Care Home: Longworth House

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What the care home does well The home provides service users with a homely, relaxed and caring environment. Service users are enabled where possible to exercise choice and control over their lives whilst resident in the home. Staff was observed to deliver care with dignity and respect. The five service users spoken with and the visiting relative all felt the care provided respected service users privacy and dignity. Six of the service users surveys stated they always received the care and support they needed and one usually, and the six service users who completed the question stated staff listen and act upon what you say. The six relatives surveys stated their relative always receives the care and support agreed, the care needs of their relatives are always met, that different needs of service users are always or usually met, and service users are always or usually supported to live the life they choose. Comments received from service users and their representatives were, `the matron and staff are all very good. I have only the best care I need,` `following my relatives recent short admission to hospital, I was grateful for the sympathetic manner in which I was informed,` `the staff always listen and do what ever they can to help,` `I consider myself lucky to have found Longworth House. I am very happy and satisfied,` `very happy,` `I would just like to add that this is a very happy home,` `I feel that everything is totally satisfactory,` `personal dignity is always maintained. The staff without exception is patient, kind, sympathetic to the needs of not only the service users, but family as well. Nothing is ever too much trouble ands all tasks are performed willingly and cheerfully.` `It would be extremely difficult to suggest any improvements,` and ` I cannot suggest any improvements.` Service users are protected by the completion of a detailed individual care plan and supporting risk assessments. What has improved since the last inspection? The Acting Manager stated that the deployment of staff in the home at meal times has been reviewed to ensure that staff can offer assistance where necessary, discreetly, sensitively and individually. The Acting Manager stated that all service users are being assessed for their own wheelchairs and that footrests are being provided. None of the service users were using oxygen in their bedrooms at the time of the Inspection and oxygen for emergency use is kept in the medical room with signage to alert of the hazard in place. A trolley has also been purchased to move oxygen around the home if required. CARE HOMES FOR OLDER PEOPLE Longworth House 28 Eversfield Road Eastbourne East Sussex BN21 2DS Lead Inspector Judy Gossedge Unannounced Inspection 14th February 2008 10:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longworth House Address 28 Eversfield Road Eastbourne East Sussex BN21 2DS 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) 01323-729700 01323 430135 longworth.house@tiscali.co.uk Mr Aleem Siddiqi Mrs Arifa Siddiqi vacant post Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty (20). That service users must be aged sixty-five (65) years and over on admission. 30th November 2006 Date of last inspection Brief Description of the Service: Longworth House is a converted former family home situated in a residential area close to Eastbourne town centre. It has been adapted to accommodate twenty older people needing nursing care. The service user accommodation is situated on three floors and consists of twelve single bedrooms and four double bedrooms. Two of the single bedrooms and two of the double bedrooms have an en-suite facility. Three of the top floor bedrooms are below the minimum size requirement. A lift provides level access to all areas of the home; there is a large lounge for the service users with a dining area at one end. A conservatory has been built, which has increased the communal day space to an acceptable level. There is no on-site car parking, but there is unrestricted car parking outside the home, the train station is approximately ¼ of a mile away and local buses stop nearby. The service provides prospective service users with a copy of the homes Statement of Purpose and Service Users Guide, and copies are available to reference in the hallway at the entrance to the home. Fees charged at the time of the Inspection are £550.0–£650.00, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided. Longworth House DS0000014015.V357713.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. This unannounced Inspection took place over six and a half hours on 14 February 2008. Prior to the Inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home, which has been completed and returned and information detailed within is quoted in this report. A tour of the premises took place to look at communal areas and a selection of service user’s bedrooms and care records were inspected. Seventeen service users were resident and two service users were spoken with individually in their bedroom, three service users and a relative were spoken with in the lounge and a number of service users were spoken to as part of the Inspection process during the tour of the building. The care that four of the service users received was reviewed. The opportunity was also taken to observe the interaction between staff and service users in the communal area. Eight service user surveys were sent out and seven came back completed. Two care workers; the cook, the housekeeper, a Registered General Nurse (RGN) and the Acting Manager were all spoken with. Eight staff surveys were sent out and four came back completed. Eight relatives/visitors