Inspection on 25/04/07 for Lindisfarne

This inspection was carried out on 25th April 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lindisfarne 11/07/08

Lindisfarne 30/01/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Lindisfarne Church End Leverington Cambridgeshire PE13 5DB Lead Inspector Nicky Hone Key Unannounced Inspection 25th April 2007 and 20th June 2007 11:15 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.V337657.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.V337657.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 Limited Susan Bredbere Care Home 10 Category(ies) of Dementia (3), Learning disability (10), Physical registration, with number disability (10) of places Lindisfarne DS0000057383.V337657.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 31st October 2006 Brief Description of the Service: Lindisfarne is a bungalow for adults with learning and physical disabilities situated at the edge of the village of Leverington, two miles north of the market town of Wisbech. There are ten single bedrooms and a large lounge and dining room. There are two shower rooms shared by two bedrooms each, and one of the bedrooms has its own ensuite toilet and washbasin. There is a kitchen, laundry room and two further bathrooms as well as an office and staff changing room. Gardens surround the bungalow and there is a large parking area at the rear. The home has a vehicle which has disabled access. The home is close to the village shop and the church. Peterborough, with its wide range of shopping and leisure facilities is a half hour drive away. Fees are from £1,319 to £2,075 per week according to the level of disability and support needed. 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. CSCI reports are kept in the office and are available to service user representatives on request. There is also a copy of the latest report near the car park entrance to the home. The manager does not currently actively discuss the report and its contents with the service users as the level of their disability makes the report format difficult to understand. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out an inspection of Lindisfarne using the Commission for Social Care Inspection’s methodology. This report makes judgements about the service based on the evidence we gathered. The inspection included visits to the home on two days. On 25/04/07 one inspector spent eight hours at the home. On 20/06/07 two inspectors were at the home for just over three hours. The evidence we accumulated at both visits is included in this report. One of the reasons we spent two days at the home was that on the first day, one of the residents “took a liking” (in the manager’s words) to the inspector. This meant, in order to remain safe, and so that the person who lives at the home did not become further distressed, the majority of the inspection was carried out in the office. A number of the key standards were not assessed. On the second day that resident had gone out so we were able to complete the inspection and spend time in the dining room, observing the morning’s activities, including lunchtime. On both days we walked round the bungalow, spoke with residents, staff and the manager, and looked at some of the records kept by the home. On the first day the manager was on a training course and arrived at the home at about 4p.m. Senior carers were on duty, and the deputy manager, who was having a day off, came to speak to us. On the second day the manager was present all the time we were at the home. There were eight people living at the home on the first day we visited as one person was in hospital, and there was one vacancy. On the second day, the person had returned from hospital, so there were nine people. What the service does well: Several compliments from relatives had been received by the home – some are repeated here: • “We were delighted to find our relative so relaxed and happy. We were impressed with our relative’s keyworker – the way she spoke to and interacted with our relative and the other residents.” • “Our relative’s care could not be better. S/he looks wonderful and so relaxed.” • “I have no worries about the care my relative receives in your care, s/he is so well looked after.” One of the staff we spoke with said “I really enjoy working here. The staff here really care for the residents, and the seniors and the management are easy to talk to.” The manager said “I am so proud of this staff team, they have done so well”. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 6 Assessments of people’s needs are carried out before the person is admitted, and each person has a contract so that they know what they can expect from the home. What has improved since the last inspection? What they could do better: We left an immediate requirement on the second day of our inspection, because chemicals were not stored securely. This inspection has resulted in a further 21 requirements being made. Some of the things the home could do better are: • • • • • • • • • • Make sure the home runs in a way that gives the people who live their the best possible quality of life; Have enough staff on duty to meet the residents’ needs; Make sure that the information in care plans is useful for staff so that people can be supported well; Show that residents are given opportunities to make decisions about all aspects of their lives; Make sure residents’ healthcare