Care Home: Langley Lodge

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What the care home does well Langley Lodge has a permanent staff team who have been in post for some years and give people a consistent approach. The management team have a good combination of nursing skills, social care support strategies, regularly update themselves on current legislation, training and are very knowledgeable about changes happening within the care sector in general. What has improved since the last inspection? All requirements and recommendations from the last key inspection have been achieved. The service has developed its person centred approaches and now consults and records each persons preferences and wishes. A care plan is then developed from this person centred approach. Activities are much more varied, frequent and there is a dedicated member of staff who arranges and monitors this. Quality assurance is to a high standard and is holistic in its approach with outcomes and achievements recorded each year. The staff now complete a skills for care induction criteria. The management team have improved safety by securing upstairs windows with safety brackets and renovation of the outside that needed attention. What the care home could do better: There are no recommendations or requirements from CQC at this time. Key inspection report Care homes for older people Name: Address: Langley Lodge 39 Imperial Avenue Westcliff On Sea Essex SS0 8NQ     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: Sarah Axam     Date: 1 9 1 0 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 26 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 26 Information about the care home Name of care home: Address: Langley Lodge 39 Imperial Avenue Westcliff On Sea Essex SS0 8NQ 01702340186 F/P01702340186 Lodgel@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Patricia A Campfield care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum nuber of service users who can be accomodated is: 26 Date of last inspection Brief description of the care home Langley Lodge provides nursing care and accommodation for up to a maximum of twenty-six older people including up to a maximum of two people who have been diagnosed with a terminal illness. The home is situated in a quiet residential area of Westcliff on Sea, close to the sea front, Chalkwell Park and the local shops and amenities on London Road. Langley Lodge is a large well-maintained older style property. The home provides fourteen single bedrooms and six double bedrooms. People living at the home have access to a small dining area, large lounge / Care Homes for Older People Page 4 of 26 Over 65 0 26 26 0 Brief description of the care home conservatory and a large well maintained garden area. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is *3 star. This means that the people who use this service experience Excellent quality outcomes. The unannounced site visit took four hours to complete and was carried out as part of the annual inspection programme for this service. This visit was conducted with assistance from the Manager and Provider. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. We looked at all the information that we had received, or asked for, or what the service has told us about things that had happened in the service since the last inspection. Two staff and residents were spoken with and one relative, during the site inspection. Prior to this site visit, CQC (Care Quality Commission) sent out surveys to all interested parties. Additionally the manager was sent an (AQAA) Annual Quality Assurance Assessment form by us. This is a self assessment required by law that asked how well Care Homes for Older People Page 6 of 26 the service think that they are meeting the needs of the people who live at Langley Lodge Care Home. All information obtained was triangulated and reviewed against the commissions key lines for regulatory activity. This helps us to use the information to make judgements about the outcomes for the people who use this service in a consistent and fair way. Care Homes for Older People Page 7 of 26 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 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clear and comprehensive assessment process assures people that their Nursing needs could be met prior to moving in their home. Evidence: The manager told us in the Annual Quality Assurance Assessment told us that there is a brochure available, which provides information about the home to help people decide if they would want to live at Langley lodge. When we visited we looked at this information. The brochure produced by the management team clearly sets out the specialist services the home offers and what qualifications the staff hold. There was also information about how a person could complain if they were unhappy about the home. We saw by documentation provided in the care plans that people who maybe interested in the home had visits arranged to the home to have a look around, meet Care Homes for Older People Page 10 of 26 Evidence: other residents and the staff. They could also have meals there and have time to get the general feel of the home. If they were happy to proceed to apply for a placement then an assessment is carried out by qualified staff. When we looked at the assessments we found that they included that persons specific issues, such as diabetes, dementia, wound care etc. All assessments we saw covered areas such as, mobility diets, weight, nutrition, safety, individual care needs, risks, mental and physical well being. All records viewed showed us that they gave sufficient detail about individual needs. All contracts were seen in all peoples files sampled and signed by all parties as expected. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Langley Lodge have support from staff in the way that they choose regarding their health and personal care. Evidence: The manager told us in the Annual Quality Assurance Assessment that the health and personal care needs of all residents are met and that staff are trained to practice person centred approaches. We saw in the eights peoples files looked at that they all receive effective personal and health care support using a person centred approach . Individual plans looked at showed us that peoples personal and health care needs are recorded clearly and detailed how they wished this to be delivered. Looking through care files we found that they all included things such as, water flow charts, fracture risk assessment, skin integrity assessment, behaviour assessment, turning charts and guidance for staff, assessment of physical needs such as, standing, mobilising, bathing and many more issue specific to an individual. All reviews were up to date with the relevant information to enable staff to support individuals appropriately. Care Homes for Older People Page 12 of 26 Evidence: We saw that when people needed to have additional support such as, aids and equipment, that they are provided and in place. They are regularly reviewed and replaced to accommodate a persons changing needs. Additionally specialist advice is sought by the home, such as Occupational health, district nurses, tissue viability