Care Home: Longmead Court Nursing Home

What the care home does well The home provides care for residents with a mental disorder or dementia who have complex nursing needs. Assessment processes are robust. Full information is provided to potential residents and their representatives to enable them to make a decision. Full information on care needs is obtained and initial assessments undertaken prior to agreeing the admission. Standards of personal care are good. Residents have good access to health care with regular visits from their GP and other health professionals. Health and personal care needs are well monitored and reviewed to ensure their changing needs are met. Residents are well nourished and there is good monitoring of their fluid intake with frequent drinks provided throughout the day. All meals are cooked on site and fresh fruit and vegetables provided daily. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.2 There is good provision of equipment for mobility and nursing care that is well maintained. The standards of health and safety are good with regular audits of premises and equipment undertaken and good standards of maintenance in place. Call systems comprise an intercall system that monitors when a resident attempts to enter another’s room. This ensures residents privacy and dignity and protects them abuse from other residents who may have behavioural difficulties. Communication between the manager and residents and their representatives is good. There are regular meetings held and there is good access to the manager on a daily basis. Staff are well supported by the manager and training officer. There is a good ongoing training programme in place that ensures staff are inducted to recommended Skills for Care Standards and receive regular updated mandatory and other training through an established training programme. Arrangements are in place to ensure staff are well supervised through handovers, observation of practice and formal documented supervision. The complaints procedure is on display in the home and included in the statement of purpose/service user guide. Residents and their representatives are kept well informed and encouraged to voice any concerns they may have. Prompt action is taken to address any issues raised. Regular training in safeguarding adults is provided to staff ensuring they are fully informed on all aspects of abuse and aware of the procedure to be followed in the event on allegation. Residents are protected by robust recruitment procedures that ensure all the required checks are obtained prior to employment. What has improved since the last inspection? Good progress has been made in reviewing care planning documentation to focus on the individual by developing person centred care plans. Care staffing hours have been increased to enable care staff to provide close monitoring and spend time in interaction with residents. Some furniture and carpets have been replaced and remaining carpets cleaned. Several bedrooms, bathrooms and communal rooms have been decorated. Records are now held securely in lockable cabinets. Social and therapeutic activity provision has been reviewed and additional coordinators employed to also provide activities at weekends. Staff training had continued to develop and has included social activities in dementia care, palliative and end of life care. The system for staff supervision has been developed so that staff received supervision six times per year by the manager and training officer. The manager has attended training in Deprivation of Liberty (DOLs) and the Mental Capacity Act and residents have had mental capacity assessments.Longmead Court Nursing HomeDS0000015357.V378015.R01.S.docVersion 5.2 What the care home could do better: Medication was generally well managed and is regularly audited. However two errors was found during the inspection and there was no evidence of follow up. It was reported that the evening medication round took two hours when there was only one registered nurse on duty. The manager said that she was acting as the second nurse until the recently appointed lead nurse/deputy manager was in post. The home was generally clean, however some rooms, en suites and sluices were not adequately cleaned. This appeared to relate to insufficient domestic hours being employed. An agreement had been made by the second visit to the service to employ additional domestic hours. Care staff were noted not to always adhere to safe infection control practices, for example in hand washing and laundering and cleaning of hoist slings. The service had a quality assurance programme which included audits, staff and relative meetings and service user and stakeholder consultation. There was evidence of action being taken to improve the service but this was not formally reported in an annual plan. There were no reports available from provider visits (as required under Regulation 26) Key inspection report CARE HOMES FOR OLDER PEOPLE Longmead Court Nursing Home London Road Braintree Essex CM77 8QQ Lead Inspector Diana Green Key Unannounced Inspection 10:30 8th & 15th October 2009 DS0000015357.V378015.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.2 Page 2 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 Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longmead Court Nursing Home Address London Road Braintree Essex CM77 8QQ 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) 01376 344440 F/P 01376 344440 Dovecote Care Homes Limited Mrs Jane Alison Billingham Care Home 54 Category(ies) of Dementia (54), Mental disorder, excluding registration, with number learning disability or dementia (54) of places Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Mental disorder, excluding learning disability or dementia The maximum number of service users who can be accommodated is: 54 12th June 2008 2. Date of last inspection Brief Description of the Service: Longmead Court is located in a cul-de-sac off the main Chelmsford to Braintree Road. It is close to local shopping facilities and a large shopping complex. It has good access to bus routes and there is car parking at the home. There are close links to the A120 and M11 motorway. The home is a two-storey building and the majority of rooms are single. There are several communal lounge/dining areas. The home is registered to provide nursing care for up to 54 people with dementia and mental disorders, who are over the age of 45 years. The home is predominantly for older people. The home had a range of information for prospective residents and their representatives. At the time of inspection, in October 2009, the fees ranged from £720 to £1300 dependant on need. Additional charges are made for toiletries, hairdressing and private chiropody. Longmead Court Nursing Home DS0000015357.V378015.