Care Home: Longview House

What the care home does well The care files seen evidenced that an assessment is undertaken by the home prior to residents being admitted. The assessments are detailed and cover aspects of risk and rehabilitation. There are also social worker and health care professional assessments that are part of the referral of residents. Residents talked about how they had been introduced to the home and had visited and spent some time getting to know staff and other residents. They felt that staff had taken time to explain how the home worked and had felt included in the admission process. We saw that residents have a full plan of care and residents stated that this is drawn together following discussion with them so that personal rehabilitation goals are agreed and recorded. For example one residents goals included voluntary work locally so that work skills could be acquired. The resident was looking forward to this placement and felt that staff had given appropriate support. The resident also spoke about how there was now structure to the day so that there were planned activities daily that helped to develop both social and domestic skills aimed at enabling the resident to live a more independent life outside the home in the future. Residents interviewed spoke about the structure of the home and how this supported them in choices to lead and more individual lifestyle. This involves the awareness of risk and there are risk assessment documents in care files that assess areas such as fire risk for smokers, self harm risk and risk around medical care. One care file had detailed risk management strategies around management of aggression as well as misuse of drugs. Contracts had been made with and signed by residents. The philosophy of the home is summed up in the pre inspection [AQAA] information which includes reference to the individual nature of planning of care and how this relates to daily activity. The evidence from the inspection generally supported this. On the day of the inspection, for example, one resident discussed the daily life in the home and was positive that it offered a degree a structure that was needed. He was involved in cooking and was also going to play football that afternoon which is a regular activity. Most people felt that taking part in cleaning a good idea. Also doing the dishes, budgeting and learning to manage their own medication were really helpful in getting ready for moving on to an independent life. Comments from residents were positive: `This place is trying to get me to plan my days and budget my money. As long as you attend the morning meetings and help with rota jobs. Keep room tidy. And sort out laundry. Tell them whether your going and what time you`ll be back`. `I can make decisions daily. I can plan my time. The staff are very helpful and support you`. Two people reported they were in loving relationships, one with another resident. They felt that Longview House was suitably supportive of these relationships. Residents are encouraged to be healthy and active. Most people said that they had generally been quite well while at Longview House and that it is easy to get appointments with GPs; `the staff remind you and its just down the road`. Residents can attend appointments alone or with the support of a staff member if required. Residents on the Care Programme Approach [or Effective Care Coordination] were undergoing regular review with psychiatric services and these are clearly recorded. Staff where observed to be interacting with residents and residents spoke in very positive terms regarding the staff`s ability to support them. Some of the comments received were that the staff at Longview House are very Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 7approachable. Staff files contained training records and staff spoken to were able to list recent updates and training courses attended and stated that they felt training in the home was good and appropriate. One staffs comments summed up the general feeling: `Being new I think the training is good. I`ve done first aid, fire, mental health conditions, key working, managing conflict, supervision, and appraisals plus more. Monthly supervision is good and communication is generally good. The service provides good training opportunities and the residents are treated as adults`. Residents and relatives are asked their views as to how the home should be run on a regular basis. There are also regular meetings with residents so that they can feel involved in the running of the home and the service can keep up to date with resident needs and aspirations. What has improved since the last inspection? The home has worked at meeting some of the requirements made on the last inspection visit. There has been a dramatic improvement in the standard of the accommodation, which had previously been assessed as `poor`. The providers have funded a complete refurbishment covering many areas in the home. This together with improved working with residents with respect to cleaning rotas and general house keeping means that the home was found to be comfortable, clean and less institutional than previously. Residents spoken with commented on how the general environment t had improved. Previous recommendations made with regard to medication administration have been met and the medicines procedures were found to be safe and meeting resident needs. The deputy manager was able to discuss the staff role in supporting residents in all aspects of the running of the home including domestic chores. A previous recommendation to consider the need for domestic staff to be employed has been discussed but the philosophy of care is for residents to improve skills in this area and therefore staff have improved their support and monitoring of standards here. The home was found to be clean. The staff compliment