Care Home: Langholme

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What the care home does well People said they enjoyed living in the home and felt well cared for. Staff were described as kind, caring and friendly. Comments such as "I am exceptionally happy here, to me it is really home" and "the staff are wonderful" were received through the surveys. The home was commended for the quality of it`s care plans, which were found to be detailed and written from the perspective of the person receiving care. Quality assurance process were also commended for the thorough way in which the home and the provider examines it`s services and identifies areas for further improvement. Staff were well trained and knowledgeable about people`s needs. Meals were nutritious and varied and daily social and leisure activities were well planned. People said the meals were "well prepared with a good choice" and "good, tasty food". What has improved since the last inspection? Refurbishment of the home continues with bathrooms and bedrooms being upgraded. The care plan format that was newly initiated at the previous inspection had been introduced for all those living in the home and as noted above was found to provide an excellent level of detail. What the care home could do better: Mrs Bagley and her staff team, with support from the organisation, are providing a safe and well managed home for the people living at Langholme and no requirements for improvement have been identified as a result of this inspection. Key inspection report Care homes for older people Name: Address: Langholme Arwenack Avenue Falmouth Cornwall TR11 3JP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Jane Gurnell     Date: 0 8 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 24 Information about the care home Name of care home: Address: Langholme Arwenack Avenue Falmouth Cornwall TR11 3JP 01326314512 01326317577 home.fal@mha.org.uk www.mha.org.uk Methodist Homes for the Aged care home 39 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Langholme Residential Home is one of many homes owned by Methodist Homes for the Aged and is registered to provide accommodation and care for a maximum of 39 service users. The home was previously inspected in June 2007. The home is purpose built and provides accommodation on two floors. There is a large lounge on the first floor and dining room on the ground floor. The home is suitable for a resident who requires a wheelchair, and two lifts provide access to the first floor. Attractive garden are located at the rear of the home that are also wheelchair accessible. Langholme is situated a short walking distance from the town centre of Falmouth and the Maritime Museum. All the facilities the town has to offer are within easy reach of the Home. Car parking is available for visitors to the home. The current fees for the home range from 458 to 470 pounds per week. Information about the services provided ca be obtained directly from the home. Care Homes for Older People Page 4 of 24 Over 65 6 33 0 0 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: three star excellent 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: This inspection was unannounced and undertaken on Monday 8th June 2009. Mrs Bagley, the Registered Manager was present and she and her staff assisted us throughout the visit. Many of the people living in the home were spoken with as were the staff on duty. A tour of the building was made and records relating to the care of three people were examined in detail as were records relating to the recruitment and training of staff and the running of the home. Prior to the inspection, the Commission sent surveys to the home for people living in the home and staff to give their views about the quality service provided. Eight were received from people living in the home and all commented favourably. Nine were received from staff and all said they receive support to undertake their role. Two staff said covering sickness at short notice was problematic. Care Homes for Older People Page 5 of 24 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 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 6 of 24 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 7 of 24 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 considering moving to Langholme can be assured their needs will be assessed before they move in to ensure the home is able to meet their needs from the point of admission. Evidence: People considering moving to the home have their needs assessed by the Registered Manager to determine their preferences and choices. The assessment enables the Registered Manager to determine if the care home is able to meet the needs of the person concerned. The Providers have established a format for recording the assessments and the assessments were found to be comprehensive, detailing the persons own views of their care needs and the support they require. This makes sure the Registered Manager is confidant the facilities and services are suitable to meet the needs of each prospective resident. Care Homes for Older People Page 8 of 24 Evidence: The records indicated that a number of the people assessed were also in regular contact with specialist workers including social workers and nurses. It was clear the opinions of specialist workers had also been taken into account. People who have recently moved to the home confirmed they were consulted about their needs as part of the assessment process and they and their relatives were invited to visit the home. They said they had been well received at the home when they were admitted and were positive about the manner in which the staff provided the care and support they require. The Providers do not offer intermediate care or rehabilitation services. The Providers are however committed to maximising peoples independence as part of the care and support they provide. Care Homes for Older People Page 9 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are very detailed and person-centred, ensuring care needs are met in a consistent and safe manner. Good arrangements are in place to meet health needs and medical services are promptly accessed when required. Medication practices are safe. Evidence: Those people spoken with and who were able to make a direct comment about the care they received said they were very happy in the home and that staff were polite, kind and friendly. When asked if there was anything that would improve the quality of their life at the home people said that they could not think of anything. One person said, Im very happy here, its lovely, and another person said, its a lovely home. Some of the people living in the home were frail and suffered from confusion: these people werent able to directly comment about the quality of the care they received however they appeared relaxed and contented and staff were seen to treat them gently and respectfully. Care Homes for Older People Page 10 of 24 Evidence: The care plans and daily care notes for three people who had been identified with more complex care needs were looked at in detail. These provided a very comprehensive description of each persons needs and were written in a manner that reflected the persons own wishes and preferences. The