CARE HOMES FOR OLDER PEOPLE
Lindenwood Residential Care Home 208 Nuthurst Road New Moston Manchester M40 3PP Lead Inspector
Mrs Lillian McMullen Unannounced Inspection 23rd March 2006 10:00 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 Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 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. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lindenwood Residential Care Home Address 208 Nuthurst Road New Moston Manchester M40 3PP 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) 0161 681 4255 Ann Catherine Smith Maureen Philomena Murphy Andrea Hudders Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Personal care only is provided for a maximum of 16 older people Staffing at the home must comply at all times with the minimum levels set out in the Residential Forum Guidelines for staffing in Care Homes for Older People. Staffing levels must be regularly assessed and increased if necessary depending on residents assessed needs. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the NCSC. 15th December 2005 3. 4. Date of last inspection Brief Description of the Service: Lindenwood is an established care home providing personal care only for up to 16 older people. The property is a two storey detached house that has been extended. It is set within its own grounds overlooking the local park area. The property is accessible via steps and ramps. There is a large well-maintained garden to the rear of the property, which is also accessible via ramps. There is parking to the front of the property for approximately six vehicles. The property is situated to the North of Manchester City Centre near the boundary of Oldham. It is close to local amenities including shops, public library, post office and local pubs. There are good public transport links to Manchester and Oldham. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced it started at 10.30am and took place over 6 hours. The Inspector spoke to 4 staff members, seven residents, the registered manager and the homeowner. Part of the inspection was spent on looking at the requirements made at the previous inspection together with the homes policies and procedures. Core standards not assessed at this inspection will have been addressed at the previous inspection on the 15th December 2005. In order to gain a full picture of how the home meets the needs of the residents it is advised that this report be read in conjunction with the previous and any future reports. What the service does well:
The home has a group of staff that are enthusiastic and work well together to provide a good quality of care for residents that live there. Residents spoken with were comfortable living at the home and got on well with the staff team. A good system of assessment and care planning is in place that ensures the home can appropriately meet the needs of the residents. Routines within the home are flexible to make sure that the people who live there can enjoy their chosen lifestyle. Residents are encouraged to have their say and are involved in making decisions about how they would like the home to be run and spend their time, through discussion with staff, the registered manager and the homeowner. The atmosphere in the home is welcoming, relaxed and friendly. The homeowner is keen to play an active part in supporting the registered manager in providing a quality service. The homeowner stated we run a home were the residents come first. The registered manager stated that she regularly reminds staff that they are the ‘guests’ in the home and that staff routines have to be designed around the needs and lifestyle of the residents. The home has good systems in place to make sure that residents are kept safe. The health needs of residents are well met with evidence of a good working relationships with medical staff such as the district nurses and doctors who visit the home. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 6 The registered manager closely monitors the performance of the staff she has high expectations and conducts regular audits on records and medication procedures. In house training is provided to ensure that staff are clear on their role and what is expected of them. Staff spoken to at the time of the inspection commented that the manager is available to offer guidance and support. Good policies and procedures are in place, which are regularly reviewed. A quality assurance system is in place that invites residents, relatives and visitors to the home to comment on the service provided. 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. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 7 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 Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 8 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 the following standard(s): 3 The pre admission assessment information is good. Information is gained to identify what the prospective residents can do independently and what help and support may be required. This information is collated from a number of sources and provides sufficient detail to establish if current needs, wants and wishes can be met by the home. EVIDENCE: The records of three residents were examined all had good pre admission information and a full assessment. The information was comprehensive and included detail of specialist needs. There was also evidence of other professional assessments being carried out to supplement the home’s assessment. Residents are only admitted to Lindenwood Care Home following a pre admission assessment of current strengths and needs by the home’s manager or senior staff member. This collated information, evidenced at inspection, enables the manager to make an informed decision as to whether Lindenwood
Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 9 care Home could satisfactorily address the prospective service user’s current strengths, needs, wants and wishes. This collated information forms the basis of the initial plan of care. In addition to the assessment information relatives are asked to contribute to the care plan by providing information of the residents previous life history. Due to the cognitive impairment of the residents admitted to Lindenwood Care Home this information is invaluable to establish a care plan based on what the individual likes and dislikes and what may be important in the life of the person. Staff members confirmed they had access to this information and could describe in detail the care needs of residents. People are not admitted to Lindenwood Care Home solely for intermediate care. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7,8,9 and 10 There is a consistent care planning and risk assessment process in place to ensure the assessed needs of the residents are met. The health care needs of residents are well met with evidence of good multi disciplinary working taking place as required. Medication procedures ensure that residents receive medication as prescribed. EVIDENCE: Individual records are kept for each resident with a plan of care setting out in detail the action that needed to be taken by care staff to ensure all aspects of health, personal and social care needs of the residents were met. Whilst the care plans are comprehensive and detailed the inspector felt that they were lengthy and not conducive to being working documents. Advice was given in relation to improving this documentation ensuring that care plans become meaningful working documents. Systems are in place to record all significant events, however daily entries were in the main brief and the registered manager was advised to instruct staff to make detailed diary entries in order that a complete and informative log is maintained of the resident’s wellbeing and daily living pattern. