Care Home: Langley Nursing Home

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What the care home does well This small friendly home with a pleasant family atmosphere. The home is comfortable, clean and attractively decorated and furnished throughout. Residents are encouraged to personalise their own rooms and these are decorated and furnished to a good standard. There are enough staff on duty at all times to meet the needs of residents effectively. Staff are respectful and provide care to the residents with sensitivity, kindness and patience. The manner of address used by staff to speak to the residents is friendly and courteous. Recruitment practices are well carried out and the staff files contain all information needed to ensure the safety of residents. Written records are well kept and up-to-date and provide staff with the information they need to provide the right care. The home offers residents a range of leisure activities including games, crafts and quizzes as well as the opportunity to see outside entertainers and to join in parties and themed events. Food provided by the home offers residents variety and choice and is well presented in pleasant comfortable surroundings. What has improved since the last inspection? Since the last inspection records relating to staff and residents have improved and contain more of the detail needed. Care records are sufficiently detailed to ensure staff knows what sort of care to provide to the residents. Medication records have improved and staff administering controlled drugs now sign the controlled drug book fully in line with the requirements of legislation to keep residents safe from harm. What the care home could do better: Catering staff should puree the different constituents of meals separately to enhance the visual appearance and make meals more appetising for residents. CARE HOMES FOR OLDER PEOPLE Langley Nursing Home 44 Langley Road Slough Berkshire SL3 7AD Lead Inspector Julie Willis Unannounced Inspection 21st February 2008 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Langley Nursing Home Address 44 Langley Road Slough Berkshire SL3 7AD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01753 676500 01753 790005 Langley Nursing Home Ltd Mrs Veeda Dennis Gill Care Home 11 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (11) of places Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. From time to time the home may accommodate persons below the age of 65. 27th September 2006 Date of last inspection Brief Description of the Service: Langley Nursing Home is situated on the main road near to Langley shops and High Street. The home is privately owned by the Trustworth Group Ltd and can accommodate 11 service users over the age of 65 years, 4 of whom may be mentally frail. The home is an adapted premises on 2 floors serviced by a passenger lift. The home has 4-shared rooms and 3 singles. There are parking facilities to the front of the home and a large garden laid mostly to lawn at the rear. The current fees for the home range from £540 to £800 per week. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 10:15 am and was in the service for five and a half hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. Prior to the visit a questionnaire was sent to the Manager along with survey and comment cards for residents. Replies were used to help form judgements about the service. Consideration has also been given to other information that has been provided to the Commission since the last inspection. The inspector toured the building, examined records and met all of the residents, ten relatives and a doctor that were visiting at the time of inspection. The inspector also spent time talking to staff and observing how care was being delivered to the residents. From the evidence seen by the inspector and comments received, the inspector considers that this service has a good awareness and understanding of equality and diversity issues and would be able to provide positive outcomes for residents in the areas of race, ethnicity, age, gender, sexuality, disability and belief. The inspector gave feedback about her findings to the Proprietors at the end of inspection. There were no legal requirements and only one good practice recommendation made as a result of this inspection. The Commission has received no information concerning complaints since the last inspection. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Catering staff should puree the different constituents of meals separately to enhance the visual appearance and make meals more appetising for residents. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. Residents are assessed by the home prior to admission to ensure the home will be able to effectively meet their need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From examination of the pre-admission assessment of 4 residents and discussion with management, residents and relatives it is evident that the home gathers as much information as it can before admitting a new resident to the home. Admission will only take place if the management are confident that they can effectively meet the needs of the individual. Information is gathered from a range of sources including the prospective resident, their relatives, advocates and health and social care professionals. The pre-admission assessment is thorough and holistic. Information about the residents health and personal care needs are sought, along with information Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 10 about the residents dietary needs, communication needs, mobility needs, history of falls, continence, medication regime and mental state. From discussion with visitors to the home it is clear that the resident and their relatives, friends or advocates are always offered an informal visit to the home where they can meet staff and other residents and observe and experience the routines of the home. A tour of the home is offered, in order that residents may see what services are available. Residents and relatives confirmed that they had been provided with the opportunity to visit the home informally and experience living at the home for a trial period before making a decision to remain permanently. One relative said, “I knew the home had a good reputation and a family atmosphere. No one likes to move into a care home but I knew Mum would be happy here and she has been”. A resident said, “ Staff are kind and always look after me”. