Inspection on 17/01/06 for Linden House Nursing Home

This inspection was carried out on 17th January 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 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 Nursing Home 03/01/07

Linden House Nursing Home 08/02/05

Linden House Nursing Home 27/09/04

Linden House Nursing Home 26/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Linden House Nursing Home Lower Westford Wellington Somerset TA21 ODW Lead Inspector Shelagh Laver Announced Inspection 17th January 2006 10:00 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 House Nursing Home DS0000029568.V270341.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 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 House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Linden House Nursing Home Address Lower Westford Wellington Somerset TA21 ODW 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) 01823 667711 NA Mrs S C Joyce Mrs Linda Marie Bennett Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to 3 places for Personal Care Staffing Levels meet the guidance set out in the Residential Forum Care Staffing in Care Homes for Older People 2nd June 2005 Date of last inspection Brief Description of the Service: Linden House is situated on the outskirts of Wellington. The house was converted to a Nursing Home in 1984 and sits in large landscaped grounds and has two private access roads. The home is registered with the CSCI to provide general nursing care for 24 elderly persons and personal care for up to three persons within the overall total resident number of 24. The home is equipped to accommodate the current service user group. The homes proprietor is Mrs S Joyce (RGN); the homes manager is Mrs L. Bennett who has been in post since September 2004. There is a Registered Nurse on duty at all times and there is a stable staff team. There is commitment to staff training. The home is well appointed and bedrooms are a good size and all different. There is regular up-dating and a thorough maintenance programme in the home. Access to the first floor is via a platform lift that has recently been replaced. Residents can have a private telephone installed if they wish. The communal rooms are well furnished and homely. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on one day by one inspector (5.5hrs). In preparation for the inspection comment cards were received from service users and their relatives. Feedback cards were received from five service users. All said they were well cared for, felt safe and their privacy was respected. All said they knew who to talk to if they were unhappy. Service users spoken to on the day who were able to express an opinion confirmed this. Some service users were too frail to talk to the inspector. Fifteen visitors and relatives of service users returned comment cards. All stated that they were welcome in the home. All were satisfied with the standard of care. A tour of the premises took place where all the of bedrooms and communal areas were seen. Ten service users and four staff were spoken with. The proprietor Mrs Joyce and the registered manager Ms Bennet were available throughout the inspection. Records relating to care, staff and health and safety were examined. The home is expanding to provide an additional ten beds. The building is due for completion in March and the inspector was able to view the work undertaken so far. Sufficient work had been completed to enable the spaciousness of the bedrooms and the pleasant outlooks to be appreciated. What the service does well: Service users benefit from the professional and caring skills of nurses and care staff. The views of service users and staff are actively encouraged and responded to. Service users spoke of the kindness of staff. Staff are well trained and supervised. They have access to in-house training and supervision and are encouraged to participate in NVQ programmes and external training events. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 6 The manager takes appropriate action to ensure that admissions only take place if the home is sure that the assessed needs of a prospective service user can be met. The proprietor and manager are pro-active in accessing the support of other health care professionals to ensure service users receive holistic care. Service users benefit from a safe, clean and pleasant environment. Those service users spoken with who were able to express a view, informed the inspectors that they liked living at the home and enjoyed the food. Service users benefit from a wholesome and varied menu which takes into account the needs and preferences of people living at the home. Special diets are catered for and choices are offered. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors. There is a comprehensive health and safety checklist used by the full-time maintenance man. What has improved since the last inspection? 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 House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 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 House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 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, 2, 3, 4 & 5. The manager ensures that the home can fully meet the assessed needs of prospective service users prior to making a decision about admission. The pre-admission process is detailed and well managed. The manager ensures that prospective service users provided with appropriate information which will assist them in making a decision about admission. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide which is made available to service users, prospective service users and their representatives. The home’s current fee range is dependant upon the room to be occupied and the assessed needs of the service user. The fee range for new service users is £540 - £720 per week. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 9 The manager ensures that prospective service users are fully assessed prior to admission. The manager stated that a service user is visited and information from other health professionals and for example hospital care notes are taken into account. Service users are invited to visit the home whenever this is possible. A variation to registration is sort to care for a service user of 62. It is was clear that the home will be able to meet this service user’s needs. A detailed assessment form was seen. Two contracts for service users were examined and found to be detailed and comprehensive. Some service users are funded under Continuing Care arrangements and do not have individual contracts. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 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 & 11. The home takes appropriate action to ensure the health care needs of service users are met. The home’s procedure for the management and administration of medication was found to be satisfactory. The home provides sensitive care and support at the end of service users lives. Service users are treated with respect. Care practices support privacy and dignity. EVIDENCE: There are records confirming the regular visits of general practitioners, district nurses, opticians and chiropodists. There were records of the physiotherapist assessment carried on one service user recently. Service users are supported to make visits to specialist clinics when appropriate. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 11 Medication records were clear. Any changes to the MAR sheet including cancellations should have a signature. Medication records are audited to ensure records are accurate and complete. A contract has been obtained to dispose of unused medicines appropriately. The home has links with the Hospice and liaises with general practitioners and nurses to ensure service users at the end of their lives are well cared for. The inspector observed many examples of sensitive care for service users who had profound care needs. Staff were observed speaking to service users with respect. Doors are closed when care is provided. Service users are smartly dressed and appeared well cared for. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 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. Service users are able to chose a variety lifestyle patterns in the home. The home provides a wholesome and varied menu which takes into account the needs and preferences of service users. Arrangements for service users to maintain contact with family and friends is good. The home provides activities and entertainments to enrich the service users lives. EVIDENCE: The manager and chef have devised a menu which is wholesome, varied and takes in to account the needs and preferences of service users. A conversation with the chef demonstrated the importance of providing service users with their individual preferences. The chef tries to ensure seasonal food is used. Service users spoke of the enjoyment they received from the food. Efforts are made to mark occasions and provide interest for service users. The next event is a themed supper for Burns Night. Care is taken to ensure that soft diets are Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 13 appealing and wholesome. Menus are regularly reviewed, with choices available and the home seeks the views of a dietician when needed. Visitors are made welcome at any reasonable time in accordance with the wishes of the service user. Visitors are welcome to spend as much time with their relatives as they wish and are supported to participate in care activities if they choose to. The inspector observed the house news sheet “Linden Latest”. This gives details of forthcoming social events and news of service users and staff. Forthcoming events included regular Flexercise classes and Sing-along entertainment. There is a trip to the pantomime and a Burns Night. There is also a review of the previous month’s entertainment which had included Christmas parties, lunch at a garden centre and a trip to see the Christmas lights. The inspector observed the activities co-ordinator talking to service users and performing manicures prior to the communion service that is held weekly. The hairdresser visits regularly. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 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, 17 & 18. The complaints procedure in this home is good with evidence that the views of service users/visitors are listened to and acted upon. Procedures and policies aim to protect service users from abuse. EVIDENCE: The inspector observed the documentation for two formal complaints that had been recorded and responded to. Service users spoken to knew who they were able to speak to if they wished to complain. Staff recruitment procedures, training, supervision contribute to the protection of service users from abuse. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 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, 20, 21, 22, 23, 24, 25 & 26. Service users live in a comfortable, safe and clean environment and are able to personalise their own bedrooms. The home’s environment is able to meet the assessed needs of service users. The home provides specialist equipment to ensure the needs of service users are met. EVIDENCE: All communal areas and most bedrooms were seen at this inspection. Bedrooms were pleasant and comfortable and it was evident that service users were encouraged to bring personal possessions into their rooms. Specialist beds and pressure relieving equipment were seen to be in place where there was an assessed need. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 16 The home has a lounge and a dining room/conservatory. Service users have a choice of where to spend the day. Some prefer to spend most of their time in their bedroom. Overall the home is very pleasantly decorated and well maintained. The standard of cleanliness was very good. Domestic staff on duty were satisfied with the time provided to care for the home and the equipment provided. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 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. The home ensures that there are sufficient staff on duty to meet the service users needs. The home’s recruitment practices are robust and designed to protect the service users. Staff are well trained and have access to a range of mandatory and developmental training opportunities. The home exceeds the requirement for staff trained to NVQ level 2. EVIDENCE: On the day of inspection there was a registered nurse on duty in addition to the manager who now works one day a week as the registered nurse in charge. There were five care staff on duty. Also on duty was the cook and kitchen assistant, two domestic staff and the maintenance man. Staff spoken to were able to list training received in the previous months. There was evidence of extensive training accessed by staff. 78 staff have attained NVQ qualifications. Manual handling up-dates, fire training, dementia care, tissue viability and diabetic care training were just some events. Seminars are attended and there are distance learning packages in Infection control and Medication management. There are plans for future training Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 18 events in the coming year. Staff confirmed that there was in-house observation and training carried out by a member of the nursing staff. The manager maintains an organised training file. Staff are also encouraged to share new knowledge at staff meetings. Training needs are identified at staff appraisals and any training need identified within the home is noted for action. Three recruitment files were observed. All contained evidence of a thorough recruitment process. A check list ensures that references are sent for and received and that all documents required are photocopied and included in the file. There are detailed interview records. One CRB had been accepted from another employer due to a misunderstanding in a change of policy following the introduction of POVA checks. A new check has been initiated. The home is increasing their bank of staff in preparation for the opening of the extention in March. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 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, 32, 33, 34, 35, 36, 37 & 38. The home is effectively managed by the registered manager who promotes a clear and inclusive style of management which ensures the needs and wellbeing of service users takes priority and that staff are appropriately supported and supervised. The home’s systems for ensuring the health, safety and welfare of service users and staff are comprehensive. EVIDENCE: The registered manager, Linda Bennet is a registered nurse with many years of management experience who is taking the Registered Managers award this year. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 20 Staff benefit from regular meetings and supervision sessions. Records were seen to support this. The proprietor Mrs Joyce manages the finances of the home. At the time of this inspection, the home was taking appropriate steps to ensure the health & safety of service users, staff and visitors to the home. The maintenance man uses comprehensive check lists to record his duties. The following records were examined: FIRE – The Fire officer had visited in November 2005 and no requirements had been made. Regular servicing carried out on the home’s fire detection and fire fighting equipment. Regular training is conducted for all staff. Fire alarms are tested weekly. SERVICING – Servicing schedules indicated that hoists are serviced according to LOLER regulations and were last tested in August 2005. There are planned dates for all servicing. Bedrails are in use for those service users with an assessed need. Regular checks are made by the home to ensure they remain safe. The home policy and signature of service user/representative were seen. ACCIDENT– The home maintains appropriate records relating to accidents at the home. The accident records include action to be taken and evidence of analysis. HOT WATER/SURFACES – All radiators are of a low surface temperature type which reduce the risk of injury to service users. Bath hot water outlets are thermostatically controlled to reduce the risk of scalding. Weekly checks are made to ensure that the temperature does not exceed the HSE recommended limit of 44C. Those checked at this inspection were found to be within the acceptable limits. 24 staff hold a current First aid certificate. The most recent quality questionnaire sent out in October was returned by only two people. Linden House Nursing Home DS0000029568.V270341.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 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 22 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 OP29 Regulation 19 Requirement The home must be aware that CRB checks are no longer portable. A new POVA and CRB check must be undertaken for the one member of staff to whom this applies. Timescale for action 18/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2 Refer to Standard OP9 Good Practice Recommendations All staff entries on the MAR charts including cancellations should be signed to provide a clear administration records. Linden House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 House Nursing Home DS0000029568.V270341.R01.S.doc Version 5.0 Page 24 - 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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