CARE HOMES FOR OLDER PEOPLE
Linden Lodge Nursing Home Linden Lane Warton Tamworth Staffordshire B79 0JR Lead Inspector
Ashley Fawthrop Key Unannounced Inspection 24th January 2008 09:00 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 Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linden Lodge Nursing Home DS0000004400.V359164.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.V359164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th January 2007 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.V359164.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people using this service experience good quality outcomes.
The inspection was carried out was unannounced and was done by one inspector over the course of one day. The inspector would like to thank everyone who took the time to talk to them and express their views. Before the visit, accumulated information about the home was reviewed. This included looking at the number of reported accidents and incidents and reports from other agencies, i.e., the Environmental Health Officer, and correspondence following the last inspection. This information was used to plan this site visit. The inspector case tracked four people’s care plans. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method, the inspectors assessed all twenty-one key standards from the Care Homes for Older People National Minimum Standards, plus other standards relevant to the visit. The inspectors spoke with identified people who live at the home and relevant members of the staff team who provide support to them. Documentation relating to these people was looked at. Where possible, contact was also made with external professionals to obtain their opinions about the quality of services provided at the home. What the service does well:
The home reviews and updates its 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 assessments were detailed and identified strengths of the person as well as their needs giving staff with the information they required to start the care plan from the time the person moves into the home. This information had been appropriately transferred to the care plans.
Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 6 Staff treat the people living in the home with respect and protect their privacy and dignity. Members of staff were seen to knock on bedroom doors before entering and refer to people by their preferred name. Staff were also seen to assist people at meal times helping them to enjoy their meal in an unrushed manner. The home has an activity organiser who is employed five days a week to assist people in how they spend their time. An activity programme is on going and distributed each month offering a wide variety of indoor and outdoor activities that are suitable for older and younger adults. The home provides specialist equipment and adaptations to the home so that the people living their can maintain as much of their independence as possible while remaining safe. The home has a vehicle that accommodates wheelchairs and enables residents to be taken out on trips thereby maintaining links with the community. People 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 were seen to come and go freely and people were able to entertain their visitors in private. The food on the menu offers people 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. People confirmed that they are asked each day which of the choices they would like. 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 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. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 7 Staff had undertaken training related to adult abuse two years previously and this was substantiated by examination of training records. The care staff have achieved NVQ Level 2 in Care demonstrating that they have the knowledge and skills to carry out their role. People are able to bring in personal possessions as was seen when bedrooms were viewed giving these a feel of individuality and ownership. The home is comfortable, attractive and well presented apart from the lounges known as the ‘den’ and the ‘smokers room’. 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. People 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:
Although there are activities offered on a daily basis, more could be done to make sure that people’s individual needs are met. This means highlighting
Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 8 socialisation and giving it the same importance as the physical needs of people. This makes sure that the diverse social needs of people are met. The home does have a quality assurance procedure that includes the opinions of people that live in the home. However, the results of the survey’s and any action taken is not openly fed back to people. In order for the quality audit to be an open document the home should find a way to feed back information and action taken by the home. This is evidence that the home takes people’s opinions and ideas seriously and openly works in the best interests of the people who live there. 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.V359164.R01.S.doc Version 5.2 Page 9 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 Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes. This judgement has been made using available evidence including a visit to this service. 1 and 3 People are given good information to make an informed choice about living at the home before moving in. Assessments are carried out and they are invited to visit before people move into the home. EVIDENCE: The home has a Statement of purpose and a Service User Guide these were available at the time of the inspection. Both documents contained helpful information for people who are looking to move into the home and other interested persons. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 11 The registered manager said that residents had received these and those residents spoken with confirmed that they had. Two visitors spoken to who had been looking for a home for a relative said they had had the chance to had a look around the home and had received information about the home before making the decision to use the service. Four care plans were inspected and pre-admission assessments were in place, these were detailed and showed strengths of people as well as their needs this makes sure that the staff have the information they required to start care plan. People admitted through social services had a care plan written by them and included in their care file. This gave the home further information to make sure them that they could meet the person’s needs before making a decision about moving into the home. There are no people in the home admitted for Intermediate care. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 People using the service experience good quality outcomes. This judgement has been made using available evidence including a visit to this service. Care plans the information needed to meet the needs of people, the health care needs are met and people are treat with respect. Medication procedures and practice protect the residents at the home. EVIDENCE: Four care plans were inspected and all recorded a detailed care plan that was easy for staff to read. Care plans accurately reflect the current needs of people as identified in the detailed assessments and there were systems were in place for reviewing these at monthly intervals. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 13 There was evidence that the care plans are revised more frequently if changes in people’s needs are seen. This makes sure that people’s individual needs are met. There were individual risk assessments risk included in care files, these included falls, nutrition, moving and handling, self administration of medication and tissue viability. People have 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 person. People said that they knew the names of staff and were aware that they had staff designated to them. The names of individual key workers are displayed in people’s rooms. Whilst the writing and reviewing of care plans is the responsibility of the nurses care staff add information such as how people spend there day. All care plans showed evidence of people having access to health professionals outside the home these include the Chiropodist, Optician, GP and Dentist. The appearance of those people spoken with or observed indicated that attention had been given to oral hygiene. Where possible people are given the opportunity to continue to see the GP they saw when living at home but this is not always possible if people have moved a long way from there GP’s area and may have to re register with a local practice. The ordering, storage, dispensation, and disposal of medications was good. 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. 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. The pharmacist at the local chemist audits the medication system regularly and the outcomes are good. There are people who self-administer their medication and robust risk assessments related to this were included in the care files examined. The interaction between staff and people were respectfully and they worked in a friendly and comfortable manner. Members of staff were seen to knock on bedroom doors before entering and refer to people by their preferred name.
Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 14 Staff are also encouraged to eat with people who live at the home this encourages staff to assist people in a relaxed manner and builds up relationships. A telephone was available for use by people in the reception. If people wish to make a call in private they can be assisted to use the telephone in the nurses station. People have the opportunity to have their own personal telephone and a number have also chosen to have one. Mail is delivered unopened by the reception staff to individual people’s rooms. These examples of good practice demonstrate that the residents’ right to privacy is maintained. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes. This judgement has been made using available evidence including a visit to this service. People are offered a wide variety of stimulating activity in and out of the home and family and friends were made to feel welcome. People were enabled to make choices about daily routines. Meals provided were nutritious and choice and variety was offered. EVIDENCE: An Activity Organiser who works every weekday and has designed an activity calendar with the involvement of people who live in the home. The 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
Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 16 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 people to be taken out on trips thereby maintaining links with the community. Care plans 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. There are also links with the community through visits made by the local churches and schools. Younger people are offered the opportunity to partake in college courses with the home obtaining the prospectus each term for them to choose from. People said that there was a choice of going out of the home or joining in with the activity in the home some preferred and chose to stay in the bedroom. This is evidence that the home takes seriously the diverse needs of people and tries hard to meet them. People said that they were able to have visitors at any reasonable time. At the time of the inspection visitors were arriving and visiting people freely. Some were entertained in lounges while others were entertained in private. People said that staff were friendly and helpful and people were offered drinks on arrival at the home. 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. People are offered 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. People said that they are asked each day which of the choices they would like. Some of the comments
Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 17 made by people 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. People said that they were able to take their meals in the dining room or in their own room if they wish. Several people chose to eat in their rooms but there would be insufficient number of places if everyone chose to use the dining rooms. 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. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes. This judgement has been made using available evidence including a visit to this service. The home’s procedures and practices and staff training provide a safe environment for the people who live in the home. They can be confident that their concerns will be taken seriously. 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 people 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 people 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 one complaint was 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.
Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 19 Training records showed that several staff have attended ‘Rights to Complain” training that would assist them in respecting the residents right to complain. Staff undertaken training related to adult protection this is documented in the training records. 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.V359164.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 13, 24 and 26 People using the service experience good quality outcomes. This judgement has been made using available evidence including a visit to this service. The home offers safe, comfortable and well-maintained surroundings that meet the needs of the people who live there. EVIDENCE: The home is clean, well furnished, decorated and maintained, and is homely in appearance two lounges on the first floor have been completely refurbished since the last inspection to a good standard. Communal space available and includes lounge/dining rooms, lounges, and quiet areas. These are decorated and furnished to a good standard. Staff are employed specifically to maintain the home and this is done to a good standard.
Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 21 People have the opportunity to furnish their bedrooms with personal items giving them a feeling of ownership and an expression of individuality. The home was clean and tidy and the laundry was well organised both laundry and cleaning staff are employed additionally to the care staff. There are sufficient bathrooms and WC’s and there are plans to convert one into a shower room with wheelchair access. The home has had assisted shower facilities installed following the last inspection. In order to maintain people within the home who require specialist equipment some internal building work has been done. This has not changed the lay out of the home but has allowed staff to care for people safely in the home. This is evidence that the manager and staff work hard to make sure that the needs of all the people in the home are met on an individual basis and is very good practice 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 assisted bathroom and toilet facilities. The bathrooms had been recently refurbished and were clean and well presented. 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. New enclosed terracing has been provided so that people can walk into this area form the lounge and enjoy the fresh air in complete safety. There was a call bell system throughout the home for residents to summon assistance when needed. The home provides specialist equipment to maximise the independence of the People. Examples of this were a special bed, hoist, commode and wheelchair for a people 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. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 22 Hand washing facilities with disposable towels and soap dispensers were sited appropriately throughout the home for staff and wash their hands as required to control infection. 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.V359164.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes. This judgement has been made using available evidence including a visit to this service. 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. 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 has appropriate good staffing levels with sufficient numbers and skill mix to meet the assessed needs of the people living in the home and the service. 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 are sufficient numbers of care staff in the home in the morning and 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,
Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 24 laundry, catering, gardening and maintenance tasks with administration and reception staff and an activity organiser in the home each weekday. People 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 good opportunities for training and development. Care staff have achieved National Vocational Qualification Level 2 in Care. Agency staff are not currently used by the home. Three 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. 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. 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.V359164.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. An appropriately qualified and experienced person manages the home in the best interests of the people who live there Procedures are in place to safeguard residents’ financial interests and their health, safety and welfare. EVIDENCE: The registered manager has worked at the home for many years since it first opened and has been the manager for several years. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 26 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. 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. People said that they felt that the registered manager was able to support them and that she would listen to their concerns. 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 involving people who live in the home that give them further opportunity to give an opinion on the service. We recommended that the results of the quality audit and any action taken be added to the service users guide. This is evidence that the home listens to people and takes there comments seriously. People are encouraged to manage their own finances, if they are unable then family or a representative would be asked. For people who have no representatives an advocacy service is available. The home holds money for most of the people as a personal allowance for spending on such 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 person or their representative. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 27 The system is robust and safeguards the interests of the people living in the home. Evidence of staff supervision being carried out every two months was available in the staff files examined and staff spoken to confirmed this. 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 handling and food hygiene. Mandatory training including fire safety had been undertaken. There are designated first aiders appointed in the home. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 28 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 4 X 3 X X 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 3 3 3 3 3 X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP14 Good Practice Recommendations Although there are activities offered on a daily basis, more could be done to make sure that people’s individual needs are met. This means highlighting socialisation and giving it the same importance as the physical needs of people. This makes sure that the diverse social needs of people are met. 2 OP32 In order for the quality audit to be an open document the home should find a way to feed back information and action taken by the home. This is evidence that the home takes people’s opinions and ideas seriously and openly works in the best interests of the people who live there. Linden Lodge Nursing Home DS0000004400.V359164.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Aylesbury Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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
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