surveys were sent out and six came back completed. One relative was spoken with during the Inspection. One service user and two relatives were spoken with after the Inspection on a short subsequent visit. One social care worker was spoken with by telephone after the Inspection. The home has been through a period of change with the retirement of the Registered Manager and the recruitment of a new Acting Manager. What the service does well: The home provides service users with a homely, relaxed and caring environment. Service users are enabled where possible to exercise choice and control over their lives whilst resident in the home. Staff was observed to deliver care with dignity and respect. The five service users spoken with and the visiting relative all felt the care provided respected service users privacy and dignity. Six of the service users surveys stated they always received the care and support they needed and one usually, and the six Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 6 service users who completed the question stated staff listen and act upon what you say. The six relatives surveys stated their relative always receives the care and support agreed, the care needs of their relatives are always met, that different needs of service users are always or usually met, and service users are always or usually supported to live the life they choose. Comments received from service users and their representatives were, ‘the matron and staff are all very good. I have only the best care I need,’ ‘following my relatives recent short admission to hospital, I was grateful for the sympathetic manner in which I was informed,’ ‘the staff always listen and do what ever they can to help,’ ‘I consider myself lucky to have found Longworth House. I am very happy and satisfied,’ ‘very happy,’ ‘I would just like to add that this is a very happy home,’ ‘I feel that everything is totally satisfactory,’ ‘personal dignity is always maintained. The staff without exception is patient, kind, sympathetic to the needs of not only the service users, but family as well. Nothing is ever too much trouble ands all tasks are performed willingly and cheerfully.’ ‘It would be extremely difficult to suggest any improvements,’ and ‘ I cannot suggest any improvements.’ Service users are protected by the completion of a detailed individual care plan and supporting risk assessments. What has improved since the last inspection? What they could do better: Not all the standards have been fully met, but the Acting Manager was able to demonstrate that where requirements are not yet in place these are in the process of being addressed. Two written references should be in place prior to a new member of staff commencing work in the home. A system needs to be in place to ensure that all new staff receives health and safety training as required to protect service users and staff. Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 7 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. Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is information available for service users and/or their representatives to view, although it must be ensured that the information is kept up-to-date. Service users are protected by the completion of a contract/terms and conditions. Potential new service users are individually assessed prior to an admission to ensure that their care needs can be met in the home. EVIDENCE: The Statement of Purpose, Service User’s Guide and a copy of the last Inspection report are available to read in hallway at the entrance to the home. Both the Statement of Purpose and the Service Users Guide needed to be updated to reflect changes in the home. Respite care can be provided and should be detailed in these documents. The Acting Manager stated that these documents would be reviewed so a Requirement has not been made on this occasion. The seven service users surveys stated they had received enough Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 10 information prior to moving in. The relatives surveys were varied and stated they always, usually or sometimes receive enough information about the home. One relative commented they would like more information and another would have like copies of the information during their visit to view the home or prior to admission. The service users contract/terms and conditions were not looked at on this occasion, but six of the service users surveys stated they had a contract and one could not remember. The Acting Manager stated that service users are visited prior to any admission. This is to ensure individual service user’s care needs can be met in the home and to provide staff with information on the care to be provided. A detailed pre-admission and assessment format is in place, and was viewed for two new service users admitted to the home since the last Inspection. For one there was detailed pre-admission information viewed, and for the other this was still being completed. The Acting Manager has subsequently confirmed this assessment has been completed. The AQAA details the pre-admission paperwork is to be reviewed and updated during the next twelve months to ensure a more in depth assessment. One new service user spoken with confirmed their relative had visited the home on their behalf prior to the admission. Intermediate care is not provided in the home. Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are protected by a detailed individual plan of care being in place, where all their personal, social and health care needs are identified at the start of their stay and which informs staff of the care, which needs to be provided and with supporting risk assessments completed. Medication policies and procedures are in place to protect service users. EVIDENCE: Four of the service users individual care plans were viewed. These were detailed and gave clear guidance to staff of the care to be provided, service users health care requirements, dietary needs, social and leisure interests. The Acting Manager stated she had recently updated the spiritual assessment to include questions that reflect a holistic approach to wellbeing rather than purely religion. Detailed supporting risk assessments were also viewed and where there are any identified risks the recording detailed how these will be Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 12 managed. All these documents had been reviewed. The four care workers surveys stated they are always given up-to-date information about the support and care required and the two care staff spoken with also confirmed they received adequate information about the care to be provided to individual service users. All service users are registered with a local General Practitioner (GP). It was noted, in care plans that were examined, that appointments visits by health care professionals are recorded. The AQAA detailed that due to the increasing dependency and needs of service users, several new pieces of equipment have been purchased. Following an audit of the service user’s pressure relief equipment against their individual requirements, the equipment provided has been reviewed. One very high risk and one high risk alternating overlay air mattress, three new top of the range memory foam mattresses and five highrisk cushions have been purchased. An electric hoist to replace one of the hydraulic hoists to aid manual handling has also been purchased. The AQAA detailed that medication policies and procedures are in place. Medication is stored in the treatment room and sample of the recording of medication administered was viewed and was adequate. The AQAA details that a pharmacist visits; the records were not viewed on this occasion. The Acting Manager stated that only the RGN’s administer medication in the home and that the deputy manager who takes the lead in medication issues had also received further external medication training. Six of the service users surveys stated they always receive the medical support that they need and one usually. Staff was observed to deliver care with dignity and respect. The five service users spoken with and the visiting relative all felt the care provided respected service users privacy and dignity. Six of the service users surveys stated they always received the care and support they needed and one usually, and the six service users who completed the question stated staff listen and act upon what you say. The six relatives surveys stated their relative always receives the care and support agreed, the care needs of their relatives are always met, that different needs of service users are always or usually met, and service users are always or usually supported to live the life they choose. Comments received from service users and their representatives were, ‘the matron and staff are all very good. I have only the best care I need,’ ‘following my relatives recent short admission to hospital, I was grateful for then sympathetic manner in which I was informed,’ ‘the staff always listen and do what ever they can to help,’ ‘I consider myself lucky to have found Longworth House. I am very happy and satisfied,’ ‘very happy,’ ‘I would just like to add that this is a very happy home,’ ‘I feel that everything is totally satisfactory,’ and personal dignity is always maintained. The staff without exception is patient, kind, sympathetic to the needs of not only the service users, but family as well. Nothing is ever too much trouble ands all tasks are performed Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 13 willingly and cheerfully.’ ‘It would be extremely difficult to suggest any improvements,’ and ‘ I cannot suggest any improvements.’ Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Where possible service users are enabled to exercise choice in their lives whist resident in the home, there are some opportunities to participate in social and recreational activities provided and the frequency of these should continue to be developed, service users are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. EVIDENCE: The AQAA details that social activities have recently been reviewed following the circulation of an activities questionnaire completed by the service users. A more varied activity timetable has been introduced, which is circulated fortnightly, a copy of which is in the front entrance for service users and visitors to view or service users can have their own copy. It is planned where possible to increase activities to two sessions one week and three sessions the other week and it should be ensured this continues to be developed to ensure increased access to activities during the week. On the day of the Inspection an additional member of staff had been made available to facilitate bingo during Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 15 the afternoon. The Inspector sat in for part of the activity and there was a pleasant atmosphere and good interaction between staff, relatives and service users was observed. One relative commented on the introduction of arts and crafts and had received a handmade Christmas and Valentines Day card, and another commented when asked what the home could improve, ‘occasional trips out, for those service users able to benefit from them.’ Two of the service users surveys stated there are always activities in the home, three usually and one sometimes. One commented, ‘more activities needed for stimulation,’ and another ‘‘I am unable to take part in any activities, due to my health.’ Not all service users spoken with stated they wished to join in these activities, as they preferred to follow their own leisure pursuits. During the Inspection a number of relatives and friends were observed visiting the home and several also joined in the activity during the afternoon. Staff was seen to be very welcoming and visitors could see their relative/friend in private if they wished. The six relatives surveys stated that they are kept upto-date with any important information. The response was varied when asked if their relatives were always supported to keep in touch from, always, sometimes and never. The care and support provided was observed to enable service users where possible to exercise choice whilst at Longworth House. The four service user files viewed, staff, relatives and the five service users spoken with confirmed this. The cook works six days a week and demonstrated he holds a basic food hygiene certificate. A designated care worker cooks on the seventh day. A rotating four-week menu is place, which the cook stated has been varied since recent feedback from service users, it takes into account service users likes and dislikes and was seen to identify that choices available at all meals. Service users are asked daily to select their choices from the menu. The AQAA details that the menu, particularly the variety at suppertime will continue to be improved and this will be achieved by asking for suggestions from service users. The Acting Manager plans to have regular meetings with the cook to revise the menu using the feedback gained. Lunch on the day was meat pie or meatballs, carrots, broccoli and mashed potato, or salad followed by pears and custard or yoghurt. Fresh fruit is available. Special diets are catered for. Service users were observed being assisted with their lunch in the dining room and lounge area by staff and a relative and it was a relaxed environment taking into account the different length of time that individual service users would need to finish their meal. Records are kept of food consumed individually by each service user to ensure they are receiving an adequate diet. Three service users surveys stated they always liked the meals, four Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 16 usually and one sometimes. One relative commented, I saw the menus and they seem to be a good variety of food.’ Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to enable service users or their representatives to raise any concerns about the care being provided and to ensure that service users are protected from abuse. EVIDENCE: The AQAA details that there is a detailed complaints policy and procedure in place, which has recently been reviewed. The copy of the policy and procedure in the hallway did not detail that complaints will be responded to within twenty-eight days, although this was detailed in the Service Users Guide. The Acting Manager has subsequently confirmed that this has been addressed. The AQAA detailed that no complaints had been received at the home during the last year. The CSCI have not received any concerns in relation to the care provided at Longworth House. Five of the service users surveys stated they were always aware who to talk to if they were not happy and one usually, one did not answer the question, five were aware of how to make a complaint and one was not, and one did not answer the question. Five of the relative’s surveys stated they were aware of how to make a complaint and one did not. Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 18 Three relatives commented any concerns were always responded to appropriately, and three commented they had had no concerns to raise. The four-care workers survey stated they knew what to do if they had any concerns and would ‘discuss with the person in charge or the manager.’ The AQAA detailed that there are policies and procedures in place in relation to the protection of vulnerable adults. The Acting Manager stated that staff had received training, but was not able to evidence this, and is the process of collating individual staff training records to access training required. The staff spoken with demonstrated an awareness of the policies and procedures. Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is decorated and furnished in a homely style. The maintenance plan and ongoing work to refurbish and improve the facilities in the home ensures that the standard of the environment continues to be maintained and improved. EVIDENCE: A tour of the building was made. The home is decorated and furnished in a homely style, and the standard of the décor, carpeting and furnishings is good. The Acting Manager stated there is an ongoing maintenance programme-taking place in the home and improvements planned to ensure the continual improvement of the environment. The AQAA detailed that during the last twelve months the banister has been re-varnished, a new garden area has Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 20 been added to the back of the home to improve security and privacy, new clinical waste bins and laundry baskets have been purchased. Over the next twelve months if finances allow it is planned to provide a shower/wet room in one or two of the existing bathrooms and planning permission is being sought to provide a covered walkway between the backdoor and the laundry. This will also enable the conservatory at the back of the home to be accessed without having to go outside. There are twelve single bedrooms and four double bedrooms on all floors in the home. A number of bedrooms were viewed and displayed service users individual styles and interests. The AQAA details that as bedrooms have become vacant these have been improved to make