They particularly liked the fact that their friend could enjoy the company of a cat, which was fed in their room and the area kept clean. A relative was seen to be well cared for by staff as they looked after a service user offering tea and lunch to the relative and being reassuring and gentle in their care. On the day of the visit to the home on 07/07/10 it was evident that all four people whoserecords of care we looked at in detail were receiving good quality care, although there were some areas for improvement. We discussed this with the manager at the completion of this inspection. What the care home could do better: The first 24 and 48 hour assessments were not particularly detailed although staff were able to talk about this persons needs. This information would help to inform staff who did not know the service user well in the initial days of them being at the home. Whilst the actual care plans were detailed, the daily records informing staff of how a person was doing were not so informative excluding wound care. We spoke to a person who has lived at the home for several years and who felt that the standard of care had gone down and that they would like to go home. They felt that staff did not have the time to spend with them. They were happy being on their own but could not use the call bell to summon staff for help relying on task times when staff would enter their room to give them a meal. They did spend some time in the garden. They felt that staff did not have the time to make them comfortable and they had complex needs and very limited mobility. They had been calling for staff to rearrange their position but no-one had heard. They said that they had been alone since 10am with their shoulder blades in an uncomfortable position. This person needed a plan to address their lack of mobility and inability to use a standard call bell to enable them to see staff on a more regular basis to check that they were comfortable. The manager told us they were aware of this persons increased needs and the GP had been informed. However there was not a clear procedure in place to inform staff of this persons wishes should they deteriorate and a copy of a living will was not available. Two carers were asked what this person`s wishes were regarding resuscitation and both were unaware and therefore may not meet this persons needs should they deteriorate. The care plan also did not reflect these needs or include a method of regularly revisiting this persons` views on resuscitation. Most fluid intake records were well completed but none had been totalled by staff at the end of a 24 hour period. This means that it is not clear whether people have been provided with enough fluid during a day. We discussed this with the manager who assured us that staff will be required to do this in future and they will be provided with training to ensure they are aware of the relevance of noting if people are not having sufficient fluid intake and take action to reduce the risk of dehydration. The care plan and a nutritional plan for one person did not include information to confirm they were receiving the support needed to maintain their weight. Although the person had been weighed regularly and the weight loss was recorded no action had been taken to manage this. Despite the records showing the person was losing weight there was a 2month period when they were not weighed. Following this gap it was recorded the person had loss a considerable amount of weight but there was no record of any actions taken to address this need. We were told that the diet for this person had been adapted to ensure that a high calorie intake was provided. Staff had made a recorded of whether the person had actually eaten the meals provided but this record was not consistent. We were told that each person living at the home has an individual nutrition plan, which includes specific individualised information about individual`s dietary needs. We asked to look at information provided, which would enable the cook and all staff to manage the specific dietary needs of this person. There was no information recorded to provide this information. We were told that staff ensured that meals were prepared in a way to ensure they were high calorie. We were told that staff would, for example, add cream to puddings and potatoes to increase the calorific value. A record had been kept of this person being visiting by their doctor in relation to the loss of weight and dietary supplements had been prescribed. However, when we looked at the record of medications, where the supplements must be recorded when received into the home, there was no record of them being received. We were told, after this inspection, that the supplements had been received and were kept in the person`s room; however there was record of this or of the administration of them. There was no evidence to suggest that, despite the considerable weight loss, this person had any problems with skin integrity and had no pressure sores. We discussed with the manager the need for more detailed guidance to be added to the care plan to ensure that the persons` weight continues to be closely monitored.However, we did discuss with the manager that there should have been earlier consultation with the GP regarding the weight loss of one of the people living at the home. Random inspection report Care homes for older people Name: Address: Langford Park Care Home Langford Road Newton St Cyres Exeter Devon EX5 5AG one star adequate service 18/01/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michelle Oliver Date: 0 7 0 7 2 0 1 0 Information about the care home Name of care home: Address: Langford Park Care Home Langford Road Newton St Cyres Exeter Devon EX5 5AG Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Vision UK Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 34 Number of