Inspection on 06/07/09 for Lindum House

This is the latest available inspection report for this service, carried out on 6th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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Larchfield Manor

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Lindum House 1 Deer Park Way Lincoln Way Beverley East Yorkshire HU17 8RN Lead Inspector Eileen Engelmann Key Unannounced Inspection 6th July 2009 09:30 DS0000069345.V376419.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindum House Address 1 Deer Park Way Lincoln Way Beverley East Yorkshire HU17 8RN 01482 886090 01482 869910 lindum@barchester.net www.barchester.com Barchester Healthcare Homes Ltd 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) Mrs Janet Burns Care Home 64 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (64), of places Physical disability (3), Physical disability over 65 years of age (64), Terminally ill (6) Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users in the category PD, must be aged 55 or over and require nursing care. 31st July 2007 Date of last inspection Brief Description of the Service: Lindum House provides purpose-built accommodation for up to 64 older people requiring nursing and personal care. Care for individuals with dementia needs and physical disabilities can all be cared for in this environment. The home has two floors and the bedrooms, most of which have en-suite facilities, are on both levels. There are well-tended gardens, easily accessible to people using the service and there is car parking at the front of the building. Lindum House is set in a residential area, less that a mile from the centre of Beverley, with its good transport links. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Information given by the manager during this visit (6/7/09) indicates the home charges fees from £468.34 to £675.00 depending on the care needs of the individual and the source of funding. Top-up fees are applicable were funding does not match the home’s fee levels; this can be discussed with the manager on an individual basis. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager and can be found in the Service User Guide. Lindum House DS0000069345.V376419.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 that the people who use this service experience good quality outcomes. Information has been gathered from a number of different sources over the past 24 months since the service had its last key inspection visit (31/7/07), this has been analysed and used with information from this visit to reach the outcomes of this report. We completed an Annual Service Review (ASR) for Lindum House on 7 July 2008. We only do an annual service review for good or excellent services that have not had a key inspection in the last year. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. The published review is a result of the assessment and does not come from our power to enter and inspect a service. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files, and records relating to the service. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 5 back from staff (50 ) and 9 from people using the service (90 ). Informal chats with a number of people living in the home took place during this visit and comments from the questionnaires and face to face conversations have been put into this report. The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have received one formal complaint about the service in the 24 months since our last visit. The complaint was around care issues and was quickly resolved by the manager. Ten safeguarding allegations have been made since the last visit in July 2007. Six of the allegations were investigated by the East Riding of Yorkshire Council safeguarding team and resolved quickly. The remaining four incidents were around money going missing from bedrooms and these were referred to the Police. Bedrooms have been provided with door locks and lockable drawers so people can keep their belongings safe and secure. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 6 at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. What has improved since the last inspection? What they could do better: The staff need to make sure that they write the information for the people living in the home in a way that they can understand. This might mean using pictures, symbols, different languages or photographs, but it will help the people living in the home take part in deciding how their care is to be given and when. People living in the home will be able to look at the information and be involved in their care and have a say in what happens. Staff in the home must make sure that the way they record and give out medication gets better. At the moment the way they do this is not safe and could put the people who live in the home at risk. We would like to thank everyone who completed a questionnaire and/or took the time to talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Lindum House DS0000069345.V376419.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 Lindum House DS0000069345.V376419.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. EVIDENCE: Four people’s care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. These documents give clear information about fees and extra charges, which are reviewed and kept up to date. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 10 from the person and their family. Those people living at the home who receive nursing care undergo an assessment by a registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. Discussion with the manager indicated she goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Discussion with five people showed that they were satisfied with the care they receive and have a good relationship with the staff. One person told us ‘the staff look after me well, they have given me an absolute rest in pleasant and comfortable surroundings’. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that all of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Information from the Annual Quality Assurance Assessment and observation of the service showed that the home employs nine care staff from overseas. People who we spoke to said they each had their own key worker and felt comfortable asking for a specific person for their care when necessary. One relative told us ‘my mum’s personal carer is wonderful, very kind and patient. In fact all the staff mum comes into contact with regularly are friendly and helpful’. The home is able to offer a choice of staff gender to people who express preferences about care delivery, as they employ 9 male care staff within the home. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, or they are booked onto training in 2009. The home is registered with us to accept placements for people with dementia, and information given to us by the training officer for the home indicates that all employees are given dementia awareness training as part of their induction programme. Staff who completed our surveys said that their training was good and that they felt they provided a high quality of care, which promoted peoples rights to individuality, privacy and dignity. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Lindum House DS0000069345.V376419.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of people using the service are clearly documented and are being met by the service and staff. Improvements to the staff performance around recording within the medication system must be made, to ensure the peoples’ health and welfare are protected. EVIDENCE: Information given to us in people’s surveys, and during discussions on this visit with people using the service, indicates that individuals are satisfied with the care they receive and enjoy life in the home. Eight people said that ‘staff listen to us and take action when needed’, and one person commented that the home ensures that medication is on time, the food is marvellous and there is a wonderful hairdresser’. One relative told us ‘on the whole the home is run well on a sound and efficient basis regarding the people’s welfare and well being’. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 12 The care plans detailed the needs and abilities of individuals and set out the actions required by staff to ensure peoples wishes and choices are respected and their care needs met. In addition to this information there are risk assessments to cover daily activities of life, and clear information about health and input from professionals and the outcomes for people. There were a few areas were the care plans could be improved and these included The four plans we looked at were evaluated every 2 to 3 months although any changes to the care being given is documented and implemented by the staff. The manager is aware that the care plans should be reviewed by staff on a monthly basis and said that she would talk to those responsible for the plans and ensure they were brought up to date and monitored monthly. There is little evidence that people are consulted on an ongoing basis about their care, especially when staff are completing the care plan evaluations. People and relatives should be able to input to their plan on a regular basis and talk with staff about changes to their care, where possible. This was discussed with the manager at the last visit, but little seems to have been done to address this issue. The manager should look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. The format of the care plans covers most areas of care needs, but the information recorded by the staff should be more person-centred and detailed. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people using the service indicate they are satisfied with the level of medical support given to them. One person told us that the staff are extremely good at getting the GP out to see you if you are unwell, I cannot fault the service. Entries in the care plans specify where individuals have dietary needs, including supplement or thickened drinks and pureed diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. A senior nurse is the designated tissue viability person, who has an excellent knowledge base of wound care and has developed good working relationships with the local GP’s and external bodies. This individual cascades information down to other members of staff to ensure continuity of practice and gives staff regular training to update and maintain their skills. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses and seat cushions. Information from the Annual quality Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 13 assurance assessment and discussion with the manager indicates that there have been nine people admitted with pressure sores to the home in the past twelve months, their wound care is documented in their care plan and treatment is given as appropriate. Evidence in the care plans show staff are being successful in healing these areas. Since our last visit in July 2007 the home has changed its medication supplier to Boots the Chemist. The medication system in use is a Monitored Dosage System (MDS) were tablets are supplied in a ‘pop out’ sheet. The manager informed us that the midday medication times have been altered from 12 noon to 1pm to prevent disturbing people’s lunch time meal. At our last visit to the home in July 2007 we made the following requirement ‘Accurate records must be kept of all medications, received, administered, leaving the home or disposed of to ensure there is no mishandling. Checks of the system at this visit showed the requirement has not been met and will remain on this report. Observation of the medication records show that there are some areas of practice that need to improve and these include • • There are a number of missing signatures where staff who have given out medication, have not signed on the record sheet. Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff must include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. Information about when to carry out the checks of a diabetic person’s blood sugars, is not being followed by the staff on at least three people’s medication records which we looked at. There should be a weekly audit of the medications carried out by a designated nurse, but these have not been completed for the past two weeks up to the date of our visit. One medication, for a person whose records we looked at, has been out of stock for two weeks. • • • We discussed the above issues with the manager who assured us she would speak to the nurses and ensure the records and practises were improved immediately. Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. Chats with people revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Comments from the surveys indicate Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 14 that people feel there is a ‘good rapport’ between the staff and people using the service. One person told us that ‘I can talk to the staff and they will act on what I say. I get the care I need given in the way that I want it, from helpful and friendly staff’. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: The home employs two activities co-ordinators (one male and one female) who work Mondays to Fridays most weeks. There is some flexibility in their hours to accommodate trips out, evening events and the occasional weekend activity. At the moment there is a range of group activities and one to one sessions taking place, which reflect the interests of the people living in the home and also their gender. The mobile library service visits the home every two months and provides large print and talking books as well as the usual reading material. The nine people who answered our survey questionnaires said that they were satisfied with the level of activities on offer and one person commented that ‘the things to do are very good’. Information from the notice boards indicates that on the Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 16 weekend following our visit the gentlemen in the home were going on a trip out Leven Airfield to watch the fly-ins. The manager told us that a mini-bus is hired one day a week during the summer to enable trips out to the local areas to take place. One person informed us that they enjoyed the film afternoons in the home and that this activity would be even better if a more varied number of films were on offer. There are monthly in-house church services, one week it is Methodist, another week is the Latimer Church and the next it is Church of England. The Catholic priest will visit anyone wishing to take Communion on request and the Community Church holds a music service once a week. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors told us that they can come into the home when they like and that they are always made welcome. Staff told us that the manager has an open door policy for staff, relatives and visitors which works well and ensures people can talk about any issues they may have. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is on display in the home. Information from the Annual Quality Assurance Assessment indicates that the home holds meetings for relatives and people using the service were they can discuss any issues around care or the service. The staff training matrix given to us on 7/7/09 shows that some of the staff have attended training on Safeguarding of Adults and those doing NVQs have done equality and diversity sessions. The manager informed us that she, the deputy manager and senior nurse have completed training on the Mental Capacity Act and Deprivation of Liberty. The deputy manager is the lead person for this topic and she is drawing together a training package for the rest of the staff. This type of training ensures that staff have sufficient knowledge about human rights legislation, so they understand individual rights within the care home and out in the community. Observation of the midday meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft diets in an attractive way. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who need help with eating and drinking. People and relatives are pleased with the quality and quantity of the meals served, saying ‘the food is very good and there is always a choice given’. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 17 Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that people feel that their views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. People’s survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said ‘the manager listens to any issues and takes action when needed to sort them out’. Information from the Annual Quality Assurance Assessment (14/5/09) and checks of the complaints record showed that there have been 14 complaints made to the home in the past 12 months and that the manager has responded to each of these and resolved the issues. The manager completes audits of the number and type of complaint received as part of the quality assurance system within the home. In the past 12 months there have been 3 safeguarding referrals made, these have been investigated by the East Riding of Yorkshire safeguarding team and Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 19 resolved. Over the past 24 months the home has improved its reporting of any safeguarding allegations in line with the Local Authorities guidelines and works with the safeguarding team to improve practises and protect those people living in the home. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. The staff training matrix given to us on 7 July 2009 shows there is an ongoing training programme for staff to attend safeguarding of adults awareness training and that the majority of staff attended this in the past year. Although staff receive dementia training as part of their induction process, the staffing matrix does not show that there is any ongoing dementia training or refresher sessions taking place. Comments from the staff surveys indicate that some individuals do not feel they always have the right skills to meet the needs of people living in the home and staff said ‘I would like training around dementia care and the psychological needs of the people we look after’. Information from the Annual Quality Assurance Assessment (14/5/09) states the home could improve safeguarding of adults training for staff and introduce sessions on dealing with conflict and difficult situations. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an extremely high standard of environment, which offers people a safe, comfortable and attractive place to live. EVIDENCE: We walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home has an ongoing maintenance and refurbishment programme and the manager was able to show us the work that has been completed in the past 24 months and discuss work that is planned for this year. Lindum House is a purpose built home that has been open for the past fourteen years. The décor is hotel standard, with lots of pictures and soft lighting, and a number of different seating areas. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 21 The home is warm and welcoming and offers people a safe, comfortable and well-designed place to live. Individuals commented that the home is always fresh and clean and that there are no odours. People have easy access to a number of outdoor areas, including a sensory garden and raised flowerbeds. Time and effort have gone into producing a wonderful display of flowers, shrubs and lawns that are enjoyed by everyone in the home. Flat walkways around these areas assist those with mobility problems to get out and about. The home was pleased to be awarded the Bronze award in the Beverley in Bloom competition and was also a finalist in the Barchester in Bloom event. Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious enough for people in wheelchairs or with walking frames to move along comfortably. The home is built on two floors and the upper floor is accessible by a passenger lift and/or stairs. There are flat walkways inside and out, providing safe and secure footing for people with limited mobility. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage their independence within the home. This includes mobile hoists, stand aids, slide sheets, moving and handling belts and handrails. Bathrooms are fitted with rise and fall baths or fixed hoists, and shower rooms are designed for disabled access. Since the last visit to the home in July 2007 the home has had two new Malibu baths fitted, giving people better bathing facilities. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. The laundry on site is spacious and a separate room is available for storage of clean clothes and linen until it goes back out to the bedrooms. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing matrix supplied to us on 7 July 2009 indicates that infection control training is part of the rolling programme of training and that 22 staff attended this in the last 12 months. Lindum House DS0000069345.V376419.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. EVIDENCE: Checks of the staffing rotas and observation of the service showed that the home employs nine staff from overseas. Discussion with the manager indicated that the home is an equal opportunities employer and there is a diverse mix in the staffing group. Staff members told us that they work as a team and this includes covering shifts when others are on leave or sick. Staff feel that their induction and training helps them meet the needs of people who use the service. We spoke to two people who use the service during this visit, and they were satisfied with the care they receive and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us that ‘staff are friendly, helpful and supportive’. At the time of this visit there were 59 people in the home and the staffing levels were as follows, in a morning from 7:15am to 2:15pm there are two Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 23 nurses and ten care assistants, in an afternoon from 2:15pm to 9:15pm there are two nurses on duty and six care assistants and at night from 9:15pm to 7:15am there are two nurses and three care assistants. Information from annual quality assurance assessment about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the minimum hours asked for in the recommended guidelines. 41 of care staff at the home have an NVQ 2 or above in care and all new starters have to complete an induction which meets Skills for Care criteria. Staff have access to a mandatory training programme, as well as a wide range of specialist subjects which reflect the diverse needs of the people using the service. Four staff files were looked at and they contained evidence of a variety of training events attended over the past year. Nurses are supported in maintaining their own professional portfolio of practice in order to keep their Personal Identification Number (PIN) from the Nursing and Midwifery Council (NMC) up to date. There are link nurses in Palliative Care, Wound Care, Pressure Ulcer Care and Infection Control. These nurses are able to lend advice to their colleagues and time to update their knowledge and skills is planned into their Professional Development Programme for the year. Individuals are receiving regular formal supervision sessions and yearly appraisals, so they know that their work is monitored and evaluated on a regular basis. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Lindum House DS0000069345.V376419.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: Mrs Janet Burns is the registered manager of Lindum House; she has been in post since 1997 and is a Registered Nurse and has an active registration with the Nursing and Midwifery Council. She has achieved her Registered Managers Award and has access to training and support from the Barchester managers training programme. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 25 The home has achieved the local council’s quality award (QDS) parts one and two. Continuous monitoring and assessment of the home and its practice/service by the Council’s Quality Assurance Team is an essential part of the process leading to the awards being reaffirmed year after year. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and the manager is aware of the need to produce a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Meetings for people using the service are held twice a year and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that the open door policy used by the manager is effective and encourages individuals to feel confident about talking about issues and the service in general. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the registered individual does spot checks and completes the regulation 26 visits. The home does not handle peoples personal allowances; instead the individual responsible for the payment of the monthly fees is billed for any additional costs incurred by the person using the service. People we spoke to are satisfied with the financial arrangements in the home and are confident they have access to their monies at all times. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, cot sides and daily activities of living. Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x 3 x x x 4 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 17(1)(a) Requirement Accurate records must be kept of all medications, received, administered, leaving the home or disposed of to ensure there is no mishandling. To make sure people receive their medication correctly and their health and safety is not put at risk. Given timescale of 01/11/07 was not met. Timescale for action 01/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations The manager should consider how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. The manager should ensure the care plans are reviewed by staff on a monthly basis. DS0000069345.V376419.R01.S.doc Version 5.2 Page 28 Lindum House 3. 4. OP7 OP9 The manager should look at how the care plans can become more person centred. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), they include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The manager should ensure that staff are carrying out checks of diabetic blood sugar levels according to each individuals care plan. The manager should ensure that staff are completing the weekly medication audits. The registered person should make sure that staff have sufficient knowledge about equality, diversity, disability matters and human rights legislation, so they understand individual rights within the care home and out in the community. The manager should make sure that staff receive sufficient training around safeguarding of adults, dementia care and dealing with conflict and difficult situations, that they feel confident of meeting the needs of the people using the service. 50 of care staff should achieve an NVQ 2 by the end of July 2010. 5. 6. 7. OP9 OP9 OP14 8. OP18 9. OP28 Lindum House DS0000069345.V376419.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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