Inspection on 07/06/06 for Linden Court

This inspection was carried out on 7th June 2006.

CSCI 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 CSCI 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

Linden Court 02/08/05

Linden Court 26/04/05

Linden Court 11/01/05

Linden Court 27/05/04

Linden Court 19/02/04

Linden Court 28/07/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Linden Court Church Walk Watton Norfolk IP25 6ET Lead Inspector Mrs Jacky Vugler Unannounced Inspection 7th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linden Court Address Church Walk Watton Norfolk IP25 6ET 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) 01953 881753 Norfolk County Council-Community Care position vacant Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate up to 36 Older People not falling in any other category. 2nd August 2005 Date of last inspection Brief Description of the Service: Linden Court is a care home providing personal care and accommodation for up to 36 older people. It is a Local Authority Home situated in the town of Watton, close to local shops, church and other amenities. The home was opened in the mid 1960s and consists of a two-storey building with an additional two-storey extension. There is a shaft lift for service users and staff to gain access to the first floor as well as being able to make use of the main staircase if appropriate. All the bedrooms at the home are of single occupancy of various sizes. There are no rooms at the home that have ensuite facilities but there are a number of toileting and bathing facilities that are near to the rooms and communal areas. The home has extensive gardens that are well maintained and accessible for the service users as well as a small courtyard that is accessible through the dining area. The fees charged as stated by the Manager on 10 May 2006 is £368.22 a week. Additional charges include newspapers and toiletries; hairdressing at £4 - £15 and Chiropody £10. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which involved and unannounced visit to the home and an examination of information submitted, comment cards and information held by the Commission. Thirty-two residents were accommodated on the day of inspection. The Manager, Mrs Pamela Millard has recently retired, and the new Manager, Ms Katrina Dixon, was present throughout the inspection. Preparation for this inspection had taken place at the CSCI office. A tour of the premises was undertaken and several records were viewed. Six residents were spoken with, three visitors and three members of staff. Comment cards were received from four residents and seven relatives. Of these, 100 were satisfied with the overall care provided and enjoyed the food. There were however, comments that the decoration and furniture were tired and in need of refurbishing. What the service does well: What has improved since the last inspection? One of the Care Coordinators in now the Entertainments Manager and as such has improved the range of activities on offer to the residents. Some outings have also been organised for the summer months. The existing staff room has become the Care-Coordinators office and the lounge in the flat on the first floor is now the staff room. The menus are displayed in clearer print making it easier for residents to make their choices. Medication procedures were observed and seen to have improved. Three lounges have been re-carpeted. Some bedrooms have automatic door closures linked into the fire system, where residents have expressed a wish to have their door open at night and this procedure is ongoing. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 6 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. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 7 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 Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. Prospective residents are given information about the home so they can make an informed choice about where to live. However, the home is operating outside its conditions of registration by accommodating people who have dementia. No resident moves into the home without having his/her needs assessed and being assured that these will be met. EVIDENCE: The pre-inspection questionnaire completed by the ex manager prior to the inspection, indicated a number of residents who have dementia. The statement of purpose says that the home offers accommodation and personal care for older people. However, they are offering services outside the scope of the statement of purpose, in that they accommodate people with dementia and this is outside their conditions of registration. These residents must have their needs reviewed and a copy of the findings sent to the Commission. The Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 9 Manager and staff said that the home is able to meet the needs of these residents. A requirement has been made that the home operates within its conditions of registration. A pre-admission assessment is completed on residents prior to their admission. They contained a lot of detail, for example, the circumstances of their admission, and they were signed and dated by the resident. The Manager said that new forms that contain more detail will shortly be implemented. Prospective residents and their families are able to visit the home prior to admission and this was confirmed by those spoken with. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. The home ensures that the residents health, personal and social care needs are set out in an individual care plan. Residents healthcare needs are fully met. Residents are treated with respect and their right to privacy is partially upheld, as the locks on bedroom doors are not suitable. The residents are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Four care plans were viewed and these were found to be well completed. They contained a social history as well as an individual assessment of needs. A record was kept of visits by other healthcare professionals. A record of falls and risk assessments were in place. Also included was an individual objectives record with the action required. The daily records informative and the information recorded was confirmed when speaking with the residents. Care plan agreements were signed by the resident or their representative and staff. This is good practice. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 11 Staff were seen to treat the residents respectfully and choices were offered. Staff were seen to be polite and thoughtful to residents. They preserve dignity, for example, a resident was put into a wheelchair and before moving, the carer pulled her skirt down over her knees and asked where she would like to go. The kindness and patience of staff was observed. Although there are locks in place on bedroom doors, staff may not always be able to gain access in an emergency. A requirement has been made for suitable locks to be fitted. The lunchtime medicine round was observed. Residents were given their medications, and observed taking them before the member of staff signed the record sheet. The record sheets were appropriately completed and medicines were randomly checked and correct. Medicines are appropriately stored. It was reported that no resident currently wishes to administer his/her own medicines. The home is currently awaiting delivery of a new cabinet in which to store controlled drugs. The recording and numbers of the controlled drugs was checked and found to be correct. All staff administering medications have received training. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 &15 Quality in this outcome area is good. The home meets the social and recreational needs of the residents. Residents are able to maintain contact with family and friends and to exercise choice and control over their lives. Residents receive a nutritious and varied diet. EVIDENCE: One of the Care Co-ordinators is now the entertainments manager and a lady visits monthly to undertake arts and craft activities with the residents. Good records are kept of these visits, with a comment being made for each resident taking part. A trip is planned this month for the residents to visit Gressenhall farm and workhouse followed by a reminiscence session. This trip was planned following discussion at a residents meeting. A trip on the Norfolk Broads is also planned. A weekly activities list is displayed on various notice boards. This is an improvement on the activities programme previously offered, however, it is recommended that any activity is recorded in the residents daily records. The home has an open visiting policy and many visitors were seen during the day. Three visitors were spoken with and all expressed their satisfaction with the care offered. Some of the comments included I dont think you could beat Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 13 this place, its a fantastic place........its marvellous, very happy with the care. Friends and families are encouraged to be involved, for example, to attend the meeting this week regarding the meals provided. Choices were observed to be offered and staff spoken to explained how they would offer choices to those less able. The days menus, including choices, are displayed in large print on notice boards and on a board in the dining room. Meals are taken in a pleasant dining room with small tables seating four. The lunch looked attractive and appetising, and the residents said they enjoyed it. Some residents were eating their lunch in a small dining room on the first floor. There is a kitchenette and the meal was provided in a heated trolley. A meeting is being held at the home on 8.6.06 to discuss meals and residents, visitors and staff have been all welcomed. It was reported that there have been some problems with food stock levels, but this is being addressed by the Manager. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The home has a complaints procedure that is taken seriously and acted upon in the best interest of the resident, relatives and friends. Staff understand how residents should be protected from abuse. EVIDENCE: The complaints forms and book are kept in the office, however, if someone wanted to make an anonymous complaint, this would not be possible. It is therefore recommended that a method of enabling people who wish to make an anonymous complaint is devised. The complaints forms seen were well completed with the action and outcome recorded. All residents spoken with would be prepared to say if they had any concerns. Staff spoken with were aware of issues regarding abuse and all had received training in abuse awareness. Evidence of staff CRB disclosures was seen. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 & 26 Quality in this outcome area is adequate. The residents live in a comfortable, safe well maintained environment. The home is pleasant, clean and hygienic. EVIDENCE: Since the last inspection three lounges have been re-carpeted. The Manager said that the Premises and Procurement department at County Hall has been contacted with a view to re-carpeting bedrooms in the new wing. Bedroom doors with glass panels have a curtain fitted. The original staff room has been changed to the Care Co-ordinators office, and the lounge in the unused flat is now the staff room. Facilities available to the residents include several small sitting areas, a hairdressing room, a thrift shop and a residents shop enabling them more choice and independence. Some bedrooms have automatic door closures linked into fire system, where residents have expressed a wish to have their door open at night. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 16 The passenger lift is smooth, but is not large enough to accommodate a resident in a wheelchair and a member of staff to travel between floors safely. It is required that an improvement plan is submitted to the Commission. Although bedrooms doors have locks fitted, these are not safe as staff may not always be able to gain access in an emergency. It is a repeated requirement that suitable locks be fitted to bedroom doors. All residents have a lockable facility in their room. Staff spoken to were concerned that only the two assisted bathrooms were used, making the mornings a rush. Although one is situated on the ground floor and the other on the first floor, this provision is poor. It is therefore required that at least one of the unused bathrooms be provided with an assisted bath or changed to a shower room. Window restrictors have been fitted to first floor windows and all hot taps have the water temperature controlled. The laundry area is clean and tidy with washable surfaces. The home is shabby in some areas, and wheelchair scuffs on doors. One comment card from a relative states overall standard of care is very good, but decoration and furniture is tired and needs refurbishing. It is required that a plan of improvement of those areas which are tired is submitted to the Commission. The home is very clean and tidy, and there were no unpleasant odours. One comment card said the cleanliness of the home was marvellous. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 & 30 Quality in this outcome area is adequate. The staff are recruited, trained and competent ensuring the residents are well cared for. Staffing levels are not adequate as the home currently accommodates some residents with dementia. EVIDENCE: A Care-Coordinator works every day from 7.30 am until 9.45 pm. She covers administrative and management duties, and works with the carers when needed. A Senior carer works from 7.30 am - 9.45 pm as well as three carers in the morning, and two in the afternoon and evening for caring duties. These hours give a total of 330 care hours a week, which are not enough given that some residents have high dependency needs. It is required that staffing levels are increased in order to meet the needs of the residents. There are two waking night staff. Three domestics are available during the mornings and one during the evenings and their duties include the laundry. In addition are a cook and kitchen assistant. The Manager has the Registered Managers Award and will soon commence the NVQ level 4 in care. One Care coordinator has achieved the NVQ level 4 and another the NVQ level 3. 33.3 of care staff have achieved the NVQ level 2 or above. It is recommended that care staff continue to be encouraged to completed the NVQ level 2 in order to meet the standard. The home has good recruitment practices and all of the necessary checks are made. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 18 Each member of staff has an Evidence of learning file. Evidence of induction and training undertaken was seen. Statutory training is undertaken during induction and updated, but no evidence was seen of training in infection control. It is recommended that training in infection control be undertaken by staff. Other training undertaken includes palliative care, emergency aid and all staff have completed training in dementia and abuse awareness. Staff commented that plenty of training is offered, training opportunities are good. Residents and visitors comments regarding the staff were very positive and included, I only have to lift my finger and they (staff) are here, I think this is a lovely home, very happy with care, staff all deserve a medal, they are very caring, I dont think you can beat this place and one resident said Im glad Ive come here. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. The home has a competent, experienced Manager who is awaiting registration. The home is run in the best interest of residents and their financial interests are safeguarded. Staff are appropriately supervised. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: Mrs Pamela Millard, Registered Manager, has just retired and another Manager Ms Katrina Dixon has been in post for only two weeks and is awaiting registration. Ms Dixon has managed another Local Authority care home for years and has a lot of experience in this field. She has achieved the Registered Mangers Award and is soon to commence the NVQ level 4 in care. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 20 Staff spoken to said that they had confidence and the utmost respect for Ms Dixon. A quality check was carried out on all finances in 2004 by Norfolk County Council and is due to be repeated. In order to monitor the quality of the service they offer, the home has sent surveys to residents, their relatives and staff, the results of which were seen. Relatives commented that privacy is usually respected by staff and we are usually encouraged to be involved in the caring process. The staff questionnaire indicated that there was scope for improvement and that staff morale was low. The Manager said that any issues highlighted as a result of these surveys, are discussed at the residents and staff meetings which are held approximately every 2 months. The residents financial records are well recorded and cash appropriately stored. Random money was checked for ten residents and all was found to be correct. Monies are also checked weekly by the administrator. Evidence of regular staff supervision was seen. The accident records were detailed. One resident was observed to have had a lot of falls, but this had been dealt with appropriately and she had seen her GP, with the result that the incidence of falls had lessened. A comprehensive risk assessment file is in place and COSHH assessments seen. Equipment is regularly serviced and suitable fire equipment testing takes place. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 x x 3 Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 22 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. 2. Standard OP1 OP19 Regulation 4, 14 23 (2)(d) Requirement The home must operate within its Conditions of Registration. The Registered Person must submit a plan of improvement of those areas of the home which are tired. The Registered Person must submit a plan for at least one of the unused bathrooms to be fitted with an assisted bath or shower. The passenger lift is not large enough to carry a wheelchair plus a member of staff safely. The registered person must submit an improvement plan to the Commission. Outstanding requirement x 3 Previous timescale of 30.1105 not met. The registered person must ensure all bedrooms are fitted with suitable locks for residents privacy. Outstanding requirement x 3 Previous timescale of 30.11.05 not met. Timescale for action 31/07/06 31/07/06 3. OP21 23 (2)(j) 30/08/06 4. OP22 23 (2)(n) 31/08/06 5. OP24 12 (4)(a) 30/09/06 Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 23 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 3 Refer to Standard OP12 OP28 OP38 Good Practice Recommendations It is recommended that activities undertaken by residents are recorded in their daily records. It is recommended that the management and senior staff team encourage the care staff to gain the NVQ level 2 qualification. It is recommended that staff undertake training in infection control. Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Linden Court DS0000038862.V299441.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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