Inspection on 01/06/05 for Linden Lodge Residential Home

This inspection was carried out on 1st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Residential Home 27/02/09

Linden Lodge Residential Home 12/10/06

Linden Lodge Residential Home 13/12/05

Linden Lodge Residential Home 29/09/04

Linden Lodge Residential Home 22/04/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Linden Lodge Residential Home Browns Lane Dordon, Tamworth Staffordshire B78 1TR Lead Inspector Terri Owen Unannounced 01 June 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. 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 Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Linden Lodge Residential Home Address Browns Lane Dordon Tamworth Staffordshire B78 1TR 01827 899911 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) Mr David Charles, Ms Deborah Leyland, Mr Donovan Charles, Mr Mark Peter Davies, Dr Alan Roy Gummery, Ms Patricia McDonagh Ms Deborah Frances Leyland Care home 34 Category(ies) of Dementia (23) registration, with number Old age (34) of places Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 29 September 2004 Brief Description of the Service: The home is purpose built and is registered to provide care to the older person and the older person with dementia (34 beds). The accommodation is provided over three floors, with the ground and first floor accommodating service users who require specialist dementia care. The majority of the service user accommodation is provided in single rooms. All rooms have good size en suite facilities. Lounge / dining and assisted bathing facilities are provided on each floor. The home is located opposite a small number of shops and close to the village amenities. A sensory room and accessible enclosed garden areas are provided to meet specialist care needs of the elderly service users. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection that took place during the daytime. The inspection was carried out by two inspectors, one of whom is a specialist pharmacist. There were thirty-three residents at the time of the inspection. A tour of the premises was undertaken. Records including care plans, risk assessments, medication administration records and menus were inspected. The inspector also spoke with the manager and four members of staff, four residents and two relatives. The inspection focused upon the premises, quality of food, social contact, staffing levels, care plans, risk assessments and medication systems. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All prospective residents have their care needs assessed by the clinical manager prior to admission to the home. Based upon the information gained at this assessment from prospective residents, family members, social workers etc, the home does not knowingly admit residents whose needs cannot be met by the home. EVIDENCE: The home has an assessment policy in place. Assessments are carried out by the clinical manager. All assessments undertaken are documented. The assessment covers social circumstances and physical and mental health. Copies of the assessments are kept in the residents’ files. Reason why the person needs admission, any difficulties in caring for the person and any behaviour problems are not specifically identified. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 The health care needs of residents currently in the home are identified and met. Not all residents have care plans in place that contain sufficient detail to meet the needs of residents. The home is in the process of introducing new care plans and these are in place for some residents. The new care plans do meet the standard required as they provide greater details of the residents’ needs and how they are to be met. At the time of the inspection the medication records did not accurately reflect what medication had been administered to the service users in all instances. EVIDENCE: At the time of the inspection new care plans were being introduced by the home. Three new care plans were assessed. They contain moving and handling assessments, CAPE assessment for mental health, and risk assessments, including risk of pressure damage. The new care plans meet the standard required as they provide greater details of the residents’ needs and how they are to be met. The new care plans were not yet in place for all residents. Care plans are signed by the resident or a member of their family. The home is working towards a system whereby care plans are reviewed at least once a month. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 9 Discussions with residents, relatives and district nurse indicate they are happy that health needs are met and that referrals are promptly made to the GP and specialist nurses if a need arises. Care plans record the involvement of GPs, district nurses and other specialist nurses. Staff had adhered to recommendations for safe administration of medications issued from previous inspections and were keen to improve practice further to meet the required standards It could not be demonstrated that all the medicines had been administered as prescribed. Medicines and doses had been incorrectly recorded on the Medicine Administration Record (MAR) chart in some instances. Some medication was not available for administration in the trolley; conversely medication was available for administration but not recorded on the MAR chart. Medicines were incorrectly stored and not secured in a locked facility at all times. This included drugs awaiting return to the pharmacy for destruction, medicines requiring refrigeration and Monitored Dosage Systems that did not fit in the drug trolley. Systems had not been installed to demonstrate that all medication prescribed and dispensed had been checked for accuracy. Quantities or balances carried over had not been routinely recorded so auditing was difficult in some instances. Inadequate