Care Home: Longmore Nursing Home

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What the care home does well All care files looked at included an appropriate pre-admission assessment that had been carried out before a person had been offered a place, to ensure that the home could meet their needs. Each person had a care plan that had been reviewed at a minimum of monthly intervals to ensure that they remained up to date. There was also evidence indicating that the resident or their representative had been included in drawing up the care plan.Longmore Nursing HomeDS0000004559.V378254.R01.S.docVersion 5.2Risk assessments related to the development of pressure sores and to moving and handling were in place. Any equipment required to transfer a person from one place to another included in the risk assessment and care plan. Records showed that on going health care needs were being met by visits from the GP, Tissue Viability Nurse, Community Psychiatric Nurse, and optician and chiropodist. Observations and discussion showed that people are cared for in a dignified manner and their privacy and dignity are respected. The home employs a designated part time activity organiser. There was evidence that stimulating activities and entertainment are provided. Surveys returned to us from residents further evidenced this. Visitors are made welcome and there was evidence to show that their needs were considered. A complaints procedure is on display for residents and visitors. Residents’ surveys indicated that people knew how to make a complaint and who to go to if they had any concerns. Staff have attended safeguarding training to give them the knowledge and skills they need to identify abuse and what to do if there is any allegation or suspicion that it has occurred. Residents’ financial interests are safeguarded and the risk of the employment of inappropriate people is minimised by the home’s relevant policies and practice. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. Sixty four per cent of the care staff have achieved the National Vocational Qualification (NVQ) Level 2 or 3 in Care exceeding the minimum requirement of 50%. This qualification means that staff have been trained and assessed as competent in their role. There is monitoring and auditing of the service and practices to ensure that all services operate in the best interests of residents. A random check of records showed that equipment had been regularly serviced and maintained and that in-house checks on the fire system were up to date. What has improved since the last inspection? The medication system safeguarded the health and welfare of the people living at the home. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.2 Menus have been changed and there is now a four weekly cycle that offers more choice. Most of the responses in the surveys indicated that people always or usually enjoyed the meals provided. There are improvements in the kitchen worktops were clean, cutting boards and some cooking trays had been replaced, the old extractor fan had been removed and storage had been reorganised. The kitchen was also due to have a ‘deep clean’ on the following day and floor covering renewed. The home’s whistle blowing policy that is related to staff informing of any concerns about other peoples’ practice, has been updated. There have been improvements made to the physical environment of the home with new décor and carpet in several bedrooms and corridors, pipework being appropriately boxed-in to create a more hygienic area and new furniture in several areas. This included a large extending table in the conservatory that enabled more people to have the choice of taking their meals at the table and this and the new crockery makes mealtimes more enjoyable for the people living at the home. Appropriate infection control systems are in place. Issues related to cleanliness and hygiene in the toilets, kitchen, the toiletries in shared rooms and rusty commodes had been addressed. Cleaning schedules have been implemented by the new manager as well as sluices being improved to provide better infection control. Staff have attended moving and handling training and further training is planned. Some senior staff have attended risk assessment training so that they are competent in carrying out these assessments. There had been some temporary improvement in the seating arrangements in the lounge and conservatory. What the care home could do better: Although staff spoken with were aware of the care required care plans looked at had some omissions of information, including that regarding the management of a person’s aggressive behaviour; preventative measures for someone at risk of developing pressure sores; instructions related to the use of bedrails. They also lacked any details to some information such as elaborating on “bath” and “body wash” given as personal care instructions. Two care files looked at showed that bedrails were in place for these two people but neither had a risk assessment. This could result in the appropriate action not being taken to minimise risk. Daily records did not reflect the care plans and were not meaningful. This had already been addressed by the newly appointed manager.Longmore Nursing HomeDS0000004559.V378254.R01.S.doc Version 5.2 Many of the residents were in bed by 07:15pm and although staff said this was their own choice because they were tired as it was usual for residents to be up early. The responses of the residents on this subject were unclear. The home should monitor that early bedtimes and rising are the wishes of the people it applies to rather than them complying with what they think is the routines of the home. Space for hairdressing continues to be a problem, with nowhere to use the hairdryer other than the adjacent corridors. Whilst the home has vacancies a bedroom is being used for this purpose. This needs addressing to provide an area that maintains the privacy and dignity of the people who wish, or need, to have their hair dressed at the home. Although records and observations indicated that there are sufficient staff to meet the needs of the residents, comments made by them and the staff could suggest that there are times when this is not the case. This should be closely monitored and any necessary action taken. Even though they had attended moving and handling training a member of staff was seen to be using a technique that should not be practiced. There were also several accidents recorded in the accident book that related to the use of hoists. The manager needs to ensure that the content of relevant training is appropriate and that learning is put into practice. Key inspection report CARE HOMES FOR OLDER PEOPLE Longmore Nursing Home 118 Longmore Road Shirley Solihull West Midlands B90 3EE Lead Inspector Lesley Beadsworth Key Unannounced Inspection 23rd September 2009 1:20pm DS0000004559.V378254.