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 Quality in this outcome area is good. Sufficient information is in place to enable staff to effectively meet the health & personal care needs of residents. Residents are encouraged to participate in the care planning and review process from the outset. The system for the administration of medication is good with clear and comprehensive arrangements in place to ensure the safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector examined four care plans and case tracked the residents from pre-admission assessment to date. There was evidence that the written records were detailed, comprehensive and well documented. They provided staff with sufficient information to enable them to offer the appropriate level of care to residents. The home reviews all care plans monthly and any changes in residents need was well documented and was responded to appropriately. The plan is a Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 12 working tool and staff are involved in writing the daily report and keeping the care plan up-to-date. Risk assessments had been routinely undertaken on a range of risks including manual handling, risk of falls and bathing. Clinical tools were being used to assess and monitor tissue viability, nutrition, dependency levels and mental state. Where a risk had been identified there were effective risk reduction measures in place to reduce the likelihood of occurrence. The care plans gave clear instruction on how staff should reduce the risks identified. Staff were observed to be polite and courteous to the residents at all times. Staff routinely knocked and waited until they were invited in, before entering the resident’s bedrooms. Observation of care practice concluded that staff were mindful of the need to encourage residents to remain as independent as possible by providing appropriate levels of support. Gentle encouragement and persuasion were used to encourage residents to mobilise. The resident’s privacy, dignity and autonomy were maintained at all times. The residents and relatives confirmed that they were provided with access to health and social care professionals when required. At the time of the inspection the local GP was carrying out a visit to the home. Residents were seen in the privacy of their own bedrooms. Where there was a change in treatment this was recorded appropriately in the care records. The doctor confirmed that screening and preventative treatments are offered routinely by the practice. All of the residents had chosen to have a flu vaccination prior to the onset of winter. There was evidence on file that residents have regular chiropody treatments, hearing tests and sight tests and may choose who they consult. From examination of the medication administration system and discussion with staff it is clear that the home follows best practice guidance in relation to the storage, administration and disposal of drugs. The home as an effective medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries and are signed by nursing staff. The home has a good record of compliance with the receipt, storage and administration of medicines. Residents and their relatives made a number of comments to the inspector about the quality of the care. One relative said, “The nurses are excellent, they always let me know how Mum is feeling and how she’s been. They always appear knowledgeable about her”. One of the residents said, “ My doctor comes to visit me. Staff here know when I’m feeling off colour and call her for me.“ Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 13 Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12, 13, 14, 15 Quality in this outcome area is good. A range of activities is offered that provide opportunity for mental and physical stimulation. Residents are encouraged to maintain contact with their family and friends and are able to have visitors at any time. The home provides a varied and nutritious menu designed to meet the needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The routines of the home are planned around resident’s needs and wishes but the service is flexible and can be changed to meet the specific needs of individuals. People may rise and retire at a time of their choosing and may spend their time alone in their rooms or in the communal areas. A range of activities is provided at the home, which are mainly carried out on a one-to-one basis. Card games, puzzles and dominoes are firm favourites. There are occasional visits by an entertainer who provides music and sing-along sessions. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 15 The majority of the residents choose to sit in their lounge chairs to eat their meals from cantilever tables. The staff team were on hand to support residents that required assistance at mealtimes. Residents said that they had enjoyed their meal and that it was pleasantly presented and well cooked. The food is satisfactory quality. The residents were eating lunch of pasta with, mixed vegetable followed by rice pudding. Special diets can be catered for including diabetic or vegetarian meals. Advice was given to management for catering staff to puree the different constituents of meals separately to enhance the visual appeal and enjoyment of residents. Discussion with service users evidenced that the food was well cooked tasty and plentiful. A number of service users made comments such as “the food is very nice”, “there is always a choice” and “generally very good”. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. The home has a satisfactory complaints system. Residents feel their views are listened to and acted upon. Residents are protected from abuse and exploitation by staff that can demonstrate knowledge of the homes safeguarding adults and whistle-blowing policies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaint policy in the home meets the requirement of Regulation and Standard. Residents are provided with information on how to make a complaint and the stages and time scales for action. Examination of the complaint records indicated that there have been no complaints made to the home since 16th June 2006. The details of the complaints were well documented and evidenced outcomes provided to complainants. There has been no information about complaints reported to the CSCI about the home since the last inspection. Residents and relatives said that that they felt confident that any concerns or complaints would be taken seriously by the home and efforts would be made to remedy any problems in a timely fashion. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 17 There was evidence in staff files and from discussion with staff, that they receive training in safeguarding adults as part of their formal induction to the home. There learning is later consolidated when undertaking NVQ training in which it forms a core module. Staff spoken with at the time of inspection understood the importance of protecting residents from abuse and exploitation at all times and were conversant with the ‘whistle-blowing’ policy. The inspector had the opportunity to speak with ten relatives during the course of inspection. All confirmed that they felt the home took any issues raised seriously and did their best to put matters right as soon as possible. One relative said that they felt management were approachable and were always on hand to deal with issues and concerns as soon as they arose. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 & 26 Quality in this outcome area is good. The standards of décor and furnishings in this home offer residents a comfortable and homely place to live. Standards of hygiene are good throughout. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives were complimentary about the quality of décor and furnishings in the home. They said that the home was always clean, comfortable and hygienic. They said that the domestic staff always kept the toilets and bathrooms clean and fresh and vacuumed and dusted their bedrooms regularly. Communal areas were comfortably furnished and were large enough to accommodate all of the residents. Residents spend most of their time in either the lounge or conservatory, which are currently the focus of the homes activities. One resident said that they particularly liked the conservatory Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 19 because it was bright and looked over the garden they told the inspector that they were able “to meet their friends and have a chat”. Residents told the inspector that they were able to bring with them small items of furniture and pictures and ornaments to personalise their own bedrooms. All staff have received training in infection control and were observed to use personal protective equipment appropriately. From discussion it was clear that domestic staff understand the need to use appropriate cleaning products and chemicals safely and have had health & safety and COSHH (control of substances hazardous to health) training. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 Quality in this outcome area is good. Staffing levels are sufficient to meet the needs of the residents in this service. Staff were able to demonstrate that they have the necessary skills and experience to effectively meet the needs of the residents. Staff recruitment procedures are robust and transparent and protect residents from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of three staff files evidenced that the selection and recruitment procedures at this home are robust. All necessary checks are carried out on staff to ensure that they possess the necessary attributes to care effectively for the residents. Records were well kept and met the required standard. There was evidence that care staff have been properly inducted to Skills for Care Standard and have received training in core skills such as fire safety, first aid, food hygiene, health & safety, COSHH and infection control. There is a need to ensure all staff undertake refresher training in manual handling as soon as possible. There was a shortfall identified in the frequency of such training in the records. Staff were observed to use precarious manual handling techniques in the care of several residents, which could pose a risk to the safety of both residents and staff. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 21 All staff have received training in safeguarding adults as part of their induction and as a core module in NVQ training. All staff at the home are well motivated and have either achieved or are working towards a National Vocational Qualification at level 2 or 3. There were sufficient numbers of staff on duty at the time of inspection to effectively meet the needs of residents. There was a nurse, two carers, a domestic assistant and chef on duty. The qualifications of nurses have been checked effectively to ensure they are fit to practice. The nurses Pin numbers and Statement of Entry on the Register were well recorded and up-to-date. The inspector spoke informally to the staff on duty. They confirmed that the management foster a friendly family atmosphere. The Proprietors are regular visitors to the home and support the staff on a daily basis. Staff confirm that they have the opportunity to express their views about how the care is delivered. It was clear that those interviewed had a good understanding of how their individual role benefits the work of the team and a thorough knowledge of the key values that underpin their work with residents. The residents and their relatives were complimentary about the qualities of the staff. They made comments such as “the staff are kind”, “they listen to you” and “the staff are warm and welcoming. Mum is very happy here”. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31, 33, 35, 38 Quality in this outcome area is good. Resident’s benefit from living in a well managed home, where there is evidence that their health welfare and safety is of primary importance. Management are qualified, competent and experienced to run the home for the benefit of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager Veeda Gill is competent and experienced to run the home for the benefit of the residents. Staff feel well supported and confirm that they feel valued by the Manager and that their skills and professionalism is respected. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 23 The home monitors its own performance against quality standards. An examination of the homes quality audits evidenced that it seeks the views of residents, relatives and staff on an annual basis. The results of the customer surveys are used by the Organisation to measure the homes success in meeting its published aims and objectives. The residents manage their own financial affairs or have family members that deal with their finances on their behalf therefore the home does not hold personal money for residents. Examination of health & safety records indicated that they were up to date and in good order. Routine servicing and maintenance of equipment is undertaken at appropriate intervals in general to maintain the home as a safe and risk free environment for residents and staff. All risks to residents are effectively risk assessed and managed. Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations Ensure that catering staff puree the constituents of meals separately to enhance the visual appeal and improve the enjoyment of the meal for residents Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Langley Nursing Home DS0000011000.V357885.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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