care plans included guidance for staff in considering peoples care needs and the action required to meet those needs, as well as advice from health care professionals regarding medical conditions such as diabetes. Included in the care plans were assessments regarding skincare, nutrition, moving and handling, the risk of falls and continence management. Should someone suffer an accident, these were well recorded in their care file and on a separate accident form. All accidents were reviewed regularly by the Registered Manager and the senior manager for the organisation to identify if environmental changes could reduce the risk of accidents or if the persons health and well being were deteriorating and professional healthcare advise was sought from the GP or District Nurse. There was evidence that the care plans and assessments had been reviewed frequently, at least monthly, and had been signed by the person completing the care plan as well as the person the care plan was written for and/or their relative. The home is commended for its person-centred and comprehensive care plans. Those staff spoken with the very knowledgeable about peoples care needs and were able to identify how to support people who are risk from developing pressure sores and also that those who are risk due to poor nutritional intake. Records indicates that General Practitioners and Nurses regularly visit the home. On the days of the inspection a District Nurse was visiting the home and she confirmed her confidence in the staff to alert her to peoples health care needs. Medicines are kept in secure facilities and the staff administering medicines are all appropriately trained and a good working relationship is in place with a Pharmacist. Medicines that are no longer required are disposed of safely and a suitable policy and procedure is in place to guide, direct and inform the staff. When it is safe to do so people are able to manage their medication but staff also assist where required. Secure storage is available in each bedroom for the storage of medicines and valuables. The Registered Manager confirmed that those people who develop terminal illnesses are able to remain at the home as long as the staff and the District Nursing Service can continue to meet their needs. People have been asked about their preferences with regard to their care towards the end of their lives and this is clear and well documented. Care Homes for Older People Page 11 of 24 Evidence: Care Homes for Older People Page 12 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good arrangements are in place to meet peoples social and recreational needs and a range of opportunities are in place at the care home and in the local community. Dietary needs are well catered for with a balanced and varied selection of food available that meets peoples tastes and choices. Evidence: People said the routines of daily life were flexible: they can get up and go to bed when they wish as well as come and go from the home. Flexible visiting arrangements are in place and people said the staff always positively welcomed visitors. People are able to decide where they meet with visitors and the staff will support the person if they decide not to have contact with a visitor. The Providers have established a range of activities at the home and in the local community that reflect peoples interests and pastimes. The programme has continued to be improved and developed and many activities are well attended. Seven people retuning a survey said the home always arranged activities they can take part in: one person did not answer this question. Several people were seen to be enjoying an Care Homes for Older People Page 13 of 24 Evidence: exercise session held in the lounge room. One person said she, really likes the exercises. Photographs were available of people enjoying recent activities in the home, such as card and picture making as well as trips out of the home. Some people choose not to participate in the activities provided and prefer to manage their own recreational opportunities. Peoples hobbies and social interests were recorded in their care plans. People said the food was very good: four people returning a survey said they always liked the meals and four people said usually. A varied nutritional menu is in operation and people have a good choice at each mealtime. There are at least two choices of cooked meals at lunchtime and a choice of a cooked and a cold meal at tea time. Further alternatives were available upon request. People are asked to contribute to the menu planning and there is meal review form in the dining room that allows people to comment about the quality of the food as well as to make their preferences known, anonymously if wished. Drinks and snacks are available at all times including during the night. There is a small kitchen in the dining room where staff can make people drinks when they wish. The chef confirmed there was sufficient catering staff employed to not only meet the needs of the people living in the home but also to provide a meals on wheels service to about 30 local people each day. The kitchen was found to be very clean indicating regular cleaning takes place, and appropriate equipment is in place that is regularly serviced and maintained. Care Homes for Older People Page 14 of 24 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. Satisfactory arrangements are in place for dealing with any concerns, complaints or allegations of abuse. People can be confident their concerns will be taken seriously and resolved promptly. Evidence: Neither the home nor the Commission has received any complaints about Langholme since the previous inspection. The Providers have established a satisfactory complaints policy and procedure. People said there were no barriers to raising any issues or concerns with any of the staff or the Registered Manager. People were confidant that any issues would be dealt with promptly. A satisfactory policy and procedure has also been established for dealing with any concerns or allegations of abuse. Any issues of concern are reported to the statutory authorities for investigation to make sure that every reasonable step is taken to protect people. A whistle blowing policy is also in place. This enables staff to report any concerns to a third party if they feel unable to directly raise the issue with the Registered Manager or the Providers. This provides people with further safeguards from abuse. Care Homes for Older People Page 15 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Langholme provides a spacious, comfortable and well-maintained home with sufficient facilities to meet the need of those currently living in the home. Evidence: Langholme is located near to the centre of Falmouth and therefore a wide range of facilities is within easy access. It offers all single accommodation and has pleasant, landscaped gardens. The care home is a two-storey building and the communal areas that are located in the centre of the home on both floors: the dining room on the ground floor adjacent to the kitchen and the lounge room on the first floor. Both rooms offer pleasant views over the gardens, as do many of the bedrooms. Two lifts provide access from the ground floor to the first floor