places (if applicable): Under 65 Over 65 24 0 old age, not falling within any other category physical disability Conditions of registration: 0 10 The maximum number of service users who can be accommodated is 34. The registered person may provide the following category of care only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) - maximum number of places 24. Physical disability (Code PD) - maximum number of places 10. The registered person must ensure that additional communal space which is suitable to meet the needs of people whose primary care needs on admission relate to their physical disability is in place and available for use by those service users within six months of this registration. Care Homes for Older People Page 2 of 11 Date of last inspection Brief description of the care home 1 8 0 1 2 0 1 0 Langford Park Nursing Home is situated off the main Exeter to Crediton Road, near the village of Langford, in a rural setting. There are ample parking facilities, but limited access by public transport. Most people living at the home have nursing needs on both the 10-bed wing for Younger Adults with Physical Disabilities and the floors, above, for older service users. The service has a shaft lift to enable people to access all floors, as well as external level access to the first floor. Only one bedroom is registered for double occupancy. Younger and older residents presently share lounge and dining areas. The cost of care ranges between £520-£750 per week for older people requiring residential or nursing care and £600- £1400 for younger adults at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing, some activities and outings and personal items such as toiletries and newspapers. Current information about the service, including CQC reports, is available to people living at the home and to those considering making Langford Park their home. Care Homes for Older People Page 3 of 11 What we found: This Random Inspection was undertaken following concerns raised in relation to the management of individuals continence and fluid intake and to look at compliance with the Requirement and recommendations made following a recent Key Inspection. Concerns had also been raised relating to alleged rejection of advice and training which was offered and general concerns had been made from other professionals, especially around staff attitude and residents quality of life. The inspection was carried out by 2 inspectors, from 10am - 3:30pm on 7th July 2010 to carry out a site visit as part of this inspection. During our visit, we spoke to 9 people who were living in the home that day and to a visitor. We read the care records of 4 people we met, one of whom had recently moved into the home. We case tracked them as a way of helping us find out more about how the home cares for or supports individuals. We looked around the communal areas of the home that they used and at their bedrooms. We read other information, that would help to tell us how the home is run, including staff training records. We talked with 3 care staff, a registered nurse and the manager. During this inspection we looked at the issues raised by looking at care plans to establish whether they provide an accurate and accessible assessment of the needs of each individual and whether they identify what interventions are required by individuals and how intervention should be evaluated and when and how completed. We also looked at daily records to check whether they show how and when every intervention has been made. This included looking at how the service actively identifies people living at the home who are at risk of pressure damage to their skin and are plans to manage this risk followed. We also wanted to look at whether the service works with people living at the home to manage their continence issues in a positive, personal and dignified way. We looked at how the service effectively ensures that all people living at the home have a sufficient fluid intake and also whether the service asks for advice and support from other professionals (e.g. G.P, specialist nurses for bladder/bowel/tissue viability/diabetes/MS/ Parkinsons Disease, therapists such as OT, physiotherapy, Speech and Language) appropriately and follow any guidance and advice given by other professionals. We looked at records to establish how the service ensures that people living at the home are supported to be as independent as possible with their care and social activities and whether people living at the home have access to meaningful activities on a daily basis. To enable us to look at these issues we looked around the building, spoke to several people living at the home and staff where clarification was needed or specific questions needed to be asked about individuals living at the home or procedures within the home. We also looked in detail at care plans for four people. This included looking at records including assessments and management of individuals skin, nutrition, fluid intake, activities and assessments of individuals mental capacity to make choices and decisions. Care Homes for Older People Page 4 of 11 What the care home does well: The home was clean and people living at the service appeared to be content and well cared for. All staff were polite, welcoming and helpful. There were plenty of drinks available and food was in plentiful supply. Care planning has improved since the last inspection but this improvement needs to be continued. The plans we looked at during this inspection included a pre admission assessment for a person admitted recently to the Home. This contained some very good information that would help staff meet their needs such as at what level their blood sugars normally ran if they were diabetic. Care plans also included detailed information about a persons needs such as a nervous disposition and how to meet these