Inspection on 28/10/08 for Lincoln House

This inspection was carried out on 28th October 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lincoln House 31/10/07

Lincoln House 18/12/06

Lincoln House 05/04/06

Lincoln House 29/11/05

Lincoln House 23/06/05

Lincoln House 07/01/05

Lincoln House 23/06/04

Lincoln House 05/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lincoln House Lincoln Close Wood Green Banbury Oxfordshire OX16 0EF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Carvell     Date: 2 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Lincoln House Lincoln Close Wood Green Banbury Oxfordshire OX16 0EF 01295257471 01295266285 manager.lincolnhouse@osjctoxon.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Elaine Ratcliffe Type of registration: Number of places registered: The Orders Of St John Care Trust care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 44. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) maximum number of places 18 Old age, not falling within any other category (OP) Physical disability (PD) - maximum number of places 6. Date of last inspection Brief description of the care home Lincoln House is one of a number of care homes run by The Orders of St John Care Trust and provides care and accommodation for older people who may be suffering some dementia related illness, and/or physical disability. The home is situated about a Care Homes for Older People Page 4 of 27 44 0 44 Over 65 0 44 0 Brief description of the care home mile from Banbury town centre. It is set in its own grounds and is close to several local shops and amenities. It has four semi-contained care units that comprise bedrooms, lounge/dining rooms and bath and shower facilities. Each lounge/dining room has a kitchenette for the preparation of drinks and snacks. There is a spacious Club Room that provides an area for activities and entertainment for residents. There are 38 single bedrooms and 3 double rooms. Local psychiatric services are available for guidance on treatment of residents and support for staff. There are plans to rebuild the home in order to bring the building up to current spatial requirements - 22 of the current bedrooms are under 10.0 square metres in size and so are below the size needed for residents who need more assistance. A site has been identified close to the existing home, which will provide the future home. It is hoped that this move will be accomplished in approximately two years. Current fees for the home range from 505.00 pounds to 700.00 per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the service was an unannounced Key Inspection. We arrived at 10.15am and was in the service until 4.00pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager in August 2008 and any other information that we have received about the service since the last inspection in October 2007. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standards of the service. We toured the premises, examined a sample of records required to be kept in the home including the case tracking of five service user files and spent time talking to service users in groups and individually. We also spent time with the manager, staff on duty Care Homes for Older People Page 6 of 27 and one visiting relative. In addition we observed how care was being delivered to service users and joined service users in one unit for lunch. At the last inspection, two requirements were made these were that equipment should be repaired in a timely manner and that the home should be managed in a stable manner. Both requirements have been complied with. Feedback was given to the manager, Elaine Ratcliffe during and at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to be developed to consistently include how the emotional, psychological and social care needs of service users are identified and met. Although detailed records are maintained by the activities organiser about each service user, this information needs to form part of the care plan and recorded in daily records. Consideration should be given to introducing protected mealtimes, so care leaders and senior staff can be present in dining rooms at mealtimes to assist serfvice users and support care staff. Verbal complaints are recorded and include action taken and outcome. Care Homes for Older People Page 8 of 27 The manager, Elaine Ratcliffe has already given an undertaking to address these areas. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their representatives are provided with sufficient information about the home, to make an informed choice about moving in. Service users are assessed prior to admission to ensure that the home can effectively meet their care needs. Evidence: All prospective service users are provided with information about the home, including the homes brochure and a copy of the last inspection report. Oxfordshire County Council have a block contract with the home for thirty eight of the forty four registered beds. All prospective service users are assessed before being offered a trial period in the home. Service users and their representatives are encouraged to visit the home, before deciding whether the home is able to meet their needs. One relative of a recently admitted service user, said she was able to visit the home and staff were happy to Care Homes for Older People Page 11 of 27 Evidence: answer any questions. The admission process was further assisted by the service user, having stayed in the home for respite care a number of times. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to be developed to consistently record how the emotional, psychological and social care needs of service users are identified and met. The healthcare needs of service users are fully met. Medication administration, recording and storage were seen to be well maintained. Service users feel that they are treated with dignity and respect. Evidence: Care plans are drawn up from the pre-admission assessment, agreed and signed by the service user and their representative, if appropriate. Care plans are reviewed on a regular basis and any changes are recorded. Information regarding health and personal care is well documented. Not all service users have a care plan detailing how the service users emotional, psychological or social care needs are identified or met. Care Homes for Older People Page 13 of 27 Evidence: Since the inspection the manager, Elaine Ratcliffe has confirmed that this is being addressed. In addition the Trust are auditing care planning documentation is all of its care homes. Service user files are well organised and contain appropriate risk assessments. Healthcare professionals, such as the falls specialist, are involved with risk assessments as necessary. The healthcare needs of service users are met by four local GP practices and a wide range of healthcare professionals, including district nurses visit the home as necessary. From evidence seen and discussion with the manager, service users and staff on duty, the healthcare needs of service users are fully met. Medication is administered by staff who have completed appropriate training from a pharmacist. Medication administration records were seen to be well maintained, with no obvious gaps in recordings. Risk assessments would be undertaken for any service user wishing to take responsibility for their own medication. Time was spent time with service users in private and in groups. All service users expressed their satisfaction of the care provided and several said that they were very happy living in Lincoln House. There is a good rapport in the home between service users and staff and all service users said that they were treated with dignity and respect. From discussion with the manager, we consider that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are encouraged to make choices and to remain independent for as long as possible. There is a wide range of activities in place to meet the social needs of service users. Service users are provided with a varied, nutritious and wholesome diet, taking into consideration service users requests. Evidence: An activity organiser is employed for thirty two hours per week and works Monday to Thursday. Information regarding weekly events and activities are displayed throughout the home. Detailed records are maintained of activities undertaken each day and the names of service users who have taken part. Volunteers undertaking Social Care courses at a local colleague also assist with hobbies, arts and crafts and activities in the home for four days per week. Service users said that they were looking forward to a pantomime, taking place the day following the inspection. Following the inspection the manager, confirmed that the activity organiser would record activities undertaken each day on service user records and also a general evaluation of the days activities for the activities file. Care Homes for Older People Page 15 of 27 Evidence: Many of the service users have friends and family who are able to visit on a regular basis. Service users are encouraged to maintain contact, as far as possible, with the local community. Religious ministers visit the home weekly and arrangements can be made for service users to attend a local place of worship, if requested. Regular service users meetings take place and are well attended. Service users confirmed that routines in the home are flexible, such as being able to choose when to get up, when to go to bed and how to spend their days. We joined service users in one unit for the midday meal, there is always a choice of dishes offered and this is recorded. Menus evidenced that a varied, nutritious and wholesome diet is provided. The meal was tasty, hot and attractively served. Service users were offered second portions. The member of staff serving meals, was observed to assist service users in a calm and discreet manner. However, the member of staff was not always present in the dining room as she was also attending to service users in their bedrooms. This was discussed with Elaine Ratcliffe, who had already identified some issues surrounding mealtimes that need developing. Service users said that the food provided was very good and requests for particular dishes was always considered. Service users said that they enjoyed having a cooked breakfast choice each day and that portions were generous. The introduction of protected mealtimes was discussed with the manager, as the care leader was busy throughout the mealtime period administering medication, rather than being able to assist staff, monitor food intake and support service users. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 comprehensive complaints procedure in place and service users feel confident that their concerns and complaints are listened to, taken seriously and addressed. The manager has agreed to record all verbal complaints received in future. Policies and procedures are in place to protect service users from abuse. Evidence: The homes complaints procedure is displayed in the entrance hall of the home and service users are given a copy of the procedure, when moving into the home. Since the last inspection the home has received one verbal complaint which was then put in writing by the complainant. The manager confirmed that currently verbal complaints are not recorded as they are dealt with immediately. She agreed that in future all verbal complaints will be recorded. Service users were clear about the process for reporting a concern or complaint and said that they were confident that their concerns would be listened to, taken seriously and addressed. In mid October, the Commission received a copy of an anonymous letter, sent to the Trusts Head Office, expressing concerns about a range of issues at the home. An immediate internal investigation was carried out by the manager and no evidence was found to substantiate the concerns raised. The manager referred the anon. letter to the Oxfordshire Safeguarding Adults team. Care Homes for Older People Page 17 of 27 Evidence: All staff receive training in the homes procedures for protecting service users from abuse and the homes whistle blowing policy, this was confirmed by staff on duty and training records. Training is provided during staff induction and then updated on a regular basis. No safeguarding adult referrals or safeguarding adult investigations have taken place since the last inspection. No referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. The home has a copy of the Oxfordshire Safeguarding Adults procedures. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home fails to meet many of the environmental standards required for care homes. However, action is being taken to build a new purpose home. The home was found to be clean, pleasant and free from unpleasant odours. Evidence: The home is reasonably well maintained, comfortable and welcoming. It is acknowledged by the Trust that the premises fails to meet many of the environmental standards required for care homes and plans are in place to build a new, larger home. A site has been identified and work is likely to commence by spring 2009. Communal areas of the home are comfortably furnished and staff have worked hard to make the premises homely. Service users expressed their satisfaction of the home and the facilities available to them. Since the last inspection several areas of the home have been redecorated and repairs have been made as necessary. At the last inspection a requirement was made that equipment that was not working, must be repaired in a timely manner. This related to equipment in the kitchen and has been complied with. During a tour of the premises it was noted that a mattress in one bedroom, was hard and needed replacing. Following the inspection Elaine Ratcliffe confirmed that she had Care Homes for Older People Page 19 of 27 Evidence: undertaken an audit of all mattresses in the home and six new mattresses had been ordered for delivery by the end of November. The housekeeping team work hard and take pride in maintaining a high standard of cleanliness throughout the home. The home was found to be clean, pleasant and free from unpleasant odours. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment procedures are robust and protect service users from possible harm. Staffing levels appear adequate to meet the needs of the current service users. Staff are well trained and confident in their respective roles. Evidence: From discussion with the manager, Elaine Ratcliffe, staff on duty, duty rosters and direct observation, staffing levels appear to be adequate to meet the needs of the current service users. During the last twelve months, twelve members of staff have left the home for a variety of reasons and exit interviews take place. The home is currently fully staffed. From examination of five staff personnel files and discussion with the manager and staff on duty, the homes recruitment procedures are robust. Personnel files evidenced that all prospective members of staff complete an application form, documentation required such as references and police checks are obtained, an formal interview is undertaken and conducted by the manager and a senior member of staff. Members of staff are encouraged to undertake NVQ ( national vocational qualification) training. 54 per cent of care assistants and care leaders have completed NVQ training, 22 per cent are working towards the qualification and 24 per cent have been Care Homes for Older People Page 21 of 27 Evidence: nominated and are waiting to commence the training. All housekeeping staff have completed NVQ training in housekeeping. All members of staff undertake induction training, appropriate to their role once in post, complete mandatory training and specialist training, as appropriate. OSJCT has its own training centre that provides a high standard of training both in house and external to the home. There is a staff training and development plan in place and it was evidenced that regular updating of training is provided to all staff. Staff on duty confirmed that they had received relevant training for their role and were positive about training opportunities available and that this gave them confidence to carry out their duties and assisted with career advancement in the future. Staff spoken to during the inspection expressed their satisfaction of working in the home, felt that the working conditions were good, felt well supported by Elaine Ratcliffe and were positive about their contribution to the daily lives of the service users. Communication systems appear to be well organised, with staff handovers at the start of each shift. Staff meetings take place and staff said that morale in the home was good. All grades of staff were observed to be professional in their approach to service users and to colleagues. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and staff benefit from a well managed care home. Evidence: Elaine Ratcliffe is an experienced and well qualified care home manager, and has been in post since December 2007 and registered with the Commission as the manager of Lincoln House in July 2008. This has had a positive impact on staff morale and the running of the home. At the last inspection a requirement was made that OSJCT ensure that the home was managed in a stable manner, following several changes of manager over two years. This requirement has been complied with. The manager is supernumerary to the homes staffing levels are is supported by an experienced and well qualified head of care, in post since May 2008. In discussion with service users and staff on duty, all expressed the view that the home was well managed and run in the best interests of the service users. Service users expressed their satisfaction of the management style of Elaine Ratcliffe and said Care Homes for Older People Page 23 of 27 Evidence: that she was approachable and was always accessible. Procedures are in place for dealing with service users monies and valuables held in safekeeping. regular auditing of accounts takes place. All staff receive formal, planned supervision every two months from either a senior member of staff or the manager. A sample of supervision records were seen to be well maintained, actions agreed, recorded and signed by the supervisor and supervisee. Elaine Ratcliffe said that she encourages feedback from service users, members of staff and visitors to the home. The home has an open door policy, so the manager, head of care or senior member of staff on duty are always available to talk to. This was confirmed by service users and staff on duty. Quality assurance systems are in place and the manager or head of care undertake regular audits. Evidence was available to demonstrate that the views of service users are obtained to measure the homes success in meeting the aims, objectives and Statement of Purpose. Report written by the homes Operations Manager on behalf of the provider, following an unannounced visit to the home each month, were available for examination. A sample of records required to be maintained and available in the home including records relating to health, fire, safety and welfare were examined and seen to be well maintained and up to date. Policies and procedures are in place and are reviewed on a regular basis. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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