Inspection on 11/12/08 for Linden House

This inspection was carried out on 11th December 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

Linden House 07/12/06

Linden House 14/10/05

Linden House 04/01/05

Linden House 28/07/04

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 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Linden House 44 - 46 Station Road Sholing Southampton Hampshire SO19 8HH     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: Nick Morrison     Date: 1 1 1 2 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. that people have said are important to them: They reflect the things 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 28 Information about the care home Name of care home: Address: Linden House 44 - 46 Station Road Sholing Southampton Hampshire SO19 8HH 02380441472 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Rita Baker,Mr Mark Baker Name of registered manager (if applicable) Mr Mark Baker Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 21 The registered person may provide the following category 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 category: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Mrs Baker and her son Mr Baker own Linden House and are the registered providers and Mr Baker is the registered manager. Linden House provides care and support to 21 Care Homes for Older People Page 4 of 28 care home 21 Over 65 0 0 21 21 21 0 Brief description of the care home elderly residents over the age of 65 and is registered to accommodate residents with dementia. Mrs Baker and her son, Mr Baker, over the years have extended and made extensive improvements to the home. The home has three floors with a stair lift to the first floor. The home has 17 bedrooms, four of which are doubles, a large lounge, and conservatory; separate dinning room and an additional quiet area. The home has an interesting scenic enclosed garden, with plenty of seating for residents to enjoy the garden in the warmer months. Linden House is located within a three-mile radius of the City of Southampton, which has a range of social, recreational and historical interests available. The home is situated within a residential area, which has good transport links to the city centre, local health facilities and local shopping. The cost of living at the home ranges from £329- £465 a week. Additional charges are made for newspapers if someone wishes for an alternative to those supplied by the home. A hairdresser visits the home and charges for this service range from £7.50- £20. A visiting chiropodist attends the home regularly and charges for this service are £10. Care Homes for Older People Page 5 of 28 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 report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 11th December 2008 and lasted five hours. During this time we looked around the premises, looked at the files of five service users, spoke with seven service users, the District Nurse, three staff, the Manager and six relatives. We observed the support people were receiving throughout the inspection visit and observed interaction between staff and service users. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to the services own selfassessment of the home. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 28 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 9 of 28 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 benefit from having their needs assessed prior to moving into the home. Evidence: Examination of service users files demonstrated that the home completed preadmission assessments prior to people moving into the home and, as part of this process, made decisions about whether or not the home could meet the needs of prospective service users. Assessments were comprehensive and covered the full range of needs. Where people had been referred by social services there were also care management assessments in place. Service users and their relatives told us that they were involved in the assessment process. Pre-admission assessments also contained pen portraits of each person. They were written by their families and described peoples history and backgrounds. In speaking Care Homes for Older People Page 10 of 28 Evidence: to the Manager and other staff it was clear that they were aware of peoples histories and that this information was used in helping to support them. Care Homes for Older People Page 11 of 28 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. Service users benefit from having their needs identified in a care plan and from having their healthcare needs met. They are protected by the homes medication policies and procedures and are treated with dignity and respect. Evidence: There had been a requirement from the previous inspection that the home must ensure that care plans are detailed, provide specific support instructions, fully address all assessed needs and are regularly reviewed. Examination of the care plans and related records demonstrated that the home has now addressed this requirement. The care plans we looked at addressed all identified needs and gave specific instructions as to how these were to be met. Records also demonstrated that the care plans were kept under regular review. The process for reviewing care plans included information from service users, their families and, where appropriate, their GP or other healthcare professionals. Where appropriate, there were risk assessments in place to support the care plans. The risk assessments were kept under regular review and were also reviewed in response to incidents. On the day of the inspection visit we noted that one Care Homes for Older People Page 12 of 28 Evidence: person had recently had a fall while walking outside the home and that her risk assessment was being reviewed as a result of this. There was clear cross referencing between the accident record, the care plan and the risk assessment. These were related to feedback from the service user and their family in response to the fall. Relatives told us that staff in the home responded promptly to the personal care needs of people living in the home and did so in a way that respected and promoted their privacy and dignity. Service users also told us they thought their privacy and dignity was respected at all times and observation of staff on the day of the inspection visit confirmed this. People living in the home obviously had the support they needed to maintain their own personal dignity by ensuring that they were very well presented. Their hair and clothes were clean and tidy and other details such as finger nails and glasses showed that the home ensured that people were supported to maintain their appearance. Examination of service users files demonstrated that their healthcare needs were regularly monitored. Records also showed that people were supported to access healthcare services as necessary. This was confirmed in discussion with relatives who told us that the home always brings in the GP straight away and always contact me. Some relatives also told us that they had noted significant improvements in health since their relative moved into the home. Discussion with the District Nurse confirmed that the home liaised well with healthcare services in the interests of people living there. The District Nurse told us she had a very good relationship with the home and