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Inspection on 15/07/05 for Lindisfarne

Also see our care home review for Lindisfarne for more information

This inspection was carried out on 15th July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager and staff are very committed and enthusiastic about meeting the needs of residents and continue to provide very positive relations with the people they support. The manager and staff are very committed to provide people with a varied, interesting and appropriately stimulating life style. People`s needs are actively re-assessed so that they will receive the care and attention they need, when they need it. Staff are knowledgeable and well trained and are involved in regular supervision. The home provides comfortable accommodation and programmes are in place to maintain this standard. The home is very well managed and is run with the needs of residents very much at the centre of everything the home does.

What has improved since the last inspection?

The requirements from the previous inspection have been completed well within the timescales requested.

What the care home could do better:

Provide appropriate ventilation in the bathrooms.

CARE HOME ADULTS 18-65 Lindisfarne Greenvale Court Frizington Cumbria CA26 3SZ Lead Inspector Cath Wilson Unannounced 15 & 19 July 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lindisfarne Address Greenvale Court Frizington Cumbria CA26 3SZ 01946 813402 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) Walsingham Pamela Brannon Care Home 6 Category(ies) of LD - Learning Disability registration, with number of places Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of LD (Learning disabilities) 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 03 December 2004 Brief Description of the Service: Walsingham are the Registered Company for Lindisfarne. They have similarly registered homes in Cumbria and throughout the Country. Lindisfarne is located in the village of Frizington on the West Coast of Cumbria. There is a large enclosed garden and patio area. Car parking is available and there is level access into the home. Lindisfarne is on a lower level to the nearby residential court of flats and houses and the incline to the home is graduated. Accommodation is on one level and the corridor and door entrances are designed for people who may use wheelchairs. There is a kitchen, dining room, lounge, office and utility room, with private bedrooms situated off the two corridors leading from the entrance hall. Toilets and bathrooms are specially equipped and designed. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced on the first part of the inspection. The inspector returned on a second day so that other people could be met. The inspector met with residents, the manager, and senior and support staff during this period. A number of records were assessed and an inspection of the premises was undertaken. What the service does well: What has improved since the last inspection? What they could do better: Provide appropriate ventilation in the bathrooms. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 6 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. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5 Arrangements and procedures are in place to ensure an appropriate assessment is done prior to having any new people into the home. People entering the home would be assured that their individual needs will be met. EVIDENCE: People’s assessed needs are known to the manager and staff who support them and are met by the care and services provided in the home. There are appropriate procedures in place for new admissions that include existing residents needs being taken into account. The home is currently updating the Statement of Purpose and Service User Guide to ensure that people can make appropriate and informed choices. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 and 10 People’s health and personal care needs are identified, clearly recorded and are met by the manager and staff in a dignified and respectful manner. EVIDENCE: People have an individual care plan that comprehensively details their needs and the actions that have been taken to meet these. People also benefit from the health care provided from specialist health care services. The ongoing assessments of people clearly identify people’s changing needs and ensure that appropriate responses can be made to meet these. The manager and staff are well informed of each person’s needs and wishes and residents benefit from this. The attention and support people need is done in an attentive, dignified manner and respects individuality. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 and 16 People are enabled to make choices about their social lives and the decisions they make are respected. EVIDENCE: People are supported and encouraged in the way they spend their time in the home or community. People have their family visit and visits have been arranged to meet their family outside of the home. The manager and staff respects the choices people make and these include people’s religious and cultural wishes. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The manager and staff are informed of people’s individual health and personal needs and are guided in this through the detailed care planning used. This greatly reduces any risk to people in the home. EVIDENCE: The health and personal care records are very detailed, up-to-date and monitored by the manager and senior staff to ensure that people’s needs are appropriately responded to. The manager and staff are sensitively attentive to these matters and include the assistance and guidance from community health care staff in ensuring that people receive the care and attention they need. The home follows appropriate policy and procedure guidance for medicines management and staff are trained in these. Medication is securely stored, administered and recorded appropriately. The manager and staff take appropriate actions to protect people’s dignity and safety. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 People are protected from abuse through staff awareness and procedures in the home. EVIDENCE: The manager and staff have training and development programmes that include adult protection procedures and the practices required to safeguard people in the home. Future staff training is to be organised to ensure that people are kept up-to-date in these matters to ensure continued protection for people. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 and 30 People live in comfortable surroundings that are generally well maintained and clean. EVIDENCE: A recorded programme is in place to maintain the furnishings and fittings in all areas of the home. At the time of the inspection one of the bathrooms was showing signs of ceiling mould from condensation building up in the room. There is a requirement about this to provide some form of ventilation, as this is also a windowless room. The registered manager and staff work in conjunction with specialist personnel to ensure that people changing needs regarding their environmental needs are met on an ongoing basis. This will not only make the room more comfortable to be in but also more hygienic for everyone. Bedrooms are very individualised to meet the needs of people and staff are very supportive in maintaining these rooms. Work was underway on the garden area during the inspection and people can use the shaded patio area also. The home is generally clean and bright throughout. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36 People benefit from receiving care and support from a manager and staff who are knowledgeable, skilled and trained and recruited using safe procedures. EVIDENCE: The manager and staff are both committed and enthusiastic in their comprehensive provision of care. They support and guide people to live an interesting and enjoyable life-style. They are guided by the needs of people and the details contained in their individual care plans. The manager and staff receive training to give them the skills needed to meet people’s needs in addition to their experience and other qualifications. There is a programme for in-house training as well as a high percentage of staff with NVQ qualifications. Staff indicated they feel very supported by each other and encouraged and guided in their work by their manager. The home has good recruitment procedures and these include appropriate checks and references being taken up for new employees to safeguard people in the home. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 15 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 40, 41 and 42 The home is very well managed and people needs are attended to in a committed and attentive manner. Staff are provided with regular supervision that supports them to provide a high standard of care. Procedures are in place to safeguard and protect residents. EVIDENCE: The manager and staff are comprehensively informed of people’s individual needs and wishes and are committed to meeting these. There were sufficient staff on duty during the inspection to meet the needs of service users. The records assessed that the home has good procedures in place to minimise the risks to service users. Care staff receive regular supervision and have regular meetings to review the care and practices in the home. Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 16 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 2 x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lindisfarne Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 x x F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 17 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. 2. 3. Standard 24.6 Regulation 23 Requirement The bathroom must be provided with appropriate ventilation. Timescale for action 31/08/05 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 Good Practice Recommendations Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lindisfarne F58 F10 s22679 lindisfarne v232550 15&190705 ui stage 4.doc Version 1.40 Page 19 - 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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