needs. One care plan showed excellent would care recording and appropriate referrals to other relevant health care professionals. Another showed attention to a safe environment such as keeping the area clutter free and a call bell to hand. The Manual Handling plans were detailed and very personalised. Whilst the actual care plans were detailed, the daily records informing staff of how a person was doing were not so informative excluding wound care. We saw that Continence Care Plans were in place which provided guidance on how to manage individual continence needs throughout the day and night and there was evidence in the care plans we looked at of referrals to other professionals. Since the last inspection the manager has introduced fluid intake records for all people living at the home. We were told this is to ensure that people take enough fluids but also as an exercise to ensure that staff maintain these records. There was no evidence to suggest that, despite the considerable weight loss, this person had any problems with skin integrity and had no pressure sores. We discussed with the manager the need for more detailed guidance to be added to the care plan to ensure that the persons weight continues to be closely monitored. The manager was very knowledgeable about individuals dietary intake needs such as one person had a very small appetite and only liked certain drinks. This information was not in the care plans but staff were also aware. The service had completed their own detailed assessments about continence promotion including 3 day diaries producing some good information for when people received their assessment. Staff knew when certain people were likely to need toileting and staff were aware of this too. One person had been referred to the speech therapist regarding their diet and this information was in the care plan. Care plans we looked at had identified those people who may be at risk of pressure damage to their skin and plans to manage these risks were being followed. There was evidence that four people, whose care we looked at in detail, were being monitored and getting the support they needed to maintain their skin integrity. Care Homes for Older People Page 5 of 11 We saw the care plan for one person and when we visited them in their room and we found evidence that their position had been changed regularly to ensure they did not suffer from pressure damage and they also had a pressure relieving mattress to further minimise the risk. The person looked comfortable their skin was being checked regularly to ensure skin integrity is maintained and had no pressure damage to their skin. All the above information was included in the persons assessment and care plan. Care plans also included information about how wounds were treated. The positions of wounds were identified on a body map, kept in individual care plans, and information of how the wound was being treated and the outcome of the treatment and any changes were recorded. We noted that people living at the service are encouraged to be as independent as possible given the limitations of their physical and mental health. During this visit we saw people walking independently around the home, saw staff anticipating individual needs and prompting some people including those who suffer from dementia, with most activities of daily living. There was evidence in care plans that the service seeks the advice and input of health care professionals. There was evidence in the four care plans we looked at in detail, of risk assessments, records of multi professional visits and daily notes to show that this home does consult other professionals and follow the guidance and advice given. We saw evidence that people living at the service are offered dental checks, flu vaccination and are visited by the Chiropodist if they choose. All four care plans we looked at included a social care plan and one to one time with the activities co-ordinators. Since the last inspection the service has recruited an activities organiser and an activities assistant at the service. At the time of this inspection we saw staff engaging with people asking them if they would like to join in with activities and offering alternatives if they chose not to. The service has started to record social information about people living at the service and relatives and friends have also been asked to be involved in this. During this inspection we saw carers assisting people at the service and their approach appeared to be respectful. Plans looked at advises that staff should always explain what they are going to do before they provide care. Service users in general seemed well cared for and their choices of how they spent their day were being met. One person was having a lie-in and the service was helping them move to a home nearer their family. They were also able to self-medicate safely which was facilitated by staff. We spoke to one visitor who visited the Home regularly. They felt that their friend (a person living at the home) was very well looked after and always looked well kempt and that their room was tidy. They particularly liked the fact that their friend could enjoy the company of a cat, which was fed in their room and the area kept clean. A relative was seen to be well cared for by staff as they looked after a service user offering tea and lunch to the relative and being reassuring and gentle in their care. On the day of the visit to the home on 07/07/10 it was evident that all four people whose Care Homes for Older People Page 6 of 11 records of care we looked at in detail were receiving good quality care, although there were some areas for improvement. We discussed this with the manager at the completion of this inspection. What they could do better: The first 24 and 48 hour assessments were not particularly detailed although staff were able