Inspection on 13/11/08 for Lindisfarne Care Home

This inspection was carried out on 13th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lindisfarne Care Home 28/06/07

Lindisfarne Care Home 14/06/06

Lindisfarne Care Home 15/12/05

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lindisfarne Care Home Masefield Road Hartlepool TS25 4JY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Martin     Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Lindisfarne Care Home Masefield Road Hartlepool TS25 4JY 01429244020 01429244240 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Wendy Moses Type of registration: Number of places registered: Gainford Care Homes Ltd care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 54 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia Code DE, maximum number of places: 34 Old age, not falling within any other category - Code OP, maximum number of places: 30 Physical Disability - Code PD, maximum number of places: 2 Date of last inspection Brief description of the care home Lindisfarne is a purpose built residential care home, owned by Gainford Care Homes Ltd. It is registered to provide residential care for a total of 54 older people, with up to 34 people living at the home needing specialist dementia care. The home opened in August 2005 and is located on the Rift House housing estate, on the outskirts of Care Homes for Older People Page 4 of 32 Over 65 0 30 0 34 0 2 Brief description of the care home Hartlepool. It is on a major bus route with small, local shops and community facilities nearby. It has ensuite bedrooms and communal facilities located on the ground and first floors. Further facilities, including the kitchen, laundry, an activities room, hairdressing salon and staff room are located on a lower ground floor. Lift and stair access is available to all floors. There is a car park and garden area. The current scale of charges starts at 357 pounds per week and does not include the cost of hairdressing, chiropody and newspapers. Up to date information about fees and terms and conditions should be sought directly from the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The inspection took place over one day on 13th November, with a total of 8 hours being spent in the home. The site visit was completed by one inspector. During our visit we spent time observing care practice, talking to care and nursing staff, talking to people who live at the home and their visitors and discussed things with the homes manager. We observed some of the lunchtime meal and looked around the home. We also looked at a selection of records that are kept by the home. Before our visit we asked the home to complete a self-assessment. This told us about the home, what they thought they did well and what they wanted to improve. It also Care Homes for Older People Page 6 of 32 provided information about the people who live and work at Lindisfarne. We sent a selection of surveys to people who live at the home, the staff and health care professionals who visit. Six people who live at the home, six relatives, four staff members and two health professionals completed and returned surveys to us. The results of these surveys have been incorporated into this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated at the next inspection, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Since the last inspection more staff have completed their National Vocational Qualifications (NVQs) in care and the manager has completed the Registered Managers Award (RMA). These are specialist qualifications for people working in care and mean that the staff are well qualified to do their jobs. Certain staff have also taken on specialist roles (including training) in continence, nutrition and infection control, to Care Homes for Older People Page 8 of 32 help and improve standards in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed, are given the opportunity to look around the home where possible and are provided with written information. This helps to make sure that the home can meet peoples needs before they move in. Evidence: In the homes self-assessment the manager told us no appointment is necessary to view the home. I spend time chatting to the family and potential client over a cup of tea, establishing their needs and how we could meet them. New clients are admitted only after a full assessment is undertaken and the home is certain their care needs can be met. During our visit the manager told us that she normally goes out to assess people before they move in, as well as gathering information from other professionals involved in the persons care. We looked at the records for someone who had recently come to live at Lindisfarne. These contained assessments and information from other professions. Care Homes for Older People Page 11 of 32 Evidence: People who returned surveys were asked if they had been given enough information about the home to help them make decisions before they moved in. Three people said yes and three said no. We asked relatives if they were given enough information about the home to help them and their relative make decisions. Five said always and one said usually. The manager explained how sometimes people are too ill to look around the home and gather information themselves, in which case relatives are given the information. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff treat people nicely and people receive the personal and health care they need. Medication is administered safely by appropriately trained staff. Evidence: Each person living at the home has their own plan and record of the care they need. We looked at two of these records. These were generally well kept, providing staff with up to date information about peoples care needs. However, some things could be improved. Occasionally reviews were not taking place when they should. One person had been assessed as being at high risk in their nutritional risk assessment, but a care plan telling staff how to manage this risk had not been put in place. We also found that one record didnt accurately reflect the care that was actually being given. For example, a record of district nurse visits showed that the district nurse hadnt visited someone since July, but the care plan said that the nurse was visiting daily to help treat a pressure sore. The plans we looked at could contain more individual and detailed information about peoples wishes and preferences. This would help make them more focused on the individual person, rather than just the care tasks staff Care Homes for Older People Page 13 of 32 Evidence: needed to help them complete. In surveys we asked people if they got the care they needed. Four people said always, one said usually and one said sometimes. We asked if staff listened and acted on what people said. Five people said yes and one said no. We asked relatives if the home met the needs of their relative. Five people said always and one said usually. Comments included mother is delighted with her support, provide comfort and care to a high standard and very well looked after. One person was not so happy with the care they received, saying some of the staff will help, others in one ear out of the other. However, this was not representative of the overall survey results. A health care professional who visits the home told us that this care home has a welcoming atmosphere, staff are courteous and respectful of their residents needs, they are working closely with community matrons, specialist MacMillan nurses and district nurses to improve care. We observed staff providing care during our visit. We saw staff assisting people nicely, talking to people and giving people different choices. Staff used equipment appropriately to help people move around the home. For example, staff used the footplates on wheelchairs, so that people were not at risk of injuring their feet and ankles while being moved around. We saw that there was usually a staff member in or around the communal lounges, particularly downstairs in the dementia care unit. This meant that people were appropriately supervised and could get help if needed. We watched a staff member giving out the lunchtime medication. She did this appropriately, giving people their medication and then signing the medication administration record (MAR). The medication trolley was neat and tidy. Medication that needed to be used within a limited time of opening had been labelled with the opening date. The MARs we looked at showed that people were being given their medication appropriately. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are regular activities and events taking place that people can join in with. People get a nutritious diet, with a choice of food being available at each mealtime. However, the food doesnt always appeal to everybodys personal tastes and snacks and drinks are not always given as often as they should be. Evidence: The home employs an activities co-ordinator. She works 30 hours each week to help keep people entertained and stimulated. She told us about some of the things she does with people, which include bingo, dominos (using big brightly coloured dominos to help people take part), manicures, ball games, reminiscence and games. There is a large activities room and regular events include a coffee, birthday parties, knitting club, crafts and sing-a-longs. Seasonal activities coming up for Christmas included carol singers, a trip to the pantomime, making crackers and putting up the tree and a Christmas party. In surveys we asked people who live at the home if there are activities organised that they can take part in. Three people said always, one said usually and two said sometimes. Comments made to us included I enjoy them, they are very good, I Care Homes for Older People Page 15 of 32 Evidence: enjoyed helping get ready for our fayre and they take people to church and allow religious figures to visit and see people, music to suit the generation is often played and appreciated by the elderly residents. We saw visitors coming and going throughout our visit. People said that they could visit regularly and were made welcome. However, as sign on the homes door says that the home discourages visitors during meal times. We spoke to the manager about this. She told us that they discouraged professional visitors during meal times, because people were being disrupted while having their meals. However, she said that family can join their relatives at meal times if they wish too. One relative we spoke to said it would be nice if they could go and make a cup of tea when they visited. During our visit we saw people spending their time in their own rooms or in communal areas, depending on what they wanted to do. Staff also offered people choices about joining in activities and what they wanted to eat and drink. However, some people at the home cant tell staff about their preferred routines or preferences (for example, when they like to get up, go to bed or have a bath or shower, if they always wear make-up or perfume and like to be smartly or casually dressed). Because of this it is important that their care records contain this information, so that staff can more easily cater for peoples wishes and preferences. We watched the lunchtime meal. The dining rooms were pleasant places to eat. Tables were set with tablecloths, cutlery, flowers, napkins and condiments. Staff gave people a choice of juice or water to drink with their meal and a kitchen assistant served the meals from a hot trolley. There was a choice of lamb hotpot or cheese and ham omelet, with potatoes and vegetables. Pudding was chocolate sponge with chocolate sauce. We thought the food provided looked appetising. The chef told us that there was a choice of corned beef hash or soup and sandwiches at teatime, followed by scones. In surveys a staff member told us in 