Inspection on 16/01/07 for Linden Lodge Nursing Home

This inspection was carried out on 16th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Lodge Nursing Home 24/01/08

Linden Lodge Nursing Home 03/02/06

Linden Lodge Nursing Home 25/08/05

Linden Lodge Nursing Home 01/03/05

Linden Lodge Nursing Home 27/09/04

Linden Lodge Nursing Home 07/11/02

Linden Lodge Nursing Home 07/11/02

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Linden Lodge Nursing Home Linden Lane Warton Tamworth Staffordshire B79 0JR Lead Inspector Lesley Beadsworth Key Unannounced Inspection 16th January 2007 09:30 X10029.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 Lodge Nursing Home DS0000004400.V328532.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 and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linden Lodge Nursing Home Address Linden Lane Warton Tamworth Staffordshire B79 0JR 01827 894082 01827 896420 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) Linden Lodge Care Homes Limited Mrs Linda Lowrie Care Home 65 Category(ies) of Dementia - over 65 years of age (65), Old age, registration, with number not falling within any other category (65), of places Physical disability (10) Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2006 Brief Description of the Service: Linden Lodge is situated in the countryside, close to the village of Warton. Originally it was a country house. It was converted into a care home and then extended to provide accommodation for up to sixty-five service users. One bed is reserved for nurse-led admissions on a rolling respite basis. The care home provides nursing and personal care for both elderly people and younger disabled people. The focus of care delivery being on general nursing and personal care. No specialist rehabilitative services are provided. A planned programme of social activities and entertainment is provided in the home. Service user accommodation is mostly provided on the ground and first floor, although there are three bedrooms and some communal space for more able people on the top floor. There are forty-eight bedrooms, all with en-suite facilities, of which fifteen are doubles. There are four lounges and a library as well as the usual domestic and office accommodation. The grounds are pleasant and wheelchair accessible. There is ample parking and the home is on the main public transport route to Atherstone and Tamworth. Fees are £360 to £682 a week and exclude hairdressing, chiropody, toiletries, newspapers and magazines, aromatherapy, trips and holidays, personal telephone expenses and transport to hospital appointments. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Linden Lodge for this inspection year. Records examined during this unannounced inspection, included, care records, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. Other evidence used included a pre-inspection questionnaire and resident and visitor Care Home Survey Forms sent to the home by the Commission prior to the inspection. Two Survey Forms from residents were completed and returned. There were none returned by visitors. Four residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their visitors (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. The inspection process consisted of looking around the home, a review of policies and procedures, discussions with the manager, staff, visitors and residents. This inspection took place between 11am and 21.30. What the service does well: The home has devised and distributed a Statement of Purpose and Service User Guide, which provided helpful information to assist prospective residents and their representatives in deciding if they want to live at Linden Lodge Nursing Home. Pre-admission and subsequent assessments were detailed and identified strengths of the individual resident as well as their needs thus supplying staff with the information they required to formulate care plans. This information had been appropriately transferred to the care plans. Staff interacted respectfully with residents in a friendly and comfortable manner. Members of staff were seen to knock on bedroom doors before entering and refer to residents by their preferred name. Discussion with residents, staff and the registered persons provided further evidence that the privacy of residents is respected ensuring that their dignity and self-esteem are maintained. The home has an activity organiser who is employed five days a week to assist residents in how they spend their time. An activity programme is devised and distributed each month offering a wide variety of indoor and outdoor activities that are suitable for older and younger adults. Adaptations have been made to call bells when a resident is unable to manage the conventional bell. One resident who is unable to use upper limbs had a Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 6 device that is blown into to alert staff. Another resident wore a pendant alarm so that assistance could be summoned even when away from the bedroom. Other examples of providing specialist equipment to maximise the independence of the residents were a special bed, hoist, commode and wheelchair for a resident whose needs could not be met using standard equipment. The home has a vehicle that accommodates wheelchairs and enables residents to be taken out on trips thereby maintaining links with the community. Residents spoken with said that they were able to have visitors at any reasonable time. At the time of the inspection one resident was entertaining two friends in her room, both of whom said that they visited daily and were always made welcome. Visitors can also join a resident for a meal if prebooked and a charge is made for this. The food on the menu offers residents a varied and nutritious choice. The menu showed a choice of the main meal offered at lunchtime, with the addition of a soft diet and diabetic diet alternative when necessary. Residents spoken with confirmed that they are asked each day which of the choices they would like. The home provides a variety of special diets such as soft