to talk about this persons needs. This information would help to inform staff who did not know the service user well in the initial days of them being at the home. Whilst the actual care plans were detailed, the daily records informing staff of how a person was doing were not so informative excluding wound care. We spoke to a person who has lived at the home for several years and who felt that the standard of care had gone down and that they would like to go home. They felt that staff did not have the time to spend with them. They were happy being on their own but could not use the call bell to summon staff for help relying on task times when staff would enter their room to give them a meal. They did spend some time in the garden. They felt that staff did not have the time to make them comfortable and they had complex needs and very limited mobility. They had been calling for staff to rearrange their position but no-one had heard. They said that they had been alone since 10am with their shoulder blades in an uncomfortable position. This person needed a plan to address their lack of mobility and inability to use a standard call bell to enable them to see staff on a more regular basis to check that they were comfortable. The manager told us they were aware of this persons increased needs and the GP had been informed. However there was not a clear procedure in place to inform staff of this persons wishes should they deteriorate and a copy of a living will was not available. Two carers were asked what this persons wishes were regarding resuscitation and both were unaware and therefore may not meet this persons needs should they deteriorate. The care plan also did not reflect these needs or include a method of regularly revisiting this persons views on resuscitation. Most fluid intake records were well completed but none had been totalled by staff at the end of a 24 hour period. This means that it is not clear whether people have been provided with enough fluid during a day. We discussed this with the manager who assured us that staff will be required to do this in future and they will be provided with training to ensure they are aware of the relevance of noting if people are not having sufficient fluid intake and take action to reduce the risk of dehydration. The care plan and a nutritional plan for one person did not include information to confirm they were receiving the support needed to maintain their weight. Although the person had been weighed regularly and the weight loss was recorded no action had been taken to manage this. Despite the records showing the person was losing weight there was a 2 Care Homes for Older People Page 7 of 11 month period when they were not weighed. Following this gap it was recorded the person had loss a considerable amount of weight but there was no record of any actions taken to address this need. We were told that the diet for this person had been adapted to ensure that a high calorie intake was provided. Staff had made a recorded of whether the person had actually eaten the meals provided but this record was not consistent. We were told that each person living at the home has an individual nutrition plan, which includes specific individualised information about individuals dietary needs. We asked to look at information provided, which would enable the cook and all staff to manage the specific dietary needs of this person. There was no information recorded to provide this information. We were told that staff ensured that meals were prepared in a way to ensure they were high calorie. We were told that staff would, for example, add cream to puddings and potatoes to increase the calorific value. A record had been kept of this person being visiting by their doctor in relation to the loss of weight and dietary supplements had been prescribed. However, when we looked at the record of medications, where the supplements must be recorded when received into the home, there was no record of them being received. We were told, after this inspection, that the supplements had been received and were kept in the persons room; however there was record of this or of the administration of them. There was no evidence to suggest that, despite the considerable weight loss, this person had any problems with skin integrity and had no pressure sores. We discussed with the manager the need for more detailed guidance to be added to the care plan to ensure that the persons weight continues to be closely monitored.However, we did discuss with the manager that there should have been earlier consultation with the GP regarding the weight loss of one of the people living at the home. 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 2. Care Homes for Older People Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 11 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, 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 1 7 The first 24 and 48 hour assessments should include detailed information to staff who did not know the service user well in the initial days of them being at the home. Development and improvement in the information included in care plans should continue. This is to ensure that each individuals health and personal care needs are set out in an individial plan of care, which is reviewed regulary and when required to enable staff to meet individual needs. 2 7 3 17 The legal rights of people living at the service should be protected. This relates to records of choices and advance decisions not being kept for at least one person who we were told had made a Living Will, which was not retained in their files. 4 37 The rights and best interests of people living at the service should be safeguarded by the homes record keeping policies and procedures. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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