them more comfortable and inviting to prospective service users. So far two bedrooms have been decorated throughout with new curtains, lampshades and quilt covers added to give the bedroom a fresh look. One bedroom has been re organised so it is safer to use a hoist in, and this information was gained from pre-admission assessment. All bedrooms have an emergency call bell system. None of the single bedrooms have en-suite facilities, but all the double bedrooms do have an en-suite facility. Bathroom facilities are provided throughout the home. Service users are able to control the temperature in their own bedrooms. The AQAA details that there is regular testing of the bedroom temperatures to ensure the required temperature is maintained and of hot water temperatures so that water at the outlets accessed by service users is being maintained at close to 43 º C. Records are kept in each room and a sample of the recording was viewed in one bedroom and one bathroom. A passenger lift is available from the lower floor to the second floor. There is one lounge and a dining room on the ground floor and large conservatory. The AQAA details that there is a policy in place for managing infection control and that it is planned to view the Department of Health Guidance to assess current infection control management. The home was clean and free from offensive odours at the time of the Inspection. Feedback from the service users, relatives and visitors to the home was that the home was always fresh and clean. One commented, ‘the staff are very diligent in keeping the home clean.’ Eighty-nine percent of service users who responded to the homes recent survey stated the cleanliness were excellent and eleven percent stated it was good. The housekeeper was spoken with and who stated she received training/guidance in infection control or the control of substances hazardous to health (COSHH). Recording was viewed of routine fire checks that had been carried out in the home. Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 21 Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are detailed recruitment policies and procedures in place, but it must be ensured these are followed to protect service users. Staff has been provided with opportunities for training to develop their skills and ensure the individual care needs of service users can be met. New staff benefit from receiving the induction training at the start of their employment. EVIDENCE: The Acting Manager, a senior care worker, with a further three care workers were on duty during the day. A further care worker was also on duty until 11.0 am during the particularly busy part of the morning and in the afternoon to facilitate an activity. A second RGN also came in during the afternoon to assist in nursing procedures. The staffing rota viewed and the Acting Manager confirmed that staffing levels are reviewed to ensure they remained adequate to meet the number and care needs of the service users resident. At night the home deploys two ‘waking night,’ staff one of whom is an RGN. Six of the service users surveys stated that staff listen and act on what they say and one stated sometimes. One commented, ‘the staff always listen and do what ever they can to help.’ Six service users also stated they always receive the care Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 23 and support they need and staff is always available when you need them and one stated usually. One commented, ‘the matron and staff are all very good. I have only the best care I need.’ The six relatives surveys stated their relative always receives the care and support agreed. One commented, ‘beyond my first expectations.’ Three of the care worker surveys stated there is always enough staff available to meet service users needs and one usually. The AQAA detailed that of the six care workers the three senior care workers all holds an NVQ Level 3 in care and two care workers and a care worker on the bank staff are working towards NVQ Level 2 in care. The AQAA detailed that a robust recruitment process is in place. The documentation was viewed for the two new members of staff, who had been recruited since the last Inspection. Both demonstrated the completion of an application form, one had two written references in place the other only had one and both had completed a Criminal Records Bureau check (CRB)/and a Pova First check which had been received prior to staff commencing work in the home. The Acting Manager was also able to demonstrate that all staff working in the home have had a CRB check undertaken. The four care workers surveys stated that references and a CRB check was undertaken prior to starting work in the home. The record of the RGN’s pin number were not upto-date so did not evidence these were current. The Acting Manager stated she was aware of this and had already taken action to address this. It is also the individual responsibility of the trained staff to ensure that they have a current pin number. The Acting Manager evidenced that induction training for new members of staff is in place and stated that this meets the requirements of the General Skills for Care induction standards. The AQAA also detailed that a new checklist induction programme has been introduced to aid senior carer workers and RGN’s on what areas should be covering during induction. New care workers are shown how to do a task then observed doing it before being signed off as competent. The care workers surveys stated the induction very well or mostly covered everything you need to know to do the job. One new care worker spoken with confirmed completion of an induction. A further new care worker has not yet undertaken the induction due to language barrier and is being