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 3 star. This means that people who use this service experience excellent quality outcomes. This unannounced inspection took place over two days on 9th and 15th of October 2009. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are being met for people using the service. This was completed by the registered provider and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and how they will address them. The inspection process included undertaking a tour of the premises, looking at the facilities and environment where residents live. Records required under the Care Home Regulations were viewed in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to residents where possible, their relatives, staff, the training officer and the manager. The manager and staff were welcoming and helpful throughout the inspection. What the service does well: The home provides care for residents with a mental disorder or dementia who have complex nursing needs. Assessment processes are robust. Full information is provided to potential residents and their representatives to enable them to make a decision. Full information on care needs is obtained and initial assessments undertaken prior to agreeing the admission. Standards of personal care are good. Residents have good access to health care with regular visits from their GP and other health professionals. Health and personal care needs are well monitored and reviewed to ensure their changing needs are met. Residents are well nourished and there is good monitoring of their fluid intake with frequent drinks provided throughout the day. All meals are cooked on site and fresh fruit and vegetables provided daily. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.2 Page 6 There is good provision of equipment for mobility and nursing care that is well maintained. The standards of health and safety are good with regular audits of premises and equipment undertaken and good standards of maintenance in place. Call systems comprise an intercall system that monitors when a resident attempts to enter another’s room. This ensures residents privacy and dignity and protects them abuse from other residents who may have behavioural difficulties. Communication between the manager and residents and their representatives is good. There are regular meetings held and there is good access to the manager on a daily basis. Staff are well supported by the manager and training officer. There is a good ongoing training programme in place that ensures staff are inducted to recommended Skills for Care Standards and receive regular updated mandatory and other training through an established training programme. Arrangements are in place to ensure staff are well supervised through handovers, observation of practice and formal documented supervision. The complaints procedure is on display in the home and included in the statement of purpose/service user guide. Residents and their representatives are kept well informed and encouraged to voice any concerns they may have. Prompt action is taken to address any issues raised. Regular training in safeguarding adults is provided to staff ensuring they are fully informed on all aspects of abuse and aware of the procedure to be followed in the event on allegation. Residents are protected by robust recruitment procedures that ensure all the required checks are obtained prior to employment. What has improved since the last inspection? Good progress has been made in reviewing care planning documentation to focus on the individual by developing person centred care plans. Care staffing hours have been increased to enable care staff to provide close monitoring and spend time in interaction with residents. Some furniture and carpets have been replaced and remaining carpets cleaned. Several bedrooms, bathrooms and communal rooms have been decorated. Records are now held securely in lockable cabinets. Social and therapeutic activity provision has been reviewed and additional coordinators employed to also provide activities at weekends. Staff training had continued to develop and has included social activities in dementia care, palliative and end of life care. The system for staff supervision has been developed so that staff received supervision six times per year by the manager and training officer. The manager has attended training in Deprivation of Liberty (DOLs) and the Mental Capacity Act and residents have had mental capacity assessments. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Longmead Court Nursing Home DS0000015357.V378015.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 Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1& 3 People using the service experience good quality outcomes in this area. Prospective residents can be assured that prior to admission a full assessment will be completed which will take into account their individual preferences and needs; and a placement will only be offered if their needs can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a statement of purpose and service user guide that met regulatory requirements. The statement of purpose and service user guide was seen on display in the entrance of the home together with a copy of the most recent CQC inspection report. A suggestion box was also available to visitors to put forward suggestions on how the service could improve. This showed the service was proactive in ensuring information was available to visitors about the service and was open to suggestions for improvement. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 10 The admission procedures were discussed with the manager of the home who said that wherever possible assessments were undertaken either in the persons own home, care home or hospital. Referrals were accepted by telephone and information on care needs obtained including a copy of the community care assessment provided by the social worker or community psychiatric team. A pre-admission assessment was undertaken using a preassessment form as a prompt to discuss care needs. The manager said that relatives were encouraged to visit the home and view the accommodation on behalf of their loved one prior to making a decision. A relative spoken with confirmed that was their experience. Information was used following admission to complete a full assessment and care plan. Four residents’ care plans were viewed during the visit to the service. All included a detailed pre-admission assessment form that provided key information on the residents care needs from which a care plan could be developed. We were informed that a copy of the pre-admission assessment was provided to care staff and kitchen staff on admission to ensure they were clear on the residents’ needs and preferences. A full assessment was completed over a four week period following admission. This was seen to include a mental health assessment and mental capacity assessment undertaken by the manager. The home does not provide intermediate care. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. The health and personal care needs of residents are met through robust care planning that focuses on the individual. Medication administration policies, procedures and practices are generally well adhered to in order to safeguard residents. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Four residents care records were viewed during the site visit. All four contained a pre-admission assessment detailing the residents care needs that had been undertaken prior to admission. Care plans were seen for personal grooming, meal-times and nutrition, night care, anti-social behaviour and monthly evaluations. All four files viewed contained very detailed care plans that provided clear guidance to staff when providing care to meet individual residents’ needs and had been signed by the relative/representative confirming their agreement to their care. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 12 Care plans included the residents ’this is who I am sheet’. We were informed that relatives were requested to complete this social history/life story to enable staff to gain an understanding of the residents personal life and interests and hobbies and supported them in providing care to meet their needs. Nutritional screening for adults with dementia or mental health disorder was undertaken on admission and reviewed with weight monitoring also undertaken monthly. Risk assessments were seen for tissue viability, risk of falls and a manual handling assessment was also seen. All had been reviewed monthly. Since the previous key inspection care plans had been developed to provide a person centred approach. A sample of both new and old documentation was viewed. It was evident that the new documentation focussed more on the individual which was a considerable improvement than those viewed at the previous key inspection. However on a tour of the premises it was noted that for one resident the daily turning chart had not been completed since 13/10/09 and there were no records made from 27/09/09 to 1/10/09 inclusive. Residents access to healthcare services was discussed with the manager and confirmed from the care records. Residents were registered with the local GP practice who attended weekly and on request. One residents care records viewed during the visit to the home confirmed they had received regular visits from their GP, had blood tests taken, chiropodist, dentist, RN Assessor, practice nurse. Another resident’s care records confirmed they had also been seen regularly by their GP, had blood tests taken and received visits from a dentist and chiropodist. A relative spoken with confirmed they visited regularly, were always welcomed into the home and were happy with the care their loved one received. The AQAA informed us that the home provided palliative care and developments had taken place to ensure staff were skilled by attending training and focusing on the person’s end of life care choices. This was also confirmed from records viewed. The home had a medication policy and procedures for staff guidance which were kept in the main office. A homely remedy list that should be agreed annually was last agreed by the GP on 12/09/07. Information on medicines (British National Formulary) was available for staff and seen in the nurses’ station in Wilson Wing where medication was stored. All medication was administered by registered nurses and a list of staff signatures and initials was held to enable appropriate follow up in the event of an adverse incident. Medication was supplied from the local supplying pharmacy in monitored dosage systems and individual containers. There were appropriate procedures for the receipt and disposal of medication available and were seen to be well adhered to. Medication was stored in two locked trolleys, one for each wing of the home. Both trolleys were secured to the wall as required for security. A controlled drugs (CD) cupboard was available for the storage of CD drugs. Room temperatures were recorded and monitored to ensure medicines were stored within safe recommended levels (maximum 25 degrees centigrade). Drug refrigerator temperatures were also monitored and recorded to ensure the safe storage of medicines requiring cold storage. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 13 The medication supplies and administration records for four residents were examined. All medication was available as prescribed. Records were in the main completed accurately but one omission was found and one medicine had been signed as given but was still present in the blister pack. Several medicines in cartons did not have the date of opening recorded. One analgesic gel had been prescribed to be given three times a day but was being given as required. The Controlled Drugs (CD) storage met requirements and a CD register was in use. Records were completed accurately and confirmed by two staff signatures. We were informed that there was only one registered nurse on duty for the 6pm medicines round for both wings of the home and that this could take up to two hours to complete the medicines round. This was disputed by the manager who said that a lead nurse/deputy manager has been appointed who will support staff in administering medicines and in the interim, they (the manager) was providing support to administer medicines. Evidence of regular medication audits being undertaken were seen, demonstrating that the manager aimed to ensure residents were safeguarded. Staff were observed to be friendly but professional towards residents and visitors. Residents personal care was observed to be provided in private. Rooms included personal items of furniture and lockable facilities for storage of valuable and medication in the event that a resident chose to self medicate. Comments seen in the compliments file at the home included one from a relative whose loved one had died ‘everyone always had respect for x ‘. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 15 & 16 People using the service experience adequate quality outcomes in this area. People living at Longmead Court can expect to be supported to maintain contact with their family and friends and to have a varied and sociable life within the parameters of their capacity. Meals are nutritious but the time taken to serve food does not ensure they are hot when eaten and therefore reduces the enjoyment residents’ experience. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The homes activities were discussed with the manager and the activities coordinator who explained that they had received dementia awareness training that included information on appropriate activities. There were a total of four activities coordinators with two being employed Monday to Friday 09:30 to 16:30. Since the previous key inspection this had been increased to provide another person on Saturday to organise activities and provide group and individual activities for residents supported by care staff. On admission to the home the manager or lead nurse undertakes an assessment and develops a care plan for the coordinators to follow. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 15 The hairdresser visited each week. The minister of a local church has recently agreed to provide a monthly service with hymns, readings and prayers. Representatives of some churches also visit to provide communion weekly for individual residents. The home had a designated activities room/dining room entered through a small room where a portable snoozeluum was stored. This had been donated by a relative for specific use of their loved one but could also be accessed by other residents. However it was not clear how frequently this was used and the provision of a designated snoozeluum room should be considered which would provide a more relaxing environment and potentially more effective use of the equipment. We were informed that an allocated number of residents come to the activities room daily where they also have their lunch. The programme provided craft activities with themed events organised, for example the Queens’s birthday and Easter. There was a large screen TV in the room for regular TV programmes and videos. The remaining residents stay in the units where care staff spend time playing music and supporting residents with jigsaws and puzzles. During the visit to the service two residents were observed in conversation with each other, one was reading a newspaper and another a book and others were involved in craft work with staff. We were informed that individual activities were provided in the afternoon. Outings to local places of interest are organised, for example to Maldon, Clacton and walks to the local supermarket and Duck Pond and pub. The home also has a visiting PAT dog. Circle dancing is also provided for residents which has proved a beneficial therapeutic activity for people with dementia. The homes visiting policy was included in the statement of purpose. A visitor’s book was seen and confirmed that visitors came into the home at various times during the day, evening and weekends. Several visitors were observed visiting the home. A relative told us they could visit at anytime, could see their loved one in private and always felt welcome. During the visit to the home residents were observed to spend time mainly in the lounges/dining rooms. However some had chosen to stay in their rooms and others were observed freely wandering the premises within a designated space and as laid down in their care plan. Some residents rooms were seen to be personalised with their own belongings (photos, pictures, ornaments etc.) Information on the Alzheimer’s Society was seen on display in the home and the manager said a representative attended some of the relatives meetings. The kitchen was viewed and was seen to be clean, well organised with plentiful supplies. The cook explained that all food was cooked on site and fresh fruit and vegetables were provided daily. Birthday cakes were also baked on site and home made soups were always available. The AQAA informed us that the home had achieved a five star rating from the local environmental health Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 