diets, diabetic diets and one artificial feeding diet (PEG feed), thereby meeting the individual needs of the people living at the home. The registered manager said that the home had achieved the Heartbeat Award. This was given by Warwickshire Borough Council in recognition of ‘Healthy Eating’ and the range of diet offered at the home. There is a robust system in place to manage complaints. Examination of the complaints records showed that the six complaints made in the past year had been addressed appropriately, demonstrating that concerns are listened to, and taken seriously and that action is taken to resolve them. Training records showed that several staff have attended ‘Rights to Complain” training that would assist them in respecting the residents right to complain. Training has a high profile at the home with staff saying that they had adequate opportunity to undertake training and for further professional development. The registered manager advised that the majority of staff had undertaken training related to adult abuse two years previously and this was substantiated by examination of training records. More than 50 of the care staff have achieved NVQ Level 2 in Care demonstrating that they have the knowledge and skills to carry out their role. Residents are able to bring in personal possessions as was seen when bedrooms were viewed. Overall the home is comfortable, attractive and well presented apart from the lounges known as the ‘den’ and the ‘smokers room’. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 7 The bathrooms had been recently refurbished and were clean and well presented. The home benefits from good staffing levels and there are sufficient numbers and skill mix to meet the assessed needs of the residents and the service. Apart from the Registered General Nurses, care staff and activity organiser there are ancillary staff consisting of domestic and laundry assistants, catering staff, administration and reception staff and maintenance and gardening staff. Residents spoken with made positive comments about the staff, who were seen to be caring for the residents in a respectful manner. What has improved since the last inspection? What they could do better: Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 8 Weight charts in care files recorded only the month of the date the person was weighed. This needs to be the exact date so that accurate monitoring of any weight loss or gain can be made. The menus provided with the pre-inspection questionnaire did not show all the meals that are offered to residents. The registered manager advised that residents are offered multiple choices at breakfast and teatime as well as for lunch and these should be added to the printed weekly menus for information, inspection and monitoring purposes. The lounge known as the Smokers lounge is drab and tired in appearance and not up to the same standard of décor or furnishing as the rest of the home. The floor covering in this lounge also looked in need of replacement. The lounge known as the Den has a badly marked carpet that needs either cleaning or replacing. An ensuite toilet viewed was also in need of redecoration. The registered persons advised that there are plans for of these rooms to be improved in the near future. In the meantime these shortfalls detract from the residents’ comfort. Some toilets had carpet in place, which can be a source of infection as it cannot be easily cleaned and this needs to be replaced with an impermeable, easy to clean floor covering. One younger adult shares a room with an older person and finds this difficult. Although the special equipment used by this resident limit the choice of room that can be offered further efforts need to continue as there is not a positive choice from this resident to share this room. One care file only contained a Criminal Records Bureau disclosure that had been obtained for a position in another organisation. All care workers need a new POVA check each time they change employment and must not be appointed before clearance is received, in order to protect residents from inappropriate people being employed. 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. The summary of this inspection report can be made available in other formats on request. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. Residents are given adequate information to make an informed choice about living at the home. Appropriate assessment is carried out prior to admission and subsequently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose (the home’s Prospectus) and a Service User Guide (the home’s Residents’ Handbook), which were made available for inspection. Both documents contained helpful information for residents and other interested persons. The registered manager said that residents had received these and those residents spoken with confirmed that they had. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 11 A resident who had completed a Commission for Social Care Inspection Care Home Survey Form wrote, “I had a contract with a prospectus telling me about Linden Lodge.” The pre-inspection questionnaire states that the Statement of Purpose is revised annually and the current Statement of Purpose had been revised in 2006. One resident had known the home well before admission and therefore made Linden Lodge her choice of home. Another resident added to a completed Commission for Social Care Inspection Care Home Survey, “I had a look around and stayed for lunch before I decided to move here.” showing that prospective residents have had an opportunity to visit the home prior to making a decision about moving in. Four care files were examined and pre-admission and subsequent assessments were in place. These were detailed and identified strengths of the individual resident as well as their needs thus supplying staff with the information they required to formulate care plans. This information had been appropriately transferred to the care plans. A resident and the friends visiting at the time of the inspection clearly recalled being involved in the assessment process, both before admission and afterwards. Those residents admitted through health or social care management had a care plan devised by them and included in their care file. This gave the home further information to enable them to assess if they could meet the prospective resident’s needs prior to making a decision about admission to the home. The registered provider advised that there are currently no residents in the home admitted for Intermediate care. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Care plans contain the information required to meet the needs of residents. Health care needs are met. Residents are supported in a respectful manner. Medication procedures and practice protect the residents at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care files were examined and all contained a detailed care plan that was easy for staff to access. Care plans accurately reflect the current needs of the residents as identified in the detailed assessments. Systems were in place for reviewing these at monthly intervals and there was evidence that they are Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 13 revised more frequently if changes occur in residents’ needs thereby ensuring that individual needs are met. A care plan devised by health or social services was included in the care files of residents admitted through Care Management arrangements. Individual risk assessments were included in all care files viewed, including falls, nutrition, moving and handling, self administration of medication and tissue viability. Each resident has a designated named nurse and care assistant acting as their key worker who are in a position to build up a special relationship with the resident. One resident spoken with discussed her relationship with her key worker. The names of individual key workers are displayed in the residents’ rooms. Whilst the care plans had been devised and reviewed by the nursing staff, care staff were beginning to add information such as how the resident’s day had been in the daily records, as well as the nurses. There were nine residents in the home with pressure sores that were now of grade 2 gravity. The registered manager advised that the majority of these were present when the residents came to the home and one of these residents had been admitted to the home with a very large grade 4 sore. However photographs of the sore, records related to the treatment and progress of the sore in the care file and discussion with the senior nurse demonstrated that this had massively improved since the resident had been at Linden Lodge. The training matrix and discussion with the registered manager showed that the nursing staff have had up to date training related to tissue viability. Discussion with, and observations of, a resident who had been assessed as having a high risk of developing pressure sores showed that preventative measures such as a pressure relieving mattress and cushion were in use and that the appropriate preventative action and treatment were in place. All care files contained evidence of residents having access to health professionals outside the home, including the Chiropodist, Optician, GP and Dentist. It was also evidenced in the pre-inspection questionnaire that the Community Psychiatric Nurse, and other specialist health care professionals including the Dietician, Physiotherapist and Macmillan Nurses visit some residents. All care files viewed included a daily record of bowel movements. Discussion with staff showed that all care files include this record. This is considered to be institutional practise and it is suggested that a record is only maintained for those residents for whom there is a concern. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 14 The appearance of those residents spoken with or observed indicated that attention had been given to oral hygiene. As previously mentioned the care files examined contained nutritional risk assessments and residents are weighed monthly. However only the month of when each resident was weighed is recorded which does not indicate the length of time between each weight and therefore the relevance of any weight loss or weight gain. The home has recently purchased new scales to assist in the accurate weighing of residents. Whilst the Statement of Purpose and the registered provider stated that each resident has a choice of GP, this is limited to each resident’s choice of GP being in agreement. In reality they tend to be out of the area and there is only one local GP practice. All residents at the home are currently patients at this practice. All regularly prescribed medication is supplied in original containers at weekly intervals by the GP Surgery’s dispensary. The practice of medication administration and storage has improved since the last inspection. No gaps were seen in Medication Administration Record Sheets inspected and there were no errors in the number of tablets remaining against the number of tablets signed for on these records. Discussion with the registered manager and senior nurse and inspection of relevant records showed that all stock received into the home was recorded and that these records were in very good order. After seeking expert advice after the inspection on the counting of tablets, it is recommended that only those in boxes be counted, as this is difficult to do for tablets in bottles, unless there was a pattern of many errors seen at the end of the week (for example tablets either left over or missing). There were no prescribed tablets or medicines stored in the home apart from the precise amount required for the week and these were stored a medication trolley on the ground and the first floor. No resident was taking a controlled drug at the time of the inspection. Also after seeking advice after the inspection, as there is no pharmacist at the GP dispensary, the home should carry out its own auditing of medication, including staff drug audits and end of cycle audits, to ensure that medication is being received, stored, given and disposed of correctly. Several residents