assisted to address this. It must be ensured that adequate guidance is provided until the induction is completed Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management team have strived to create an atmosphere within the home, which is open, relaxed, homely and caring. Quality assurance systems are being developed to enable ongoing feedback about the care provided in the home and systems are in place to ensure a safe environment for staff and service users. But it must be ensured that new staff has received the required training to protect service users and staff. EVIDENCE: There is not a Registered Manager in place in the home. A new Acting Manager has been working in the home since September 2007, who stated that an application has not yet been commenced to apply for a Registered Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 25 Manager for the home and this should now be addressed. The Acting Manager confirmed she is an RGN and was about to commence the Registered Manager Award. The deputy manager post to support the Acting Manager had recently become vacant. Subsequently the Acting Manager has confirmed the deputy manager is returning to work in the home. Feedback received was that the running of the home was open and transparent and there were opportunities for staff, service users and their representatives to affect the way in which the service is delivered. A quality assurance system is in place. It was evidenced that feedback about the service provided has been sought from service users through service users meetings and surveys. The outcome of the recent survey has been collated and was quoted in the AQAA. The results should also be made available to service users and their representatives and the Acting Manager stated this would be addressed. The last service users meeting was held in September 2007 and it is recommended that the frequency of these meetings be reviewed to ensure service users have a regular forum to give their views on the service provided. The AQAA detailed that policies and procedures have been reviewed. The Proprietor visits the home and makes a record of this to meet the requirements of Regulation 26 and the records for the last two visits were viewed. Where a small ‘float’ of money is held for one service user a sample of the financial records to support this activity were viewed and were adequate. The AQAA details that appraisals and supervision should occur more regularly and that it is an area, which needs to be improved. The care workers surveys stated they regularly or often meet with their manager. Records were viewed of group meetings with senior care workers The Registered Manager who recently retired was an in house trainer. The Acting Manager stated they are in the process of exploring other ways of providing ongoing training to the staff. Although the Acting Manager stated that all the established staff are up-to-date with their training it was only possible to evidence this for the senior care workers. She is working through appraisals and supervision with staff to ascertain their training needs and compile records to evidence training undertaken. The four care workers surveys stated the training given is relevant to the role, provided information to meet individual service users need and keeps staff up-to-date and they always or usually has the right support and experience to meet service users care needs. One commented, ‘we are trained staff absolutely confident, knowledgeable and experienced to meet the different needs of people who use the service.’ Two new care workers were found to be assisting with moving and handling service users but have not received the required training. The Acting Manager has subsequently confirmed that arrangements are being made to access this training for staff and for the interim period these staff will refrain from any moving and handling tasks. Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 26 Risk assessments of the environment had been completed, but had not been reviewed since 2003 and should be subject to regular review. The Acting Manager stated this would be addressed so a Requirement has not been made on this occasion. The AQAA detailed that the maintenance of equipment and services has been carried out. A fire risk assessment in place, but had not been reviewed since 2006 and the Acting Manager agreed to seek advice as to the required frequency this document should be reviewed and comply with the advice given. So a Requirement has not been made on this occasion. Records were viewed of regular weekly and monthly checks undertaken in the home. Records were viewed that evidenced that staff had attended fire training and there are also fire drills facilitated in the home. One of the care workers spoken with confirmed attendance at this training and the other a new member of staff confirmed she had received guidance during her induction. Further training is booked during March 2008 and the Acting Manager confirmed this member of staff was booked to attend. Recording was viewed of incidents and accidents. Longworth House DS0000014015.V357713.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 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation Requirement Timescale for action 29/02/08 2. OP38 19 (1) (bi) That two written references are received prior to new staff working in the home, to protect service users. 23 (4) (d) That staff have received the required training in moving and handling prior to undertaking this task to protect service users and staff. 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Longworth House DS0000014015.V357713.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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