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. Longmore Nursing Home DS0000004559.V378254.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 Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longmore Nursing Home Address 118 Longmore Road Shirley Solihull West Midlands B90 3EE 0121 733 6595 0121 733 3159 longmore@live.co.uk None Mr & Mrs Grant 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) Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Longmore Nursing Home DS0000004559.V378254.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: 2. Old age, not falling within any other category (OP) 22 The maximum number of service users who can be accommodated is: 22 24th September 2008 Date of last inspection Brief Description of the Service: Longmore is a purpose built, two story, detached building, set in a residential area of Shirley. Located close to all local amenities and with a good public transport system, which services the area. There is a large garden to the rear of the property with patio areas and designated car parking spaces at the front of the building. The home is set back from the road behind a small car park and fits well into the neighbourhood. It is close to local amenities and bus routes. There have been no changes in the layout of the home with a porch entrance leading to the reception and offices with two small bedroom corridors off this through to the lounge and conservatory. The first floor accommodates further bedrooms and the lower ground floor the kitchen, laundry and staff facilities. There is a passenger lift to all floors. Any queries about up to date charges for fees should be directed to the management of the home. Additional charges include hairdressing and chiropody. Longmore Nursing Home DS0000004559.V378254.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 inspection included a visit to Longmore Nursing Home. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Surveys were sent to service users and staff. Seven were completed by or on behalf of service users and five by staff and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families, where possible, about their experiences, looking at residents’ care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place over two visits on 23rd September from 1:20pm and 06:40pm and 28th September between 04:00pm and 09:00pm What the service does well: All care files looked at included an appropriate pre-admission assessment that had been carried out before a person had been offered a place, to ensure that the home could meet their needs. Each person had a care plan that had been reviewed at a minimum of monthly intervals to ensure that they remained up to date. There was also evidence indicating that the resident or their representative had been included in drawing up the care plan. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.2 Page 6 Risk assessments related to the development of pressure sores and to moving and handling were in place. Any equipment required to transfer a person from one place to another included in the risk assessment and care plan. Records showed that on going health care needs were being met by visits from the GP, Tissue Viability Nurse, Community Psychiatric Nurse, and optician and chiropodist. Observations and discussion showed that people are cared for in a dignified manner and their privacy and dignity are respected. The home employs a designated part time activity organiser. There was evidence that stimulating activities and entertainment are provided. Surveys returned to us from residents further evidenced this. Visitors are made welcome and there was evidence to show that their needs were considered. A complaints procedure is on display for residents and visitors. Residents’ surveys indicated that people knew how to make a complaint and who to go to if they had any concerns. Staff have attended safeguarding training to give them the knowledge and skills they need to identify abuse and what to do if there is any allegation or suspicion that it has occurred. Residents’ financial interests are safeguarded and the risk of the employment of inappropriate people is minimised by the home’s relevant policies and practice. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. Sixty four per cent of the care staff have achieved the National Vocational Qualification (NVQ) Level 2 or 3 in Care exceeding the minimum requirement of 50 . This qualification means that staff have been trained and assessed as competent in their role. There is monitoring and auditing of the service and practices to ensure that all services operate in the best interests of residents. A random check of records showed that equipment had been regularly serviced and maintained and that in-house checks on the fire system were up to date. What has improved since the last inspection? The medication system safeguarded the health and welfare of the people living at the home. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.2 Page 7 Menus have been changed and there is now a four weekly cycle that offers more choice. Most of the responses in the surveys indicated that people always or usually enjoyed the meals provided. There are improvements in the kitchen worktops were clean, cutting boards and some cooking trays had been replaced, the old extractor fan had been removed and storage had been reorganised. The kitchen was also due to have a ‘deep clean’ on the following day and floor covering renewed. The home’s whistle blowing policy that is related to staff informing of any concerns about other peoples’ practice, has been updated. There have been improvements made to the physical environment of the home with new décor and carpet in several bedrooms and corridors, pipework being appropriately boxed-in to create a more hygienic area and new furniture in several areas. This included a large extending table in the conservatory that enabled more people to have the choice of taking their meals at the table and this and the new crockery makes mealtimes more enjoyable for the people living at the home. Appropriate infection control systems are in place. Issues related to cleanliness and hygiene in the toilets, kitchen, the toiletries in shared rooms and rusty commodes had been addressed. Cleaning schedules have been implemented by the new manager as well as sluices being improved to provide better infection control. Staff have attended moving and handling training and further training is planned. Some senior staff have attended risk assessment training so that they are competent in carrying out these assessments. There had been some temporary improvement in the seating arrangements in the lounge and conservatory. What they could do better: Although staff spoken with were aware of the care required care plans looked at had some omissions of information, including that regarding the management of a person’s aggressive behaviour; preventative measures for someone at risk of developing pressure sores; instructions related to the use of bedrails. They also lacked any details to some information such as elaborating on “bath” and “body wash” given as personal care instructions. Two care files looked at showed that bedrails were in place for these two people but neither had a risk assessment. This could result in the appropriate action not being taken to minimise risk. Daily records did not reflect the care plans and were not meaningful. This had already been addressed by the newly appointed manager. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.2 Page 8 Many of the residents were in bed by 07:15pm and although staff said this was their own choice because they were tired as it was usual for residents to be up early. The responses of the residents on this subject were unclear. The home should monitor that early bedtimes and rising are the wishes of the people it applies to rather than them complying with what they think is the routines of the home. Space for hairdressing continues to be a problem, with nowhere to use the hairdryer other than the adjacent corridors. Whilst the home has vacancies a bedroom is being used for this purpose. This needs addressing to provide an area that maintains the privacy and dignity of the people who wish, or need, to have their hair dressed at the home. Although records and observations indicated that there are sufficient staff to meet the needs of the residents, comments made by them and the staff could suggest that there are times when this is not the case. This should be closely monitored and any necessary action taken. Even though they had attended moving and handling training a member of staff was seen to be using a technique that should not be practiced. There were also several accidents recorded in the accident book that related to the use of hoists. The manager needs to ensure that the content of relevant training is appropriate and that learning is put into practice. 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. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 9 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 Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 10 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): 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Preadmission assessments are carried out to assess if the needs of prospective residents can be met. EVIDENCE: The AQAA told us that every new resident is given a Statement of Purpose and Service User Guide that are “detailed, clear and simple”. We did not look at these documents on this occasion. The majority of the people who answered the surveys said that they had received sufficient information about the home before moving in. Three care files were looked at as part of the case tracking process. Each had a pre-admission assessment that had been carried out by a senior member of staff in order to assess if the home could meet the person’s needs prior to offering them a place at the home. The assessment is then considered by the Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 11 management team in order to be sure that they can be confident that the person’s needs can be met at Longmore. All the appropriate heading were included in the assessment and all medical conditions and needs were identified. There was sufficient detail to decide if the home could meet the person’s needs or not. One subsequent assessment carried out a few days after admission showed several major differences to the pre-admission assessment. This was explained to us to be because the person’s representative had given inaccurate information at the time of the pre-admission assessment. It is recommended that a record is made of the reason for these differences rather than anyone assuming that there had been such changes in a person. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 12 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. We have made this judgement using a range of evidence, including a visit to this service. There are care plans that include the residents’ needs but with some shortfalls in information. Residents have access to health care professionals and are cared for in a respectful manner. The medication system safeguards residents’ well being. EVIDENCE: Three care files were looked as part of the case tracking process. A care plan for all needs identified in the assessment was included in each of them. A new care plan format had begun to be used at the previous inspection and this was now being used for all residents. This is a pre-formatted system but can be cumbersome and prescriptive. The care plans were fairly well detailed but some information was missing in each of them. For example, a person at risk of developing pressure sores had a Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 13 corresponding care plan but this did not inform of any other preventative measures that pressure relieving cushion and mattress; identified aggressive behaviour had no details to inform staff of how to manage the behaviour; there was reference to bedrails in a care file but these were not included in the care plan. The plans would also benefit from more detail such as elaborating on “bath” and “body wash” as instructions to staff about someone’s personal care needs. Staff spoken with were aware of these needs and the care required, including how to manage the aggressive behaviour but this information should be recorded to ensure that they are not relying on verbal communication or the memory of staff members. The care plans are reviewed at a minimum of monthly intervals and revised as necessary to ensure that they are up to date. There was evidence that residents’ and or their representative are included in drawing up the care plan. Records of falls, pressure areas, weight and bathing nail checks, nutrition and nutritional screening were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) were now in place and risk assessments for moving and handling (transferring a person from one place to another) was also in place. This included the type of hoist and size of sling, or any other equipment required to assist someone to move. These would help to minimise any risk in these areas. Individual risks were also assessed, for example a risk assessment was in place for someone who experienced frequent urinary tract infections. However risk assessments were not seen for bedrails in the two care plans looked at belonging to people who had bedrails. As there are known potential risks to the use of bedrails these must be completed before bedrails are used in order to know what action is required to minimise these risks. Preventative measures such as pressure relieving mattresses and cushions were in use for those people at risk of developing pressure sores. Residents on going health care needs were being met with evidence of visits to or visit by the GP, Tissue Viability Nurse, Community Psychiatric Nurse, optician and chiropodist being identified in the care files looked at. Daily records were in place and completed each day for each resident. The newly appointed manager had already begun to address that they were not always meaningful. The medication system was inspected. The pharmacist supplies most of the medicines in a monitored dosage system (MDS) where each medicine is dispensed in a blister pack from which to administer on a daily basis. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 14 The room in which medicines are stored had been fitted with a digi-lock since the previous inspection enabling the room to be easily locked and was locked throughout both visits. The medication keys were kept separately form general keys and were the responsibility of the person in charge of medication. A sample of the signatures of all people who administer medication was available. The Medication Administration Records were correctly completed and through a random audit, observation, discussion and examination of records it was demonstrated that the staff order, store, administer and dispose of medication in accordance with current clinical practice. Controlled drugs are maintained in a controlled drug cabinet and records of these drugs were seen and were in good order. With the improvements the medication system safeguards the health and welfare of the people living at the home. Observations and discussion with staff and visitors showed that residents are cared for in a respectful manner, whilst maintaining dignity and privacy. There are two shared rooms and the screens between beds in these rooms afford privacy whilst personal care is being given. We saw that there was comfortable interaction between staff and residents. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 15 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are occupied and regular activity is facilitated. Visitors were made welcome and their needs considered. Residents had some choices and control over their daily lives. Residents enjoyed the nutritious and varied meals provided. EVIDENCE: The home employs a designated activity organiser who works four days a week and who, according to the programme on display, organises activities chosen by the residents from 10:30am to 3pm on these days. The activity organiser was on leave at the time of the visits. Some of the activities that are listed include, darts, Scrabble, dominoes, skittles, croquet, gardening club, flower arranging, greeting card making, and quizzes and crosswords. Any forthcoming special events are displayed on the notice board and these included, a Singalong, Name the Tune, a visiting Keyboard entertainer. Visiting entertainment was arranged for the following two weeks. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 16 All but one resident answered “Always” or “Usually” to the question, “Does the home arrange activities that you can take part in if you want?” in the surveys. One person answered “Never”. The manager should monitor whether there is sufficient and appropriate activity for all residents, including the activity organiser’s days off, and that they wish and are able to join in with. The AQAA tells us that there are plans to have more entertainers, such as “short music concerts and talks on local and general history” visiting the home in the afternoons. The AQAA also informed us that there had been some research carried out regarding reminiscence and that there are plans to “incorporate this into our activities and décor”. There is a budgerigar in the conservatory and a new fish tank in the lounge for added interest and enjoyment. Visitors are made welcome as was evidenced by observations and discussion with visitors. They are encouraged to eat with their relative/friend that lives at the home and one visitor spoken with said that they had lunch on most occasions that they visit. Comfortable stacking chairs have been purchased so that they can sit at the table if they wish, but can be stored when not in use. New tablemats and crockery have also been provided. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as what to eat, what activities to join in with and where to spend their time, although there was some concern about the early hour that the majority of residents were assisted to bed and to rise in the morning. The large majority of residents were in bed by 7:30pm. Staff said that this was because they wanted to be in bed as they were tired. Staff also said that many residents were up very early with some day staff coming on duty at 7am to assist night staff in getting residents up. Comments from staff indicated their concern that there is some urgency to get people up in the mornings, rather than these times being the choice of the people living at Longmore but responses from residents about this were vague. These practices should be monitored to ensure that so many people are wishing to get up and go to bed at these times that they are aware that there is a choice and are not doing so to act in accordance with the routine of the home and staff rotas. Since the previous inspection a large and expanding oak table has replaced the old worn table in the conservatory. This is a big improvement and as photos taken at Christmas show it can seat a large number of people. Residents now have a choice of eating at the table, from over chair tables in their room or in the communal sitting areas. New tablemats and crockery have also been purchase. These improvements make mealtimes a more pleasant experience. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 17 The home has revised the menus since the previous inspection and there is now a four week cycle. There is a choice of meal at each of the three mealtimes, with cereals and toast or teacake and/or a cooked breakfast each day; a meat and non-meat main meal choice with dessert for lunch; the evening meal offers soup with sandwiches or a cooked meal, and a dessert. People are asked each morning what they would like for lunch that day and an alternative is found if none of the choices are wanted. Most of the responses in the surveys said that they “Always” or “Usually” liked the meals at the home, although one person answered, “Sometimes”. The management should monitor this and ensure that there is no general or individual dissatisfaction with the meals that are provided. The cooks work a split shift and the kitchen was visited between these shifts. The kitchen is located in the lower ground floor of the premises. There is a newly introduced cleaning schedule in place and appropriate temperature records have been maintained. The worktops were clean but the cooker hobs had been left dirty and the heated trolley used to transport meals to the dining areas, was also dirty with food spillage. A very dirty tray was found inside the trolley. However the kitchen was to have a deep clean the following day and to be fitted with a new floor covering. There had been improvements in the kitchen area since the previous inspection with the old extractor fan being removed, food stored hygienically and cutting boards and some cooking trays replaced. The store room has been rearranged so that food items are separate from other items. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns are listened to. The home has appropriate policies and procedures to safeguard residents. EVIDENCE: Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 19 The complaints procedure was displayed in the reception area of the home to inform residents and visitors of what to do if they had any concerns. The home has recently introduced a confidential comments box in the hallway. All but one of the surveys told us that there was someone they could talk to if they were not happy and all but two of the surveys told us that they knew how to make a complaint. The home maintains a complaints record of all formal complaints and these had been addressed and responded to appropriately. The AQAA and discussion showed that there is an open approach to listening to concerns. People can be confident that they will be listened to and any necessary action will be taken. Records showed that staff have attended training related to the safeguarding of vulnerable adults. Discussion showed that staff had an awareness of how to identify abuse and what to do if they witnessed or suspected it. There had been a safeguarding referral made related to the use of hoists and slings. This had been investigated by the safeguarding team and social workers and all issues raised have now been appropriately addressed. The newly appointed manager has familiarised herself with the details and is aware of the areas that needed improvement and continued monitoring. The home has updated their whistle blowing policy which informs staff what to do if they have any concerns about the practices of people working at the home whilst protecting the ‘whistleblower’. The financial interests of residents whose money is held for safekeeping by the home on their behalf is safeguarded by the procedures and practices. The recruitment procedure minimises the risk of the employment of unsuitable people. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 20 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, 20, 21, 26 People using the 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 offers the people living there comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. EVIDENCE: Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 21 The home is set back from the road behind a small car park and fits well into the neighbourhood. It is close to local amenities and bus routes. There have been no changes in the layout of the home with a porch entrance leading to the reception and offices with two small bedroom corridors off this through to the lounge and conservatory. The first floor accommodates further bedrooms and the lower ground floor the kitchen, laundry and staff facilities. There is a passenger lift to all floors. The seating arrangements in the lounge and conservatory had been altered a little and look more homely and less crowded but this may not remain so when vacancies are filled or if the five day care places are taken. Residents continued to have over bed tables