Inspection on 13/04/05 for Lindisfarne Nursing Home

This inspection was carried out on 13th April 2005.

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

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

Other inspections for this house

Lindisfarne Nursing Home 20/06/07

Lindisfarne Nursing Home 07/08/06

Lindisfarne Nursing Home 11/10/05

Lindisfarne Nursing Home 30/11/04

Lindisfarne Nursing Home 17/05/04

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

CARE HOMES FOR OLDER PEOPLE Lindisfarne Nursing Home Kepier Chare Crawcrook Tyne and Wear NE40 4TS Lead Inspector Mrs P A Worley Unannounced 13 April 2005 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Lindisfarne Nursing Home Address Kepier Chare Crawcrook Tyne and Wear NE40 4TS 0191 413 7081 0191 413 7081 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Gainford Care Homes Ltd Eileen Bellas Care Home with Nursing 54 Category(ies) of Dementia - over 65 - 54 registration, with number Mental Disorder - over 65 - 54 of places Lindisfarne Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 30th November 2004 Brief Description of the Service: Lindisfarne Nursing Home is a two-storey purpose built home providing nursing care and personal care to people suffering from mental illness and dementia. The home is situated in the centre of Crawcrook and close to local shops, park and other facilities, and is on a main bus route. All bedrooms are single and the majority are en-suite, and all the necessary services and facilities are provided including an emergency call system. Bathrooms and toilets that are suitable for physically frail or disabled people. There is a passenger lift to take service users and visitors between floors. A choice of lounges is also available. The home has extensive and pleasant gardens and a safe area for service users to sit outside. Lindisfarne Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7 hours and was an unannounced inspection. Two Inspectors carried out the inspection after planning which areas of service provision would be inspected. Both Inspectors carried out a tour of the building, and time was spent talking with service users and staff and also observing staff practices. Three visiting relatives were also spoken with in order to gain their views of the service provided by the Home. One Inspector joined some residents for lunch and the other spent time with the Manager examining records and documents. What the service does well: What has improved since the last inspection? Unfortunately, despite the assurances given from previous inspections, little progress has been made in making improvements in the Home. The ventilation systems have not been repaired or serviced and the accumulation of strong smelling, dirty linen in the bathrooms was still evident. Fire doors were propped open as has been the case at previous inspections and this poses a fire safety hazard. Wheelchairs did not have footrests in place and this could cause an accident to residents. An improvement in the cleanliness and organisation in the kitchen has been maintained with the exception of some outstanding provisions to the food stores and hand washbasin. Staff recruitment procedures have improved to ensure the protection of the vulnerable people being cared for in the Home. Lindisfarne Nursing Home Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lindisfarne Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Lindisfarne Nursing Home Version 1.10 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 standard(s) 4. As staff had not identified or recognised all service users basic needs, through lack of knowledge and/or guidance and support, service users mental health needs were not being met. Appropriate therapeutic stimulation and interaction for the service users with mental health needs was not offered in order to improve their quality of daily life. EVIDENCE: Not all of the basic and mental health needs of service users were being met. The client group for which this home is registered, because of their mental health and cognitive impairments are unable to adequately express and indicate their needs and whether they are being met. Two visiting relatives spoken with indicated they were generally satisfied that their relatives’ needs were being met, and one relative said, ”the majority of times things are OK, the staff are great”. As the service users were unable to reliably express their views, observations indicated that staff had not identified all service users needs’, especially those that clearly required staff intervention and support. A number of residents in the lounges on both floors were sleeping in their armchairs, whilst a member of staff was sitting there but not communicating or Lindisfarne Nursing Home Version 1.10 Page 9 interacting with anyone, and one resident was sitting facing a blank wall with no stimulation of any kind available. During the lunchtime meal on the first floor in one of the two dining rooms, three residents displayed antisocial behavioural problems, which staff were unable to effectively deal with. Two residents were unsuccessful at managing to eat their meal independently, but were not given