presently is full. The deputy manager explained that they are now more able to action local needs in terms of immediate repairs and the amount of money that can be used locally by the manager has been increased so that there can be more autonomy. Previous reports included comments around the lack of local autonomy in the home and the need to refer all decision making to central management higher in the company. CARE HOME ADULTS 18-65 Longview House 215 - 217 Longview Drive Huyton Knowsley Merseyside L36 6ED Lead Inspector Mike Perry Unannounced Inspection 2nd July 2008 10:00 Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longview House Address 215 - 217 Longview Drive Huyton Knowsley Merseyside L36 6ED 0151-489-4334 0151 480 2521 lvmgr@2care.rsl.org.uk 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) 2 Care Brenda White [acting manager] Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19) of places Longview House DS0000021468.V367661.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 only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 19 Date of last inspection 11th December 2007 Brief Description of the Service: Longview House is a purpose built building, which accommodates up to 19 residents with mental health problems. It is situated in the Huyton area of Knowsley close to a variety of shops. The care home was registered with the Commission in 2002 and is owned by 2 Care. The Registered manager is Peter Sinnott. The care home offers stays of varying length and works towards assisting residents to live and work independently. The care home is divided into three units; the main part of the building, a unit to encourage independence and a separate, attached house for other residents. Longview House concentrates on a model of care providing short-term stays for adults requiring a period of help prior to returning to live independently. The current fees for the service are £600 to £1120 per week. Longview House DS0000021468.V367661.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 stars. This means the people who use this service experience good quality outcomes. The inspection was a ‘key’ inspection for the service and covered the core standards the home is expected to achieve. The inspection took place over a period of one day. The inspector met with residents and spoke with some in more depth. The inspector also spoke with members of care staff on a one to one basis and the deputy manager. Prior to the inspection the home was sent a form to fill in called the Annual Quality Assurance Assessment [AQAA] which details information about the service and is completed by the management team. Information from this is used in the report. Service user comment cards were also sent to the service some time prior to the actual site visit to try and gain more views as to how the home is run and what it is like to live there. Eight of these were returned. Comment cards were also sent to staff working in the home so that their opinions could be sought and nine of these were returned. A tour of the premises was carried out and this covered all areas of the home including one of the resident’s bedroom and the facilities in the ‘cluster unit’. Records were examined and these included two of the resident’s care plans, staff files, and staff training records and health and safety records. What the service does well: The care files seen evidenced that an assessment is undertaken by the home prior to residents being admitted. The assessments are detailed and cover aspects of risk and rehabilitation. There are also social worker and health care professional assessments that are part of the referral of residents. Residents talked about how they had been introduced to the home and had visited and spent some time getting to know staff and other residents. They felt that staff had taken time to explain how the home worked and had felt included in the admission process. We saw that residents have a full plan of care and residents stated that this is drawn together following discussion with them so that personal rehabilitation goals are agreed and recorded. For example one residents goals included voluntary work locally so that work skills could be acquired. The resident was looking forward to this placement and felt that staff had given appropriate Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 6 support. The resident also spoke about how there was now structure to the day so that there were planned activities daily that helped to develop both social and domestic skills aimed at enabling the resident to live a more independent life outside the home in the future. Residents interviewed spoke about the structure of the home and how this supported them in choices to lead and more individual lifestyle. This involves the awareness of risk and there are risk assessment documents in care files that assess areas such as fire risk for smokers, self harm risk and risk around medical care. One care file had detailed risk management strategies around management of aggression as well as misuse of drugs. Contracts had been made with and signed by residents. The philosophy of the home is summed up in the pre inspection [AQAA] information which includes reference to the individual nature of planning of care and how this relates to daily activity. The evidence from the inspection generally supported this. On the day of the inspection, for example, one resident discussed the daily life in the home and was positive that it offered a degree a structure that was needed. He was involved in cooking and was also going to play football that afternoon which is a regular activity. Most people felt that taking part in cleaning a good idea. Also doing the dishes, budgeting and learning to manage their own medication were really helpful in getting ready for moving on to an independent life. Comments