self-administer their medication and robust risk assessments related to this were included in the care files examined. The Medication Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 15 Administration Record Sheets of one of these residents was examined and satisfactory monitoring records were maintained. Discussion with the senior nurse confirmed that medication is kept in a secure location in the residents’ bedrooms who administer their own medication. The home had literature regarding medication in the form of the British National Formulary (BNF) but this was several years out of date. The registered manager advised that a monthly publication of medication information (MIMS) is also kept in the home and that she had been advised by the pharmacist that this is adequate for their use, however this needs to be replaced often so that up to date copies are kept in the home. During the inspection there was opportunity to observe the staff working with residents. They interacted respectfully with residents in a friendly and comfortable manner. Members of staff were seen to knock on bedroom doors before entering and refer to residents by their preferred name. Discussion with residents, staff and the registered persons provided further evidence that the privacy of residents is respected ensuring that their dignity and self-esteem are maintained. A telephone was available for use by residents in the reception. If a resident wishes to make a call in private they can be assisted to use the telephone in the nurses station. One resident had her own personal telephone and the registered manager advised that several other residents have also chosen to have one. As is stated in the Statement of Purpose, any cost incurred are the responsibility of the resident. Mail is delivered unopened by the reception staff to individual residents’ rooms. These examples of good practice demonstrate that the residents’ right to privacy is maintained. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. Residents are offered a wide variety of stimulating activity in and out of the home. Family and friends were made to feel welcome. Residents were enabled to make choices about daily routines. Meals provided were nutritious and choice and variety was offered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an Activity Organiser who works every weekday from 09:00 to 15:30 and devises a new Activity Calendar at monthly intervals, with the involvement of the residents. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 17 These are attractively done and would attract the attention of the people living at the home and to whom they are made available. This programme includes a very wide range of activities, outings and occupation. The items in the programme range from Prize Bingo and dominoes to classical music, to outings of interest and a narrow boat trip. Each activity that is suitable for the younger people, as well as the older people, living at Linden Lodge is identified on the programme. These included aromatherapy sessions, cooking, armchair exercises, quizzes, arts and crafts, trips out, live entertainment and ‘pampering’ and manicure sessions. The home also has a vehicle that accommodates wheelchairs and enables residents to be taken out on trips thereby maintaining links with the community. Care files viewed included interests, hobbies and pastimes of each person and a document that described their life history. Birthdays are celebrated with a cake, card and present and other special occasions are also celebrated. The residents spoken with said that they had plenty to keep occupied. There are also links with the community through visits made by the local churches and schools. The local schoolchildren were present to sing for residents and the registered provider advised that the schoolchildren visit regularly to entertain the people living at the home. The feedback from residents was positive. Younger people are offered the opportunity to partake in college courses with the home obtaining the prospectus each term for them to choose from. The registered manager advised that whilst in the past residents have taken up the opportunity there are currently no residents attending any college courses. Furthermore no resident currently chooses to take up any form of paid or voluntary employment despite the registered manager advising that the appropriate assistance is offered for this. One younger person spoken with said that there was a choice of going out of the home or joining in with the activity in the home but preferred and chose to stay in the bedroom. Discussion with the registered persons and observations made provided evidence to support that the needs of a resident from an ethnic group are met, including enabling contact with people able to speak the language of the resident. The registered manager advised that she gives general advice regarding appropriate benefits or refers them to the appropriate agency for specific advice. However she also advised that the majority of the residents at Linden Lodge have the support of their family or an independent advocate in financial matters. Further evidence of this was seen in the transactions and invoices of personal monies held by the home. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 18 If able and willing to do so, residents are encouraged to handle their own financial affairs and the pre-inspection questionnaire indicated that three residents do so. Residents spoken with said that they were able to have visitors at any reasonable time. At the time of the inspection one resident was entertaining two friends in her room, both of whom said that they visited daily and were always made welcome and were always offered a drink. The registered provider said that the attractive lounge at the front of the home is not used regularly by residents and is therefore available for visits as well as the residents’ bedrooms and other sitting areas around the home. The Service User Guide states that visiting is between the hours of 9am and 9pm but that visiting outside of these hours could take place if arrangements were made, and that visitors have the opportunity to purchase a meal to eat at the home with their friend or relative, thus assisting in maintaining family links. The home provides a menu and a copy of the three-week cycle was provided with the pre-inspection questionnaire. The food on the menu is varied and the meals listed appear nutritious, but breakfast, some teatime choices, supper and the vegetables and potatoes provided with the lunchtime meal are not shown on the menu. The registered manager advised that residents are offered multiple choices at breakfast and teatime as well as for lunch but all meals available should be added to the printed weekly menus for information, inspection and monitoring purposes. There are choices offered for each meal each day, with the addition of a soft diet and diabetic diet alternative when necessary. Residents spoken with confirmed that they are asked each day which of the choices they would like. Some of the comments made by residents about the food included that the food was, “alright” and, “they have good cooks here”, “I enjoy my meals”. The home provides a variety of special diets such as soft diets, diabetic diets and one artificial feeding diet (PEG feed). It currently does not cater for any resident who requires a special diet for cultural or religious reasons. There is a dining room on the ground and first floor where tables were attractively set. Residents said that they were able to take their meals in the dining room or in their own room if they wish. Several residents always chose to eat in their rooms but there would be insufficient number of places if everyone chose to use the dining rooms. The teatime meal was observed and it was served at an appropriate pace. It was noticed that some residents that were being assisted to eat had colourful and good quality plastic teaspoons. Whilst there was no reference to these in the care plans all domestic, care and nursing staff asked about them answered that these were used because they were gentler on the mouth for those people being fed. The registered manager confirmed this. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 19 This would appear to be an appropriate reason for using what would otherwise be considered inappropriate cutlery for the age of the people using them. However in order to inform staff of the need and reason for this it should be included in the care plans. The registered manager gave the information that the home had achieved the Heartbeat Award. This was given by Warwickshire Borough Council in recognition of ‘Healthy Eating’ and the range of diet offered at the home. There are no facilities to allow for residents assisting in the preparation or cooking of meals in the home but an area of the home is to be refurbished this year to provide an area for residents to be able to make their own beverages and snacks. The Service User Guide and pre-inspection questionnaire stated that these were currently available on request at any time. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home’s procedures and practices and staff training provide a safe environment for the residents. They can be confident that their concerns will be taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and this is included in the Statement of Purpose and Service User Guide. The Service User Guide also encourages residents to take their concerns to the relevant personnel such as concerns about food to the Head of Catering via the staff in Reception. Comments made by residents spoken with included that they felt able to raise their concerns with the staff where necessary. There is a robust system in place to manage complaints and examination of the complaints records showed that the six complaints made in the past year had been addressed appropriately, demonstrating that concerns are listened to and taken seriously and action is taken to resolve them. Training records showed that several staff have attended ‘Rights to Complain” training that would assist them in respecting the residents right to complain. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 21 The registered manager advised that the majority of staff had undertaken training related to adult abuse two years previously and this was substantiated by examination of training records. She also advised that training regarding management of dementia last year incorporated the managing of abuse and that there were plans for staff to undertake further related training in the coming year. Staff spoken to understood what adult abuse was and were able to say what action they should take if there was any suspicion or allegation of abuse in the home, demonstrating that they had the knowledge to protect residents. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25, 26 Quality in this outcome area is adequate. Overall the home offers safe, comfortable and well-maintained surroundings but with some shortfalls in some of the décor, furnishings and provision of choice of bathing facilities. The sharing of a bedroom is not always a positive choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall the home is clean, well furnished, decorated and maintained, and is homely in appearance apart from two lounges on the first floor. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 23 Communal space available for the residents’ use included a dining room on both the ground and first floor, two lounges on the ground floor, two lounges on the first floor – one known as known as ‘the den’ and the other as the ‘smokers lounge’ – and a comfortable and spacious sitting area on the second floor. The smoking lounge is drab and tired in appearance and not up to the same standard of décor or furnishing as the rest of the home. However the registered provider advised that there are plans for this room to be refurbished this year. The floor covering in this lounge also looked in need of replacement although the registered provider advised that carpet had been replaced more often than in any other area of the home, due to cigarette burns. Part of the den is used for hairdressing and the floor covering was badly marked at the time of the inspection. However the registered persons advised that this room was also to be refurbished this year and as well as a hairdressing area would provide a coffee bar-type space where residents could make their own refreshments. This is also intended to provide designated space for the younger people at the home to spend time together. Only the bedrooms of the residents’ who were case tracked were viewed. These bedrooms were comfortable in appearance, contained personal possessions and the required items of furniture and fittings. However one of the ensuite facilities was in need of decorating and making more domestic in appearance. One shared bedroom viewed had appropriate screening that afforded privacy for both residents whilst in bed and when using the washbasin in the room. All doors were clearly labelled. The registered provider and registered manager were able to demonstrate through discussion and comments made that there was a programme of maintenance and renewal of furnishings and decoration although a written programme was not looked at on this occasion. The home provides adequate assisted bathroom and toilet facilities although it did not have an assisted shower facility. The registered provider advised that the provision of a walk-in shower is planned for later in the year. The bathrooms had been recently refurbished and were clean and well presented. Some toilets had carpet in place, which can be a source of infection as it cannot be easily cleaned. However the registered manager advised that this was soon to be replaced with a non-slip and cleanable floor covering. New carpets were being also being fitted in some bedrooms during the inspection. There are attractive gardens that can be accessed by the residents to enjoy and the areas of gardens seen were in good order. There is a designated gardener to maintain the outdoor areas. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 24 There was a call bell system throughout the home for residents to summon assistance when needed. It was noted that there were adaptations made to this system for residents for whom a conventional bell is not adequate. One resident who is unable to use upper limbs had a device that is blown into to alert staff. Another resident wore a pendant alarm so that assistance could be summoned even when away from the bedroom. These examples demonstrate that the home provides specialist equipment to maximise the independence of the residents involved. Other examples of this were a special bed, hoist, commode and wheelchair for a resident whose needs could not be met using standard equipment. All areas of the home are accessible to residents through the provision of a passenger lift to each floor. A younger resident shared a bedroom with an older person and whilst knowing that private accommodation would be shared before coming to the home now found the limited privacy difficult. Discussion with the registered provider and registered manager showed that efforts had been made to transfer this person to a single room but that the size of the equipment, including bed and wheelchair, limited the choice that could be offered. The other person sharing the room was asked for an opinion on this but communication was difficult and a response was not given. However it is clear that the sharing of this room is not a positive choice for at least one of the occupants and every effort needs to be made to offer suitable accommodation that meets the social and emotional needs of this resident as well as the physical needs. The home was a comfortable temperature for residents throughout. Lighting was of sufficient brightness for them in all areas viewed apart from the shared bedroom where the occupant said that three bulbs had gone almost simultaneously. The registered manager said that these would be replaced as soon as possible, but in the meantime there were over bed wall lights that could be used for additional brightness. The resident spoken with was satisfied with this. Records were examined related to hot water temperatures and Legionella risk assessments. It was difficult to ascertain from the records which hot water outlets had been tested as they were relating to the tanks providing water to the outlets. All temperatures recorded were at the required 43°C, or close to this. The registered persons said that they would seek clarification from the maintenance staff about which outlet each record related to. Records need to be clear for the purposes of inspection and management’s monitoring and auditing. The laundry area was not inspected on this occasion although discussion with the registered persons and the staff at the home showed that the machines were industrial and that staff were on duty there throughout the day and night. The laundry for the sister residential home is also carried out in this laundry. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 25 Hand washing facilities with disposable towels and soap dispensers were sited appropriately throughout the home to enable staff and residents to wash their hands as required to control infection. One toilet did not have a dispenser for the paper towels, which creates the potential for cross infection or contamination. Clinical waste was collected in appropriate sacks in sack holders with lids that were foot operated thereby reducing the risk of cross infection. There was observational evidence, and through discussion, of protective clothing being provided and used appropriately to further control infection. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. There are a good staffing levels with the training and skill mix to meet the needs of the residents and to maintain the standards of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a recorded and detailed staff rota that was easy to understand once a key to the abbreviations was provided. For inspection purposes this key needs to be available with the rota. The home benefits from good staffing levels with sufficient numbers and skill mix to meet the assessed needs of the residents and the service. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 27 Apart from the registered manager there is a registered nurse on duty on both the ground and first floor throughout the day and one registered nurse on duty throughout the night. There is ten care staff in the home in the morning and eight in the evening with an overlap of shifts to enable a handover of information to take place. In addition to this there are dedicated staff to carry out domestic, laundry, catering, gardening and maintenance tasks with administration and reception staff and an activity organiser in the home each weekday. There are no care staff under the age of 18. Residents spoke positively about the staff at the home and said that they were generally available to assist them. There was the impression of good staff morale in the home and those members of staff spoken with said that they were happy to work at the home. When asked they said that they felt that they had more than adequate opportunities for training and development. Discussion with the registered persons, staff and looking at relevant records showed that the staff turnover is low, further indicating that staff morale is good and providing residents with continuity and consistency. The home has now more than 50 of its care staff that have achieved National Vocational Qualification Level 2 in Care. Agency staff are not currently used by the home. The home had a student nurse on placement from Coventry and Warwick Hospital, who was supervised by the nursing staff. The student was supplementary to the staffing rota and said that she had been made welcome at the home and was well supported by the nurses. Five staff files were examined. All contained two references and evidence of a completed Criminal Records Bureau disclosure. However one had been obtained for a position in another organisation. All care workers need a new Protection of Vulnerable Adult check each time they change employment and must not be appointed before clearance is received. However this member of staff was employed for just the Christmas period and therefore her employment had ceased by the time of the inspection. Staff pay for their own Criminal Records Bureau disclosures and this could prevent such temporary staff taking up an appointment. All staff undertake an induction training programme and there was evidence of this in the individual files. There was also evidence of staff supervision taking place at two monthly intervals, which gives staff and management the opportunity to discuss the home, their practice and training needs. Discussion and the examination of training records showed that the registered person recognises the importance of training, giving this high priority. Staff had undertaken a variety of training since the last inspection to give them the skills and knowledge to protect and to meet the needs of the residents. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 28 The training includes specific nursing tasks such as with the use of syringe drivers; specialist needs training for nursing and care staff such as managing dementia; mandatory training for all staff including moving and handling and food hygiene. The home achieved the Investors in People Award in December 2005. This is a national standard, which sets out a level of good practice for the training and development of people. This is reviewed every three years to ensure that the Award is still relevant to the organisation. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. An appropriately qualified and experienced person manages the home in the best interests of the residents. Procedures are in place to safeguard residents’ financial interests and their health, safety and welfare. This judgement has been made using available evidence including a visit to this service. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 30 EVIDENCE: The registered manager has worked at the home for 17 years since it first opened and has been the manager for seven years. She is a Registered General Nurse and has achieved the Registered Managers Award. She is therefore suitably qualified and has the appropriate experience for the post that she holds. She has also undertaken a range of training alongside the other trained staff throughout the year to up date her knowledge and skills. She is only responsible for Linden Lodge Nursing Home. Staff spoken with said that they felt supported by the registered manager. In turn senior nursing and care staff support the registered manager in the way that the service is delivered. Residents also said that they felt that the registered manager was able to support them and that she would listen to their concerns. The registered manager is introduced and staff, residents and relatives know her as ‘matron’. This title could be considered an institutional term that does not reflect the aim of the home, as seen in the Residents’ Handbook, to “provide residents with a secure, relaxed and homely environment”. The registered provider and registered manager appear to work closely together but discussion with them indicated that there were also clear lines of accountability. There is a Quality Assurance Programme in place that monitors and audits different areas of the service although this was not fully assessed on this occasion. The registered persons and the residents’ Handbook advised that annual surveys are carried out with residents to give them an opportunity to give feedback on the service they receive. Meetings are also held with residents that give them further opportunity to give an opinion on the service. As this visit was unannounced the registered manager was unable to inform residents beforehand of the inspection. However she took every opportunity to inform residents and staff of the inspection during the day. Discussion with the registered manager and the pre-inspection questionnaire showed that policies and procedures are reviewed at a minimum of yearly intervals. These are accessible to staff and are kept in the nurse station on the ground floor. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 31 The registered manager and the pre-inspection questionnaire advised that most residents have family that act as their financial representative, although some use an independent advocacy service in Leamington. The designated member of staff responsible demonstrated the financial system for money held by the home on behalf of residents. The home holds money for most of the residents for incidental spending such as hairdressing, newspapers or small purchases from the small shop located in the reception. The monies are all banked in one interest free account in the name of the home with some petty cash kept in the home. Transactions are initially kept manually and this information is then put onto a spreadsheet to enable individual statements to be printed for each resident or their representative. It is suggested that when the transactions are transferred to the spreadsheet each month that a credit and debit balance of cash is shown as well as recording and signing that the cash held is correct. Other than this the system is robust and safeguards the interests of the residents. Whilst the home does not benefit financially from this account, residents could have earned interest had their money been held in individual interest accounts. However it is appreciated that banks may not agree to administer numerous small accounts. The home runs a type of lottery based on the bonus ball number drawn in the National Lottery. Each resident is invited to join for £1 a week, the winner taking half of the proceeds and the remainder going to the home for extras such as outings and entertainers. Residents show a good deal of interest in this. The registered manager advised that resident have given their verbal agreement that half of the proceeds goes to the home but it was suggested that agreement is given in writing to confirm their understanding and agreement. The registered manager forwarded a copy of the form devised for this purpose prior to the completion of this report. Evidence of staff supervision being carried out every two months was available in the staff files examined and staff spoken to confirmed this. The records only related to the training and development aspect of the supervision but the registered manager evidenced in discussion that the other aspects of supervision - the philosphy of the home and all aspects of practice – are also covered in these sessions. The records kept should include these areas. The home is well maintained and appears to offer a safe environment to its residents. The registered persons demonstrated that they were aware of health and safety matters. No environmental concerns with regard to health and safety were seen during the visit, apart from the concerns about infection control whilst carpets are used in toilets. There was evidence in discussion and examination of training records that staff have undertaken a great deal of training including that related to moving and Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 32 handling and food hygiene. The registered manager advised that all mandatory training including fire safety had been undertaken. There are designated first aiders appointed in the home. The kitchen area was visited, and appeared clean and tidy, but was not fully inspected on this occasion. The kitchen was inspected by Environmental Health last year and documentation made available shows that this was satisfactory. Fire alarm tests were carried out weekly and emergency lighting and records made available for inspection. Records related to hot water outlet checks were difficult to follow, as previously discussed, but all temperatures recorded were at, or close to, 43°C, which would prevent accidental scalding. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 33 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 3 2 x 3 3 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 3 ENVIRONMENT Standard No Score 19 2 20 3 21 2 22 3 23 x 24 x 25 3 26 2 STAFFING Standard No Score 27 4 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 3 34 x 35 3 36 3 37 x 38 3 Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 34 No 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. 2. Standard OP19 OP26 Regulation 23(2)(d) 13(3) Requirement The registered persons must ensure that all parts of the home are reasonably decorated. The registered persons need to ensure that infection control is maintained by the replacing of toilet carpet for an impermeable floor covering. The registered persons must ensure that new staff are not confirmed in post without receipt of a Criminal Records Bureau disclosure. Timescale for action 30/06/07 30/06/07 3. OP29 Sch 2 (7) 30/01/07 Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 35 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. 4. 5. Refer to Standard OP8 OP9 OP15 OP21 YA25 Good Practice Recommendations The registered manager should ensure that the precise date of weighing a resident is recorded in order that accurate monitoring can take place. The registered manager should ensure that the home carries out its own auditing of medication. The registered manager should ensure that all choices available are included in the printed menu for information, inspection and monitoring purposes. To increase choice to residents and reduce the risk of cross infection, the registered manager should identify ways of installing more separate showering facilities in the home. The registered manager, wherever possible, should offer alternative accommodation according to the wishes of the residents so that any room sharing is a positive choice for those residents. Linden Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 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 © 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 Lodge Nursing Home DS0000004400.V328532.R01.S.doc Version 5.2 Page 37 - 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. 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