needs are fully met; Complete risk assessments for all identified risks; Give all aspects of health and safety greater priority so that residents are kept safe; Keep personal information about people secure so that confidentiality is upheld; Improve the amount and range of daytime and leisure activities offered to the residents; Provide opportunities for personal development; DS0000057383.V337657.R01.S.doc Version 5.2 Page 7 Lindisfarne • • • • • Make meals and mealtimes a pleasant experience for everyone; Provide specific training for staff so that they are able to meet the special needs of all the individuals living at the home; Show that all staff have received enough training so that they can meet the needs of the residents; Make sure the complaints procedure is accurate and that residents are supported to complain if they want to; Make sure that all incidents of abuse are reported in line with Safeguarding (Protection of Vulnerable Adults) guidance so that residents can be confident they will be protected from harm; Improve the cleanliness and maintenance of the home and the gardens so that people have a clean, comfortable, pleasant place to live; Further develop a quality assurance system so that residents know their views are taken into account; and Make sure that the statement of purpose and service user guide (SUG) are up to date and the information is correct. • • • 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.V337657.R01.S.doc Version 5.2 Page 8 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.V337657.R01.S.doc Version 5.2 Page 9 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): People who use this service experience adequate quality outcomes in this area. Some information about the home is available and assessments are carried out so that people can decide if they want to use this service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The statement of purpose we found on the first day was dated 2005. It referred to the NCSC (which changed to CSCI in April 2004), gave the wrong address and telephone number and named an inspector who left in 2005. On the second day we found a statement of purpose which had been updated in June 2007 and contained correct information about CSCI. However, the service user guide we found on our second visit, also updated, gave a Shrewsbury address for complaints to CSCI as well as the Cambridge address. Each resident has a contract with the home so that they (or their representative) know what they can expect from the home. There was a contract on the file we looked at. One resident told us she had been asked to sign a contract by the home’s staff. She said they had explained it to her but she had not really understood it: she signed it because she trusts the staff. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 10 Assessments are usually undertaken by the home’s staff, and usually new residents would go through a transition period, with a series of visits to the home until they felt ready to move in. However, an assessment before admission, and a proper transition had not been possible for the last person to be admitted as it had been an emergency situation. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 11 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): People who use this service experience adequate quality outcomes in this area. People who use the service are not given enough opportunities to make choices and decisions about the way they lead their lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Generally care plans were neat and tidy, with the information in them well organised. However, the care plans we looked at showed that the information is not always kept up to date, and is not always in enough detail to make sure staff know how to meet each person’s needs. The care plans we saw did not include any goals for people to aim for, there was no evidence of the ways staff should promote each person’s independence, and there was nothing to describe each person’s personal development. When we discussed this with the manager, she told us that the staff had done some very good work with the service users. She quoted an example of how one person had been very gradually encouraged to leave the house, which had taken many months of Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 12 work. The manager said that person-centred planning (PCP) and care plans are discussed in supervision with each staff member. We spoke with one person who lives at the home who said she has not had much input to her care plan. She said it was done 2 years ago, and now she has her own PCP (Person Centred Planning) folder in her room. This person uses a wheelchair so staff had to retrieve the folder from under her bed, where staff said she chooses to keep it. It was evident that this person had written much of the information in the folder herself. There were details about activities (see the Lifestyle section of this report), and about her life. This person told us that she is able to choose most of what she does during the day, for example what she wants to wear and how she spends her day. However, on the second day an issue arose which showed us that her choices have been limited. We found a folder in the dining room containing “Quick client information”. The resident said she did not like what was written about her, and felt (as we did) that the folder should not be in an open area