Care Home: Long Close

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What the care home does well Prospective residents have their needs assessed prior to being offfered a placement at the home. Relatives and prospective residents are invited to visit the home and are fully informed of the services provided at the home. Residents health needs are met through the home`s care planning systems. Residents are treated with respect and dignity. Medication administration is generally well managed within the home. Residents leisure and rereational needs are met with communal and individual activities being arranged. Residents are able to maintain contact with families and friends. Residents are provided with a good standard of food. The home has well publicised complaints procedures and the staff have been trained in adult protection. Long Close provides a `homely` and well maintained environment for residents. There is also an attrative and well maintained garden available to residents. The home provides sufficient staff to meet the needs of the residents and they have been provided with core mandatory training. The home is well managed and run in the interests of the residents. What has improved since the last inspection? The home provides higher staffing levels at night time than at the previous inspection. There was evidence of ongoing maintenance of the premises. What the care home could do better: Care plans should be updated as soon as possible when the needs of residents change, so that staff work consistently to meet assessed needs. Where hand entries have to be made to the medication administration records, a second person checks and signd that the entry has been transposed correctly. Some infection control issues were identified during the inspection that could reduce the risks of spreading infection in the home, such as the provision of paper towels in communal bathrooms, the repainting of the laundry room and making sure that personal toiletries such as razors are not left in communal bathrooms. Key inspection report Care homes for older people Name: Address: Long Close 23 Forest Road Branksome Park Poole Dorset BH13 6DQ     The quality rating for this care home is:   two star good 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: Martin Bayne     Date: 1 1 0 8 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 27 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 27 Information about the care home Name of care home: Address: Long Close 23 Forest Road Branksome Park Poole Dorset BH13 6DQ 01202765090 01202768958 long_close@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Keith London-Webb care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 17 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Long Close is situated in a quiet residential area of Branksome Park, and set in pleasant woodland gardens. The home is easily accessible to shops in Westbourne, local amenities and beaches. It is registered under the category of OP (Older Persons) for up to seventeen elderly service users. The home caters for people who have low to medium personal care needs. The majority of rooms are single en-suite and some have access to the garden or a balcony. There is a spacious lounge leading on to the dining room. The home has a passenger lift that is able to accommodate wheelchair users. Mr London-Webb the proprietor lives on site and shares the day to day running of the Care Homes for Older People Page 4 of 27 Over 65 17 0 Brief description of the care home home with the registered manager Mrs Barrow. between 500 pounds and 625 pounds. The current weekly fees range Care Homes for Older People Page 5 of 27 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: two star good 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: We, the Commission, carried out a key inspection Long Close residential home between 9:45am and 3:45pm. The inspection was carried out by two inspectors, but throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons, and to follow up on the one recommendation made at the last key inspection in November 2007. At the time of our inspection there were 15 residents accommodated within the home. We looked at the personal care records for a sample of three residents and used these records to track how their care was managed. We carried out a tour of the premises and spoke with many of the residents about their experience of living at the home. We had the opportunity of speaking with a visiting ditrict nurse and three visiting relatives. We also looked at other records that the home is required to maitain under the Care Homes Regulations 2001. Care Homes for Older People Page 6 of 27 Additional information that helped formed the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document completed by the home. The home has recently submitted a variation to their conditions of registration to accommodate one person within the category of dementia. Care Homes for Older People Page 7 of 27 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 Care Homes for Older People Page 8 of 27 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 9 of 27 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 10 of 27 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. Residents benefit from having their needs assessed prior to being offered a placement at the home and through being informed of the services and facilities provided at Long Close. Evidence: We looked at the how residents are admitted to the home. We were told that prospective residents and their relatives are invited to view the home in order to assist them in choosing a suitable placement. We saw that a copy of the last key inspection report was available at the front reception area. We were told that propsective residents and their families are given copies of the homes brochure and the Terms and Conditions of Residence so that they are fully informed about the services and facilities provided at Long Close. We looked at the personal files for the three residents we tracked through the inspection and found that the manager had carried out a preadmission assessment of Care Homes for Older People Page 11 of 27 Evidence: the persons needs, to make sure that the home was able to meet these at the home. Once a decision has been made to accommodate a person at the home, a letter is sent out to inform that the needs of the person referred can be met with an offer of a placement at the home. Care Homes for Older People Page 12 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their health care needs being met through the homes care planning system, through being treated with respect and dignity and by having medication administered safely. Evidence: We looked at the assesssments and care plans for the three residents we tracked through the inspection. We saw that at the front of the care planning file containing all the care plans, there were information and guidance sheets to prompt staff. These included guidance on the Mental Capacity Act and what to do if there were concerns about a resident loosing weight. We saw good practice of a a photograph of each resident attached to the front of their individual plan. We saw that care plans had been developed from various assessments such as a moving and handling