CARE HOMES FOR OLDER PEOPLE
Lindisfarne Care Home Ltd Bridgehouse Lane Haworth Keighley West Yorkshire BD22 8QE Lead Inspector
Ann Stoner Announced Inspection 22/9/05 09:30 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 Ltd DS0000064238.V251789.R01.S.doc Version 5.0 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 Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lindisfarne Care Home Ltd Address Bridgehouse Lane Haworth Keighley West Yorkshire BD22 8QE 01535 645206 01535 648001 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) Lindisfarne Care Home Ltd Mrs Jayne Ricci Care Home 30 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (30), Physical disability (1) Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The place for PD is specifically for the service user named in connection with the variation application dated 1.6.4 The place for MD(E) is specifically for the service user named in connection with the variation application dated 1.6.4 19th May 2005. Date of last inspection Brief Description of the Service: Lindisfarne is a converted extended property situated in the village of Haworth, and is close to local facilities. The home was first registered in 1993 and provides residential and personal care, without nursing, for residents of both sexes over the age of 65. Accommodation is provided in a combination of single and double rooms, the majority of the single rooms have en-suite facilities. Communal areas consist of a lounge, dining room and a large conservatory on the ground floor and a further lounge on the first floor is used as a quiet room. The home is situated in its own grounds with car parking facilities to the front and side of the building. There is a level area at the front of the home where residents may sit. Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was unannounced and took place on the 19th May 2005. There have been no further visits until this announced inspection. The people who live in the home prefer the term resident; therefore this will be the term used throughout this report. Two inspectors carried out this inspection between 9.30am and 3.00pm. During the inspection, we looked at records, saw care staff carrying out their work and spoke with residents, visitors, staff and the manager. Comment cards/questionnaires are left for residents, visitors and other professionals at each inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection (CSCI). We discuss any comments received with the manager without revealing the identity of those completing them. In total 13 have been returned and no negative comments were made. Copies of previous inspection reports are available via the Internet at www.csci.org.uk. However, as the home has recently become a limited company, and as such needed to make a new application for registration, previous reports are not available by this route. Anyone wanting to read these reports should contact the home, where they will be made available. What the service does well:
The atmosphere at the home is very friendly and we observed a good relationship between staff and residents. Where personal care tasks were undertaken it was completed in a professional manor. The staff spent time with residents in and among their daily duties. Staff understand and respond to the likes and dislikes of residents and wherever possible will go out of their way to make sure that individual tastes are met. The home understands the importance of good nutrition, and hot and cold drinks are always on offer. The feedback from residents and visitors was very positive. They felt that they received a good standard of care and were very complimentary about the staff and the manager. One visitor visits the home every day and helps to feed her husband lunch. She felt very confident that the staff and the manger are able to meet her husband’s needs and felt she was kept very well informed of any changes. Additional information given on comment cards returned from visitors state, “The home is friendly, everybody is approachable. It is well run Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 6 and I am always made welcome.” Another states, “We are highly delighted with our relative’s care, his needs are always met.” What has improved since the last inspection? 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. Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 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 Ltd DS0000064238.V251789.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 & 9. Care plans are being updated to provide staff with the detail required to carry out care tasks. Medication practices follow guidelines from The Royal Pharmaceutical Society. EVIDENCE: The manager explained the new format for care planning and described how this documentation will be implemented. We sampled a total of 4 care plans, none of which had been transferred onto the new format. We found that residents and family have involvement in care planning, and agree and sign the completed document. On the whole care plans contained some good information, but we discussed the value of involving care staff in compiling the revised care plans so that the exact and precise way that care is delivered on an individual basis is recorded. This should eliminate terms such as ‘maximum assistance’, and include details about personal preferences, likes and dislikes. Care staff described how they give pressure relief to those residents at risk of developing a pressure sore, and residents identified as being at risk nutritionally are given a nutritious high calorie diet. However, we recommend that records to evidence this be kept, such as turn charts and food diaries. Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 10 Two care plans related to residents who have diabetes. The records clearly identified the care required to stabilize and monitor the condition. Blood sugar monitoring was undertaken as required and accurate records were kept. Information was provided for staff on how to deal with any abnormal readings from the blood sugar monitoring. We recommend that the agreed blood sugar safety levels be recorded in care plans for each individual service user. This will give staff more knowledge of when residents are at greater risk. There was excellent information recorded in daily records, such as monitoring, treatment and review of someone with a pressure sore, but less information was recorded about social and recreational activities. We found plenty of evidence that residents enjoy a good social life within the home, and we recommend that this be recorded on a daily basis within care plans. Staff should remember to cross reference any changes identified in the daily notes to the care plan. We checked the medication system and found drug administration records are well recorded and safe secure storage is provided. Policies and procedures are available for staff and training is provided for staff that handle medication. Further accredited training is being organised at a local college. We made some recommendations in relation to care records. Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 14. The home provides a comfortable homely environment where residents’ choices are respected. Visitors are made to feel part of the home. EVIDENCE: We spoke to a number of residents and 2 visitors during the inspection. They felt the staff and the manager provided an excellent standard of care. The visitors felt they were always made to feel welcome and were kept informed of any changes. A quote on a comment card completed by a visitor states, “We are always received with a smile and made to feel very welcome.” A senior member of staff was able to describe the choices available to residents, and explained how by careful monitoring and observation of body language he is able to determine the choices of those residents unable to communicate. Through discussion with this person, we felt that he had a good understanding about individual residents, such as their favourite TV programmes, preferred milky or alcoholic drink and their past and current interests. The cook explained about the flexible approach taken at meal times and said that residents are never afraid to ask for an alternative meal. We saw staff working at the pace and level of individuals, and saw their decisions respected. Residents described some of the choices they make, these included times for going to bed and getting up in the morning. Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The level of staff knowledge and understanding of abuse, assures that residents are protected. EVIDENCE: Staff described the different types and signs and symptoms of abuse. They were also aware of the more subtle kind of institutional abuse, saying that this was included on a recent ‘in-house’ training session. The manager said that she has obtained a new policy on abuse, which she has not yet amended to include details and contact numbers of the multi-agency adult protection unit. She also said that she is having difficulty contacting the adult protection unit to arrange training for senior staff on how to use the multi-agency procedures. We have made a recommendation relating to this. Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessesd. EVIDENCE: Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30. Safe recruitment practices are in place and staff are trained and competent to do their jobs. EVIDENCE: We checked the records for 2 new staff recently recruited. The records contained all the information required including 2 written references and CRB (Criminal Record Bureau) checks. Information from the pre-inspection questionnaire, completed by the manager, showed that 90 of care staff have an NVQ (National Vocational Qualification) at level 2 or above. This is commendable. The manager described how staff training records are being reorganised. All staff are being provided with individual training records. The records will provide information of all the training undertaken by the staff. An annual training plan is in place, which reflects the training identified from the staff meetings and the individual staff training sessions. The manager said that a training programme is being organised with a local college to provide additional training for dementia, diabetes, infection control and administration of medications. Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. EVIDENCE: The manager has a nursing qualification and many years of experience in the care field. She is undertaking the Registered Manager’s Award. There are clear lines of accountability in the home. A quote from a returned comment card completed by a visitor to the home states, “My praise goes to the manager, who is an excellent manager and role model.” The manager has recently purchased a quality audit system, which includes a self-assessment audit tool. Questionnaires are being sent out, and regular staff meetings are held. No benefit books are held on behalf of residents, however a number of personal allowances are held for service users. We carried out a spot check of
Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 16 two accounts, and found these in order. An accurate record is kept of the income, expenditure and balance held. Staff confirmed that supervision takes place. One person said that supervision was constructive, that records are kept, and that staff are given positive feedback. The manager and a senior care worker have both attended fire training and are now competent to deliver this training to other staff in the home. This takes place at six monthly intervals. The manager completed a pre-inspection questionnaire that confirmed all the necessary health, safety and maintenance checks have been completed. COSHH (Control of Substances Hazardous to Health) risk assessments are in place for all products used by the home, and the home has information on the safe use of bed rails. The manager explained how she audits all accident forms on a monthly basis to help her identify any patterns or trends. It is recommended that when an accident is not witnessed, a record is kept of when the person was last seen, and by whom. Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 17 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 x 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 3 x 3 Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 18 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Turn charts should be kept for residents whose position is changed as part of their pressure area care plan. Food diaries should be kept for residents who are identified as being underweight. Precise details of how care is to be delivered should be recorded on the care plan. This should include the likes and dislikes of the resident in all aspects of their care. Daily notes should include information on any recreation and leisure activities undertaken by the resident. Any changes recorded in the daily notes should be crossreferenced to the care plan. Abbreviations and Latin terms in care records should be avoided.
Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 19 2 OP7 3 4 OP8 OP18 A record should be kept of the individual blood monitoring safety levels for residents who are diabetics. The policy on adult abuse should refer to the Multi Agency Adult Protection Procedures. Senior staff should have training on how to use the Multi Agency Procedures. When an accident is not witnessed, a record should be kept of when the person was last seen and by whom. 5 OP38 Lindisfarne Care Home Ltd DS0000064238.V251789.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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