assistance therefore the residents did not have an adequate meal. Lindisfarne Nursing Home Version 1.10 Page 10 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 standard(s) 7,8,9 & 10. Limited progress has been made on improving the arrangements to ensure that all the healthcare needs of residents are identified, met and recorded. Failure to meet all healthcare needs has the potential to put residents health at risk. Improvements have taken place with the arrangements for medicines. Not all personal support is offered in a way that promotes and protects service users’ privacy and dignity. EVIDENCE: Individual plans of care are available but little progress has been made on the requirement from the last inspection, and a complaint three months prior to that, which identified the need, to ensure that all aspects of health, personal and social care needs are identified and planned for. Plans remain basic, are not all up to date and evaluations statements are not adequate or specific. Significant events for service users had not been recorded and daily entries gave little indication of the actual care given. The instructions to staff as to what actions to be taken in each plan of care do not all state ‘how’ they should carry them out, and where some instructions stated that they should ensure for example, that a service users preferences and dislikes are recorded, no evidence was found of this being done. Lindisfarne Nursing Home Version 1.10 Page 11 Better evidence was available of physical health care needs being identified and met with the assistance of health risk assessments being carried out and advice and guidance sought from specialist professional staff where required. The arrangements for the ordering, receipt, administration and disposal of medicines are satisfactory. Inspection of stocks of medicines no longer required was carried out as this was an issue from the last inspection, and has been addressed. Thorough inspection of medicines administration was not made but observation of the security of medicines when the administering nurse left the drug trolley unattended was appropriate, which had not been the case at the last inspection. Staff treated service users with respect in there approach to them, and upheld their dignity when dealing with personal care issues. However, some issues of service users’ dignity were compromised and staff failed to protect them from this. Some female residents were sitting in armchairs with extensive areas of bare legs exposed, and were within sight of males and visitors to the Home, and even when this was brought to staffs’ attention, was adequately dealt with. The majority of females who wore a dress or skirt did not have on tights or stockings. Lindisfarne Nursing Home Version 1.10 Page 12 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 standard(s) 12 & 15. The social activities provided are varied, flexible and adequate for those who choose to participate, but poor provision is made for those who need therapeutic stimulation related to their mental health needs. The meal was poor with little evidence that service users are served quality meals or offered choice. There are concerns relating to whether those who require assistance are receiving an adequate diet intake, and also the poor presentation of soft diets. EVIDENCE: An Activities Co-ordinator is employed at the Home. She shares times between the residents on both floors, usually a half-day per floor. A basic programme of activities is planned and additional events and outings are arranged. On this day she spent time with residents on the first floor in the morning and in the afternoon took a number of residents went out for the afternoon in the Company’s own transport. The limited number of the residents going out expressed their enthusiasm at this. In the absence of the Activities Co-ordinator a limited level of alternative activity and stimulation was available. Those service users who were spoken with indicated that they enjoyed the games and other activities offered, whilst others who chose not to join in were not pressured to do so. Lindisfarne Nursing Home Version 1.10 Page 13 One Inspector joined residents for the lunchtime meal. The experience was not enjoyable with inadequate staff available to assist service users and meet needs, poor preparation, poor presentation of the meals and the surroundings. A plated meal was presented to all with no choices or preferences for portions or vegetables asked, and the meal was cold and unappetising. The menu board had not been completed and the soft diets were offered in an unappetising style. The organisation at mealtimes and the quality of meals served, have been the subject of concern at past inspections including the last two, and appear to have deteriorated further. The main area of ineffectiveness appears to be the lack of sufficient staff to give assistance and support to residents who need it whilst also trying to supervise and monitor the other requirements at the mealtime, including assisting residents in the lounge. In discussion with some care staff they were able to describe more preferable approaches if they had more time and staff. Advice and guidance