across the front of their armchairs, which are used by some residents for their meals, and by most as a ‘coffee table’ for their drinks, magazines and odds and ends. These look institutional and domestic side tables would look much more homely. In the meantime the manager placed some of these to the side of the armchairs so as to remove the suggestion of restraint. A new and large extending oak table had been provided in the conservatory. This looked attractive and new tableware and placemats added to this. A photo taken at Christmas when the table was extended showed that this had greatly increased the number of people who could now choose to sit at the table. The attractive and well maintained garden is easy for residents to get through using the conservatory doors. New carpet has been provided in some bedrooms and corridors and several areas of the home have been repainted. The pipe work in the ground floor has been appropriately boxed-in and is now hygienic. All areas visited including toilets and bathrooms were clean and free of any unwanted odours. When asked in the surveys if the home was fresh and clean all answers were “Always”. Several bedrooms have had replacement furniture which is of light wood and good quality. Some new commodes have also been purchased. These changes have improved the comfort of the people who occupy these rooms. All bedrooms have been fitted with locks so that any resident can have a key to maintain their privacy and security of their belongings if they choose. All bedrooms seen had been personalised by personal possessions. Shared bedrooms have labelled shelving for their toiletries to minimise the risk of cross infection from shared toiletries. The owner is planning to provide a toiletry storage unit for both occupants of these rooms. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 22 Hairdressing space is a problem, with a bathroom being used for hair washing but with nowhere to use the hairdryer other than the adjacent corridors. Whilst there are vacant rooms a bedroom is being used for this purpose. This needs addressing to provide an area that maintains the privacy and dignity of the people who wish, or need, to have their hair dressed at the home. Senior staff have recently undertaken infection control training and the ongoing Improvement Foundation training regarding infection control in health care services outside of hospitals. The staff are provided with protective clothing of disposable gloves and aprons to prevent cross infection whilst supporting residents’ personal care. There are appropriate hand washing facilities of disposable towels and soap dispensers in communal areas where residents and staff are expected to wash their hands, in order to maintain infection control. Alcohol gel is provided at the entrance of the home for visitors. This should also be available at hand washing sites for staff to use. The manager has addressed infection control issues in the sluices and set up cleaning routines for all areas of the home in the short time she has been employed, in order to further improve infection control measures. The laundry room is in the lower ground floor. This had suitable laundry equipment to disinfect and sluice laundry if required and was clean and well organised. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 23 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, 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient care staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. EVIDENCE: The AQAA and rotas showed that the normal staffing was one registered nurse and four to five care staff in the morning and evening, and one registered nurse and two care staff during the night. Ancillary staff consist of a cook working 8.30am to 2pm and 4pm to 7pm each day; domestic assistants, one working the morning shift and one working the afternoon and a part time activity organiser. There is currently no designated laundry staff but the manager said that this was planned for the future. This will mean that staff do not have to leave residents in order to carry out domestic tasks. All but one of the responses in the surveys to the question, “Are the staff available when you need them?” were “Usually” or “Sometimes”. The survey responses from staff when asked if there were enough staff to meet the individual needs of the people using the service were mixed, with one person not answering the question and the other staff divided between “Always” and “Usually”. Other comments from staff also showed that they feel that the Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 24 mornings are too rushed. The manager should closely monitor why residents and staff feel that there are times when there are not enough staff available and take any necessary action. Records showed us that 64 of the care staff have achieved the National Vocational Qualification (NVQ) Level 2 or 3 in Care exceeding the minimum requirement of 50 . This qualification means that staff have been trained and assessed as competent in their role. Three staff files were looked at to assess the recruitment procedure and practice of the Centre. Each of these contained the appropriate Protection of Vulnerable Adults (POVA) First checks and the Criminal Records Bureau (CRB) disclosures, two written references and evidence that there had been a formal recruitment process of application form, interview and that a contract had been issued. Training records were also included in the staff files. Criminal Records Bureau disclosures had been renewed for all staff this year and these were looked at during our visit. All new staff undertake induction training to give them the knowledge and skills they require to be able to start their job. The manager should ensure that this is in line with ‘Skills for Care’. Other training undertaken by staff includes mandatory training such as moving and handling, infection control, first aid, food hygiene, health and safety and safeguarding of vulnerable people, assisting them to have the knowledge and skills to be able to work safely and effectively. Staff have also attended training related to dementia awareness and pressure area care to assist them to meet these needs with the people living at the home, and some senior staff have attended risk assessment training so that they are competent in carrying out these assessments. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 25 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, 38. People using the 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 managed by a person who is newly in post, has applied for registration with us and has the appropriate nursing. There is monitoring and auditing of the service and practices to ensure that all services operate in the best interests of residents. Health and safety practice generally protects residents and staff at the home. EVIDENCE: The AQAA had been completed by the registered provider. It included all the information we asked for, was in good detail and told us about progress with all previous requirements. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 26 The manager was present throughout the inspection visit. The visit was made on the second week of her appointment but she was already showing knowledge and awareness of the home, the residents and the staff. She is a Registered General Nurse and has previous management experience in a hospital environment. She also has had care home experience prior to her nursing training. She is supported by the deputy manager. The registered providers continue to be involved in the home, with regular visits and support. One of them also carries out a monthly unannounced visit to the home when staff and residents are interviewed regarding their views of the home. A report is made and a copy of this is given to the manager and a copy is held at the home to be available to us for inspection when requested. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Comments in the staff surveys in response to “What does the home do well?” were, “It caters for everyone’s needs including staff.” “It’s home from home for both residents and staff.” However two of the responses to the survey’ question, “Does your manager give you enough support and meet to discuss how you are working?” were “Sometimes”. This could be a reflection of the changes of managers in recent times, there having been three different managers in the past year and some lack of continuity before then. The other surveys said “Always” to the same question. Staff supervision, which allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues, was not assessed on this occasion due to the short time the manager has been in the post but may be assessed at the next inspection. Staff spoken with said that they felt supported by and confident with the manager, with one member of staff saying that this applied to “present and past” managers. Some money is held on behalf of residents, which is kept in a secure location. There were appropriate records of all transactions and cash balanced against these records. Receipts for any spending were kept with these records. Staff had undertaken mandatory training related to health, safety and welfare in order to work safely. One member of staff was observed performing an out of date and a potentially unsafe form of transferring a resident from a chair to a wheelchair. The care assistant said that she had attended moving and handling training but did not know that this technique could no longer be used. A colleague assisting with the transfer, and who was practising correctly, was aware of this. No other concerns regarding moving and handling techniques were noted. However, there were several incidents recorded in the accident Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 27 book related to minor injuries as a result of transferring and the use of hoists. It was recommended to the manager that the content of the moving and handling training is assessed and that action is taken to ensure training is put into practice. As mentioned in section two of this report there were no risk assessments for bedrails that were in use for two of the people whose care files were looked at. Although staff were aware of the risks and were managing these, there was no record that the risks involved in their use had been minimised. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 28 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 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x x x x 3 STAFFING Standard No Score 27 3 28 4 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 Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 29 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 OP38 Regulation 13 Requirement Individual risk assessments for bedrails must be in place where they are used. This will help to minimise the risk. Timescale for action 30/11/09 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 OP3 OP7 OP12 OP14 OP19 OP19 Good Practice Recommendations It is recommended that the reason for any major differences in assessments is recorded. Care plans should include all information required to meet the needs of the people living at the home, rather than relying on verbal communication and staff’s memory. Activity and occupation that they wish and are able to join in with should be available for each resident. The going to bed and rising from bed times should be monitored to ensure that they are within the wishes and preferences of the residents. Appropriate accommodation should be made available for the hairdressing to enable the residents to receive a service that maintains their dignity and privacy. Consideration should be given to replacing the over bed DS0000004559.V378254.R01.S.doc Version 5.3 Page 30 Longmore Nursing Home 7. 8. OP27 OP38 tables with side or coffee tables. It should be established why residents and staff feel that there are times when there are not enough staff available and any necessary action be taken. Moving and handling training content should be assessed and that staff are putting learning into practice should be monitored. Longmore Nursing Home DS0000004559.V378254.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission West Midlands Region 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). 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. 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