as it contained personal information about the residents. We were present when the resident spoke to the manager about this. The manager was very brusque and said that if the residents wanted staff to know how to look after them properly, this folder would need to be available to them. The resident rightly pointed out that staff should know that anyway from their care plans. This person also tried to discuss with the manager something that was written in the folder which was an issue that had been troubling her. Quite a long time ago this person had agreed with the staff that she would not lie on her bed during the afternoon if she got up after 9a.m. She told us that because of this agreement she now she has to stay in her wheelchair all day, bending over and resting her head on the bed when she is really tired. She cannot go to bed before 9p.m. in case she wets the bed. The manager was reluctant to listen to her, interrupting what she was trying to say, and insisting that a contract this person had agreed with the staff must be upheld. We asked the manager to look again at this issue with the resident. The person we spoke to was very proud that she had been instrumental in getting the local shop to have the door widened and put in a ramp so she is now able to get into the shop. She sent them a thank you card. One resident’s care plan stated that the person understands some Makaton. The plan did not specify which signs the person understands. It also said “I need staff to understand my noises as well as having training for Makaton”. The manager said that “only a few” staff have had Makaton training, as the topic is no longer available. It was clear that little effort has been made to develop this person’s level of communication using Makaton (or any other method). One person’s monthly review included “encourage her to have Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 13 conversations”. We sat at the dining room table for over an hour and noted that this person was completely ignored by the staff. On the second day of our inspection, one of the residents had moved to a different bedroom. The manager said she had moved him because she was worried about the smell from the damp shower room (see Environment section of this report). He had not chosen to move, and it is very unlikely that he would have understood the reason for the move. One person’s ‘likes and dislikes’, dated 30/05/07, recorded they do not like soup. On 13/06/07 and 17/06/07 this person had been given soup for lunch. Caretech has produced a generic risk assessment document which lists a large number of risks. Although staff delete some of the risks that are completely inappropriate for the individual, we found virtually the same risk assessments on each of the files we looked at. For the person ‘case-tracked’ on the first day, the risk assessment listed a number of risks, for example ‘out in the community’, ‘spending time alone’, ‘fire evacuation’, ‘use of wheelchair lap belt’, ‘epilepsy’ and so on. There were no risk assessments relating to his behaviour, for example, pulling another service user’s hair, and no guidelines to staff on how to manage the risk. On 25/04/07 the manager said she was working on making the risk assessments “more client-specific”: there was no change in the assessments we saw on 20/06/07. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 14 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): People who use this service experience poor quality outcomes in this area. People are not offered enough opportunities to lead full and active lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We spoke with one of the people who live at Lindisfarne. She chose to have a member of staff with her. She told us that “this is the first home that’s ever understood me”. With support from the staff she is learning to read and write. She has not been able to access any school or college courses, but said she will ask her care manager again about funding for external day services. The manager later explained that this person has an ongoing referral to a day centre and is on the waiting list. On the second day, staff were supporting this person to make a birthday card for a relative. Although she was pleased with the results, we felt that the staff, with the right training, could have supported her differently so that the finished card was more her own work. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 15 This person told us she goes to church every Sunday: staff take her and pick her up, and during the service she sits with the churchwarden who also prints out a copy of the service for her. She likes to go shopping but does that with a relative, not the staff, and she likes to go to the pub. She said as there is only one vehicle she can not get out as much as she would like, but she had been out to lunch on Monday. There is an activity board in the hallway. On both our visits, the board still included the name of a resident who had died, and did not include the resident who moved into the home in February 2007. It had not been filled in on either of the days we visited. During our first visit we were told there had been no activities in the early part of the week as the vehicle needed new tyres. As that had been done, residents who wanted to would be going to the Butterfly Park the following day, and to a birthday party at another of the organisation’s homes in the