were given to the Manager about how the arrangements at mealtimes could be improved. Lindisfarne Nursing Home Version 1.10 Page 14 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 standard(s) 18. Adequate staff training has not been given to staff on the Protection of Vulnerable Adults against abuse and has been a long-standing training need. Documents and procedures are available for staff but appropriate guidance on procedure was not followed, which could lead to the mismanagement of responses to any suspicion or allegations of abuse . EVIDENCE: A Protection of Vulnerable Adults policy, including ‘Whistle Blowing’, and a copy of the Department of Health publication ‘No Secrets’ is available for staff reference. The Manager has a copy of the Local Authority guidance and procedures, which she indicated is used for guidance. Staff were able to describe what actions they would take in the event of any suspicion or witnessing of abuse. Adequate training for staff in the protection of vulnerable adults has not been given to date with only two members of staff having attended such training. ‘In-house’ training by means of showing a video on the subject, is given to staff at their induction and external training for staff was being arranged, but the process was slow as insufficient places could be offered. The subject of staff training in the Protection of Vulnerable Adults has been discussed at previous inspections and little progress has been made in achieving adequate training for staff. Lindisfarne Nursing Home Version 1.10 Page 15 An incident of potential abuse was reported to the Inspectors during the inspection, which had already been reported to, and was being dealt with through the Local Authority Social Services procedure. However, the procedure from the Home initially, did not appear to have been strictly in line with the guidance procedures, indicating lack of thorough understanding of appropriate procedure, and the need for training. Lindisfarne Nursing Home Version 1.10 Page 16 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 standard(s) 19,22,25 & 26. The Home presents a pleasant and homely environment. The heating and lighting in the Home was satisfactory and appropriate to service users needs. The outstanding matters regarding cleanliness, infection control and ventilation do not ensure that the residents living in the Home are safe and comfortable. EVIDENCE: The majority of the Home was clean, with some exceptions to furniture and equipment. Old and worn wooden sideboards in the ground floor dining room were dirty with dust and food debris in the drawers, and were in need of revarnishing to allow effective cleaning to be carried out. An area behind a bath seat in one bathroom had a build up of grime and was faecal stained and two bathrooms had uncovered linen skips containing foul linen, which were very odorous and a potential source of infection. The practice of leaving full foul linen skips in bathrooms was an issue at the last inspection when a requirement was made to address it and an assurance within the Providers action plan was made, that it would be addressed. Bin lids were missing in a number of toilets and the extractor/ventilators in the bathrooms and toilets Lindisfarne Nursing Home Version 1.10 Page 17 were switched off and the one that was switched on was not functioning. Requirements were made to repair/maintain the ventilation systems appropriately at the last two inspections. Inappropriate storage of equipment and furniture was still taking place as has been previously reported. The cleaning procedures in the kitchen have improved and the Manager carries out audits of these. Some matters of provision however, remain outstanding in the kitchen; appropriate ventilation has not been provided in the dry food store cupboard, new shelving has been provided in another store cupboard but needs to be painted or sealed to allow effective cleaning and elbow taps to be fitted at the hand washbasin. All kitchen staff have completed Intermediate Food Hygiene training and the last Environmental Health inspection report indicated satisfaction with the measures taken in the kitchen following the Improvement Notice they had previously issued. Lindisfarne Nursing Home Version 1.10 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29. The procedures for the recruitment of staff are now satisfactory and provide safeguards to protect the vulnerable people living at the Home. The numbers and skill mix of staff do not enable all the current residents’ individual needs to be met. EVIDENCE: Appropriate and minimum numbers and skill mix of staff were provided and additionally adequate numbers of ancillary and support staff are in post. Residents spoken to and who were able to express their views said that the staff at the Home were kind and caring. One visiting relatives said, “the staff are great”. Observations throughout the day indicated that staff were courteous and sensitive towards residents, were prompt and attentive to their needs where they were able, but worked in a busy and task orientated way with for example meals, personal care and activities. Some staff spoken with confirmed that they