Care Home: Longfield

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What the care home does well The home ensures that all residents have an assessment prior to admission to the home and care plans and risk assessments are then written with the assistance of the resident and/or their relative or representative. Mealtimes are unhurried and all meals are home cooked with an alternative option being available for each mealtime. There is an efficient complaints procedure in place and the home`s processes and staff training should protect the residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. The home has a staff team that has the necessary skills and experience to the meet the needs of current residents and staff training is on going. The management and administration of the home is good, with evidence of consideration being given to the residents and/or their relative`s opinion. What has improved since the last inspection? Following the last key inspection in July 2006 four requirements were made and these have now been met. All residents have now been provided with a written contract. Care plans are now signed by the residents or their relative/representatives to say they agree with these plans. Carpets were required to be replaced in two of the bedrooms and this has now been completed. Records are now kept of all fire drills within the home. What the care home could do better: Two requirements were made following this key inspection. Nutritional risk assessments to be completed for all residents in the home and ensure that these are reviewed regularly. This will ensure that staff are aware of the nutritional requirements of each resident and can adjust their diet accordingly if necessary. The home must be kept in a good state of repair. Consideration should be given to assessing some of the furniture in the home to ensure it is adequate for the residents. Worn furniture and fixtures for example some chairs and the kitchen units should be replaced where necessary. This will ensure that the residents live in an environment that is well maintained with fixtures and furniture that meets their assessed needs. CARE HOMES FOR OLDER PEOPLE Longfield Killicks Road Cranleigh Surrey GU6 7BB Lead Inspector Lesley Garrett Key Unannounced Inspection 21st February 2008 10:30 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 Longfield DS0000033052.V357996.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. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longfield Address Killicks Road Cranleigh Surrey GU6 7BB 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) 01483 275505 01483 277753 lisa.soper@surreycc.gov.uk South West Surrey Adults & Community Care Services Mrs Lisa Sharon Soper Care Home 58 Category(ies) of Dementia - over 65 years of age (34), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (16), Sensory Impairment over 65 years of age (4) Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Accommodation and services may be provided to named persons aged 60 - 65 years with prior written agreement of the CSCI Gene Kelly, Fred Astaire and Gracie Fields units will be used exclusively for Service Users who require dementia care. Respite care may be provided to six service users within Audie Murphy unit for a period of six weeks Charlie Chaplin unit will be exclusively for service users in the category OP Old Age not falling within any other category 17th July 2006 Date of last inspection Brief Description of the Service: Longfied is a large detached three-storey residential Care home. The home provides personal care and accommodation for fifty older people. The home is managed by Surrey County Council and is situated on a large housing estate adjacent to the village of Cranleigh. All rooms are for single occupancy. The home can accommodate 50 residential places. Each unit in the home has its own sitting/dining room and kitchenette. The home grounds are of a good size, well maintained and have disabled access. There are parking facilities at the front of the building. The fees for the home are £560 per week. Longfield DS0000033052.V357996.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 the 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 care home was an unannounced ‘Key Inspection’. Mrs L Garrett Regulation Inspector carried out the inspection and the acting joint team managers represented the service. For the purpose of the report the individuals using the service prefer to be addressed as residents. The inspector arrived at the service at 10.30 and was in the home for six hours and thirty minutes It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The Commission did not send questionaires to people associated with the service. The use of an ‘expert by experience’ (who is a person who visits the service with the inspector to help the get a picture of what it is like in or use the service) was also not used as part of this inspection. The home had supplied the commission with a documented Annual Quality Assurance Assessment (AQAA) some detail of which has been included within the report. A number of residents living at the home have difficulties communicating clearly, so their responses were assessed by observing their facial expressions, body language and observing resident and staff interactions. Additional information was also sought from talking with visitors to the home during the inspection. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, health and safety records, and several of the homes policies and procedures. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of residents who have diverse Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 6 religious, racial or cultural needs. What the service does well: What has improved since the last inspection? Following the last key inspection in July 2006 four requirements were made and these have now been met. All residents have now been provided with a written contract. Care plans are now signed by the residents or their relative/representatives to say they agree with these plans. Carpets were required to be replaced in two of the bedrooms and this has now been completed. Records are now kept of all fire drills within the home. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Longfield DS0000033052.V357996.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 Longfield DS0000033052.V357996.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): 3&6 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The homes admission and assessment procedures ensure that resident’s needs are appropriately identified and met prior to admission to the home. EVIDENCE: Three pre admission assessments were sampled and evidenced that robust arrangements are in place to ensure that the home would meet the needs of prospective residents. The acting managers stated that all new admissions are also invited to visit the home if this is possible. The AQAA advises that the home have reviewed the admission procedure and the managers try to have the appropriate key worker on duty on the day of admission but recognises this is not always possible. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 10 No intermediate care is offered by the home at present as some beds have now been closed. Longfield DS0000033052.V357996.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): 7 8 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Health and personal care that individuals receive is based on their individual needs. Respect, privacy and dignity are maintained at all times. EVIDENCE: Three care plans were sampled and these were found to be well documented and contained the medical, social and personal care needs for each resident. The AQAA advises that the residents are encouraged to manage their own personal care needs wherever possible. Suitable risk assessments are in place for all areas of the client’s daily life in order to promote independence whilst ensuring the person’s safety and wellbeing. The managers stated that the residents are consulted and where necessary the relatives are involved with their permission. Daily care records Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 12 were well written and maintained to reflect the individual resident’s needs and care provided. There was no evidence of nutritional risk assessments in place for residents so this will be a requirement at the end of the report. Nutritional assessments should take place on admission and reviewed regularly to ensure that the residents are eating a well-balanced meal and that any weight loss or weight gain is acted upon promptly. There was evidence in the individual care plans that the residents are weighed monthly. The care plans evidenced that regular and appropriate health care appointments are attended and the General Practitioner (GP) visits the home when necessary. The managers said that the health centre has special clinics for example a vascular and diabetic clinic. Through sampling care plans it was evident that the home has maintained good working partnerships with health care professionals, which include visits from the opticians, dentists, hygienist and chiropodists. The senior carer showed the inspector that the home has good, clear procedures in place for the monitoring and recording of all medicines administered and those entering and leaving the home. The carer stated that the pharmacist visits the home every three months to audit the medicines and that the night staff check the Medication Administration Record every night to ensure that there are no gaps on this record. It is a recommendation that that any non-administration of medication is clearly written to give the home a good audit trail for all medicines. Throughout the day the inspector observed that residents were addressed in a polite and courteous way by staff and were observed knocking on residents doors prior to entering the bedroom. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 13 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): 12 13 14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People who use the service are able to make choices about their lives and recreational activities meet their expectations. EVIDENCE: The home has a large activities room which all residents have access to. The managers stated that they had recruited an activities organiser five months ago who is part time and also works as a carer. The rota for the week demonstrated that a variety of activities were planned which included a film afternoon, painting and manicures. The activity organiser also spends time with the residents or their relatives to write their biographies. The home has a church service every two weeks with Baptist or Church of England vicars coming into the home. The managers stated that they have good links with the local churches and residents are assisted to visit the church on Sunday if they would like to. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 14 The AQAA states that the home wishes to develop the activities that are available but to do this the activity organiser would need to increase her hours. It is a recommendation that management increase the hours of the activity organiser so that the activity programme can be expanded for the benefit of the residents who have increasing needs. The AQAA also stated that six residents with various needs went on holiday last summer to Somerset. Outside entertainers also visit the home approximately four times a year and the staff raise funds for this with the funds from raffles and donations also helping. The mangers said that the residents enjoy going into the village especially on Thursday when there is a local market. Contact with family and friend’s is positively encouraged with visitors being able to attend the home at any time and in accordance with the resident’s wishes. Several visitors were at the home at the time of the inspection and each spoke highly of the home’s management and the care their relative or friend received. Lunchtime was observed and residents were served their meal in a relaxed unhurried manner. Tables were laid with tablecloths and napkins and the meal was served in the three dining rooms on each unit. Drinks were available and staff were seen to be offering choices to the residents about what they would like to drink and eat. One resident said that ‘the food was very good and there was always plenty’. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 15 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): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents are protected by the homes complaints and safeguarding adults procedures. EVIDENCE: The home has a complaints procedure. The managers stated that all complaints received by the home are fully investigated and the records kept by the home evidenced this. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The home has not received a complaint since August 2007 and all complaints are now resolved. Records sampled indicated that staff had attended safeguarding vulnerable adults training and for newly recruited staff this had been included in the induction programme and ongoing training provided by the home. The managers stated that it is now the local authority policy that the managers receive training every year and the rest of the staff attend every two years. The home has a copy of the local authority Multi-agency Procedures for the Safeguarding Vulnerable Adults. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 16 Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 17 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): 19 & 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvement is required to ensure that residents have a pleasant and comfortable home to live in. The home was clean and hygienic at the time of this visit. EVIDENCE: At the previous inspection in July 2006 it was documented that the structure and layout of the home does not meet the national minimum standards. However the local authority is committed to looking at the future development of the home and the inspector was provided at the time with written information confirming that the local authority is working with other stakeholders to look at the options for redevelopment. The home currently has sixteen beds closed. This is an ongoing process as no major refurbishment has Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 18 been undertaken. The managers stated that carpets continue to be replaced but there has been no decoration or replacement of worn furniture. Each unit has a lounge and dining area. The small kitchens on these units are old and worn and in need of replacement or repair. Bedrooms are small but all have been personalised by the resident or their family and height adjustable beds are available. No bedroom has an en-suite facility but shared bathrooms are available on each unit. Some dining room tables, chairs and lounge chairs are worn and some are in need of replacement. A requirement will be made at the end of the report. On the day of the inspection the home was clean and hygienic and separate laundry facilities were available. The AQAA states that the home has a domestic team that is available seven days a week and all staff are aware of infection control procedures. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 19 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): 27,28,29,30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staffing levels of the home were considered adequate to meet the current needs of residents. The residents are fully protected by the home’s recruitment policies and procedures with competent trained staff. EVIDENCE: The staff rota was sampled and demonstrated that adequate staff were on duty for each shift. There is always six care staff divided between the units with a senior carer covering during the day 0730-2100. The managers also stated that they are on duty every day and that bank staff are available if they need to use them. The home does not use agency staff. The home also has the benefit of domestic and catering staff and an administrator. A relative spoken to on the day of the site visit said ‘staff here are very good and look after my relative so well’. A resident stated ‘I feel at home her I am comfortable and the staff treat me very well. They are very kind to me and everyone here’. Over fifty per cent of the staff have gained their National Vocational Qualification (NVQ) at level 2 and the managers said that this training is on going so that all staff eventually have the qualification. It was also stated that Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 20 the senior care staff have NVQ level 3 and one has level 4 with one studying for this qualification now. Three recruitment folders were sampled and they confirmed that that these files contain all items required under the Care Homes Regulations 2001. The managers stated training is available for all staff and the training needs of are identified during their supervision sessions. An example of training undertaken was safeguarding adults, manual handling, medication, dementia and food hygiene. One member of staff spoken to said that they had really enjoyed the dementia training and had given them a good knowledge of the subject which has assisted with their practice. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 21 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): 31, 33, 35, 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management of the home is robust to ensure the safety and wellbeing of residents. Consultation takes place regarding the running of the home and their health and financial interests are safeguarded. EVIDENCE: In July 2007 the registered manager resigned and a letter informed us of this. This was followed by e-mail from the service manager to say that the two deputy managers would be taking the role of the manager until a service review takes place. Both of the managers have their NVQ level 4 and the registered managers award. They both demonstrated a good knowledge of the service and the residents. Staff that were spoken to were complimentary about Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 22 the managers and the support they were given by them. The managers stated that their positions at the home had been extended until June 2008. The managers said that the home holds residents meetings every three months and minutes are kept. A relatives survey was completed in August 2007 and positive comments were noted. The managers said that the results are analysed and an action plan is drawn up of anything that has to be followed up. This survey is completed every year. No other surveys take place and following a conversation with the managers it will be a recommendation that they send surveys to other visiting professionals and stakeholders in the home. The service manager makes monthly quality visits to the home and records are kept. The staff have regular supervision sessions with the managers and records of these are kept in their individual folders. The home has an administrator who is responsible for the resident’s finances but the managers stated that no money is kept in the home. If any of the residents wish to purchase anything the home will invoice them at the end of each month. All receipts and invoices are kept for reference. The home employs a part time maintenance person who is responsible for the regular checks within the home for example the fire alarm testing and water temperatures. All of the readings are recorded. The AQAA stated that the home has completed a variety of health and safety checks and certificates are in place for the lift, gas appliances and emergency call bell equipment. Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 23 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 2 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 Longfield DS0000033052.V357996.R01.S.doc Version 5.2 Page 24 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. 1. Standard OP7 Regulation 12(1)(a) Requirement Nutritional risk assessments should be in place for all residents and these must be reviewed regularly. The home must be kept in a good state of repair. Consideration should be given to assessing some of the furniture in the home to ensure it is adequate for the residents. Worn furniture and fixtures for example some chairs and the kitchen units should be replaced where necessary. Timescale for action 21/03/08 2. OP19 23 21/05/08 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 OP9 Good Practice Recommendations It is recommended that all non-administration of medicines is clearly documented and the reasons why the DS0000033052.V357996.R01.S.doc Version 5.2 Page 25 Longfield 2. 3. OP12 OP33 medicine was not given also documented. It is recommended that the hours of the activity organiser should be increased so that the activity programme can be expanded to meet the needs of the residents. It is recommended that surveys be extended to visiting professionals to the home and any other stakeholder. Longfield DS0000033052.V357996.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 Longfield DS0000033052.V357996.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!