2007 the EHOs (environmental health officers) introduced a new system called safer food handling. Our chef scored the full five star rating for food handling, food hygiene, documentation and cleanliness, the highest award given. The manager showed us a letter confirming this during our visit. In the surveys we asked people if they liked the food at the home. Two people said always, one person said usually, one person said sometimes and one person said never. The people we talked to about the food had very mixed views. Some people thought it was good and others said that they really werent keen on it and thought it could be more varied. One person told us how he could have different things if he didnt like the main options, saying they are very good that way, I even had the chef up to see me. We looked at the menus, which showed a varied selection of food. People told us that they usually get a drink during the morning and afternoon, but that Care Homes for Older People Page 16 of 32 Evidence: this sometimes doesnt happen. One person commented that it depends on whos on or if they are busy. People also said that they didnt very often get biscuits or snacks with their mid-morning and afternoon drinks. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures and staff training help to ensure that any concerns are dealt with appropriately. Evidence: In their self-assessment the manager told us we have a robust and effective complaints procedure. All complaints are dealt with seriously - we listen and act on all information given to us by clients and relatives. In surveys we asked people if they knew how to complain and who to speak to if they were unhappy about something. Four people said always and one person said usually. One person was less positive, commenting that they didnt feel people listened to their concerns. We asked relatives if the home had responded appropriately if they had raised concerns about their relatives care. Five people said always and one said usually. Comments made to us regarding complaints included always listen to complaints if any, they report back with response regarding any concerns and excellent. We looked at recent complaints records, which showed that complaints had been handled appropriately. The home told us in their self-assessment that they have in place policies and procedures for adult protection and whistle-blowing. Staff have received training on no secrets and the manager told us how she plans to continue actively promoting whistle-blowing with staff. Further staff training in adult protection is planned during the next year. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a pleasant, comfortable and safe home in which to live. Evidence: Lindisfarne is a purpose built care home. It opened approximately three years ago and its furniture, equipment and decoration are still modern and new. We spent time looking around the building. The communal areas were bright, clean and tidy. The furnishings were comfortable. Peoples bedrooms were personalised, with people bringing ornaments, pictures, photographs and other personal belongings with them from home. However, we did notice that a number of doors were being held open by wooden wedges, rather than proper door closure systems. Each bedroom has its own en-suite toilet and basin. These were clean and tidy, although we noticed that a lot of people had large piles of incontinence pads stored in their bathrooms. This does not look very nice and is not very dignified for people, so alternative storage arrangements should be found. Communal bathrooms and shower rooms were located around the home. These were also clean, tidy and practical spaces for people to use. We saw a range of hoists and other equipment in use around the home. The manager has started work to make the environment more stimulating for people Care Homes for Older People Page 20 of 32 Evidence: with dementia. Bedroom corridors have been themed, with names and pictures. For example one corridor is called pet lane and is decorated with pictures of animals and pets. Staff have started to develop memory boxes for each resident, which are put up next to their bedroom doors. These boxes contain personal photographs, pictures and keepsakes that help people recognise their bedrooms and stimulate memories from their past. Tactile and stimulating objects (such as fluffy balls and cushions) had been purchased for the lounge, so that people had things to touch and play with. The manager acknowledged that this work is still in the early stages of development, but that they hope to continue making the environment better for people with dementia. The home was clean and tidy on the day of our visit. We saw two domestic staff cleaning throughout the day, including using a shampoo cleaner to clean carpets. The domestic staff confirmed that they had completed infection control training. People we spoke to confirmed that the home was always kept clean and tidy. People who returned surveys were asked if the home was kept fresh and clean. Four people said always and two said usually. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well qualified and receive training to help them do their jobs. However, the management need to make sure that all staff recruitment is carried out and recorded thoroughly. Staffing levels and deployment also need to be reviewed, to make sure people can get help promptly. Evidence: People generally spoke highly of the staff who work at the home. Comments made to us included I get on well with the staff, Im a bit of a joker, most of them are alright, I find the staff are fine, Ive got no problem with them and the staff are nice, they are lovely. In the self-assessment the manager told us that Staff training and development is ongoing and exceeds the mandatory requirement. They also told us that twenty-three out of twenty-five of their permanent care staff had achieved a National Vocational Qualification (NVQ) in care. The remaining two permanent staff were working towards an NVQ. Staff were very positive about the training that they were provided with. Comments made to us during the inspection included always training going on in here, we are always going on something and everyones trained in everything. The staff who returned training told us that they were given training that is relevant to their role, keeps them up to date and helps them understand the needs of the people they Care Homes for Older People Page 22 of 32 Evidence: look after. We looked at the homes training records. These showed that training had been provided in dementia awareness, protection of vulnerable adults, fire safety, moving and handling, food handling, first aid, handling medication and other topics. However, the records we were given showed that some staff needed training in some areas. For example the records showed that some staff had received manual handling training in January 2007, but did not show that they had received any updates since then. In their self-assessment the homes manager told us our recruitment process is thorough and robust to ensure the protection of service users. All staff undergo enhanced CRB (Criminal Records Bureau) checking before the post is confirmed. Two written references are received for all staff, ensuring one is from the previous employer. We checked the recruitment records for two staff who had recently started work at the home. One of these showed that the person had undergone a thorough recruitment process, with the required checks taking place before the person started work. However, the other record did not show that this process had been followed. The persons CRB check and one of their references had not been received until after the person started work (according to the start date recorded in their terms and conditions). The CRB check also showed a number of relevant convictions. However, there was no record of the manager discussing them with the person concerned or making an informed risk assessment about whether or not the person was considered suitable to work with vulnerable people, including any additional safeguards that would be needed (for example, an increased probationary period with additional supervision). We looked at staff rotas. These showed that there are usually four care staff on duty upstairs all day, for up to thirty residents. Downstairs there are usually three care staff on duty during the day, for up to twenty-four residents. The staff and manager told us that sometimes a fourth member of staff is on duty downstairs during the evening, to help people get ready for bed. In surveys we asked people if staff were available when they needed them. Five people said always and one said sometimes. However, some people and staff (particularly on the upstairs unit) did not feel that staffing levels always worked as well as they should. Comments made to us about staffing levels by people and their families included short of carers in my estimation, staff on a weekend sometimes give out the night time medication very late (10:30 one night) and people want to go to bed, but staff say they are busy and if you want to go to the toilet, its made me constipated lots of times, by the time they come to you its gone off. Some staff told us that they cant always take their breaks because people need assistance and that giving everyone the care and supervision they need when they need it can be a struggle. Other comments included sometimes it would Care Homes for Older People Page 23 of 32 Evidence: be nice to give more individual attention, it can be hectic and feels like too much, we do have bad days. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally managed well, with systems in place to monitor and improve the service that is being provided. However, the recent increase in the number of people with dementia that the home looks after has caused problems. Evidence: The manager of the home has relevant management experience and qualifications and is registered with CSCI. She is supported in her role by the companys senior management, who regularly visit the home and check that things are being done properly. We saw records of these visits and checks and thought that they were regular and thorough. The information that the home sent us before the inspection had been completed well and was returned to us on time. Staff comments about the manager included we get support from Wendy, shes always there if we need her. Other peoples comments made about the general management and running of the home included I would like to thank managers, staff and cleaning staff for their helpful and caring attitude and all other members of staff for making mothers care as Care Homes for Older People Page 25 of 32 Evidence: comfortable and pleasant as possible, they all do a good job and a very good home. However, a number of people we spoke to during our visit felt that one aspect of the home needed to be improved. The home has recently increased the number of people with dementia that they can look after. This means that all of the people with dementia can no longer be looked after together on the downstairs floor. Some people with dementia are now being looked after upstairs, where the majority of people do not have dementia. This has caused a number of people concern and distress. People told us how confused residents frequently wandered into their rooms, went into their bathrooms and wardrobes, often refusing to leave. Comments included Im frightened during the night as I like my door open a bit for the light and Im frightened they come in, I woke up once (was sleeping in her chair) and found a man in my bed, now theres a man who keeps taking his trousers down and last night I was in bed just going to sleep and one of them came in and she wouldnt go, she was in my en-suite, raking around, it was so annoying. Staff we spoke to confirmed