for those people who are unable to manage the stairs. The home was found to be very clean and tidy with no offensive odours. People said they were very satisfied with their bedrooms and it was clear that people were able to bring personal belongings such as furniture and ornaments with them. Each bedroom is fitted with a lock to provide privacy and security of personal belongings and in addition to this there is a safe in each room to provide further security for valuable items. The Register Manager confirmed that bedrooms are redecorated to the persons choice when necessary, and in readiness for new people to move to the home. Care Homes for Older People Page 16 of 24 Evidence: Throughout the home the radiators were covered to reduce the risk of burns should people come into contact with them when they are on, and the hot water temperatures will control to prevent the risk of scalding. A range of toilet and bathroom/shower facilities is distributed throughout the care home and within a reasonable distance from the communal areas and peoples bedrooms. All the bathrooms have been refurbished to a high standard. It is evident that a wide rage of disability equipment is provided throughout the care home to assist people to maintain their independence. In addition people are individually provided with equipment when this is required following the completion of a specialist assessment, for example pressure relieving mattresses and cushions to reduce the risk of developing pressure sores. Care Homes for Older People Page 17 of 24 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 kind and well-trained staff employed in sufficient numbers to meet the needs of those currently living in the home. Recruitment practices are safe and robust. Evidence: People said the staff were kind, caring and very friendly. One person said, the staff are always happy and nothing is too much trouble another person said the staff have cheerful, friendly, kind attitude to the residents. People said they were assisted promptly when they needed help indicating that there were sufficient staff employed at present. The Registered Manager said she regularly monitors and reviews staffing levels to make sure peoples needs are fully met and is able to increase the number of staff available as peoples needs change. Those staff spoken with said they felt there was sufficient staff employed to meet the needs of the people currently living in the home. They also said they receive regular supervision and feel very well supported. Appropriate arrangements are in place to recruit new staff: three staff recruitment and training files were examined and all of these contained the necessary pre-employment checks, including written references and a criminal record bureau check. This makes sure, as far as possible, only suitable people are employed at the home. Newly appointed staff complete a comprehensive induction programme to make sure they are able to provide the care and support required. One member of staff who has Care Homes for Older People Page 18 of 24 Evidence: worked at the home for several years, confirmed that he is in training for a senior care position and is working through an induction for this role. This demonstrates very good practice that the home recognises a senior role as requiring specialist skills. The staff group are trained to a good standard in order they have the knowledge and skills to meet peoples needs. A training profile identifies training undertaken by the staff and when updates are necessary and records indicated that staff received training in fire safety, moving and handling, first aid and issues relating to aging such as dementia. Each day five to six care staff, including the senior member of staff, are employed each morning and four every afternoon and evening. In addition two waking night staff are on duty each night and additional staff can be called upon in an emergency. These numbers do not include the Registered Manager when she is on duty. Care staff are supported by catering, housekeeping, maintenance and administrative staff. Care Homes for Older People Page 19 of 24 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. Langholme is a well-managed home, run for the benefit of the people living there. Excellent arrangements are in place to regularly monitor and consult about the quality of the services and facilities. Evidence: The current Registered Manager, Mrs Bagley, took up the post in February 2006 and has made a significant impact in improving the quality of the facilities and services provided. Mrs Bagley has many years experience in providing care and support to older, vulnerable people and she holds the Registered Manager Award and a National Vocational Qualification at level 4 in Social Care: both qualification necessitated Mrs Bagley to demonstrate her skills and competence in managing care services for older people. Those people spoken with including staff members were very positive about the Registered Manager and had confident in the management arrangements. The home has a comprehensive quality assurance programme to consult with people living in the home and staff about the quality of the services provided. Regular staff Care Homes for Older People Page 20 of 24 Evidence: and residents meetings are held to discuss the running of the home, peoples preferences and to identify any additional staff training needs. Bi-annual in-house assessments look at all services provided within the home relating to peoples care and support and staff knowledge and development. The most recent assessment from March 09 was available and this gave a very detailed description how well the home supports people and how knowledgeable the staff are about care practices. In addition, a senior manager from organisation visits the home at least monthly to meet with staff and people living in the home. Once a year the senior manager undertakes a Standards and Values assessment that measures the home against the National Minimum Standards for Older People and the organisations own practice standards. This is a very comprehensive document that evaluates and identifies areas for improvement. The home is commended for having a detailed and honest evaluation of its services, for their commitment to treating people and staff in a manner that promotes equity and diversity and for continuing to strive for improvement. It is clear people are supported to maintain responsibility for their personal finances. Where people are unable to manage this and where there is no third person available to offer assistance, the home offers safe keeping for money and valuables. The records were well maintained and those checked were found to be accurate: the Registered Manager regularly monitors and audits these records. The Providers have established robust policies for fire prevention and fire safety. The records confirm the fire equipment is regularly checked and regular fire practices and training for staff are in place. Care Homes for Older People Page 21 of 24 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 22 of 24 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 23 of 24 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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