Inspection on 02/11/07 for Lindisfarne Care Home

This inspection was carried out on 2nd November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lindisfarne Care Home 10/11/08

Lindisfarne Care Home 15/03/07

Lindisfarne Care Home 01/11/05

Lindisfarne Care Home 12/05/05

Lindisfarne Care Home 26/10/04

Lindisfarne Care Home 01/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lindisfarne Care Home Gainford Whitehill Park Chester Le Street Durham DH2 2EP Lead Inspector Tanya Newton Unannounced Inspection 09:45 2 November 2007 nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lindisfarne Care Home DS0000000727.V352935.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindisfarne Care Home Address Gainford Whitehill Park Chester Le Street Durham DH2 2EP 0191 3883717 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) cls@gainfordcarehomes.co.uk CLS@gainfordcarehomes.co.uk Gainford Care Homes Ltd Position Vacant Care Home 56 Category(ies) of Dementia (56), Dementia - over 65 years of age registration, with number (56) of places Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 2007 Brief Description of the Service: Lindisfarne Care Home is registered to provide nursing and residential care for up to 56 people aged 65 years and over, who experience mental health problems. The home is a purpose built unit, with two floors (ground and first). Each person has their own bedroom, and there are a number of lounges, quiet rooms and a dining area on each floor. The garden area provides a pleasant enclosed area, and the general presentation of the home is friendly and welcoming. The home is located within the community in a residential area of Chester-le-Street, and is easily accessible by car and public transport. Fees are £431.00 per week. Fees do not include personal items such as clothing, toiletries or newspapers. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out on the 2nd November between the hours of 9:45 and 4:15. A tour of the building was taken and the inspector spent time talking to people living and working at the home. An expert by experience also attended the inspection and spent time observing practice and talking to people living at the home as well as visitors and staff. Many of the comments received during the inspection have been included within the report. The provider of the home completed an annual assessment, which provided the Commission with information about the home prior to the inspection. What the service does well: What has improved since the last inspection? Care plans contained up to date information regarding people’s care needs. Records generally were improved. Audits are now carried out on medication and accounting systems. The policy for the disposal of medicines has been updated. Any gaps in staff training have been identified and relevant courses are booked. Supervision for staff is taking place more regularly. A manager has been recruited and will commence employment once reference and police checks have been received by the home. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Assessments continue to be well managed and the home does not admit people whose needs cannot be met. EVIDENCE: People are assessed before being admitted to the home. Assessments form the basis from which the care plan will be written. This describes how the home will meet individual needs. The assessments viewed contained detailed information The home does not admit people for intermediate care. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People’s health care needs are well managed by the home. Systems to administer medication are safe and people living at the home are treated well. EVIDENCE: The health and personal care which a person receives is based on their individual needs. What is identified during the assessment process is put into the plan of care and agreed by the person being admitted or their advocate. Care is delivered in accordance with the care plan, with privacy, dignity and personal choice being maintained and promoted at all times. The care plans include risk assessments so that people can continue to take reasonable risks in a safe manner. The staff maintain high standards of personal care whilst promoting people’s capacity for self care. Equipment necessary for promotion of tissue viability is provided as required for prevention of pressure sores. Nutritional screening, falls risk assessment and moving and handling needs are all assessed on an ongoing basis. Care plans are evaluated and reviewed monthly. Appropriately Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 10 trained staff are always on duty to assess people’s health and liase with GPs if necessary. Medication is administered only by appropriately trained staff and the home has a comprehensive medication policy. There were clear records of all medicines being received and administered. The home carries out weekly stock checks. There were a few missed signatures on the drug administartion record (MAR) where people refused medication and the nurse would try again after a short interval had passed, this information should also be recorded. An expert by experience who assisted with the inspection gained the following information: Relatives value the support they receive from Lindisfarne and are especially grateful for the care that people receive. Comments from them included “I wouldn’t leave my Mum here if I didn’t think it was the best. I wanted to keep her at home but I know I couldn’t offer anything like the care they do here. The staff are excellent and nothing is too much bother. Mum was always smart and we all try to keep her that way.” “My sister’s been here a few years and I can’t fault the care and attention she gets. She’s always kept beautifully clean and tidy – her hair is always done and the staff are warm and caring. I come twice a week although she doesn’t know who I am”. “I cried such a lot when my husband came in here but the staff are so good and kind. I know he’s in the right place, I have no complaints at all”. One of the people living at the home said, “They are very nice here. They look after me well”. The overwhelming sense gained from visiting Lindisfarne is that of a caring environment and person centred care. Staff all appeared to be respectful towards individual’s privacy and to maintain people’s dignity at all times. It was a pleasure to observe the interaction between staff and residents. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The home provides a range of activities with input from the people that live there. Relatives are made welcome and encouraged to visit the home. People living at the home are encouraged wherever possible to make choices within all aspects of daily living. There is a varied menu and people likes and dislikes are well catered for. EVIDENCE: The activities co-ordinator is imaginative and creative as well as motivated and interested in developing skills to support the needs of people living at Lindisfarne. Each person living at the home has a written record of interests and likes and dislikes, and efforts are made to meet the needs of individuals. Those who require it are stimulated and occupied. Those who need less stimulation are also catered for with relaxation and massage. The sensory room is well equipped and has been designed to provide either stimulation or relaxation. There is a mini bus which is well utilised and people have the opportunity to get out and about. Photographs on the walls showed the pleasure gained from trips out. All staff appeared to enter into activities. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 12 Lunchtime was busy and appeared to be random in the way that people were served and helped with meals. Not every person was given a drink of water or juice and this is of concern given the need for good hydration in older people. After the meal, however, there were further offerings of tea or juice as well as sweets and ice creams. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Complaints and adult protection matters are supported by clear guidance and training. EVIDENCE: The home has a complaints procedure in place, which is displayed throughout the home. The complaints procedure is also available in a pictorial format to aid people’s understanding. Four complaints had been made to the home since the last inspection, two of which were upheld. Staff are trained to recognise and prevent abuse. The home has a clear adult protection procedure which links with the local authority procedure for safeguarding adults. The home also has an active whistleblowing policy. All staff spoken with said that they would have no hesitation in whistle blowing (telling someone) if there was a problem. Information on how to report abuse is publically displayed for relatives, people living in the service and staff to follow. Staff are also trained to manage challenging behaviours and deescalate situations. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Although the environment in the main is kept clean and tidy, there were some concerns, which need to be addressed to ensure the health, safety and well being of service users and staff. EVIDENCE: The expert by experience who visited the service said, “On entering Lindisfarne there is a warm welcome and the visitor has a feeling of activity and bustle. This is less the case upstairs, which is deliberately designed for people who require a quieter environment and less stimulation. That is not to say, however, that the atmosphere is less welcoming or inviting and there is a feeling of homeliness throughout”. Lounges and the conservatory are spacious and people have room to move around without being crowded. Furnishings are comfortable. The garden is Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 15 well kept and used as a resource for people who require time out in a quiet space. Bird feeders provide added interest. Bedrooms are not en suite but the warmth of the atmosphere somewhat compensates for less luxurious facilities. The inspector also had a tour of the building. Bedroom furniture is being gradually replaced and the older metal-framed beds are being changed for divans. Some bedrooms were personalised to reflect individual taste, some people choose not to have personal items within their rooms. Bathrooms and toilets are fitted with aids and adaptations to meet the needs of people using the service. One staff member said that they would like to see fixed hoists available in bathrooms and an additional electric hoist. Many of the bathrooms contained piles of slippers and other personal items belonging to people. Thermometers should be available in each bathroom so that staff can check the temperature of the water prior to people bathing. The manager said that this practice did take place and that people living at the home often moved thermometers. The stairwell was still being used to store bags of curtains and bedrails and bumpers. This was raised in the previous inspection. As this area is a fire route it must be kept clear. The locks to bedroom doors need replacing as they are in poor condition and some are faulty. Some people have been locked out of their rooms and there has been a complaint from a relative regarding this matter. Some of the lights above sinks in people’s rooms had no covers and some lights in bathrooms had no lampshades. The temperature of the upper floor must be monitored as it was very hot and staff said that it was difficult to work in. Window restrictors fitted throughout the home are the type that can be overridden. This poses a risk to people living in the home. The manager contacted the owner and agreed that this work would be carried out. The intercom system being used within the home is intrusive as each time it is used it can be heard throughout the home. It is recommended that an alternative form of communication be used which does not impact on people living at the home. The manager agreed to this. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Staffing numbers, recruitment systems and training, support and protect people living and working at the home. EVIDENCE: Staff rotas were looked at. The number of staff on duty is sufficient to meet the needs of the people living within Lindisfarne care home. Comments about the staff included “The staff are lovely” and “they are good girls”. Staff recruitment files contained sufficient information to protect people. This included a police check and two references. The home has also introduced a policy on Equality and Diversity. All staff have read and signed a copy of the policy to say they understand it and this is kept in their personnel file for future reference. Seven staff had completed a long distance training course on Equality and Diversity. Induction is provided for all new staff. Training files were also looked at. Some staff had gaps in their mandatory training this has been booked. Mandatory training includes First Aid, Fire, Manual handling, H&S, protection of vulnerable adults (POVA) and food hygiene. Other training included NVQ’s, dementia awareness, and infection control, challenging behaviour and crisis intervention. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 17 Comments from staff were positive and included “I wouldn’t do this job if I didn’t like it, the staff work well together and we have a professional team” another said we get good support from the nurses and everyone gets on well”. 90 of the staff team had an NVQ at level 2 or above. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The home does not have a registered manager at present. The home does have systems to monitor quality, which seek the views of relatives and other professionals. Health and Safety systems ensure the safety and well being of those living in the home as well as staff. EVIDENCE: The home does not have a registered manager as the person who was applying for the post has since left. The day to day operations of the home are well managed by an appropriately trained manager. There are clear lines of accountability within the home. Staff, relatives and those living at Lindisfarne are actively involved in the decision making process of the home. The home has an annual plan for quality assurance which includes, meetings with people using the service, relatives and staff. These are held monthly and information Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 19 from these are included in quality monitoring. The proprietor completes a regulation 26 visit monthly. The home has also sent out satisfaction surveys and are collating the responses from these. People’s financial interests are well managed and accurate records are maintained. Health and safety systems were looked at. Safe working practises are maintained in line with current regulations and appropriate risk assessments are available. All safety checks for maintenance are carried out by external contractors as designated by law. All accidents are recorded and reported appropriately. Safety procedures are posted and explained during the staff induction process. Accident statistics are audited monthly and care plans amended where required. The window restrictors were easy to override and must be changed for a suitable alternative. The owner agreed this during the inspection. All fire escape routes must be kept clear and free from hazards. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation 23(2) Requirement Fire escape routes must be kept clear and must not be used to store cleaning materials or other items. (Previous timescale of 30/05/07 not met). Alternative window restrictors, which cannot be easily overridden, must be fitted throughout the home. New locks are required throughout the home to bedroom doors. The temperature of the upper floor must be monitored so that it is safe for staff to work within. The home must employ a manager who is registered with the commission. (Previous timescale of 30/06/07 met in part). Fire escape routes must be kept clear and must not be used to store cleaning materials or other items. (Previous timescale of 30/05/07 not met). Alternative window restrictors, which cannot be easily overridden, must be fitted throughout the home. DS0000000727.V352935.R01.S.doc Timescale for action 30/11/07 2. OP19 23(2) 30/12/07 3. OP31 9 30/12/07 4. OP38 23(2) 30/11/07 5. OP38 23(2) 30/12/07 Lindisfarne Care Home Version 5.2 Page 22 New locks are required throughout the home to bedroom doors. The temperature of the upper floor must be monitored so that it is safe for staff to work within. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP15 OP19 Good Practice Recommendations Where medication is refused and given later, this should be recorded within the Mar sheet. Drinks should be given to everyone at mealtimes. Bathrooms should be kept tidy and free from clutter and thermometers should be available. New light covers should be purchased for strip bulbs in people’s bedrooms. An alternate communication system should be considered which is less intrusive on people living at the home. Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lindisfarne Care Home DS0000000727.V352935.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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