from residents were positive: ‘This place is trying to get me to plan my days and budget my money. As long as you attend the morning meetings and help with rota jobs. Keep room tidy. And sort out laundry. Tell them whether your going and what time you’ll be back’. ‘I can make decisions daily. I can plan my time. The staff are very helpful and support you’. Two people reported they were in loving relationships, one with another resident. They felt that Longview House was suitably supportive of these relationships. Residents are encouraged to be healthy and active. Most people said that they had generally been quite well while at Longview House and that it is easy to get appointments with GPs; ‘the staff remind you and its just down the road’. Residents can attend appointments alone or with the support of a staff member if required. Residents on the Care Programme Approach [or Effective Care Coordination] were undergoing regular review with psychiatric services and these are clearly recorded. Staff where observed to be interacting with residents and residents spoke in very positive terms regarding the staff’s ability to support them. Some of the comments received were that the staff at Longview House are very Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 7 approachable. Staff files contained training records and staff spoken to were able to list recent updates and training courses attended and stated that they felt training in the home was good and appropriate. One staffs comments summed up the general feeling: ‘Being new I think the training is good. I’ve done first aid, fire, mental health conditions, key working, managing conflict, supervision, and appraisals plus more. Monthly supervision is good and communication is generally good. The service provides good training opportunities and the residents are treated as adults’. Residents and relatives are asked their views as to how the home should be run on a regular basis. There are also regular meetings with residents so that they can feel involved in the running of the home and the service can keep up to date with resident needs and aspirations. What has improved since the last inspection? The home has worked at meeting some of the requirements made on the last inspection visit. There has been a dramatic improvement in the standard of the accommodation, which had previously been assessed as ‘poor’. The providers have funded a complete refurbishment covering many areas in the home. This together with improved working with residents with respect to cleaning rotas and general house keeping means that the home was found to be comfortable, clean and less institutional than previously. Residents spoken with commented on how the general environment t had improved. Previous recommendations made with regard to medication administration have been met and the medicines procedures were found to be safe and meeting resident needs. The deputy manager was able to discuss the staff role in supporting residents in all aspects of the running of the home including domestic chores. A previous recommendation to consider the need for domestic staff to be employed has been discussed but the philosophy of care is for residents to improve skills in this area and therefore staff have improved their support and monitoring of standards here. The home was found to be clean. The staff compliment presently is full. The deputy manager explained that they are now more able to action local needs in terms of immediate repairs and the amount of money that can be used locally by the manager has been increased so that there can be more autonomy. Previous reports included comments around the lack of local autonomy in the home and the need to refer all decision making to central management higher in the company. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 8 What they could do better: All residents receive a file that has information about the home so that they can refer to this if they wish. The example seen contained a very out of date [2003] CSCI inspection report. The most recent report should be made available and information kept up to date. The issue of resident involvement in the running of the home was discussed in general terms with the manager who felt that the home encourages all sorts of input by residents. The concept of residents getting involved in staff recruitment has not been considered however and could be a future development. A communication from the company following the inspection confirms that this will be considered over the next year. The deputy manager was not able to produce an overall policy statement on sexuality and intimate relationships. This has been discussed previously and is important given the complexity of the living arrangements in the home and the risk and vulnerability of some residents. Again we found a thread of opinion that some people would be happier if the women’s bedrooms were in one part of the building, rather than scattered around. The managers need to consider the points made in this report and produce an overall management strategy in the form of guidelines that include all aspects of good practice in this area. In discussion with staff it was felt that there is marked lack of space for privacy and meetings. Staff commented that the lack of administration space as well as having no meeting place for social workers or other visitors to the home. The manager mentioned some possible plans to create more space by moving the laundry area and perhaps this should be actioned. There was some discussion with the manager around the layout of the home with respect to privacy. There are marked risk factors associated with mixing of female and male residents in any communal setting and these have been addressed in good practice reports in the past. Some comments from residents have been recorded earlier in this report regarding the need for more privacy. The previous recommendations made need to be again considered and any agreed practice formalised in an overall policy on the management of intimate relationships and privacy and dignity within this framework. The laundry was tidy and well managed although there is a need to ensure that hand washing facilities are provided as there was no soap or paper towels available. The manager stated that checks are made on windows above ground floor level to ensure limited opening and thereby reduce the risk of accidents from falls. This is not recorded anywhere and a recommendation is made to do this. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2,4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Professionals carry out assessments prior to admission and these are supplemented by the homes own assessments so that a full picture of the resident is gained. EVIDENCE: The care files seen evidenced that an assessment is undertaken by the home prior to residents being admitted. The assessments are detailed and cover aspects of risk and rehabilitation. There are also social worker and health care professional assessments that are part of the referral of residents. The homes own assessment document is completed over a series of visits to the home by the resident. If residents are not matched to the home or the home can’t meet needs then this is discussed with all concerned. The final say is the residents in the home who ‘vote’ any new resident in at one of the community meetings. The staff interviewed were able to give a very clear picture of the needs of the residents. Staff commented that referral information is very thorough and it includes day visits and overnight stays, risk assessments and rehabilitation plan prior to admission’. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 12 Residents talked about how they had been introduced to the home and had visited and spent some time getting to know staff and other residents. They felt that staff had taken time to explain how the home worked and had felt included in the admission process. All residents receive a file that has information about the home so that they can refer to this if they wish. The example seen contained a very out of date [2003] CSCI inspection report. The most recent report should be made available and information kept up to date. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards and standard 8 The quality in this outcome group is excellent. This judgement has been made using available evidence including a visit to this service. Care planning has been devised so that a full picture of the resident is made available and residents can feel involved in the way care is managed including risk factors associated with resident’s choice of lifestyle or behaviour so that residents feel supported in activities they choose. EVIDENCE: The care files seen showed that residents have a full plan of care and residents stated that this is drawn together following discussion with themselves so that personal rehabilitation goals are agreed and recorded. Staff were clear about the care for each resident and how this related to future planning and aspirations. For example one residents goals included voluntary work locally so that work skills could be acquired. The resident was looking forward to this placement and felt that staff had given appropriate support. The resident also spoke about how there was now structure to the day so that there were planned Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 14 activities daily that helped to develop both social and domestic skills aimed at enabling the resident to live a more independent life outside the home in the future. The care plans are highly individualised with set rehabilitation goals that are evaluated regularly. All residents have a copy of the plan. Residents are encouraged to take part in the home rather than being passive receivers of services. There are regular community meetings, a ‘food’ group and leisure groups. The daily morning group was observed and residents said that this was good start to the day because it helped focus and remind people what they had to do. Residents are reminded of any appointments, given any mail etc. Everyone is expected to attend and they are seen as a useful step in helping people move forward. The feeling of resident involvement is very strong in the home. The concept of residents getting involved in staff recruitment was discussed and recommended on the last inspection as a natural progression of service user involvement in the running of the home; but has not really been considered. We discussed this again with the manager and have made a second recommendation again. Residents interviewed spoke about the structure of the home and how this supported them in choices to lead and more individual lifestyle. This involves the awareness of risk and there are risk assessment documents in care files that assess areas such as fire risk for smokers, self harm risk and risk around medical care. This means that staff highlight and discuss [for example] the risk of non-compliance with medication and how this could affect future discharge plans and maintaining future well being in the community. One care file had detailed risk management strategies around management of aggression as well as misuse of drugs. Contracts had been made with and signed by residents. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. The quality outcome for this area is good. This judgement has been made using available evidence including a visit to this service. As much as possible residents are encouraged to contribute to activities and therefore feel part of the external and internal community of the home but the management need to be aware of further written policy developments needed to support residents in safe relationships in the home. EVIDENCE: The philosophy of the home is summed up in the pre inspection [AQAA] information: ‘Daily routines are person-centred and therapeutically important. Service user privacy is respected at all times, and staff enter their rooms only with consent. Service users receive keys to their rooms which are signed for, and all mail is recorded on premises and signed for by the service user. All support plans contain the appropriate form of address, and daily running of the house is Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 16 allotted in cooking and cleaning rotas, keyworker notes and safety checks. All meals are selected by service users during the food group, with alternatives to those with dietary requirements. Service users have 24hr access to snacks and refreshments’. The evidence from the inspection generally supported this. Several residents reported regular visits to the local shops and café and found this an enjoyable activity. On the day of the inspection one resident discussed the daily life in the home and was positive that it offered a degree a structure that was needed. He was involved in cooking and was also going to play football that afternoon which is a regular activity. Most people felt that taking part in cleaning a good idea. Also doing the dishes, budgeting and learning to manage their own medication were really helpful in getting ready for moving on to an independent life. Comments from residents were positive: ‘This place are trying to get me to plan my days and budget my money. As long as you attend the morning meetings and help with rota jobs. Keep room tidy. And sort out laundry. Tell them whether your going and what time you’ll be back’. ‘I can make decisions daily. I can plan my time. The staff are very helpful and support you’. Two people reported they were in intimate relationships, one with another resident. They felt that Longview House was suitably supportive of these relationships. For example one person could have a partner ‘staying over’ from time to time and there were plans for more permanent arrangements. Again this is evidence that the home are supportive of peoples relationships. The deputy manager was not able to produce an overall policy statement on sexuality and intimate relationships however. This was discussed in the previous inspection and is important given the complexity of the living arrangements in the home and the risk and vulnerability of some residents. Again we found a thread of opinion that some people would be happier if the women’s bedrooms were in one part of the building, rather than scattered around. One resident for example felt that there were issues around feelings of privacy when accessing the shower / bathroom. Staff reported instances where residents have got up in the night and not be appropriately dressed. There is also a recent incident where a female resident reported unwanted advances from male residents. These situations have been managed well in the main [see ‘complaints / protection’] but the issue of privacy and safety [especially for Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 17 females in the main house] remains an issue. The managers need to consider the points made in this report and produce an overall management strategy in the form of guidelines that include all aspects of good practice in this area. Again we would refer the managers to department of health guidance. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health care needs are attended to so that they are supported to remain healthy. EVIDENCE: Residents spoken to were satisfied with the way staff approached issues around personal care and support. Residents are physically capable of attending to their own self care and interventions are geared around the need to encourage and monitor levels of self care and attention to personal hygiene. Care planning documentation supported this and showed that staff regularly talk to residents and encourage responsibility in this area. Residents are encouraged to be healthy and active. For example one resident talked about the use of the local leisure centre to participate in sport. Most people said that they had generally been quite well while at Longview House and that it is easy to get appointments with GPs; ‘the staff remind you and its just down the road’. Residents can attend appointments alone or with the support of a staff member if required. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 19 All residents have a key to their bedrooms and stated that staff respect their privacy and do not enter rooms without invite/ permission. Staff were observed respecting this. There were entries in all care files recording the input from health care workers and appointments with GP’s and hospital appointments. Residents on the Care Programme Approach [CPA] were undergoing regular review with psychiatric services and these are clearly recorded. Medication administration was reviewed. The AQAA completed by the manager states: ‘Regular spot checks are carried out on those who are self medicating in order to identify any difficulties as soon as they occur. Written consent from the consultant psychiatrist is obtained prior to an individual beginning the process. Staff spend time outlining the process and explaining the various medications and possible side effects. An information folder has been compiled for service users to access and is available in one of the communal areas’. Currently there are two residents fully self medicating and others partly so. The records and interviews support the above practice. It was observed that risk is assessed on the signed agreement with the resident. The administration records [MAR] were clear in that medicines given were recorded appropiately in terms of times and frequencies. Previous recommendations for two signatures on written instructions have been actioned. The administration of PRN [ give when nessarsary] medicicnes is montored on the administration record. It is good practice to also monitor this through the care plan where specific instructions can be listed for use which should ensure consistency with all staff and also act as a reviewing / evaluation process. All staff who administer medicines are trained inhouse and there is a ‘medication proficiency’ form for each staff member on file. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure and concerns are acted on so that residents feel safe in the home and are protected. EVIDENCE: There is a complaints procedure available in the home and complaints are recorded and responded to. Those residents spoken to understand who they would access if they had a complaint. The complaints book was seen and various in-house complaints have been addressed. The home have procedures in place to manage reports or allegations of abuse and staff are trained to respond appropriately. Staff reported company led training in this area and records evidenced that staff attend this. Most people reported no problems while out and about in the local neighbourhood. Felt that the staff at Longview House were supportive. Most people did not feel under any kind of threat within Longview House. There has been a recent incident however involving a female resident complaining about unsolicited attention form male residents in the home. This was well managed by staff who entered into discussion with the social work team and considered the immediate safeguarding implications. The rights of the individual were reinforced. The issues arising were discussed with the deputy manager in the broader context of management of such relationships in the home. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been major improvements in the standard of the accommodation so that the home is now comfortable and more homely for residents. There still needs to be some thought about available use of space so that good practice principals can be fully actioned. EVIDENCE: The home is divided into three main sections, which fits in to the homes philosophy around rehabilitation so that there is a structured pathway in terms of developing more skills and independence. The building is over two floors with requisite day space. There is access to external gardens. The home is situated close to local shops and facilities. The last inspection listed requirements upgrading the environment as many of the furnishings and décor was run down and in poor condition. The home was also not clean. Since that time there has been some upgrading. The AQAA states: Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 22 ‘Longview House has employed a new maintaince firm and the standard of work carried out at the home has improved. The cleaning rota has been reviewed and improved following a community decision not to replace the household assistant.The dining area furniture and the lounge furniture for the cluster and mainhouse has been replaced. We have successfully implemented the new smoking legislation and continue to strive for excellence in terms of our service user bedrooms, and communal areas. We have refurbished several service user bedrooms’. Overall the home has improved immensley. All areas were found to be clean and well managed and the home as a whole presented as much more homely and comfortable. This was commented on by residents who now feel more ownership of the home. In discussion with staff it was felt that there is marked lack of space for privacy and meetings. Staff commented that the lack of administration space [one small office and two computers] caused problems with day-to-day work such as updating care plans as well as having no meeting place for social workers or other visitors to the home. One staff commented: ‘The working conditions in the office are very poor. It is cramped due volume of paper work. Its also very hot’. [We experienced this in terms of the office lacking privacy for much of the time with staff continually trying to make space]. The manager mentioned some possible plans to create more space by moving the laundry area and perhaps this should be actioned. There was some discussion with the manager around the layout of the home with respect to privacy. There are marked risk factors associated with mixing of female and male residents in any communal setting and these have been addressed in good practice reports in the past. The homes philosophy of getting residents to have more responsibility is good but this means staffing levels are not always high with resultant difficulties in monitoring residents. [This is particularly so at night with no waking staff]. Some comments from residents have been recorded earlier in this report regarding the need for more privacy and this could be achieved with, for example, attention being paid to the positioning of bedrooms and toilet / bathroom areas in the main building so that these are accessed by single sex residents. The previous recommendations made need to be again considered and any agreed practice formalised in an overall policy on the management of intimate relationships and privacy and dignity within this framework. The home was found to be clean in all areas. The laundry was tidy and well managed although there is a need to ensure that hand washing facilities are provided as there was no soap or paper towels available. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained appropriately so that the residents care needs can be met. EVIDENCE: For 16 residents the home was staffed at the time of the inspection with the deputy manager and two support workers. These numbers fluctuated throughout the day with some times four staff on duty. The shifts are flexible to meet resident needs at various times. We were advised that the usual staffing numbers for days is three carers and the duty rota confirmed this. There are no other staff – no kitchen staff and no domestic cover. The philosophy is that residents take responsibility for much of the housekeeping work. The role of care staff in supporting residents to meet the aims of this philosophy have been evaluated since the last inspection and the evidence this time is that residents are supported. Staff where observed to be interacting with residents and residents spoke in very positive terms regarding the staff’s ability to support them. Some of the comments received were that the staff at Longview House are very approachable. Staff for their part commented that they could more quality time with residents if some of the administration work was taken from them. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 24 Staff files were seen and the manager ensures that recruitment processes are followed so that staff are not employed with out references or criminal records [CRB] and Protection of Vulnerable Adult [POVA] clearance so that residents are protected. Staff files contained training records and staff spoken to were able to list recent updates and training courses attended and stated that they felt training in the home was good and appropriate. The induction programme was discussed and is very thorough. All staff receive training in areas such as listening skills and mental health. One staff summed up the general feeling of staff working in the home: ‘Being new I think the training is good. I’ve done first aid, fire, mental health conditions, key working, managing conflict, supervision, and appraisals plus more. Monthly supervision is good and communication is generally good. The service provides good training opportunities and the residents are treated as adults. An admin assistant would free up staff time’. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good management systems in place based on seeking the views of service users so that the home can be run in their best interests. EVIDENCE: Peter Sinnott is the Registered manager at Longview House. Peter was not present at the inspection and has two deputy managers who run the home in his absence. The managers have addressed some of the issues following the previous inspection including the upgrading of the home environment and the management of the cleanliness and daily cleaning. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 26 Residents and relatives are asked their views as to how the home should be run on a regular basis and service user surveys are given out and feedback sought. There are also regular meetings with residents so that they can feel involved in the running of the home and the service can keep up to date with resident needs and aspirations. There are also quality audits carried out by the company on a regular basis. For example the care services director carried out a service review annually and there is also an annual quality audit lasting 2 –3 days carried out by the companies quality officer. This also covers health and safety issues. The home also has an ISO quality audit, which is an audit external to the company. The monthly management audits [Regulation 26 audits] were also seen. The AQAA stated that all health and safety checks are up to date. Some of these were reviewed and found to be in order. There are routine checks made by staff including hot water temperatures, infection control, and other risk assessments for the general environment. The manager stated that checks are made on windows above ground floor level to ensure limited opening and thereby reduce the risk of accidents from falls. This is not recorded anywhere and a recommendation is made to do this. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 4 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 X X 3 X Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA8 Good Practice Recommendations The service user information files should be kept up to date with a copy of the most recent CSCI inspection report available. Consideration should be given to extending residents input into the running of the home by including them in the staff recruitment process. The managers should develop an overall policy statement and guidelines covering sexuality and intimate relationships. This should be tied in with the comments under ‘environment’ and reference to good practice guidance in this area. The administration of PRN [ give when nesarsary] medicicnes is monitored on the administration record. It is good practice to also monitor this through the care plan where specific instructions can be listed for use which should ensure consitency with all staff and aslo act as a reviwing / evaluation process. DS0000021468.V367661.R01.S.doc Version 5.2 Page 29 3 YA15 4 YA20 Longview House 5 YA24 The manager should review good practice guidance such as the document ‘Safety, Privacy and Dignity in Mental Health Units’ [DOH 2000] which is available on the Department of health website. This good practice guidance can be used to develop the environment in the home in conjunction with the development of policies around sexuality and privacy / dignity. Longer term planning needs to make provision for both storage and improved day space. There needs to be hand washing facilities available in the laundry [ liquid soap and paper towels]. 6 YA42 The manager stated that checks are made on windows above ground floor level to ensure limited opening and thereby reduce the risk of accidents from falls. This is not recorded anywhere and a recommendation is made to do this. Longview House DS0000021468.V367661.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Regional Contact Team 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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