Inspection on 14/01/09 for Linden Manor Care Home

This inspection was carried out on 14th January 2009.

CSCI found this care home to be providing an Good service.

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 Manor Care Home 14/02/07

Linden Manor Care Home 28/04/05

Linden Manor Care Home 11/11/04

Linden Manor Care Home 15/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Linden Manor Care Home 159 Midland Road Wellingborough Northants NN8 1NF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Carol Mitchell     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Linden Manor Care Home 159 Midland Road Wellingborough Northants NN8 1NF 01933270266 01933229141 manager.linden@regalcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Regal Care Homes Ltd care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Linden Manor must only admit service users within the category of Dementia DE(E) One existing service user within the category of Mental Disorder MD(E) may remain at Linden Manor while their needs can be met The total number of service users at Linden Manor must not exceed 28 Date of last inspection Brief description of the care home Linden Manor is a care home providing personal care and accommodation for 28 older people who have a dementia related condition.The home is owned by Regal Care Homes who run a number of homes in the area. The home is situated close to the centre of Wellingborough and is easily accessible by private and public transport. Parking is available in the grounds of the home. The accommodation is a three-storey detached house set within its own grounds, which have been improved and are accessible for the residents. There are spacious communal areas including an all weather conservatory. There is a mixture of single and shared bedrooms on all three floors, most of which do not have en-suite facilities. The first and second floors can be accessed by stairs or by a passenger lift. Further information about the home can be obtained by telephone, fax or email. The last report we wrote is available at the home Care Homes for Older People Page 4 of 27 Over 65 28 0 Brief description of the care home on request. The following information about fees was obtained on 14th January 2009:Fees range from £359.01 to £450.00. There are extra charges for hairdressing, chiropody, special activities and personal items. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key, or main inspection report takes account of information we have received since the last key inspection in February 2007. We did an Annual Service Review, or check, in January 2008. After that review we concluded that the service was working well with us, was still a good one, and that the next key inspection should be done by January 2009. As part of this key inspection we asked the manager to complete a detailed quality assurance assessment, and she has given us a lot of helpful information about the home. Before our visit we also sent 17 surveys to residents, staff, and health care professionals who regularly go into the home. Care Homes for Older People Page 6 of 27 We visited the home on 14th January 2009 and stayed for around five hours. During the visit we concentrated on the care and support received by four residents, and spent time in the lounge. We looked around some parts of the home. We also spoke to residents, family members, staff, the manager, and the area manager. In addition, four staff files were checked, as were some other records. We would like to thank everyone involved with the inspection visit. What the care home does well: What has improved since the last inspection? Since the last key inspection in February 2007 the home has continued to make improvements. They now make sure that there is always a member of staff in the lounge, and use of the call bell system is part of staff training. Other improvements include: Better information given to prospective residents; the introduction of end of life care plans; increased involvement of residents in care planning; updated staff contracts; better hand overs for staff; and use of an improved complaints form. An Occupational Therapist for the company has just been appointed, and an activities coordinator for the home is to start work soon. Care Homes for Older People Page 8 of 27 Decoration at the home is done on a rolling programme. Recent works include partial refurbishment of the laundry, new kitchen surfaces, and the addition of a breakfast bar to the dining room. A new bath hoist and a freezer have been purchased. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager makes sure that she has a thorough knowledge of residents before they move in. This means that people living at the home can be sure their needs will be met. Evidence: A resident told us that she was satisfied with the information she was given before she moved in. Another resident wanted us to know that everyone was lovely to her when she arrived at the home. People moving into the home are given information called a Service User Guide. A simplified version with pictures has been produced, and large print copies are available. We looked at the records for two people who had been admitted within the last year. Care Homes for Older People Page 11 of 27 Evidence: Detailed assessments of their needs had been recorded in an organised way. One persons son had visited the home twice, and another resident had been admitted urgently. The manager visits people in their own home or in hospital often taking a staff member with her so that introductions to the prospective resident can be made. Likes and dislikes are noted and all of the information is used to write a care plan which is agreed by the individual or his/her representative. A member of staff is appointed to help the person settle into the home. Residents receive contracts with terms and conditions specifying the room to be occupied and the fees charged. This home does not offer intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have detailed care plans, staff receive training, and the manager makes sure that residents see family doctors and other health care professionals when they need to. This means that people living at the home can be sure their health needs will be met. Evidence: We looked at the records of four residents in detail. We found that individual care plans and risk assessments had been written, reviewed, signed and dated. One persons minority cultural and religious needs were summarised in the care plan in a meaningful way. Care plans were complemented by information sheets covering medical