Inspection on 25/08/05 for Linden Lodge Nursing Home

This inspection was carried out on 25th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Linden Lodge Nursing Home 24/01/08

Linden Lodge Nursing Home 16/01/07

Linden Lodge Nursing Home 03/02/06

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 Church Road Warton Tamworth, Staffordshire B79 0JR Lead Inspector Terri Owen Unannounced 25 and 30 August 2005 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 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 E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Linden Lodge Nursing Home Address Church Road Warton Tamworth Staffordshire B79 0HQ 01827 894082 01827 896420 Telephone number Fax number Email 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 with nursing 65 Category(ies) of Dementia - over 65 - (65) registration, with number Old age - (65) of places Physical disability - (0) Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1 March 2005 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. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection that took place over 2 days during the day/early evening and lasted eight hours in total. There were 58 residents at the time of the inspection. A tour of the premises was undertaken. Records including care plans, risk assessments, complaints, staff files and residents’ finances were inspected. The inspector also spoke with the manager, four members of staff, three residents and two relatives. The inspection focused upon the recruitment practices and staff records, the standard of the premises, care plans and risk assessments and complaint procedures. What the service does well: What has improved since the last inspection? Eighteen bedrooms have undergone refurbishment this year as part of the ongoing maintenance, replacement and repair programme. There has been improvement in the provision of the amount and range of activities since the last inspection. More staff resources are available for undertaking activities with residents and there is a member of staff dedicated to organising 1:1 and group activities. An Activity Calendar is now produced monthly and a copy is given to all residents. This standard will be inspected fully during the next inspection. A cleaning programme has been introduced to ensure mattresses; wheelchairs and hoist slings are cleaned on a regular and on a “as necessary” basis. The registered manager is in the process of updating infection control policies to include this programme. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 7 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 Standards 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 E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 8 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed at this inspection. Key standards will be assessed at the next inspection. EVIDENCE: Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 9 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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7 The residents’ health, personal and social care needs are not suitably recorded and information is missing which could result in the risk of harm to residents. EVIDENCE: Four residents’ records were examined. Standardized care plans are used that can then be individualised to meet specific needs however there was little evidence of this being done. In one case the “Continence Plan” stated “pads” and did not include anything about whether the resident was continent at any time or whether they could use the toilet or commode. Other records for this Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 10 resident did indicate they were using the toilet successfully at times. For bowel care the plan stated, “follow usual toileting pattern” but did not state what this is. For residents identified to be at risk of pressure damage, the care management plans were not comprehensive and did not always identify the equipment that was being used, or state what interventions should take place to relieve pressure. For one resident with specific needs relating to fragile skin and paralysis there were no care plans in place to inform staff of how to provide care to ensure the their safety in relation to these needs. Evaluation of care plans showed little evidence of any changes being made as a result of changing needs. Records for one resident identified assessment by a Community Nurse, but there was no information in the care plan to indicate that the psychological needs of the resident had changed and how these were to be met; the original assessment remained in place. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 11 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 asssistance 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) x None of these standards were assessed at this inspection. Key standards will be assessed at the next inspection. EVIDENCE: Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has dealt with complaints in a confident and professional manner therefore residents and their families may have confidence that their concerns are listened to and acted upon. EVIDENCE: The home has not received any complaints since the last inspection. The inspector reviewed the records of previous complaints and these demonstrated that the home had followed their procedure in dealing with complaints and within the timescales set out. Service improvements to address the issues raised were identified and have been implemented. Information was made available to the complainant about their right to refer the complaint to the Commission at any time or if they were not satisfied with the way the home was dealing with the complaint. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, The home is well maintained and decorated, which contributes to the safety of residents and enhances their quality of life. The home is set in attractive grounds and the quality of life for residents is enhanced by access to a range of safe and comfortable inside and outside communal areas. All toilet and bathing facilities provide privacy for residents. Residents are not offered a choice between bathing or showering as there is only 1 en-suite shower room at present. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 14 The home has a selection of equipment to assist in maximising the residents’ mobility, independence and comfort that enhances their quality of life. Residents’ bedrooms are safe and comfortable. Most residents have some personal possessions in their bedroom that enhances the quality of their life. EVIDENCE: A tour of the home demonstrated that it is kept in a good state of repair and decoration. The home is on three floors with three bedrooms on the top floor and the remaining ones on the ground and middle floor. There is a range of safe and comfortable communal areas including two dinning rooms and five lounges. Residents may see visitors in private if they wish. All areas are well ventilated and well lit. There is a range of equipment available to residents including wheelchairs, hoists, hospital type beds, larger beds, chairs, commodes and pressure relieving equipment. There is a call bell system installed in the home. Eighteen bedrooms have been refurbished this year. These bedrooms have been provided with a bedside cabinet with lockable storage space. Ceiling mounted screens are provided in one double bedroom. In the other double bedrooms mobile screens are provided. These appear cumbersome to manoeuvre and take up floor space that is limited when residents require wheelchairs, hoists and other equipment available in their bedroom. A large sign stating “Thickened Fluids Please” was placed over one resident’s bed. This impinges upon the dignity of the resident and gave an institutionallike appearance that was out of character with the rest of the home. Some bedrooms have baths and one has an en-suite shower. There are five other communal bathrooms with baths. There are plans to install a walk in shower in another bathroom on the ground floor. These are the only showering facilities available to residents at the home that are separate from the baths. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 15 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, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 There are qualified nurses on duty at all times ensuring the safety of residents. The recruitment policies and practices ensure that residents are protected from harm. EVIDENCE: One qualified nurse is on duty on each floor during the day and one qualified nurse is in the home overnight. Currently 43 of care staff have achieved National Vocational Training to level II or above. The home is aiming to achieve 50 early in 2006. Ten care staff are to commence level II training in September. The home avoids using agency staff wherever possible. An Agency Nurse has covered one shift during 2005. No care staff are under 18 years of age. Younger aged staff are only employed in other areas like reception and catering. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 16 Six employment records were seen. The records demonstrated that full checks on staff are undertaken to ensure they are suitable to work with vulnerable adults. All Contracts of Employment are made subject to satisfactory criminal record checks and Protection of Vulnerable Adults checks. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 17 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 polies 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 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The residents’ personal monies are handled appropriately and they are safeguarded from financial abuse by the home. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 18 EVIDENCE: All residents have family members or advocates to support them in respect of their financial affairs, including payments of fees. The financial systems were demonstrated to the inspector. Itemised statements and invoices to residents are made for any items or services purchased on behalf of residents by the home that are not included in their contract e.g. hairdressing, chiropody, sweets, toiletries, some expenditure during trips out. There are dedicated staff to manage payments of fees and invoices. Any cash payments are receipted by using a carbonated book. Secured cash tins are available for residents if they choose to have them and lockable cabinets are being fitted in bedrooms as they are refurbished. The home has secure facilities and appropriate policies for keeping money and valuables safe. Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 19 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 x 2 x 3 x 4 x 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 3 3 x 3 x x Score Standard No 7 8 9 10 11 Score 2 x x x x Standard No 27 28 29 30 x 2 3 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 x 34 x 35 3 36 x 37 x 38 x Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 12(1)(b) 15 (1) Requirement Timescale for action 31/11/05 2. 7 12(1)(b) 15 (1) The registered manager must ensure care plans set out in detail the actions to be taken by nursing and care staff to meet the physical, psychological, health, personal and social needs of residents. (Timescale of 30/10/04 not met.) The registered mananger must 31/11/05 ensure evaluation of residents care plans reflect their changing needs and objectives of the residents. (Timescale of 30/10/04 not met). 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. Refer to Standard 19 21 Good Practice Recommendations The registered manager should ensure the sign stating “Thickened Fluids Please” is removed from above the bed of the resident identified at the inspection. To increase choice for residents and reduce the risk of cross infection, the registered manager should identify ways of installing more seperate showering facilities in the home. E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 21 Linden Lodge Nursing Home Linden Lodge Nursing Home E53 S4400 Linden Lodge Nursing Home V245878 250805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 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