assessment, nutritional assessments and skin care assessments. In addition the home has developed short summary care plans that provide basic information so that agency staff or new staff can obtain a quick precis in understanding each residents needs. Care Homes for Older People Page 13 of 27 Evidence: One of the the residents we tracked through this inspection had been discharged from hospital three days earlier and was being cared for in bed. We found that their care plan was not up to date, so too their moving and handling assessment that still reflected their condition prior to going into hospital. We found however that there were no poor outcomes for this resident as the staff we spoke with were aware of this persons needs and we found the person being well cared for by the staff. We recommend that care plans are updated as soon as possible when the needs of a resident changes, so that there is a consitent plan of care for staff to follow. Concerning other care plans, we saw we found that these were up to date and were being reviewed each month to make sure that they reflected current needs. We saw good practice of care plans being signed by the resident concerned, demonstrating that they were involved in their development. During the inspection we spoke with a visiting district nurse who told us that timely and appropriate referrals were made for district nursing intervention and that the district nursing team had no concerns about the way health care needs of residents were being met at the home. This view was corroborated by the relatives we spoke with, who told us that they were always informed about events in the home concerning their relatives. We found that there was one person living at the home who had developed memory problems and had exhibited behavioural problems. We saw that the home had sought advice and support from the community mental health team and that a community psychiatric nurse was involved in this persons care. Both the residents we spoke with who were able to give an account of what it was like to live at the home and the relatives, told us that residents were treated with respect and dignity. We looked at how medication was being managed within the home. The majority of the residents have their medication administered by the staff. We found that one person managed some of their own medication and we saw that a risk assessment had been carried out as to this persons abilities to manage their medication on their own. We were told that the procedure for administering medication was for one person each shift to have delegated responsibility for this task. We were told that medication is taken from the blister packs supplied by the pharmacist, put into a pot and then this is taken to the resident concerned. Once the person has taken their medication, their records are then signed. We saw that the homes pharmacist had recently been to the home and recommended that a photograph of the resident concerned is put at the front of their records so that new members of staff can readily identify the correct person. We were told that all of the staff who administer medication have received Care Homes for Older People Page 14 of 27 Evidence: training in safe medication administration. We found that the medication administration records were being completed in full with no gaps within the records. We saw that where hand entries have been made to the records, generally there was evidence a second person checking and signing that the record was entered correctly, but not in all cases. It was agreed that the records would make clear how many tablets were given when the instructions are made for a variable dose. We recommend that this pracice is adopted in all cases, as it ensures that these entries have been made correctly. We saw that medication was being stored correctly. Care Homes for Older People Page 15 of 27 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. Residents benefit from activities being provided, being offered a good standard of food and from being able to maintain contact with friends and family. Evidence: The home keeps a book where they record the activities carried out with residents, which we saw. The home had recently held a summer party and an outing was being arranged to take residents to see the Bournemouth Air Show. We saw that some communal activities are arranged such as a weekly exercise group. We were told that many of the residents like to spend time on their own in their rooms, whilst some who have developed memory problems do not like to join in communal activities. Staff therefore spend individual time with these people. We saw that residents birthdays are celebrated, a sunflower growing competion was arranged and the home has purchased a computer for residents to use. The relatives we spoke with told us that they thought there was a reasonable level of activities provided and we saw that quality assurance questionaires asked residents for suggestions as to activities that they wished to be arranged on their behalf. We were told by relatives we spoke with that they could visit at any time and that they were always made welcome. Care Homes for Older People Page 16 of 27 Evidence: We saw that when a person is admitted to the home, they were asked about whether they had any spirtual or cultural needs. The residents and the relatives we spoke with told us that the food provided at the home was of a good standard. We looked at the records of food provided and we saw that residents likes and dislikes were respected and catered for, and that there was a choice of menu provided. Care Homes for Older People Page 17 of 27 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 benefit from a well publicised complaints procedure and through the staff team being trained in adulpt protection. Evidence: Residents we spoke with said that they were aware of how to make a complait and that they had confidence that their complaint would be taken seriously. The complaints procedure is document in the homes literature and residents and relatives have access these documents. The home maintains a complaints log. Since the last key inspection there have been no complaints made to the management and none have been brought to the attention of the Commission. One concern was raised with the Commission and issues covered as part of the key inspection. We saw from training records that all of the staff have been trained in adult protection and the home has full policies and procedures relating to the safeguarding of vulnerable adults. Care Homes for Older People Page 18 of 27 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. Residents benefit from a well maintained homely environment. Evidence: On the day of our visit we carried out a tour of the premises. We found the home to be clean and free from adverse odours. The home was also in good decorative order with furniture and fittings in good repair. The home also has very well maintained gardens to the rear that residents can access. Since the last key inspection the managers office has been moved to a room in the owners property that is sited behind the home. We asked if this change had affected the running of the home and were told that the office move had had no detrimental effect in terms of managing the