area on Saturday. Staff told us they would “like to see more games here: we usually just stick the TV or music on”. On the second day of our inspection, when we arrived staff put several activities (such as games, colouring books, craft materials) on the dining room tables and the residents chose what they wanted to do. Staff said that people can go out when they want to; everyone goes out once or twice a week. For example, they go ice-skating, bowling, to the pub, to the butterfly park and to Hunstanton. Two staff go with two residents if they plan to get out of the bus. If they are not getting out, then two staff can take four residents. There had been two barbeques in the last few weeks. However, the records of activities that people had done showed a different picture. The daily service records for one person showed that they had not been out, and had done very little in-house, between 1st and 19th June. Another person’s ‘weekly activity sheet’ listed 15 activities the person wanted to do each week: her daily record for nine days in June recorded three activities: “watched DVD”, “walk”, “car ride”. On the first day, we looked at the record of activities and opportunities for development for the person case-tracked. His activity plan showed that he goes to college on Mondays, Wednesdays and Fridays, but he was at home on the day we visited (a Wednesday). Staff explained he had recently taken up swimming but because he needed a male staff member he had had to change his college day to Tuesday. It was not clear why he could not go swimming on Tuesdays and keep his college days as usual. He did not go swimming on the first day of our visit (a Wednesday). On the second day we visited (again a Wednesday) he had gone to college. We looked at daily records for this person for 14 days from 10 – 24 April 2007. He had gone out on 8 days (for example, 3 - walk round the village, 2 – ride in the bus) and had spent the other 6 days doing “in-house activities”. In his Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 16 notes we found a ‘Life and Leisure Experiences Plan’. This showed a list of activities month by month for a year. It was not signed or dated, and there was no indication of whether any of the activities had actually taken place. Staff support residents to go on holiday if they want to. For example, one person said she has a holiday booked in Suffolk where she will be supported by 2 staff; one person went to Eurodisney; two people went to Centreparcs. One person, who needs to maintain a strict daily routine so prefers not to go out much, had enjoyed a day at the Butterfly Park. An aromatherapist visits several of the people who live at Lindisfarne: a service which they pay for themselves. The manager said that not many families visit people at the home, but when they do “everything’s discussed with them”. One person’s parents visit every month. Residents are supported to telephone their relatives if they want to: we were told that they have to use the office telephone as there is no other telephone in the home. Since the inspection we have been informed that this telephone has a cordless handset which can be taken to the residents’ rooms if they prefer. Staff said that residents can help with household chores if they want to. Staff told us that residents can only help to a limited extent with food preparation because “food hygiene says they can only cook for themselves”. This statement was repeated at our second visit so, as we thought it rather unusual, we asked the manager to clarify this with the Environmental Health Officer. The manager has done so, and has been told residents can cook for others provided the staff supporting them have had food hygiene training (which all staff must have). One person we spoke with told us that staff write the menus. Residents’ likes and dislikes are known by staff, and they also use pictures and recipe books to help people decide what they want to eat for the week ahead. On the second day we observed lunchtime: it was not a particularly pleasant experience for anyone. One person needs a strict routine and his lunch has to be ready when he wants it. We were told this is usually between 12 and 12.15, and then everyone else gets their lunch at about 12.30. When this person started his lunch, another resident sitting at the same table asked for hers. She was told she would have to be patient. A sandwich was put in front of her 40 minutes later. At the second table another person was assisted with her lunch: it was a bowl of orange coloured mush. We were told it was jacket potato and beans. The manager said staff have been told that food items must be pureed separately. Again, a second person at the table indicated she wanted her lunch but was told she would have to “wait a few minutes”. Quite a while later a sandwich was put on the table next to the toy which was in front of her. No one was Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 17 offered a drink with their meal, and there were no serviettes or anything else on the tables to indicate it was a mealtime. One person was given a fabric tabard to protect her clothes: another had a plastic apron as all the tabards were in the wash. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 18 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): People who use this service experience adequate quality outcomes in this area. The home could improve the way it meets people’s healthcare needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The new member of staff we spoke with on the first day said that the care plans are clear and explained everything well, so she was able to support people in the way they want. She said some things are commonsense, such as supporting people to clean their teeth twice a day, even if it’s not in the care plan. A hairdresser visits the home, or people have their hair washed in the bath. Two of the residents had been out to the hairdresser. She said all the residents have their own clothes which have their names on. There was a health action plan in place for the person we ‘case-tracked’ on the first day, and a record of health-related visits. This record showed that the person had not been to the doctor since 12/01/05: the manager said this was not correct as she could recall him seeing the doctor about a chest infection quite recently. The record showed he had been to the dentist in April 2006, Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 19 and the optician in November 2004. He was weighed monthly but there was no indication as to why staff thought this was necessary, as his weight has remained stable for some time. On the second day, when we looked at two more files, we realised that everyone gets weighed on the same day each month, regardless. One person went into hospital in April because there was serious concern about her loss of weight (the record showed she had lost almost 6 of her body weight in 5 weeks). She returned from hospital on 21/05/07: she was not weighed until 07/06/07, and had not been weighed again by 20/06/07. One person told us she goes to the dentist every 6 months, and staff said residents who need to are supported to visit a chiropodist in Wisbech. One of the residents went to the dentist, accompanied by staff, on the afternoon of the first day of our inspection. None of the people who live at Lindisfarne are able to look after their own medication. Medicines are kept in a locked cabinet in the office and administered by staff. We saw Medication Administration Record (MAR) charts for January and February 2007 on one person’s file which were completed correctly. The manager said she has been trained and assessed to administer medication, and she trains staff and assesses their competence. One person has been prescribed a drug for epilepsy which is administered rectally. The manager told us the training was done by a member of Careforce staff who is a qualified nurse, but in future will be done by an external trainer. There is a letter on the person’s file, dated 24/08/05, from the person’s doctor, stating that it is acceptable if this drug is administered “by suitably qualified staff”. Following the inspection the manager sent us a copy of one of the certificates issued to staff which states that the trainer is an “ENB N45 RNMH Epilepsy Specialist Nurse”. The certificate states that the staff member ‘has achieved a satisfactory degree of awareness in the assessment that concluded this course’. CSCI guidance on the safe administration of medicines states that a healthcare professional can delegate this task to care staff, providing the healthcare professional is satisfied that the staff member is competent. The healthcare professional retains responsibility. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 20 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): People who use this service experience poor quality outcomes in this area. Adult protection protocols were not followed for some incidents so people who live at Lindisfarne cannot be confident they will be kept safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Part of the reason for this inspection being started in April was that a complaint was received by CSCI from the relative of a person who moved out of Lindisfarne a few months previously. CSCI does not investigate complaints, so we asked the person’s funding authority (Cambridgeshire County Council) to investigate the complaint. However, as some of the issues raised gave us some concern, we discussed the complaint with the manager. She told us that several complaints had been received from this person and had been dealt with. At the time of writing this report we have not received the conclusion to the investigation from Cambridgeshire County Council. The complaints procedure did not contain accurate enough information for people to be able to contact external agencies such as funding authorities or CSCI if they want to (see Choice of Home section of this report). On our first visit, one of the male service users “took a liking” (in the manager’s words) to the inspector, and grabbed her several times. Staff did not know how to release his grip, and were unable to distract him sufficiently for the inspector to be able to work anywhere but in the office. The manager said staff had not had any training in dealing with this type of behaviour as this Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 21 had never happened before. However, on checking this person’s file, we found a record that he had pulled another resident’s hair three times in three weeks. These incidents had not been reported to the POVA team, so the person who had been assaulted (or their representative) had not had the opportunity to decide if they wanted to take this further. Nor had they had the support they would have needed to make a complaint about the treatment they received, or about the fact that the home had not reported the assaults they had endured. One person told us that she has a bank card: “staff take it and get the money from the hole in the wall for me”. We were told that Caretech has an account in the residents’ names. One person has a solicitor who deals with everything. Residents pay for their holidays. For example one person rented a cottage in Suffolk: she paid for the cottage, her food and any leisure activities. The home paid the staff’s wages, and the staff paid for their own food. Residents pay for mileage: the cost is divided between whoever went on the trip. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 22 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): People who use this service experience adequate quality outcomes in this area. There is still more work to be done at this home, both inside and outside, to make sure the residents have a comfortable, homely, clean and safe place to live in. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We walked round the home on both days we visited. We were pleased that some of the defects we pointed out on the first day had been put right by the second day. For example, fire extinguishers in the bedroom corridor were completely surrounded by hoists and other equipment so would not have been reached in the event of a fire. By the second day the extinguishers had been re-positioned. The manager told us that a lot of flooring has recently been replaced, including the carpets in six bedrooms, the lounge carpet, and hard flooring in the dining Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 23 room. The carpet in the front hall and two of the bedroom carpets we saw as we walked round were very badly stained. Stains were appearing on the new lounge carpet: the manager had removed these by our second visit. We noticed that the covers of some of the chairs in the lounge were torn and stained. The manager told us these chairs were left from when Lindisfarne was a home for elderly people. The chairs look very institutional. Other defects we noticed on both days included damp patches on the walls in the bedroom corridors; a very dirty bath; stained flooring and wall in one of the bathrooms; several bedroom doors badly damaged by wheelchairs; and two very dirty wheelchairs. One person who is in a wheelchair told us she is not able to open her bedroom door without assistance from staff, because the door closer (required because of fire regulations) keeps the door closed. There are devices approved by the fire authority which hold a fire door open so that residents can get in and out of their rooms when they want to. However, since the inspection we have been told that this person is able to open her door independently. There are two shower rooms in the home, each between two bedrooms. On our first visit these were both in need of refurbishment. One was far worse than the other, but both had mould growing on the flooring, tiles, boxing round the pipes and so on, and smelt very damp. In one the shower chair was covered in mould and grime, the toilet was dirty and the fluorescent light was flickering. The damp smell from this shower room was in both the bedrooms at either side. The manager said that these were going to be refurbished very soon: she agreed that they would be done by 31/05/07. When we returned on 20/06/06, nothing had been done, and the worst of the two shower rooms was absolutely disgusting. As well as all the mould (much of which could have been wiped off), the toilet was spattered on the outside with brown matter. The manager said she had moved one of the residents from one of the rooms because she was worried about the damp (see Individual Needs and Choices section of this report). On our first visit, there was a large tin full of cigarette ends in the porch outside the front door. The tin was so full it had overflowed onto the floor. This was still there on the second day. The manager said the company will be buying proper outdoor cigarette bins (see Conduct and Management section of this report). The company must ensure they follow the requirements of the Smokefree Regulations 2007. There is a small patio outside the dining room where some of the residents were sitting in the sun on the second day we visited. On the first day we visited the home the gardens were untidy and full of weeds, and in the front garden there was a pile of broken paving slabs which could be a hazard. This Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 24 was discussed with the manager who said she was about to get the gardens sorted out. On the second day the gardens were still in a poor state; even the paving slabs had not been moved. The manager told us during our first visit that the staff are hoping to make one of the bathrooms into a sensory bathroom which they think one of the residents in particular will enjoy. Nothing had been done in this bathroom by our second visit two months later. Staff also feel a sensory cabin in the garden would benefit the residents, but the company is not keen on the staff doing fund-raising activities, so the funding for this might not be found. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 25 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): People who use this service experience poor quality outcomes in this area. There are not enough staff on duty to make sure each person’s needs are met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager told us there are five staff on duty from 07.30 to 21.30. The staff also do all the cleaning, cooking, laundry and so on as well as supporting nine very dependent people. The manager told us that one person is funded to have one-to-one support. From the evidence we found during both days of our inspection, staffing levels are not adequate to make sure people’s individual needs are met. One of the seniors used to be a registered manager at a service for older people. She has been awarded NVQ levels 2 and 3 and is now undertaking a “trainee manager course”. Training records seen on the first day showed that no training had been recorded for one member of staff since 12/12/05 (16 months). Records for another person showed that in the 18 months since they started working at the home they had received training in a range of topics, such as moving and Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 26 handling; epilepsy; fire; first aid; medication; POVA; LDAF (Learning Disability Awards Framework) induction and more. A training matrix for 2007 provided by the manager showed that most of the staff were due to have training in a number of topics in the first months of 2007, but that the majority of this training had not taken place. The manager told us that training in Makaton is no longer available (see Individual Needs and Choices section of this report). On the first day we spoke with a member of staff who had been at the home for about 6 weeks. She said she had had a week’s induction, covering a wide range of topics. At the end of the week she had completed a written test which had been sent away to be marked. She was doing fire training, and moving and handling training was booked for a date in May. This person said she had not had a supervision session, but had attended a “very useful” staff meeting. We checked the personnel record for one staff member. Some of the information that must be kept on file was not available, including a photograph. The manager thought that as each staff member has an ID card with their photograph on it, it was not necessary to keep one on the file. By our second visit she had realised this was not correct and that a photograph of each staff member must be kept on their file. She told us she had done this but we did not check any more files. We will do this at a future inspection. The deputy manager explained that she supervises the senior support workers, who in turn supervise the support workers. She said that everyone has supervision monthly. We did not check supervision records. Staff meetings are held monthly: most staff “turn up” and night staff have to attend three times a year. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 27 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): People who use this service experience poor quality outcomes in this area. This service is not managed well enough to make sure the people who live at Lindisfarne have the best possible quality of life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We found several examples of very institutionalised practice. For example, • • all the residents being weighed on the same day, regardless of their individual needs (see Personal and Healthcare section); drawers in bedrooms labelled (for example ‘socks’, ‘nighties’, ‘underwear’ and so on) (see Environment section); DS0000057383.V337657.R01.S.doc Version 5.2 Page 28 Lindisfarne • • • • a notice on the board in the corridor stating which flannels should be used for washing which part of the body; plastic aprons being used to protect people’s clothes at lunchtime (one of the residents commented that this looks like a hospital); a folder containing “Quick client information” in the dining room (see Individual Needs and Choices section); the procedure at lunchtime (see Lifestyle section). The manager said she knows there is a lot of institutionalised practice going on which she is having difficulty addressing. We observed an interaction between the manager and one of the residents which concerned us (see Individual Needs and Choices section). The home has a system to check the quality of the service it offers. The manager said that a survey form was sent to residents’ representatives in December 2006. She told us the results will be collated and a report will be written. She told us that the organisation carries out a 6 monthly audit: the last one was done in November 2006 for the period from July to December 2006. The manager explained that this audit is changing, and will be based on CSCI’s AQAA (Annual Quality Assurance Assessment). Staff rotas on the wall did not have surnames of staff, and a lot of correcting fluid had been used. The rota is a legal document which must be accurate, and correcting fluid must not be used. Records of tests of the fire alarm showed that tests were carried out weekly to 03/04/07, then on 16/04/07 (a gap of 2 weeks). On 25/04/07 we reminded the manager that a test was due, and that tests must continue to be done weekly. The record showed that the emergency lighting is tested monthly as required. The last fire drill was carried out on 13/12/06. All staff must be involved in a fire drill at least once a year. The manager must ensure that all other relevant legislation is met, which will include the new smoking laws which come into effect on 01/07/07 (see Environment section of this report). On our first visit there was a bottle of cleaning chemical in one of the bathrooms which the manager removed during the visit. On the second day there were chemicals being stored in unlocked cupboards in the kitchen and the laundry. We left an immediate requirement notice with the manager to make sure this hazard to the safety of the residents was dealt with quickly. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 29 In the laundry we found a sink full of dirty laundry. This included the tabards people wear when eating their meals, dirty towels, and a red bag full of personal laundry. The red bag (usually used to ensure personal clothing is kept separate to reduce the risk of infection spreading) was split. This system of storing dirty laundry does not meet infection control standards. The kitchen was clean and tidy, and all food in the fridge was labelled with the date it was opened/put in the fridge. Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 30 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 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 1 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 1 LIFESTYLES Standard No Score 11 1 12 1 13 2 14 1 15 2 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 1 2 X 2 1 X Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 31 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 YA1 Regulation 4, 5 and 6 Requirement The statement of purpose and service user guide must contain up to date, accurate information, and be reviewed regularly, so that people have correct information about the home. Care plans for each of the residents must give clear guidance to staff on the way in which each person’s individual needs are to be met. Goals must be included, and broken down into measurable tasks with specific timescales. Evidence must be provided to show that residents are supported to make decisions about the way they want to lead their lives. Risk assessments must be completed in all areas of activity relevant to each person, so that staff know how to keep people safe. Timescale for action 31/08/07 2 YA6 15 31/08/07 3 YA7 12(2) 30/09/07 4 YA9 13(4)(c) 30/09/07 Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 32 5 YA10 17(1)(b) Information about people who live at the home must be kept securely so that confidentiality is maintained. People who live at the home must be given opportunities for personal development. Opportunities for residents to take part in meaningful daytime activities, in and out of the home, must improve, so that residents lead full and active lives. Residents must have opportunities to take part in appropriate leisure activities so that they can have full social lives. Healthy, nutritious and appetizing meals, chosen by the people who live at the home, must be provided in a pleasant setting so that people enjoy their mealtimes. Residents’ healthcare needs must be fully met, so that residents keep well. The complaints procedure must be clear so that people know who they can complain to. Incidents of abuse must be reported according to the Safeguarding (Protection of Vulnerable Adults) Protocols, so that residents are kept safe from harm. The defects in the environment, inside and outside, discussed on the days of the inspection and DS0000057383.V337657.R01.S.doc 20/06/07 6 YA11 12(1)(b) 30/09/07 7 YA12 16(2)(n) 30/09/07 8 YA14 16(2)(m) 30/09/07 9 YA17 19(2)(i) 31/08/07 10 YA19 12(1)(a) 30/09/07 11 YA22 22 31/08/07 12 YA23 13(6) 20/06/07 13 YA24 23(2)(b) 31/08/07 Lindisfarne Version 5.2 Page 33 referred to in this report, must be rectified so that residents have a pleasant place to live in. 14 YA27 23(2)(j) The bathrooms and shower 31/08/07 rooms which were in a poor state must be refurbished, so that they are pleasant and hygienic rooms for residents to use. All parts of the home must be clean and smell pleasant, so that residents have a nice home to live in. There must be enough staff on duty at all times to make sure residents’ need are fully met. Training must be provided to all staff, in all relevant topics, so that they know how to support the residents well. The management of the home must be open, inclusive and effective so that residents are offered a good quality service. Records required by the regulations must be up to date, accurate and retained for three years, so that evidence is available to show that the regulations and standards have been met. Staff rotas must contain staffs’ full names. Correcting fluid must not be used on any legally required records. Chemicals must be stored securely so that residents are protected from harm. An immediate requirement was left at the home regarding this. 31/08/07 15 YA30 23(2)(d) 16 YA33 18(1)(a) 15/08/07 17 YA35 18(1)(c) 30/09/07 18 YA38 9 30/09/07 19 YA41 17 and schedule 4 31/08/07 20 YA42 13(4)(a) 20/06/07 Lindisfarne DS0000057383.V337657.R01.S.doc Version 5.2 Page 34 21 YA42 23(4) Tests of the fire alarm system must be carried out as required to make sure the system works well and keep residents safe. Infection control measures must improve so that the people who live at the home are protected from infection being spread. 20/06/07 22 YA42 13(3) 15/08/07 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.V337657.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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 - 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. 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