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 11 Care plans are reviewed monthly and evidence was seen to confirm that relatives are invited to contribute to the care planning process and staff and management consistently invite relatives to comment on the service. Residents spoken to, commented, that they were extremely satisfied with the care they receive with one resident saying “staff are very kind, we can have anything we want”. Risk assessments accompany the care plan and are reviewed also on a monthly basis. The health needs of the residents are closely monitored and records provided evidence that other professionals are regularly consulted and their advice incorporated into the individual residents care plan. From examination of these records it was noted that a doctors visit had not been recorded and the registered manager was asked to ensure that all staff are vigilant in their recording. Staff spoken to had a good understanding of the care needs of the residents and confirmed that they have good management support. The inspector observed staff assisting residents and was pleased to see they had good relationships with residents and carried out all tasks in a friendly and sensitive way. A good medication system is in place, which is currently being reviewed to ensure the best possible practice. The supplying pharmacy is being changed which will entail a new monitored dosage system being introduced. All medication is receipted into the home and clear records are maintained of all unused medication, which is returned to the pharmacy. The medication administration records were examined, these were found to be correctly completed, with dose omission and refused medication appropriately recorded. All medication is stored securely with the keys held by the senior staff on duty. At present no controlled drugs are in use. Due to the mental frailty of the residents they are unable to take responsibility for their own medication, however all bedrooms have a lockable facility ensuring medication could be stored securely. Staff that have responsibility for administration of medication receive training and the new supplying pharmacist is to provide training for all staff and conduct regular monitoring visits to check the procedures and provide guidance and support. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 12 It was pleasing to note that the registered manager is vigilant in her efforts to ensure that best practice is followed at all times, to achieve this she carries out weekly audits on the procedures and staff practice by checking records, counting tablets and observing practice. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 12,13,14 and 15 The staff have a good understanding of resident support needs. This was apparent from the comfortable relationships that have been formed between staff and residents. Residents are encouraged to maintain contact with family and friends and visitors are welcome at any time. There are no restrictions on maintaining contact with family, ensuring social interaction. Meals are balanced and nutritious EVIDENCE: During the inspection the Inspector witnessed the way in which visitors to the home were welcomed. There was a friendly and homely atmosphere and the visitor spoken to confirmed that he visits his wife each day and that the staff are always friendly. Staff spoken to confirmed that there are no restrictions on visiting and that they do everything possible to build positive relationships with relatives and encourage the maintenance of significant relationships between residents and their loved ones. The menus are based on providing residents with nutritious and balanced meals designed around the known likes and dislikes of the residents. Special diets were being provided and a list of what residents had chosen was kept. The cook bases the menus on good home cooking and evidently took a pride in preparing a nutritionally balanced meal. The Inspector spoke to a number of
Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 14 residents who had just finished their meal and they confirmed that they enjoyed their food. All food is bought daily by the homeowner from local suppliers. The dining room is pleasantly decorated and makes a congenial setting for eating and socialising. Due to the cognitive impairment of the residents group activities are not always successful therefore staff spend time with residents on a one to one basis. Staff also take residents out for walks and act as escort for residents to keep appointments and access community resources. Policies within the home state that all residents would be encouraged to live the lifestyle of their choice and exercise control over how they spend their time. Information regarding the local advocacy service is made freely available for residents and their relatives in communal areas of the home to enable them to access this service independently if required. From observation and discussion, it was evident that residents are encouraged to bring some of their own possessions with them into the home to make their individual bedroom feel homely and more familiar. An inventory of these possessions is kept on the resident’s file. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 18 in part Residents are protected, Criminal Record Bureau clearances are obtained for all staff employed. EVIDENCE: Staff recruitment files were examined. Criminal Record Bureau or Pova first checks are now in place for all staff working in the home. A new umbrella company has been commissioned to ensure all future referrals are processed quickly and efficiently. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 16 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 the following standard(s): EVIDENCE: All of the above core standards were assessed at the previous inspection. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 in part Staff are trained to a competent level and all training is recorded. EVIDENCE: The advice provided at the previous inspection has been acted upon. A training matrix has been developed that will enable the registered manager to monitor the training undertaken whilst providing information of when refresher courses are due. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: All of the above core standards were assessed at the previous inspection. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 20 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 2 3 4 Refer to Standard OP30 OP7 OP7 OP7 Good Practice Recommendations Records of induction training provided should be signed by the manager/trainer. Care plans should be reviewed in order that they become meaningful working documents. Staff should sign the care plans confirming they have read and understood the content. Daily diary notes should be expanded to ensure they provide a comprehensive log of the health and wellbeing of the individual resident. Lindenwood Residential Care Home DS0000045504.V287285.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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