that the Manager and staff were responsive to guidance and suggestions about supporting service users. There had been a requirement from the previous inspection that written guidance must be avilable for all service users who had been prescribed as required medication and that this should also be noted in their care plan. Examination of service users files demonstrated that this requirement has now been met. Medication in the home was well managed through a monitored dose system. Records kept in relation to medication were clear and up-to-date and provided a good basis for monitoring all the medication in the home. There were also very clear records relating to Controlled Drugs in the home. The change to a monitored dose system had presented some problems in relation to the storage of medication in the home. All medication was stored safely in the office, but the Manager told us he was going to reorganise the office area to ensure that there was adequate space for the storage of medication. All staff administering medication in the home had received appropriate training. Staff had not been trained in administering injections and this service was provided by the District Nurse. Care Homes for Older People Page 13 of 28 Care Homes for Older People Page 14 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being able to exercise choice and control and have stimulating activities. They also benefit from good support in maintaining contact with friends and families and a good, balanced diet Evidence: The home employs an Activities Coordinator to provide planned activities in the home. Each planned activity has a rationale explaining the potential benefits of the activity for people living in the home. In addition, records are kept of all activities that take place and these included which service users were involved in the activity and how they each responded to it. Activities currently available in the home included shuttles, bingo, skittles, musical movement and hand-eye coordination games. Plans were also in place to take some service users to pantomimes over the Christmas period and the home had also had local children in to sing to people living in the home. The Activities Coordinator has attended training and is in the process of planning more activities specifically designed people for people who have dementia. People living in the home were also supported to be involved in activities outside the home. One service user regularly went to church on her own until she recently had a fall. The review of her risk Care Homes for Older People Page 15 of 28 Evidence: assessment identified that, as a result of the fall, she now lacked the confidence to continue going to church on her own. Her care plan had been changed to reflect the fact that she now needed support to go to church. During the inspection visit we observed the Manager reassuring the person that she would be able to continue going to church and that there would be someone to support her to ensure she is safe. Service users spoken with told us that there was always something going on in the home and also that they got on well with each other and there was always someone to talk to. Relatives also told us they thought there were sufficient activities in the home and that people living there received adequate stimulation. On the day of the inspection visit we observed staff interacting with service users throughout the day in meaningful ways and encouraging service users to interact with each other. One relative told us she thought people living in the home were always relaxed and comfortable in the home. Relatives were encouraged to visit the home at any time that was mutually convenient to them and their relative. All relatives spoken with told us that they were always made to feel welcome in the home and that the staff were always welcoming and hospitable. On the day of the inspection visit we observed that relatives were given trays of tea, coffee, biscuits and homemade cakes. Relatives spoken with told us that this always happened when they visited the home. The District Nurse told us that there always seemed to be lots of visitors to the home and that there was a lovely, homely atmosphere. On the day of the inspection visit we observed that one relative ran a Bingo session in the lounge in the afternoon and that staff encouraged and supported service users to play. One service users husband told us he came to the home six days a week and spent most of the day there. He said the staff were very good and nothing is too much trouble for them. He told us how he was well looked after in the home and how staff enabled him to care for his wife as much as he was able to. Observation of food storage areas in the kitchen showed that the home made a lot of use of fresh ingredients. The home concentrated on providing traditional home cooked food. All service users and relatives spoken with told us that the food was always of very good quality and was served in ample portions. During the mealtime on the day of the inspection visit we observed that staff were available to provide support for people who needed it and that they did this in a discreet way. The mealtime was a relaxed and enjoyable time for people living in the home. The dining tables had been set with table cloths and napkins, along with condiments, side plates, tea cups and fresh fruit and flowers. There was an orientation board in the dining room that provided information about the date, the weather, which staff were working and what choices were available for meals. Care Homes for Older People Page 16 of 28 Care Homes for Older People Page 17 of 28 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. Service users benefit from a clear and effective complaints procedure and are protected by the homes adult protection procedures and practices Evidence: The home had clear procedures in place to ensure that service users were protected from any kind of abuse. The Manager was clear about the local reporting procedures and all staff had received training from the local authority in identifying, understanding and preventing abuse. Service users told us they felt safe in the home and that they thought they were protected from any kind of abuse. Relatives spoken with also told us they thought people in the home were safe. Observation on the day of the inspection visit demonstrated that staff were aware of the needs of service users and responded to those in a kind and sensitive manner. There was a clear complaints procedure in place that was made available to all service users and their families. Service users and relatives spoken with confirmed that they were aware of how to make a complaint if they felt they needed to, but none of those spoken with had ever had the need to complain. One relative told us that this was because the home was very responsive to service users needs and any slight concerns that relatives had would be dealt with efficiently and appropriately so that there would be no need to make a formal complaint. The home did have a recording system in place for recording and responding to any complaints but no complaints had been Care Homes for Older People Page 18 of 28 Evidence: made in the past twelve months. Care Homes for Older People Page 19 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in clean, safe, well-maintained environment. Evidence: There were clear and comprehensive Infection Control procedures in place in the home. There were also notices around the building to remind staff of the importance of infection control. Staff observed throughout the inspection visit demonstrated an awareness of infection control in their practice. There were paper towels, protective gloves and liquid soap available throughout the building in order to promote infection control and all staff had received training in infection control procedures. During the inspection of the premises we observed that a box of washing powder was left open on the floor in the unlocked laundry room. We mentioned this to staff and to the Manager during the inspection and it was dealt with immediately. The Manager told us he would be reminding staff of the storage arrangements for such items and the potential risk to service users of cleaning products being left unattended around the building. The home has two lounges and a large dining room in between them. There is also a conservatory which visitors told us they often used as a quieter place to talk with their relatives. Service users rooms were well equipped and all service users spoken with Care Homes for Older People Page 20 of 28 Evidence: told us they had everything they needed in their rooms. The bedrooms also had privacy locks designed to enable people to maintain their own privacy but without the possibility of accidentally getting locked in their rooms. During the inspection we found that all areas of the home were clean. Relatives and the District Nurse told us that the home was always kept clean. Care Homes for Older People Page 21 of 28 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. Service users benefit from being supported by adequate numbers of sufficiently trained staff and are protected by the homes recruitment policies and practices Evidence: There were three care staff on duty throughout the day, which appeared sufficient to meet the needs of people living in the home and matched with the rota. In addition there were cleaning and kitchen staff. Service users spoken with spoke highly of the staff and said there always appeared to be enough staff around. Relatives spoken with also told us they thought there were sufficient staff in the home. We looked at the files of five members of staff and found that they all contained information to demonstrate that the home made sufficient checks on all staff prior to them working in the home. This was confirmed in discussion with staff who told us they were not able to begin working in the home until all their checks and references had been confirmed. We found that the staff files, along with other files in the home, were not well ordered and that some items fell out of them as they were lifted from the shelf. We discussed this with the Manager, who was planning to re-order the files as part of the reorganisation of the office. Staff training was kept up to date and this was demonstrated by records of training and confirmed in discussion with staff. Staff observed on the day of the inspection visit appeared to be competent and confident in Care Homes for Older People Page 22 of 28 Evidence: their roles. Service users spoken with said the staff were competent in supporting them and relatives spoken with confirmed this view. The District Nurse told us that she ran some training sessions with staff and found the staff to be open to learning and said that they demonstrated a high level of competence. Eighty per cent of staff in the home had been trained to National Vocational Qualification (NVQ) level two. The kitchen and cleaning staff were also supported to be involved in training, including NVQs. Our observation of staff throughout the visit showed that they demonstrated a very caring approach towards people living in the home and ensured that people were comfortable and stimulated throughout the day. The Manager had acknowledged to us in his own assessment of the service that formal support and supervision sessions for staff had recently not been occurring as often as they should be and he has a plan in place to ensure that all staff receive formal supervision on a regular basis. Staff spoken with told they were well supported by the Manager and felt they could approach him whenever they needed to. Care Homes for Older People Page 23 of 28 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 are protected by the homes financial procedures and by the management of health and safety issues. Service users benefit from living in clean, safe, well-maintained environment. Evidence: The Manager is registered and has demonstrated that he has the skills, training, knowledge and experience to manage the home. All relatives, service users and staff spoken with spoke highly of the Manager. Staff said they felt supported by the Manager and service users told us they found him very approachable and helpful. Relatives told us that he managed the home well and ensured that people were well cared for. One relative told us that the Manager went out of his way to ensure that relatives were made welcome in the home and that he even offered him a lift home on occasions so that he did not have to catch the bus. The home has begun some positive work on quality assurance, ensuring that service Care Homes for Older People Page 24 of 28 Evidence: users and their relatives are able to contribute to the development of the service. Service user satisfaction surveys have developed and improved and now included pictures in order to make them accessible to more people. The home has regular service user meetings and the minutes from these have also been produced with pictures to make them more easily understood. There had been a requirement from the previous insepction that the home must keep photographs on file of all the people living there. Examination of service users files demonstrated that this requirement has now been met. Records in the home, as described previously in this report, were not always kept in good order. The home kept all the necessary records and recording was good. However, limited space in the office and the fact that there were a lot of old records that need to be archived meant that records were not always as they should be. Some pages fell out of some files as they were taken from the shelves and this caused them to be disordered. The Manager was aware of the problem, which had been made worse by the fact that a lot of medication was now being stored in the office. He told us that he planned to reorganise the office and ensure that old files were archived so that current records could be kept in a more ordered fashion. Health and safety in the home was well managed and records were kept of all heath and safety issues. All staff had received health and safety training. There were regular health and safety checks and all staff spoken with were aware of their responsibilities in relation to health and safety. Good records were kept to demonstrate effective management of health and safety in the home.. Care Homes for Older People Page 25 of 28 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 26 of 28 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 27 of 28 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. Copyright © (2009) 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. 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