diagnoses and advice regarding individual behaviours. Care plans referring to a persons wishes at the end of life have been introduced. We questioned staff and they knew about the care plans and the care required by named residents. We saw that staff are confident and knowledgeable and they have good relationships with residents, families, family doctors and others. During the visit Care Homes for Older People Page 13 of 27 Evidence: staff dealt with residents sensitively and in private. We looked at a shared room where curtains were fitted to provide screening. Personal wash items are kept separately. A resident spoke with satisfaction and pleasure after receiving help with washing from two care assistants. She was smiling and relaxed and said Ive just had a lovely freshen - up. A local surgery provides the services of family doctors, district nurses and a practice nurse. The Community Psychiatric Nurse (CPN), diabetes nurse, chiropodist and optician also visit residents. The practice nurse conducts regular health reviews. A family doctor and the CPN filled in questionnaires sent to them by the service. They expressed satisfaction with the home. A family member reported to us that she could not praise the staff enough when her mother had a suspected heart attack. The paramedics and family doctor were called promptly and the family were immediately informed. These family members have every confidence that their relative is being cared for properly and that staff cope well with emergencies. Medicines at the home are very well organised. The manager and area manager make regular checks on the management and administration of medicines, they also complete risk assessments for residents taking particular medication, and care plans where as needed prescriptions cannot be avoided for clinical reasons. The providing pharmacist does inspections, most recently in September 2008 when planned changes to the system were established. We looked at the record of checks made by the manager and we saw medicines being administered safely. We also checked four medicine record sheets and these had been correctly completed. Staff we spoke to had received formal training in the administration of medicines. We asked staff about the call bell system at the home, and we witnessed it being used safely. The staff know that they must always check the resident before cancelling the buzzer. We also asked the manager about this issue and she confirmed that it forms part of the training given to staff. We suggested that it is also regularly discussed during supervision sessions, and the manager is going to do this. We saw that the lounge is now manned by a member of staff. Staff told us that there is always someone whose role it is to keep a check on people in the lounge, and a family member confirmed that she can always find a member of staff around when she visits. Her visits to the home are always unannounced. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and staff find out as much as possible about likes and dislikes, and there is an understanding of how residents choose to live their lives. There is an organised and improving approach to daily life and activities in the home. This means that people can be sure their expectations of living at the home will be met. Evidence: We checked assessment and care planning information for four residents and found details of likes, dislikes, personal choices and social needs. A Hindu lady has been offered a place at a local day centre to mix regularly with people who share her culture. Family members told us they visit the home often, at varying times, and that they are always made very welcome. They are very pleased with the food at the home and the way their relatives diet is managed even though her appetite is very poor. Menus at the home have been altered in line with comments received when the home issued questionnaires to residents. One lady told us that she goes where she wants to and sits where she likes. We spent Care Homes for Older People Page 15 of 27 Evidence: time in the lounge, dining room and conservatory and noticed that staff often interacted with residents. We observed that people were calm and contented. Entertainment is arranged every month, for example sing-a longs and pottery lessons. A residents handywork was displayed in her bedroom. A hairdresser and specialist hairdresser visit the home regularly. The company has appointed a Group Occupational Therapist and the home will have a designated activities person from late January 2009. The home has recently qualified for a local council grant and will be spending the money in the area of activities for residents. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager tries hard to make sure everyone at the home is satisfied and she investigates any complaints thoroughly. The correct checks are made before anyone is employed, and staff are trained about safe-guarding residents. Therefore people living at the home can be sure they will be protected from harm. Evidence: During our visit we saw that residents feel confident and comfortable with staff to whom they spoke freely. The manager and staff know the residents well and recognise when discontentment arises. The manager encourages family members to speak about problems before they develop into complaints. The home also takes notice of any concerns raised in questionnaires. The manager knows how to find an advocate for any resident should one be needed. A complaints procedure is displayed and given to residents in the information pack. There is a box for concerns or complaints and a simple illustrated guide to making a complaint is also available. The home has a low level of complaints with one being upheld since the last key inspection in February 2007. The complaint was to do with staff communications. It had been investigated, records kept, and the result and actions taken noted. Family members told us they have never needed to complain but could do so easily if there is reason to. The homes questionnaires and surveys returned to us show that Care Homes for Older People Page 17 of 27 Evidence: other family members agree with this. Staff who spoke to us had received training about the safeguarding of vulnerable adults and they were able to discuss their role should abuse be suspected or identified. We looked at four staff files. Safe recruitment procedures had been followed and the proper checks made prior to employment. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The company pays for improvements to be made and decoration and maintenance is planned and continuous. Competent maintenance, cleaning and laundry staff are employed. Therefore residents can be sure they are living in a safe and well maintained environment. Evidence: We looked around some parts of the home. Areas we saw were well decorated and maintained. We noticed that personal items were displayed in bedrooms. We saw that curtains are used for screening in a shared room and there were clearly separate items for each residents personal hygiene needs. A call bell cord in the lounge was caught behind a piece of furniture, and in a toilet the pull cord was too short. (The particular call bells are primarily used by staff but still need to be reachable by residents, and the manager is going to deal with this). A maintenance man and gardener are employed at the home. There is a planned programme of decoration and refurbishment. Recent improvements include replacement of kitchen surfaces, and the purchase of a new bath hoist. Two bathrooms have hoists. At the time of our visit a breakfast bar was being added to the dining room, and the laundry was being partially refurbished. The dining room carpet has Care Homes for Older People Page 19 of 27 Evidence: some staining and is scheduled for replacement soon. There are also plans to paint the walls of some corridors. Laundry and cleaning staff are employed and there is weekend cover. All areas of the home that we saw were very clean, and the laundry is well organised by a committed and thorough member of staff. We looked at the records of health and safety checks such as those for fire and hot water, and found these to be in good order. On the ground floor we saw that very good quality new signs have been purchased to help people with dementia find their way around the home with confidence. The new signs are gradually replacing the older ones in use on the other floors. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed at the home. Staff are well trained and happy in their work. Proper checks are made before anyone is employed. Staff are organised, well led, and they know the residents well. Therefore people living at the home can be sure that they are in safe hands. Evidence: During the visit we saw that staff were attentive to the needs of residents, organised, and happy in their work. A family member told us that she cant praise the staff enough, they are very kind. Staff who spoke to us were well informed about the needs of residents and they had received essential and other training. A substantial majority of the staff have completed National Vocational Qualification (NVQ) training, and four more staff are just starting courses. Two staff on duty at the time of the visit had achieved NVQ level 3. At the time of our visit 26 residents were present and on duty were a Head of Care, four care assistants, a cook, two cleaners, a laundry assistant and the maintenance man. The Head of Care on duty told us that the staffing levels were sufficient to meet the needs of residents. A flexible approach is taken and staffing levels altered to meet Care Homes for Older People Page 21 of 27 Evidence: extra demands when necessary. Staff told us that they have hand overs which are more effective than in the past. They also have staff meetings and receive regular helpful supervision sessions. The company sends questionnaires to staff to guage their satisfaction. There is a stable staff group. Staff told us they are happy working at the home-Its very organised, I am really enjoying it; The staff and residents are lovely. Staff described a good team spirit and excellent support from senior staff and the manager. We looked at a sample of staff files and found that proper procedures are in place for the recruitment of staff, and that training is given a high priority at the home. A formal induction programme for new staff is in place, and this includes at least three days where the new person shadows an established employee. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is well supported by an area manager and has two deputies working with her at the home. The manager has an open door policy and residents and family members approach her freely. The manager and area manager make sure that they regularly check things are done right and change things quickly if they need to. Therefore people living at the home can be sure it is run with their best interests at heart. Evidence: The manager at the home is experienced and qualified. She is currently undertaking additional management training and has studied the implications of the Mental Capacity Act. We saw that the manager has a very open relationship with residents and family members, is very approachable and easy to talk to. The manager is well supported by an enthusiastic area manager who has experience of running a home herself. There are also two deputies (Heads of Care) who support the manager and the staff group. Staff told us that they feel well supported by the management of the Care Homes for Older People Page 23 of 27 Evidence: home and by the heads of care. Staff think that communication in the home has improved and is now good. We looked at the results from some questionnaires sent out by the home. The results from these were in general very good indeed. The manager and area manager described a methodical and comprehensive approach to checking on quality. For example they check everything to do with medicines every week, they look at infection control issues every two months, and health and safety every month. The checks are recorded and any problems are sorted out in a productive and timely manner. The home achieved a high quality rating from the local council last year and intends to obtain Investor in People status this/next year. The area manager completes the regulation monitoring visits required by us. Results are recorded on reports and action taken when necessary. We saw an example of a recently completed report with details of findings and actions taken. The manager also does out of hours spot checks during weekend and night shifts, and similarly records and acts on the findings. During our visit we observed that records in the home were well ordered, stored safely and carefully kept up to date. We checked the money held by the home for a resident and found that the amount matched the record correctly. The manager has a training matrix which she uses to keep track of the training done by staff and in so doing she makes sure that no-one misses essential updates. Records are also maintained of staff supervision sessions. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!