CARE HOME ADULTS 18-65
Lindale Residential Care Home 81- 85 Wharfdale Road Tyseley Birmingham West Midlands B11 2DB Lead Inspector
Catherine Mundy Unannounced Inspection 23rd November 2005 11.15 Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 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 Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lindale Residential Care Home Address 81- 85 Wharfdale Road Tyseley Birmingham West Midlands B11 2DB 0121 706 3273 0121 624 5334 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) Genesis Homes (Essex) Limited Adenike Adebukanla Adenuga Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Nine residents with a learning disability under the age of 65 years. The home can accommodate one named service user over 65 years. The details regarding how the specific needs and social needs of people over 65 years will be met must be included in the service user plan. 9th February 2005. Date of last inspection Brief Description of the Service: Lindale provides care and accommodation to nine adults who have a learning disability. The home is privately owned and had a change of owner/manager in May 2003. The home is in Tyseley, Birmingham and is a corner property, which blends in well with local housing and industrial buildings. To the front of the home there are walled gardens and to the rear there is off road parking. To the rear at either side of the property there are two small gardens. The interior of the home is decorated and furnished to a good standard. On the ground floor there is a communal dining room, TV lounge, quiet lounge, separate WC, a large bathroom and toilet, a kitchen, hairdressing salon, laundry and two ground floor bedrooms. On the first floor there are seven bedrooms and two bathrooms and toilets with shower facilities. The home is situated off the main A41 Warwick Road and is well served by public transport. Trains run frequently from Tyseley station to Birmingham city centre and Solihull. The home is near to local shopping facilities as well as places of worship, parks, adult education centre, library, restaurants, a leisure centre and pubs. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 23rd November 2005, between 11.15 am and 2.30 pm. During this time the inspector was able to examine records relating to the management of the home and the care provided to the residents. The inspection also included a tour of the home, discussions with the Registered Manager and one staff member. One resident was present during part of the inspection. This resident was reluctant to participate in the inspection, however the interactions between the resident, staff and her environment were observed. This inspection focused on the progress made towards meeting the requirements made at the last inspection and upon the management of the home. What the service does well: What has improved since the last inspection?
The home has met 13 of the 14 requirements made at the last inspection. To promote the health and safety of the residents and staff the home now test the fire alarms each week and test the temperature of the water each month. Risk assessments are in place to guide the staff on how to support the residents safely. Hand towels have been put in the bathrooms and toilets. Broken furniture in one resident’s bedroom has been fixed. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 6 The staff have had training to ensure that they can safely administer medication needed in an emergency. Written guidelines have also been developed to support the staff to decide when medication, that is prescribed by the doctor, to be given ‘when required’ should be given to the residents. The staff have also had training in adult protection and receive regular supervision from the manager. The manager was to ensure that the number of hours worked by the staff is safe and complies with the law. The manager monitors this. The manager has made an application to allow the home to continue to care for a resident who has turned 65. The manager has also applied to be the home’s Registered Manager. These applications have been approved by the Commission. What they could do better: 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.
Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): x EVIDENCE: The standards within this section were not inspected on this occasion. The Registered Manager stated that she is in the process of updating the home’s Statement of Purpose to reflect her recent appointment to the role of Registered Manager. There have been no new residents admitted into the home since the time of the last inspection. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9. The care planning system in place is good, providing the staff with sufficient information to enable them to meet the residents’ identified needs. Introduction of a Person Centred Approach to care planning will enhance this further. EVIDENCE: The care plans relating to two residents were examined. These confirmed that the residents have been provided with plans of care that meets their individual needs. The Registered Manager stated that the residents are involved in devising these. The residents had signed the care plans seen. Regular recording is maintained as identified in the individual plans. The residents care plans are stored in their bedrooms. Some of the residents can access these documents freely. This is dependant upon the residents’ individual needs and abilities. Risk assessments have been completed and risk management strategies devised to reduce the risks identified. Care plans and risk assessments are regularly reviewed and updated.
Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 10 A requirement made at the last inspection to complete risk assessment relating to the home wedging a residents’ bedroom door open has been addressed. This bedroom door now remains closed. The Registered Manager stated that there is a plan in place to complete an assessment of the residents’ needs and aspirations using a Person Centred Approach. Documentation to enable this was available in the home at the time of the inspection. This had been completed in part in the files seen. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): x EVIDENCE: The standards within this section were not assessed on this occasion. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20. The residents’ personal care needs are met in a manner which reflects their personal preferences and promotes the safety of the residents and staff. The systems in place for the management of the residents’ medication are good, clear guidance is available, and training provided to ensure that the residents’ medication needs are met. EVIDENCE: The residents’ personal care needs are recorded in the residents individual care plans. These reflect the residents’ personal preferences as to how their needs are to be met. The residents have been consulted over whether they prefer to receive personal care with the support of a staff member of the same gender. Where appropriate risk assessments have been completed with regard to this. Manual handling risk assessments have also been completed for all residents. These identify the actions to be taken by the staff to maintain safety. These are subject to regular review and update. Action taken by the home to meet the residents’ health care needs was not assessed on this occasion other than to note that the home is in the process of introducing an annual health assessment record for each resident. This will
Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 13 involve a thorough assessment of the residents health care needs and will be supported by the Community Learning Disability Team. The residents needs are such that the responsibility for ordering, storage, administration and disposal of medication is retained by the home. Most medications are dispensed using the monitored dosage system. Medications that can not be dispensed in this way are audited daily by the home. Records relating to this were accurate. Medication Administration records are also completed. These records have been amended using either correction fluid or tape. The staff were told the correct way to make amendments to these records. Protocols for the administration of medication in the event of an emergency are in place. The staff demonstrated in discussions that they are confident with administering this medication. Training records confirmed that the staff have received training from a specialist nurse with regard to this. Protocols for administering medication on an ‘as required’ basis are also available. The staff member demonstrated that she is familiar with these. The home is audited by a representative of the dispensing pharmacy. The most recent audit took place on 16 November 2005. A copy of the report made during this visit was available in the home. The recommendations made have been actioned by the home. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has a satisfactory complaints system in place, with information provided to the residents in a format that is more accessible to them. Review of the homes policy relating to meals out and implementation of the Department of Health guidance on POVA (Protection Of Vulnerable Adults) will enable the home to demonstrate that the residents are protected from abuse. EVIDENCE: The Registered Manager stated that there have been no complaints made since the time of the last inspection. This is confirmed in the homes complaints log. The complaints procedure is available in the home. A complaints form has been developed in a format that is more accessible to the residents. The Registered Manager stated that none of the residents have professional advocates, however some residents do have family involvement and access day placements that are independent of the home. Information leaflets relating to citizens advocacy are available in the home. The home continues to facilitate house meetings each week. Records relating to this were not examined during this inspection. The manager stated that this meeting provides the residents with an opportunity to raise concerns or make complaints. The resident stated that she liked living in the home. Observations of her interactions indicate that she is comfortable and relaxed in the home. The Registered Manager confirmed that she is aware of the actions to be taken, within the home, in the event of suspected abuse. This would involve following vulnerable adults guidance provided by Birmingham Social Services.
Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 15 The Registered Manager was not aware of the actions she should take, to meet Protection Of Vulnerable Adults (POVA) guidance issued by the Department of Health. The finances relating to one resident were examined. The resident’s needs are such that the home maintains responsibility for the safekeeping of their finances. The organisation acts as appointee for all residents. Each resident has an individual bank account. The Registered Manager keeps a log of all expenditure made on behalf of the residents. Receipts are retained of all purchases. Bank statements examined accurately reflect the records retained in the home. Concern was raised regarding the home’s policy for birthdays. The Registered Manager advised that on each resident’s birthday, the residents and staff go out for a celebratory meal. The resident, whose birthday it is, is responsible for the cost of this meal. In the records examined the cost of this meal came to £159.80. There is no evidence that the resident had given her consent to this expenditure or of the opportunity to choose an alternative way of celebrating her birthday. The Registered Manager stated that this policy is not detailed in the contracts of residency. The Registered Manager stated that she had intended to review this policy. The care plans examined and discussions with the staff and Registered Manager confirmed that, in the event of the residents exhibiting self-injurious or aggressive behaviour, the home does not use physical restraint. Care plans and risk management strategies detailed the actions to be taken in the event of a resident exhibiting these behaviours. These include clear guidance on the use of diversional techniques, promote the health and safety of all residents and staff and detail the arrangements in place to reduce the frequency of incidents. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The standard of the environment is good providing the residents with a clean and comfortable place to live. EVIDENCE: The inspection included a tour of all of the home, except a spare room on the first floor. The home continues to be furnished and decorated to an acceptable standard. On the day of the inspection the home was clean and free from odour, with sufficient heating and lighting. Each of the residents has their own bedroom. These are arranged and decorated to reflect the residents individual preferences and personalities. Communal space within the home consists of a large dining room, two lounges, kitchen and hairdressing room. There are three bathrooms, each with bath and shower facility, WC and wash hand basin. One of these is located on the ground floor, in addition there is a WC also on the ground floor. The residents’ bedrooms are also provided with hand basins. The requirement made at the last inspection to provide hand towels in all toilets and bathrooms has been met. These are also available in the laundry. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 17 The laundry facilities available are suitable for the needs of the home. The staff member demonstrated in discussion that steps are taken to reduce the risk of cross infection. Cleaning materials are stored in a locked cupboard to which the staff have a key. Data sheets are available to advise the staff in the event that these products are ingested or come into contact with the skin. The staff member on duty was not familiar with these sheets, and was initially unable to locate them. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36 Records and limited observations indicated that the people living in the home are supported by an appropriately trained and supervised team of staff. EVIDENCE: Discussions with the staff and observations of the interactions between the staff member and resident demonstrated that the staff member has the competency to fulfil her role effectively. Training records examined confirmed that the staff have received training that is relevant to their role. This includes adult protection and administration of individual medications, which were required following the last inspection of this home. Records seen confirm that the staff receive formal supervision at appropriate intervals. The Registered Manager stated that the staff also receive annual performance appraisal. Records relating to this were not examined on this occasion. The staffing rota was examined. This confirmed that the practice of working long days and mixing day shifts with night duties continues. The manager is aware of her responsibilities to ensure that the staff work in line with the European Working Time Directive. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 19 The rota indicated that the Registered Manager works long days on weekdays and on a Saturday afternoon. She advised that she works flexibly to meet the needs of the home and as such may not actually be present in the home for the periods indicated on the rota. The Registered Manager stated that she is available to provide telephone advice and will come to the home if required. It was demonstrated that the home adopts safe recruitment practices at the time of the last inspection. This standard was therefore not inspected on this occasion. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Despite the positive action taken by the home to promote the health and safety of the residents and staff, this is compromised by the practice of wedging open fire doors. EVIDENCE: Records relating to the health and safety in the home were available during this inspection. These demonstrate that the home takes appropriate action to minimise the risk to the residents with regard to fire, food hygiene, water temperatures and legionnaires disease. A tour of the home confirmed that the requirement made at the last inspection to cease propping open fire doors remains outstanding. It was noted that this practice was with regard to the residents bedroom doors. During this inspection these doors were closed and wedges removed. However the door to the office and to a door in the hallway were propped open with wedges. This compromises the safety of staff and residents in the event of a fire. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 2 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 2 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Lindale Residential Care Home Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x DS0000047064.V267176.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Schedule 3.3(i) Requirement Timescale for action 23/11/05 2 YA23 13(6) The practice of using correction fluid or tape must cease. Errors in recording are to be amended with a single line which is to be initialled by the staff concerned. The home must obtain guidance provided by the Department of Health relating to POVA 31/01/06 (Protection Of Vulnerable Adults). Policies and Procedures must be updated accordingly. The home must review its policy relating to birthday meals out. The home must ensure that the residents or their representative has given consent to expenditure made on the residents behalf. 3 YA23 12(2)(3) 13(6) 12/12/05 4 YA30 13(3) The residents must be given a choice as to how they celebrate their birthday. The home must ensure that all 31/01/06 staff are familiar with COSHH data sheets and are aware of the location in which they are stored.
DS0000047064.V267176.R01.S.doc Version 5.0 Page 23 Lindale Residential Care Home 5 6 YA32 YA42 17(2) Schedule 4.7 23(4)(c)(i) 13(4) The rotas must accurately reflect the actual hours worked by the staff and manager. Fire doors must not be wedged open. This is with immediate effect. Automatic door closures are to be fitted to all fire doors that the residents or staff require to remain open. This requirement was made at the last inspection of this home. 12/12/05 31/01/06 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 YA6 YA19 Good Practice Recommendations It is recommended that the home continue with the plan in place to adopt a Person Centred Approach to the assessment of the residents needs and aspirations. It is recommended that the home continue with the plan in place to complete annual health care assessments. Lindale Residential Care Home DS0000047064.V267176.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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