checks had taken place to confirm new service users medication was their current drug regime. There were inadequate policies and procedures for risk assessing service users wishing to self medicate their own medicines. Managerial staff did assess the care staff for their practice in drug administration on a yearly basis, but random staff drug audits to demonstrate competence did not take place. The home had a Controlled Drug cabinet but this was incorrectly secured in a cabinet in the medication room. The home had no Controlled Drug register. Staff did not always administer medication from the pharmacist labelled container and secondary dispensing took place into the pharmacist dispensed Monitored Dosage System. Staff have received accredited training in the safe handling of medicine but knowledge gained from the course had not been implemented in all instances. The home seeks medication reviews on an annual basis and had a good relationship with the doctors and pharmacist involved with the healthcare needs of the service users. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 15 The home ensures that visitors are made welcome and residents benefit from visits from family and friends. Residents have three nutritious meals a day and are offered a choice each time. The dining areas are suitable and residents benefit from staff support at mealtimes. EVIDENCE: At the time of the inspection there were many visitors to the home. Those spoken with said they were always made welcome by staff and that they could visit at any time. They also said they were encouraged to have meals with their relatives and one of the visitors had a meal each week with his father. The relatives said they were always kept informed of any changes. The manager said that as most residents came from the local community or have family locally, they have a number of friends and relatives that visit regularly. Relatives and residents spoken to commended the food. They said there was always variety and a good choice. One relative said their father had a large appetite but he was well catered for. The inspector had lunch with some of the residents. Those who needed assistance with eating were sensitively supported and the food served was nutritious and well presented. Residents can choose to eat in their room if they wish. When asked about menus, residents and relatives said they did not recall seeing one. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents and relatives are informed of how to make a complaint. The home has suitable policies and procedures in place. Residents and relatives feel confident staff will deal appropriately with any issues and concerns they may have. EVIDENCE: Previously the home has demonstrated it has met this standard. The home has a detailed complaints procedure. The procedure is displayed in the reception area and contained within the Service User Guide. Relatives said that if they had any concerns, criticisms or complaints they would go to staff or managers and that they felt confident any issues would be dealt with appropriately. Those able to express their views said they felt their concerns would be appropriately dealt with and acted upon. The home has not received any complaints since the last inspection. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Overall the premises are comfortable and well maintained and offer a range of indoor and outdoor space that meets the needs of residents. The home was in breach of fire regulations as some fire doors were not closing properly, putting residents at risk in the event of fire. EVIDENCE: A tour of the premises was undertaken. CCTV cameras have been installed on the corners of the building and entrance area. They do not intrude on the privacy of residents. The home is purpose built and in a good state of repair. Furniture and fittings are of a good standard. Residents and relatives said the home is always kept tidy and well presented. There is a lack of storage space resulting in excess equipment being stored in bathrooms. The under-floor heating in the home has caused the flooring in the ground floor shower room to come away from the wall and some of the carpet on the middle floor has also become unstuck. The manager stated that flooring required frequent maintenance due to this problem and these areas would be attended to. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 13 On the day of the inspection four fire doors identified to staff were not closing properly and therefore breached fire safety regulations. Action was taken by management and maintenance staff on the day of the inspection to repair the doors. Some combs, flannels and other personal items had been left in some of the bathrooms and staff removed these during the inspection. A number of mattresses were seen to be stained and in need of replacing. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30 There are a sufficient number of staff on duty at all times with an appropriate range of skill mix to ensure the needs of residents are met and staff are appropriately supervised and supported. There are comprehensive training programmes in place to ensure that staff are competent and have the necessary skills to meet the care needs of residents. EVIDENCE: Duty rotas have been revised to give a better skill mix of staff on duty at all times. There is always a team leader on duty with care supervisors and care staff. Staffing levels are monitored to ensure minimum levels and skill mix is achieved. A 24hour “on-call” management system is in place. Care staff are supported by dedicated administration staff, kitchen, cleaning and maintenance staff. The home has recruited more staff than actually required and this ensures staffing levels are maintained. The company has in place a training matrix for all staff and has been awarded the “Investors in People” award. The inspector saw a range of training packs and training records. All new staff undertake an induction programme and then proceed on to a training programme that leads to national vocational qualification at level 2. Forty four percent of staff had achieved a minimum of level 2 qualification at the time of the inspection and the manager expected this to have risen to 50 by the end of June. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 15 Care supervisors undertake NVQ level 3 training. Staff spoken to confirmed the training they had received and said they had completed or would complete their NVQ level 2 training by the end of June. They also said they received “loads of training”. All care staff have now had training on the recognition and management of abuse and dementia care. The home uses a “cascade” system of training where appropriate. Specific staff receive detailed training and then become responsible for ensuring all staff are trained on the specific topic. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 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. They will be assessed at the next inspcetion. EVIDENCE: Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 18 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. Standard 7 Regulation 15 Requirement The registered manager must ensure that a care plan, using the new format, is in place for all residents. The registered manager must ensure care plans are reviewed at least monthly. The medication policy must be updated to include new good practice implemented into the home. A self-administration risk assessment policy must be written and used to assess all service users wishing to self medicate their own medication. Any service user wishing to self medicate their own medication must be suitably risked assessed as able and compliance checks regularly undertaken to confirm compliance. The quantities of all medication received or balances carried over from previous cycles must be accurately recorded to enable audits to demonstrate medication is administered as prescribed. All medicines that are hand written on the Medicine Administration Record (MAR) Timescale for action 30/06/05 2. 3. 7 9.1 15 13(2) 30/09/05 1 month and ongoing 4. 9.2 12(3) 1 month and ongoing 5. 9.3 17(1)(a)S chedule 3(3)(i) 1 day and ongoing 6. 9.3 17(1)(a)S chedule 3(3)(i) 1 month and ongoing Page 19 Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 7. 9.3 13(2) 8. 9.3 13(2) 9. 9.3 13(2) 10. 9.4 13(2) 11. 12. 9.4 9.4 13(2) 13(2) 13. 9.4 13(2) 14. 9.4 13(2) chart must be transcribed from the prescription and countersigned by a second member of staff for accuracy. MAR charts must record any sequential page numbers e.g. 1 of 2, 2 of 2 and start dates. All occasional use medicines prescribed must be administered against a written protocol recording reasons for administration, dose, maximum daily dose and recording requirements. The medication of all new service users entering the home must be checked with their prescribing doctor to confirm the current drug regime. The medication room temperature must fall below 25°C at all times to ensure medication is stored within their product licences. Any medicine requiring refrigeration must be stored in a lockable facility and the refrigerator maximum, minimum and current temperatures recorded on a daily basis and must lie between 2 and 8°C at all times. All medication must be stored in a lockable facility at all times. All prescriptions must be seen prior to dispensing and a system installed to check the dispensed medication and MAR chart against the prescription for accuracy. All medicines recorded on the MAR chart must be available for administration. All medication must be administered to the service user they were prescribed to. Managerial staff must undertake staff drug audits to demonstrate 1 month and ongoing 1 day and ongoing 1 month and ongoing 1 week and ongoing 1 hour and ongoing 1 month and ongoing 1 hour and ongoing 1 month and Page 20 Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 15. 9.4 13(2) 16. 9.4 13(2) 17. 18. 9.5 9.7 13(2) 13(2)17 (1)(a) 13(2) 23(4) 19. 20. 9.8 19 21. 19 16(c ) staff competence in medicine management. All medication must be administered from the pharmacist labelled containers at all times. All secondary dispensing into or removal of medicines no longer required from compliance aids supplied by the pharmacist must cease. All surplus medication must be returned to the pharmacy for destruction and not stored on the premise for future use. The Controlled Drug cabinet must be rag bolted to a permanent wall. All staff must be trained to adhere to any new medication policy implemented into the home. The purchase of a Controlled Drug register is required. The registered manager must ensure all fire doors are made safe and that they close properly. The registered manager must replace all stained mattresses and ensure suitable waterproof covering where necessary. ongoing 1 hour and ongoing 1 day and ongoing 1 week and ongoing 1 month and ongoing 1 week and ongoing 2 days 30/09/05 22. 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 3 Good Practice Recommendations It is recommended that assessment records include the reason why the person needs admission to the home, any difficulties in caring for the person and any behaviour problems. All medicines purchased by relatives and brought into the E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 Page 21 2. 9.4 Linden Lodge Residential Home 3. 4. 15 19 home for services users must be checked by the pharmacist for any drug interactions with existing prescribed medication. Menus should be displayed within the home. Storage space should be improved if possible. Linden Lodge Residential Home E53 S28077 Linden Lodge Residential Home V28077 030605 Stage 4.doc Version 1.30 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. 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