needed more time and staff in order to spend more individual time with residents. The staff files of the two most recently appointed members of staff indicated that all the necessary recruitment documentation and pre-employment checks had been carried out to ensure protection of the residents. This had not been the case at the last inspection. These included Criminal records Bureau (CRB) and Protection of Vulnerable Adults (POVA) list checks, and two written references for each member of staff. Lindisfarne Nursing Home Version 1.10 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 38 The Manager is not adequately supported by senior staff and in turn does not provide clear and robust leadership staff. This is having an effect on staff that are not able to demonstrate awareness of their roles and responsibilities in relation to residents with mental health needs and health and safety. EVIDENCE: Matters outstanding from previous inspection requirements, within the Providers and the Managers areas of responsibility have not all been addressed despite the action plan indicating that they would be on more than one occasion. The Manager is said by residents, relatives and staff to be open, fair and approachable in her manner. However, evidence of staff practices and procedures and awareness of how to meet residents’ needs indicated that staff would benefit from a more robust and assertive style of leadership and support. Inappropriate practices that were observed at previous inspections Lindisfarne Nursing Home Version 1.10 Page 20 are still being carried out by staff as indicated in the previous section with the foul linen and the inappropriate storage of equipment. Some health and safety practices observed at this inspection, such as propping open fire doors and using wheelchairs for service users without foot rests, whilst an unused bath had numerous footrest stored within it, are also unacceptable and unsafe practices. Staff worked diligently and tirelessly but appeared to lack adequate leadership and awareness within there roles. Lindisfarne Nursing Home Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 2 x x x x x 3 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x 2 x x x x x 2 Lindisfarne Nursing Home Version 1.10 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 4 7 Regulation 14 15 Requirement All service users needs including specific needs must be met. Service users care plans must be in sufficient detail, reflect all assessed needs, and provide clear guidance to staff on the actions to be taken to meet their health and welfare nneds. (Timescale of 31/3/05 not met) Service users dignity must be protected at all times. The Home must provide activities for all service users with regard to individuals needs. Service users must be provided with suitably prepared wholesome and varied foods. The Registered Person must ensure that appropriate training is provided for all staff working in the Home on the Protection of Vulnerable Adults. The wooden furiture in the dining room must be removed or revarnished to allow effective cleaning to take place, and maintained in a clean condition. Suitable storage facilities must be made available for equipment in the Home. (Timescale of 1/4/05 not met) Version 1.10 Timescale for action 30th June 2005 1st July 2005 3. 4. 5. 6. 10 12 15 18 12(4)(a) 16(2)(n) 16(2)(i) 13(6) 13th April 2005 31st July 2005 13th April 2005 1st June 2005 7. 19 23(2) 15th May 2005 8. 22 23(2)(l) 31 July 2005 Lindisfarne Nursing Home Page 23 9. 25 23(2)(p) 10. 26 13(3),16( 2)(k) 11. 33 24 12. 34 25(2)(i) 13. 38 13(4) 14. 38 23(4)(i) Repair and maintenance of the ventliation systems must be carried out in the bathrooms. (Timescale of 1/8/04 and 15/1/05 not met) The Home must be kept free from offensive odours and foul linen and waste must be appropriately stored. All equipment in the Home must be maintained in a clean condition. (Timescale of 30/11/04 not met) A quality assurance report and development plan must be made available to the Commission for inspection. (Timescale of 1/4/05 not met) A statement as to the Homes financial viability must be made available to the Commission for inspection. (Timescale of 31/3/05 not met) Footrests must be in place on wheelchairs in order to reduce the risk of accidents to service users. Fire doors must not be propped open.(Timescales of 17/5/04 and 30/11/04 not met) 30th May 2005 13th April 2005 1st June 2005 1st June 2005 13/4/05 13/4/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 15 27 32 Good Practice Recommendations Review of the meal time arrangements and organisation to ensure appropriate supervision and support is provided for service users. Review the staffing arrangements and practices to ensure that all service users needs are met. Review the management style to provide more leadership, guidance, support and direction for all staff. Lindisfarne Nursing Home Version 1.10 Page 24 Commission for Social Care Inspection Baltic House Port of Tyne, Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lindisfarne Nursing Home Version 1.10 Page 25 - 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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