16 department. Residents were observed enjoying the lunchtime meal which comprised sausages, mashed potatoes, cabbage, carrots and gravy. Drinks were served with the meal and were noted to be provided during the day. Residents records viewed confirmed that a nutritional risk assessment was undertaken on admission to the home and weights monitored with nutritional supplements provided as needed ensuring that residents did not lose weight unduly. Pureed food was served attractively in separate portions of meat and vegetable and finger type foods were also provided for some residents to enable them to eat independently. Meals were served onto a trolley and taken to the dining room on the Wilson Wing. A number of residents in this wing required assistance and some resident’s meals were observed left for more than twenty minutes before they were able to eat and were not being kept hot. This was discussed with the manager who reviewed staff deployment and had requested the purchase of a heated trolley by the time of the second visit to the service. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience excellent quality outcomes in this area. People living at Longmead Court are assured that their concerns and complaints are listened to and acted upon and that they are safeguarded by the home’s policies, procedures and practices. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a complaints procedure that was included in the statement of purpose and service user guide and was seen on display in the home. The record of complaints was viewed and confirmed that complaints were fully investigated in line with the homes procedures. A compliments’ file was also kept by the home. This was viewed and seen to include numerous letters and cards from satisfied relatives, thanking the staff for the care their loved one had received. Comments included ‘your kindness and attention to my x was always evident and very much appreciated’. The AQAA informed us that residents/relatives are provided with a copy of the procedure and encouraged to raise any concerns they have. No complaints had been received since the previous key inspection. A record of compliments was also seen that showed the satisfaction of relatives whose loved one had been cared for at the home. Relatives spoken with said they knew how to make a complaint but also said they were happy with the care their loved ones received. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 18 The home had safeguarding procedures in place and the records confirmed that all staff received regular updated training in safeguarding adults by the designated trainer, an experienced psychiatric nurse, employed by the service. We were informed that the trainer was to attend the ‘train the trainer’ course organised by Essex County Council ensuring he was up to date with local procedures. The manager was knowledgeable about safeguarding procedures and the action to be taken in the event of an alert being made. However she had not attended updated safeguard training since being employed as manager at the home and a recommendation is therefore made in this report. The home had detailed policy and procedures for safeguarding adults and the manager confirmed that the Essex safeguarding procedures were available for staff guidance in the event of needing to refer an allegation. A whistle blowing policy was also available to support staff should they witness an allegation of abuse. However this did need to be updated to reflect the details of the Commission and the Nursing & Midwifery Council. From discussion it was evident that the manager was well informed on the Deprivation of Liberty (DOLs) and Mental Capacity and had been involved in issuing a DOLs authorisation on behalf of one resident. There had been no safeguarding alerts made since the previous inspection. The homes recruitment procedures were inspected and were confirmed to protect residents by ensuring all relevant checks were undertaken prior to appointment. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 People using the service experience adequate quality outcomes in this area. People living at Longmead Court live in a comfortable, homely and generally clean environment that is well maintained and appropriate for their needs but some infection control practices may pose a risk to their well being. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A tour of the premises was made during the visit to the home. The entrance to the home was secure with a door entry system in place. We were informed that a CCT camera had been installed in all three lounges of the home to enable close monitoring of residents. The entrance hall was welcoming with seating provided, a visitor’s book and various items of information on display for visitors including the most recent inspection report. The home is a two storey purpose built home and has two wings with two floors in each; Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 20 the Waters Wing and a new Wing named the Wilson Wing. The new wing had single en-suite accommodation throughout. Several residents rooms, communal rooms, bathrooms, a shower room, medication room, kitchen, sluice rooms and laundry were viewed. The premises were generally clean and well maintained. The home had a programme of maintenance and repair in place and on the second day of the visit to the service, a bedroom had been decorated and a shower room was also being redecorated. The home had views from the first floor over the garden of the adjacent property. A quadrangle garden was located next to the lounge dining room on the ground floor and was secured with fencing and was accessible and used by residents when weather permitted. The garden was planted with containers of flowers and shrubs. Records viewed during the visit to the home confirmed that systems were in place to ensure the building complied with the requirements of the local fire and environmental health department. The home