nurse, GPs to ensure effective use of equipment and care is consistently provided. We were told by four residents and saw in peoples files, that they had the opportunity to choose their own GP. (or have the choice to keep their existing GP ) Looking through recorded entries made by the staff it is clear to us that all people have good access to all NHS health care facilities within their local community. We saw that regular appointments or visits made are made and there are systems in place to make sure that health appointments are not missed. We were told and saw through documentation looked at that one person at Langley Lodge had made particular requirements about the type of medication they wanted and we saw that the staff fully respected the right of that person. Discussion with the management and a RGN on duty revealed to us that they clearly recognise and work with the decisions made by the individual regarding any refusal to take medication, or any specific requests about how their health care is managed and that this is recorded. A relative we spoke with and the information recorded within peoples files and a professional (MacMillan nurse) spoken with. We saw within one persons files that the wishes of this individual about dying and terminal care and the arrangements they want after death are openly and sensitively discussed during the development of a person centred plan of care and is recorded well. We saw this in information looked through and with the staff and one relative who was spoken with. All staff receive in house training and practical advice and have continuous support and opportunities to discuss any anxieties or concerns. The staff and management team work closely with external professionals and specialists (consultants, MacMillan nurses etc) for advice and support. We saw that there was good information recorded about how medication is managed, for instance, we saw the correct receipt, recording, storage and handling, administration and disposal of medications. When we visited the service the staff confirmed to us that they knew procedures well and were aware of individual need. We saw by looking through staff files that all staff who administer medication have the required training. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their identified needs will be met appropriately and that they will be able to live the lifestyle they choose Evidence: Since the last inspection the management team have employed an activities worker to establish a more person centred approach to the activities provided. For instance the activities information looked at, showed us that all individuals had been consulted about activities, records showed us that they were asked, what they like and what they would like to try or if nothing was recorded from a person because they did not want to participate, of how staff could motivate some people into experiencing some form of interaction or stimulation. Things recorded that people liked to do were knitting, having access to daily newspapers, having walks outside of the home and using the local park and a variety of games provided, cards, jigsaws board games etc. This was well recorded and outcomes achieved were monitored. The home still continued to provide activities for special occasions such as Easter, Christmas, birthdays and parties arranged when families, friends and significant people in the residents live were invited to. Lots of pictures of these events were displayed and kept within the premises. We were told that there are plans to buy a Care Homes for Older People Page 14 of 26 Evidence: games console so that people can use this as an extra resource to be engaged in interesting pursuits and meaningful activity at any time during the day if they choose. Additionally we saw in peoples individual plans and daily notes, that plenty of visits by family and friends went ahead and that people had access to and visits from the local religious faith and ministers of their choice on a regular basis. The manager told us in the Annual Quality Assurance Assessment that each person had a care plan, which was reviewed every month or more often where this was appropriate. They told us that emphasis was put on enabling residents to make decisions and choices about their daily lives including what meals they eat. Feedback from speaking with two of the people who live at Langley Lodge confirmed to us that the food provided was of their choice and cooked well. Documentation showed us that the staff supported residents to choose, eat a healthy and well balanced diet and that they monitored weight and fluid intake on a regular basis. Food cooked and looked at on the day of inspection was fresh (using local suppliers of fish, meat, vegetables and fruit) and was home cooked by the chef on a daily basis. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated well and their concerns or complaints are dealt with appropriately. Evidence: We were told in the Annual Quality Assurance Assessment that any complaints or safeguarding alerts would be dealt with openly and thoroughly. The manager told us that residents and their relatives are provided with information on how to complain and how their concerns would be dealt with. They also told us that staff received information about dealing with complaints and whistle blowing when they commence work at the home. When we visited the home we looked at the policies and procedures. We saw that there was detailed information available for residents to assist them in understanding how to complain if they were unhappy. The complaints procedure was also available within the main area of the home, for all visitors to read and use. There was also detailed information made available to staff once they commenced work at the home, which described their roles and responsibilities in reporting bad practise. This included a whistle blowing policy. This helped to assure staff that they would be protected from harassment should they need to raise concerns. We looked at how staff were recruited to work in the home and saw that all of the checks such as employment references, Criminal Records Bureau disclosures were Care Homes for Older People Page 16 of 26 Evidence: obtained before a person started work at the home. This helped to ensure that only people who were suitable were employed. We saw that all staff had undertaken training in recognising and reporting abuse or bad practises. There have been no complaints raised about the home since the last inspection. Observation showed us that staff treated residents with respect and that residents were very comfortable and open in the company of staff. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a clean and well maintained homely environment. Evidence: Two people we spoke with who live at Langley Lodge told us that there is always plenty of hot water and the temperature in the home can be changed to meet their personal choice, especially in their own rooms. The home is always very well lit, clean and tidy and smells fresh. When we carried out a tour of the home we saw that it was fully accessible throughout for people who have physical disabilities. Throughout the home adaptations and specialist equipment were seen and fitted to blend within the homely environment. The home was clean and comfortable and was decorated and furnished with items which reflected the persons personality and likes. Four residents told us that the house was decorated to their tastes and the furniture and fittings were all of their choosing. The management had a good infection control policy and all staff did have training to reduce the risk of infection, this was further backed up by the documentation, (such as monitoring and checks of infection control and the cleaning rota) which protects the residents welfare. We saw that the management had a proactive infection control policy and they work closely with their own staff and external specialists, such as NHS infection control staff to ensure that infections are minimised. Care Homes for Older People Page 18 of 26 Evidence: During the tour of the building there were no apparent odours and residents rooms were all clean and well maintained. All bathrooms, showers and toilet are in good working order, clean and provide plenty of facilities for all residents to use. Four people stated to us that their rooms were kept clean and that if there was any kind of a problem it was quickly rectified. We saw that there was a lockable storage room which holds all of the chemicals or substance hazardous to health, (COSHH) date and safety sheets were acquired and updated to ensure that staff have the necessary documentation to refer to, so that safety is maintained. The home regularly spends money and time on the environment such as redecorating, refurbishment of the areas that need attention. Recently all upstairs windows have had new windows locks provided and a balcony has been rebuilt to maintain peoples safety. In general the inside and outside of the premises is kept to a high standard and is continually monitored and maintained by the two handy persons employed. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are well cared for and supported by a competent and skilled staff team. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home did not rely on the use of temporary agency staff but had their own supply of bank staff. She told us that staff are recruited thoroughly and trained to meet the needs of residents. When we visited the home we looked at staffing levels and how staff were recruited, trained and supported to meet the needs of residents. We looked at the recruitment files for members of staff. We saw that before they commenced work that satisfactory employment references, Criminal Records Bureau disclosures had been obtained and a full ten year employment history was checked for all people. The home has registered a nurse on each shift who oversee a team of 3 care staff. These registered nurses work opposite shifts to allow good cover and give support to all residents and to monitor the staff team on duty.Staff ratios are worked out according to each persons need. Residents and a relative told us that they felt staffing levels were good and that there were always permanent staff that they knew on each shift. Care Homes for Older People Page 20 of 26 Evidence: We saw that once people started work in the home that they undertook a detailed induction which follows the skills for care induction criteria. In addition we saw that staff had detailed job descriptions and information about their roles, responsibilities and the conduct expected of them. We saw that staff undertook training in a wide range of topics including managing pressure sores and safe handling of medicines. Staff were also trained to recognise and report abuse or poor practises. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management strategies of the home were stable which ensures the health, safety and welfare of all residents. Evidence: The manager told us that there was a system in place for monitoring the quality of the service, including obtaining the views of residents, relatives and professionals. When we visited the home we looked at the arrangements in place for obtaining the views of the people who live in the home, people who are important to them such as family and other people who are involved in their care. We saw that people were provided with questionnaires and that residents were asked if they were happy with their surroundings, lifestyles and opportunities available. They were asked if staff allow them privacy, dignity, independence and choice. Additionally the homes questionnaires (which are readily available) are used to gain views or any suggestion people would like to use to improve the service in general and of all aspects of the service they are offered and receive. Care Homes for Older People Page 22 of 26 Evidence: The management team possess good people skills, they have strong leadership of staff, and are seen to be responsive to the needs of all residents. The management in place at present provide an excellent role model for other employees such as being organised, person centred in their approaches and caring towards the residents. This was seen by observation and by looking through records sampled. Other professionals feedback we received see the management as effective leaders who consistently provide a high quality services to all people under their care. The management team undertake regular training and understand and value opportunities for their continuing professional development. The manager ensures that staff practise and performance are discussed during supervision, staff training and team meetings. Spot checks and quality monitoring systems provide management evidence that practise reflects the homes and organisations policies and procedures. Two staff spoken with told us that they felt well supported by management and that they felt that there are clear lines of accountability among the staff group and within the management team. The AQAA provided excellent information that was fully supported by appropriate evidence that we sampled at the site inspection. Information looked through showed us that the management team had a high level of understanding about the importance of equality and diversity and how they listen to residents views and opinions. The home demonstrates a high level of self awareness and recognises the areas that it still needs to improve, and has clearly detailed the innovative ways in which they are planning to do this. Insurance cover ensures that the home or corporate body are fully insured to meet any loss or legal liabilities. We looked at the arrangements for ensuring that the home was maintained safely. We saw that regular checks were carried out on equipment such as hot water and heating systems, fire alarms and fire fighting equipment, gas and electrical installations and equipment. All equipment was well maintained and repaired as required. There is full and clearly written recording of all safety checks and accidents, including analysis, and there is no evidence of any failure by the managers to comply with any statutory reporting and other relevant legislation requirements. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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). 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