home. The room that used to be the managers office in the home is now being used to accommodate two members of staff who live in and are employed as night staff. We saw that these staff can access their accommodation via a set of stairs leading to the back of the home and they dont have to go through the home to get to their accommodation. The home has a shaft lift for residents to access bedrooms on the first floor of the home. We saw that when a room becomes vacant at the home, the room is refurbished before it is let to a new resident. We saw that residents were able to bring their own posssessions and furniture to personalise their rooms. We saw that the home had a hoist and the resident who required hoisting had been provided with a bed suitable for Care Homes for Older People Page 19 of 27 Evidence: using the hoist. We found that the majority of radiators in the home have been covered to protect residents from the risk of getting burnt. We were told that the radiators that remained uncovered could not be fitted with a standard cover and action would be taken to make these remaining radiators safe. The home has thermostatic mixer valves fitted to the hot water outlets to protect residents from scalding water. We tested the hot water temperature of one of the communal baths and found this to be of a satisfactory temperature. We found however that although the bathroom provided liquid soap, there were no paper towels provided. We recommend that paper towels are provided in all communal bathrooms. We also found a razor and a denture cleaning product in the bathroom. We recommend in interests of safety and infection control that residents razors are kept within their rooms and that the denture cleaning products are kept away from residents with confusion, as these products have been known to cause fatalities if ingested. We found that the home did not have a clinical waste contract and were told that waste was incinerated. A requirement was made for the home enter into a clinical waste contract for the disposal of clinical waste. We saw that the home has a dedicated laundry room that is set aside from food preparation areas and was equiped with washing machines and driers suitable to meet the laundry needs of the home. Hand washing facilities are also provided. The walls of the laundry room are in need of repainting as we found some flaking paint. The Regisitered Provider agreed to scheduling this task into the maintenance plan. This will be followed up at the next inspection. We saw that the home has some surveilance equipment. We were told that these had been put in place as the home had been burgled in the past. None of the cameras looked into the premises and so could not be used to monitor residents. Care Homes for Older People Page 20 of 27 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 benefit from staffing levels being provided that meet the needs of the residents, through the staff being well trained and through staff being recruited in line with Regulations. Evidence: We were told that daytime staffing levels remained the same as at the time of the last inspection, with two care staff on duty throughout the daytime period. At the last inspection, night time staffing levels were one awake member of staff on duty with a second person carrying out a sleep-in duty. We were told at this inspection that night staffing had been increased to two awake members of staff, as night time needs of residents had changed. We saw a staff duty roster that reflected the above staffing levels. In addition to the care staff, the Registered Manager works in the home during the day throughout the week, as well as the providers son who has completed an NVQ level 4. The Registered Provider also maintians a high presence in the home. Both the residents, staff and relatives we spoke with told us that this level of staffing met the needs of the current residents. We looked at the recruitment records for four members of staff who had been recruited to the staff team since the time of the last inspection. We found that all of the checks and records required under Schedule 2 of the Care Homes Regulations 2001 had been complied with. These include the taking up of references, a Criminal Care Homes for Older People Page 21 of 27 Evidence: Record Bureau check, and a check against the register of adults deemed unsutiable to work with vulnerable adults. All these checks had been taken up before the person started working at the home. We looked at the staffing provided to the staff and we found that core mandatory training had been offered in such areas as adult protection, first aid, basic food hygiene, health and safety, fire safety, moving and handling and infection control. We also saw that some of the staff had received specialist training in areas like care of people with dementia and training to use MUST, (malnutrition universal screening tool). We found that the home has nearly reached a level of 50 of the staff team trained to NVQ level 2 or above. Care Homes for Older People Page 22 of 27 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. The home is well managed and run in the interests of the residents. Evidence: The Registered Manager has had many years experience of running Long Close and has completed NVQ level 4 in care. The Registered Providers son who works as a deputy manager has completed the Registered Managers Award. In general we found that the home was well managed with relatives also reporting this view. The relatives we spoke with told us that they had peace of mind that their family members were being well cared for at the home. We saw that quality assurance questionaires had been sent out to residents and relatives. All the returned surveys provided postive feedback about the home and the care provided to residents. We were told that the home does not look after any monies on behalf of residents. Care Homes for Older People Page 23 of 27 Evidence: We looked at the accident book and saw that all accidents were being recorded and analysed for any trends in accidents that occur in the home. We checked a sample of equipment provided in the home and saw that safety testing and servicing was taking place as required. We looked at the fire log book and saw that tests and inspections of the fire safety system were taking place to the required timescales. Care Homes for Older People Page 24 of 27 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 25 of 27 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 1 19 23 You are required to arrange a clinical waste contract for managing clinical waste in the home. To maintain a safe environment. 14/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 9 We recommend that care plans are up date as soon as needs of residents change. We recommend that where hand entries have to made to medication administration records, a second member of staff checks and signs that the entry has been made correctly. We recommend that paper towels be provided in all communal bathrooms and that residents personal toiletries, such as razors and denture cleaning products are not kept in communal bathrooms. 3 26 Care Homes for Older People Page 26 of 27 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. 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