that people do wander into peoples rooms and that people are often complaining about it. The home helps some people look after small amounts of personal money. The administrator showed us how this was done and checked two peoples records with us. Money and records are kept securely and the records we looked at were up to date. The manager checks the records and money balances every month to make sure things are being done properly. We saw records of these checks. In the self-assessment the manager told us about the regular checks she completes, to make sure the home is safe and providing a good service. These include giving questionnaires to professionals and relatives who visit the home. We spoke to the manager about these quality assurance systems and looked at some of the records. The manager undertakes monthly checks of accidents, the way medication is handled, health and safety issues and an internal audit of the homes fixtures and fittings. An analysis of the most recent questionnaires that had been given to people who use the service was available and showed that action had been taken to address things that had been raised. A health and safety committee now meets every month and the manager has completed level 2 training in health and safety. The homes self-assessment also told us that maintenance contracts are in place, helping to make sure that equipment is in safe working order. We looked at some of these records and confirmed what the home had told us. However, two health and safety issues that need addressing did come up during this inspection. Where people used bed-rails we saw that risk assessments and guidance Care Homes for Older People Page 26 of 32 Evidence: documents were in place and the rails we looked at were generally fitted safely. However, we found that one person had badly fitting bed-rails on their bed. The rails were loose and could be wobbled from side to side, creating gaps that were big enough to entrap peoples limbs. The manager arranged for these to be replaced straight away. However, the home must have in place a checking/maintenance system that ensures that bed-rails are correct fitted at all times. We also saw that one or two doors were being propped open with wooden wedges. Fire doors should only be held open using specialist door closure systems that will automatically close in the event of a fire. In the event of a fire people will not be adequately protected from spreading smoke and flames if doors are propped open with wooden wedges. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 Staffing levels and deployment need to be reviewed, taking into account the dependency of the people who are using the service. People should be able to get the help and assistance they need promptly and staff should be able to take their allocated breaks without interruption. 31/01/2009 2 29 19 The required checks (including 2 written references and enhanced CRB disclose or in exceptional circumstances PoVA First check) must be completed before new staff start to work in the home. The management can not be sure that vulnerable people are protected from unsuitable staff unless the required checks are completed and fully 31/12/2008 Care Homes for Older People Page 29 of 32 considered before staff start work. 3 38 23 Fire doors must only be held 31/12/2008 open with appropriate door closure systems. Doors that are held open with wooden wedges and other inappropriate means will not adequately protect people in the event of a fire. 4 38 13 Bedrails must always be 31/12/2008 fitted correctly and should only be used in accordance with up to date good practice guidance from the Health and Safety Executive and Medical Devices Agency. Bedrails can be dangerous if they are not fitted correctly. 5 38 13 The mixing of people with dementia care and residential needs must be managed carefully and appropriately, to avoid unnecessary distress and risk to both parties. The mix of people with residential and dementia care needs is not currently being managed appropriately. This is causing people distress and putting vulnerable people at risk of unnecessary confrontations. 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 30 of 32 No. Refer to Standard Good Practice Recommendations 1 7 Staff should ensure that there is a care plan in place for all relevant areas of need and that these care plans (and any related risk assessments) are reviewed on a monthly basis. Reviews may need to take place more often if someones needs are rapidly changing. Care pans should be more person centred and should contain more information about peoples individual wishes, preferences and abilities (for example, peoples preferred times for getting up and going to bed, when they like a bath or shower, if they like to dress smartly, always like to wear make-up etc). Given the very mixed views expressed about the food at Lindisfarne it is recommended that the management and chef consult people about the menus and look to see if any changes can be made to increase peoples levels of satisfaction. Drinks and snacks should always be provided at midmorning and mid-afternoon. It is recommended that a more appropriate storage arrangement for incontinence pads is found. Where CRB disclosures highlight cautions or convictions the manager must fully consider the implications of employing the person. For example, by carrying out a full written risk assessment which considers the risk to vulnerable people that employing the person would create and any safeguards that are necessary if the person is employed. Legal advice about equal opportunities and employment law should be sought where necessary. Training up dates in key areas should be provided at appropriate intervals. For example, staff should receive manual handling training updates on a yearly basis. 2 7 3 15 4 5 6 15 19 29 7 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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