had stairs and two passenger lifts to enable access to the first and floor of the premises. Doors between units were secured by entry systems for the safety of residents. There were grab rails throughout corridors with aids in bathrooms and toilets to meet the mobility needs of residents. Call systems were provided throughout communal and individual rooms to enable residents and staff to call for assistance and records confirmed these were well maintained. The home had some adjustable beds and a range of specialist pressure relief equipment, hoists and slings was available to meet the needs of individual residents. The AQAA informed us that there were plans to purchase an additional hoist to ensure the needs of the increasing number of urgent admissions could be accommodated. The home was generally clean but some individual rooms and en suites and sluice rooms were not adequately cleaned. Systems were in place to ensure staff had personal protective clothing for use when providing personal care. Hand washing facilities (liquid soap and paper towels) were provided throughout to ensure care staff had appropriate equipment to safely provide personal care. However bins were not available for disposal of gloves in some rooms and bathrooms. Cleaning equipment was inappropriately stored in sluice rooms obstructing access for staff hand washing. Staff said they used another room to wash their hands which poses a risk of infection by touching door handles before washing their hands. This indicated that the number of domestic hours was insufficient and was discussed with the manager who took prompt action to increase the hours provided by the date of the second visit to the service. Resident’s individual toiletries were observed left in some bathrooms. Slings were used communally and from discussion with a care assistant were regularly laundered but not cleaned between use. The laundry room was viewed and was clean and well organised with shelving, individual boxes and hanging rails to enable staff to organise the sorting and return of residents laundry to the rightful owner. There were two washing machines fitted and a drier all in working order. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 21 Both washing machines had sluice facilities (able to wash at 65 degrees centigrade for a minimum of 10 minutes) to minimise the risk of infection. Relatives spoken with during the visit to the home confirmed they were satisfied with the standard of laundry. However a relative did raise concerns that slippers go missing. The laundry assistant said that slippers do need to be laundered at times and that a box of such items had been placed in the bathrooms for care staff to ensure they are returned to the rightful owner. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 7 30 People using the service experience good quality outcomes in this area. People living at Longmead Court are cared for by staff who are robustly recruited, well trained and well supervised. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There were forty-nine residents at the home and one attending day care. We were informed that in addition to the manager (also acting as second registered nurse until 11:00) there was one registered nurse and fourteen care assistants. We were informed that since the previous key inspection staffing had been reviewed and less registered nurse hours were provided with an increased number of care assistants employed to enable improved monitoring and interaction with residents. Two activities coordinator, one cook and two kitchen assistants, one administrator, one handyman, two domestic assistants and one laundry assistant were also on duty. The duty rota was seen and confirmed the staffing levels were as discussed. During the visit to the home, residents were observed to be well cared for, however as previously reported (standard 9) registered nurse hours were not always sufficient to ensure medication could be provided in a timely manner. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 23 The manager said she expected this to be resolved with appointment of a lead nurse/deputy manager. Night staffing levels comprised one registered nurse and four care assistants. The AQAA informed us that the home employed a total of fifty-two care staff of which thirty-two had an NVQ level 2 qualifications or above. This is 65 and therefore exceeds the 50 needed to meet the recommended standard. During the visit to the home the recruitment files for four recently employed staff were viewed. All files included evidence that the relevant checks (CRB, two satisfactory references, identification etc.) were undertaken prior to appointment. We were informed that a copy of the General Social Care Council (GSCC) Code of Practice was given to all new staff on appointment to ensure they were aware of their responsibilities as a care worker. The files also included staff contract/terms and conditions detailing their legal rights of employment. Arrangements for staff training were discussed with the manager and records viewed. The home had a designated trainer (also spoken with) who worked one day per week providing training, including induction and assisting with staff supervision. The records confirmed that since the previous key inspection training had been provided in safeguarding adults, manual handling, fire safety, medication administration (Boots), Deprivation of Liberty, Nutrition in dementia care, difficult behaviour, care in diabetes, personal care, palliative care. The training records for the same four staff were viewed and confirmed that since appointment they had received training in manual handling, safeguarding adults, fire safety, health and safety, Parkinson’s and infection control and had completed the common induction standards. The AQAA informed us that sixteen staff had completed the common induction standards recommended by Skills for Care. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 36 & 38 People using the service experience good quality outcomes in this area. Longmead Court is well managed with good health and safety standards that protect them and staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Discussions were held with the manager, a registered nurse who informed us that she had managed the home for several years. She had acute and community experience and had completed the Registered Managers’ Award. Records viewed confirmed that regular updated training had been undertaken, ensuring she was skilled and knowledgeable to manager the home effectively. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 25 The manager was well supported by a senior manager who attended the home regularly. During the visit to the home it was clear that the manager was well known to staff and relatives. From observation and an inspection of records, the home appeared to be well managed. The homes quality assurance policy and procedures were discussed with the manager. Regular audits were undertaken for health and safety, medication, the kitchen, environment and care plans. Questionnaires with an anonymous response were forwarded annually to residents’ representatives, general practitioners and other health professionals (district nurses, chiropodists, social workers etc.). A suggestion box was also provided to enable residents, visitors and staff to put forward any suggestions to improve the service. Information obtained was used to develop an action plan to address any issues raised. There were no records to confirm that regulation 26 reports were completed and a misunderstanding that these reports were no longer required. However the senior manager was frequently on site and was spoken with during the visit to the service and it was evident that there was close monitoring of the service. The home had a comprehensive range of policies and procedures in place for staff guidance that had been regularly reviewed ensuring they met with up to date legislation and best practice guidance. The arrangements for handling residents monies were discussed with the manager and administrator. Neither the manager nor representative was appointee for any resident. No resident managed their own financial affairs. All residents had a relative or representative to manage their finances on their behalf. Personal allowances were held in secure facilities on their behalf. The personal allowances and records were inspected for four residents. The amounts of money were present and correct for all four residents with records of transactions made and receipts held as evidence. The manager said that supervision was undertaken for all staff at two monthly intervals to discuss care practice and performance. Handover was provided between shifts to ensure staff were aware of residents changing needs and this was noted during the visit to the home. The training officer confirmed that he assisted the manager in supervision of staff. The records for four staff members were viewed and confirmed these arrangements were in operation. The home had a health and safety policy and procedures in place for staff guidance that had recently been reviewed. The records confirmed that staff had attended health and safety training following appointment. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment (hoists, sling etc.) and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment, fire alarms and emergency lighting etc.). Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 26 Notifications deaths, incidents and accidents were forwarded to the Commission as required in accordance with Regulation 37 of the Care Homes Regulations 2001. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 27 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X 3 X X x 2 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 x 3 Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 28 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 OP9 Regulation 13(2) Requirement Timescale for action 30/11/09 2. 3. OP15 OP26 13(4) 13(3) & 18(1) 4. OP33 26 To ensure residents are safeguarded and receive their medication as prescribed: 1. Medication records must completed accurately and in full. 2. Errors must be followed up promptly and appropriate action taken. 3. The date of opening must be recorded on all individual containers and cartons. To ensure residents enjoy their 30/11/09 meals, action must be taken to ensure it is hot when served. To ensure the premises are clean 30/11/09 and odour free and residents are protected from infection: 1. Domestic staff must be employed in sufficient numbers. 2. Hoist slings must be cleaned between use and a procedure developed for staff guidance. Reports from visits by the 30/11/09 registered provider must be maintained and made available to the commission on request. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 29 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. 2. 3. 4. 5. 6. Refer to Standard OP9 OP15 OP18 OP18 OP26 OP33 Good Practice Recommendations To ensure they are current, the list of homely remedies should be agreed annually with the GP. To enable residents to understand and make choices about their food, menus should be provided in pictorial format. The whistle blowing policy should be reviewed to accurately reflect the details of the Commission and the Nursing & Midwifery Council. To ensure the manager is skilled and competent she should attend updated training in safeguarding adults. To ensure residents are protected from infection and their individual needs are met, purchase of slings for individual use should be considered. An annual development plan for the home that includes the outcome of the service user and stakeholder consultations should be developed and a copy made available to the commission. Longmead Court Nursing Home DS0000015357.V378015.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission East Midlands Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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