Inspection on 11/07/08 for Lindisfarne

This inspection was carried out on 11th July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lindisfarne 30/01/08

Lindisfarne 25/04/07

Lindisfarne 31/10/06

Lindisfarne 15/02/06

Lindisfarne 23/09/05

Lindisfarne 21/02/05

Lindisfarne 29/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Lindisfarne Church End Leverington Cambridgeshire PE13 5DB Lead Inspector Andy Green Unannounced Inspection 11th July 2008 10:30 Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 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 Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindisfarne Address Church End Leverington Cambridgeshire PE13 5DB 01945 464817 01945 464817 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) Caretech Community Services Ltd Care Home 10 Category(ies) of Dementia (3), Learning disability (10), Physical registration, with number disability (10) of places Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three named service users with dementia under 65 years of age Date of last inspection 30th January 2008 Brief Description of the Service: Lindisfarne is a large bungalow situated at the edge of the village of Leverington, which is near to the market town of Wisbech. The home provides care and support for 10 adults with learning and physical disabilities. There are ten single bedrooms and a large lounge and dining room. There are two shower rooms shared by two bedrooms. The remaining bedrooms have their own ensuite toilet and washbasin. There is a kitchen, laundry room and two further bathrooms as well as an office and staff changing room. There are gardens to the front and rear of the property. There is a large parking area at the rear and the home has two vehicles, one of which has disabled access. The home is close to the village shop and the church. Peterborough is a half an hour drive away, giving residents a wider range of shopping and leisure facilities. Residents fund their own social activities including admission for their carer if required. They pay for their own holidays, any extra day services beyond those as part of their care plan, personal clothing and hairdressing. Fees are from £1319 to £2075 per week according to the level of care and support that is required. CSCI reports are kept in the office and are available to service user representatives on request. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. CSCI undertook a key unannounced inspection on 10th July 2008. We inspected a number of records including care plans, training records, health and safety records and staff files. A tour of the building and grounds was also undertaken. We met a number of residents during the inspection. As the majority of residents have very limited verbal abilities it was not possible to gain their views regarding the support they receive in the home. However, it was clear from observations that they receive a caring and supportive input from the staff team. Three members of staff were interviewed to gather their views regarding the service, training and support they receive. The Annual Quality Assurance Assessment (AQAA) was completed by the manager of the home. This a self assessment process that focuses on how outcomes are being met for people who use the service. What the service does well: What has improved since the last inspection? A number of improvements have been made to the environment details of which are contained in the ‘Environment’ section of this report. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 6 Some improvements have been made regarding the provision of activities for residents. Two carers have been allocated to give greater emphasis to this area. A Personal Profile document has been implemented, which documents resident’s goals in a pictorial style to include the resident’s views in a more creative way. 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. The summary of this inspection report can be made available in other formats on request. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures that appropriate information is sought prior to a resident being admitted to the home. EVIDENCE: The home carries out a pre admission assessment. Evidence of a recent assessment was seen during the inspection. Medical and social reports are also received where appropriate from a variety of professionals. The manager stated that there have been no changes made to the assessment procedure since the last inspection however, she stated that the assessment process is reviewed throughout the year to ensure its effectiveness and that appropriate information is received. Prospective residents and their family/relatives can visit as part of the assessment process and when they move in to the home. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive personal care and support to meet their assessed needs. The care planning processes need to be reviewed so that information is adequately recorded. EVIDENCE: Four care plans were inspected and they contained detailed and appropriate information. The care plans are written in a style that incorporates the resident’s views, choices and preferences as much as possible. Likes and dislikes, support and personal care needs are recorded. Visits made by healthcare professionals are also documented. Daily notes were also seen and they contained appropriate information describing events and appointments, which have occurred during the residents’ day. There was evidence that reviews of care plans have recently taken place. This was seen in the care plans seen during the inspection. However, the care planning system needs to be reviewed, as information is recorded/stored in a variety of files. There was evidence to show that information is not always cross-referenced. An example was noted in a personal file where a resident would like to make their own drink in the kitchen Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 10 with staff assistance, but no reference was recorded in her main care plan documents as to how this would be achieved. Making a drink had previously been recorded but had been scribbled out without explanation. Staff spoken to confirmed that the care planning system was cumbersome, confusing and sometimes unnecessarily complex. It would be more efficient if information was held in less files and older information was archived so that care plans are easily accessed and cross-referenced. The home has recently introduced an individual person centred file for each resident, which is in a pictorial format using photographs showing the individual resident engaged in the life of the home and also pursuing activities. and engages the resident in a more interactive and creative way. A risk assessment process is in place to ensure that residents are protected from potential harm both within the home and when accessing the community. These are kept in a separate file. There was insufficient detail recorded in a risk assessment regarding how staff should assist one of the resident’s challenging behaviours. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide support to ensure that residents have access to activities appropriate to their needs. EVIDENCE: Residents have access to a variety of activities. Examples given included shopping, visits to the Butterfly Park, hairdressers, daytrips to local resorts, and regular trips out with relatives. Three residents continue to attend local day services. Residents have access to television and DVD’s in the main lounge. They can spend time in their own rooms if they wish and a number of bedrooms clearly evidenced that personal preferences are promoted including sensory areas, music and television. Two of the carers have been given the delegated task of developing a wider range of activities for residents. It was suggested that the home makes Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 12 contact with NAPA, (National Association for Providers of Activities) to gain more knowledge and ideas regarding further activities for residents. Residents are encouraged to take part in the daily life of the home with staff assistance including laundry, cleaning and food preparation where possible The gardens are being redeveloped to include a sensory area to provide further interest for residents. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal care is provided appropriately in the home to ensure that the residents’ assessed needs are met EVIDENCE: Residents continue to receive care from a range of healthcare professionals and staff provide assistance for residents to attend outpatient appointments as required. The manager stated that there had not been any significant changes in healthcare arrangements since the last inspection. Health and personal care is documented in individual care plans and visits from healthcare professionals are recorded as appropriate. Individual risk assessments are recorded and there was evidence that they are reviewed to ensure that residents are protected from potential harm. Three resident files were inspected and risk assessments were in place . Examples included bathing, eating, using transport and accessing the community. Medication records were accurate and up to date apart from some omissions in the recording of ‘Thick & Easy’ drinks. However, the current arrangements for the storage of medication must be reviewed. The medication room needs to be re-sited as staff have to negotiate Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 14 two sets of stairs and open a stair gate, often while holding medication prescribed in a syrup form. All staff spoken to stated that there had been a number of occasions when they had nearly tripped when negotiating the steps and would prefer to have the medication cabinets back in the office. The current medication room is cramped and difficult to work in. Both inspectors felt that the office could easily be reorganised so that the medication cabinets could be re-installed over the sink/worktop area and medication could be dispensed without potential hazards. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22.23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints process to ensure that residents have their complaints and concerns listened to and acted upon properly. Residents are protected from abuse. EVIDENCE: The home has a complaints procedure, which ensures that all complaints are fully investigated and actioned appropriately. The home has received one complaint since the last inspection, which has been satisfactorily dealt. CSCI has not received any complaints regarding the home. Care staff spoken to confirmed that they had received Safeguarding training and it was clear from conversations that they would have no hesitation in reporting any incidents or allegations of abuse. It was clear through observations that the care team are committed to the care of residents. They were observed to speak in a respectful, sensitive and friendly manner. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment of the home provides residents with a safe, comfortable, clean place to live. However, there are areas that need attention. EVIDENCE: A number of improvements have been made to the environment since the last inspection including the following; • • Incontinence pads have been removed from the bedrooms and ensuite toilets. Bedrooms are well presented, clean, and tidy and reflected the preferences of individual residents. A blind has been installed in one of the bedrooms. Ensuite toilets and communal bathrooms were clean and hygienic. An area of the wall in one of the corridors needs attention and the senior carer stated that the maintenance department are dealing with it. DS0000057383.V368279.R01.S.doc Version 5.2 Page 17 • • Lindisfarne • • The lounge/dining area has been redecorated. A number of appliances have been replaced in the kitchen including; a toaster, kettle and a food processor. One the resident’s bedrooms has a set of impressive sensory equipment installed which includes a fibre optic light display, two projectors and an in built music system. This has proved very beneficial and calming for the resident especially when he has been agitated or stressed during the day. Another resident proudly showed us her bedroom, which reflects her favourite colour and has been decorated with a ‘pink theme’. Resident’s artwork is now being displayed around the home and it was positive to see an attractive display on the wall in the reception area. The gardens are being regenerated and re-landscaped to include a sensory area with a pond. However, a number of carpets and floorings in bedrooms and hallways are clearly stained and damaged and must be replaced. Although carpets are cleaned with professional equipment they are now beyond renovation. An audit/research needs to be undertaken so that appropriate flooring is laid especially in areas where there is continuous ‘traffic’ during the day and where the management of resident’s incontinence remains a problem. A lounge chair in one of the resident’s bedrooms was badly stained even though the staff stated that it had been regularly cleaned. The chair needs to be replaced with one that can be easily maintained. A more appropriate chair was found and the carer stated that she would swap them over later in the day. Members of staff also stated that the installation of a ramp near to the front door would be beneficial so that residents can access the front gardens instead of the current arrangement, which is somewhat complicated. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The agency’s recruitment and training processes ensure that residents are protected from harm. EVIDENCE: Four staff files were seen and they contained appropriate recruitment information. The organisation’s personnel department continues to deal with all recruitment to ensure a consistent approach. The home then receives a staff information document, which confirms that all recruitment checks have been made including CRB/POVA and references. References are not kept in the staff files in the home. Care Tech has an agreement with CSCI that recruitment documentation is dealt with in this way. Members of care staff stated that they received regular ongoing training throughout the year in both mandatory health & safety issues and care related topics. Examples included Safeguarding Adults training, food hygiene, infection control, epilepsy, bereavement, supervisor training, crisis intervention, medication and moving and handling. NVQ training courses continue at both levels 2 & 3 to meet nationally agreed standards. Care staff confirmed that they felt well supported by the manager and senior staff and that they received recorded supervision on a monthly basis to Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 19 monitor their performance and development needs. They also stated that they were encouraged to participate in the development of the service and that they were able to raise ideas and issues in the regular staff meetings. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and the manager provides supportive leadership to ensure care and support is delivered. EVIDENCE: The manager continues to provide an inclusive and supportive management style in the home. This was confirmed by the staff spoken to during the inspection. She undertakes regular training to update her own knowledge and skills. The manager is in the process of applying to become registered with CSCI. There have been some improvements in the management of the home especially regarding the environment . Weekly alarm and monthly emergency light testing records were inspected and they are recorded accurately. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 21 It would be beneficial if the home had access to a more up to date computer system including e-mail and internet to improve management processes. Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 23 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. 1. Standard YA6 Regulation 15 Requirement Timescale for action 30/11/08 2. YA24 23(2)(b) 3 YA20 12(2) The care planning process must be reviewed to ensure that information is accurate, accessible and up to date The home must be well 30/11/08 maintained. Flooring in hallways and a number of bedrooms must be replaced The current arrangements for 31/10/08 the storage of medication must be changed to minimise potential hazards and aid administration. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Lindisfarne DS0000057383.V368279.R01.S.doc Version 5.2 Page 25 - 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. 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