CARE HOMES FOR OLDER PEOPLE
Lindisfarne Nursing Home Kepier Chare Crawcrook Ryton Tyne & Wear NE40 4TS Lead Inspector
Sam Doku Key Unannounced Inspection 20 & 22 June 2007 09:45 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 Nursing Home DS0000018174.V338518.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 Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lindisfarne Nursing Home Address Kepier Chare Crawcrook Ryton Tyne & Wear NE40 4TS 0191 413 7081 0191 413 7308 e.bellas@gainfordcarehomes.com 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) Gainford Care Homes Limited Eileen Bellas Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (61) Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Of the 61 rooms registered, one of two rooms without en-suite facilities (room 36) to be used as short stay/emergency respite only. 7th August 2006 Date of last inspection 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 and bathrooms and toilets that are suitable for physically frail or disabled people. There is a passenger lift to take residents and visitors between floors. A choice of lounges is also available. There is easy access into and around the home and corridors and doors widths are wide to allow access for wheelchair users. The home has extensive and pleasant gardens and a safe area for residents to sit outside. Fees in the home range from £370 to £380. For free nursing care and continuing care, the PCT makes up the difference. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over two days and was unannounced. Time was spent talking with service users, relatives and staff and observing practices in the home. A sample of records that the home must keep was looked at. This included assessments before and after admission, care plans, service users financial records, medication records, fire logbook, accident record, servicing records and staff files. A tour of the premises was carried out to check that the home was clean and maintained to a good standard. The inspector also spent time sitting in the lounge and watching care practices and staff interaction with the service users. Before the inspection date, questionnaires were sent to the service users asking them to tell the Commission about their views on the service they receive. Seven responses were received from the service users, some of who were assisted by their relatives to complete the questionnaires. Their comments are included in this summary and in the main body of the report. What the service does well:
The service encourages service users to bring items of personal belongings into the home. Some service users have used this opportunity to furnish their rooms with personal items, making it more personal to them. These include, small pieces of furniture, pictures and photographs of family and friends. The home has a good system in place for ensuring that the service users receive good medical care from their GPs and other medical personnel such as psychiatrist, dietician, chiropodist and optician. Comments from relatives and service users were very positive. One relative said, “you cannot fault the medical care the service users receive”. Another relative said, ”they are not only cared for, they are loved”. Some care plans had good information that provided the basis for the good care that is provided. The manager is good at identifying bad practices and bringing it to the attention of staff during staff meetings. The staff meeting record shows how she has warned staff about bad practices and the consequences for those who continue to engage in those practices. The religious and spiritual needs of the service users are fully met. During the inspection, a church service was organised for the service users. The service was are well organised and people are supported to take part.
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 6 Staff generally have a good rapport with the service users. Staff were observed to speak quietly and pleasantly with service users. Service users and relatives confirmed that the staff treat them with respect. The home is generally clean and maintained to a good standard. What has improved since the last inspection? What they could do better:
The company is supposed to make arrangements for a responsible person to visit the home and make a report to the company on how the home is performing. These visits have not been taking as often as they should. This arrangement is required by law and must be adhered to. Although the staff confirmed that they are in regular contact with the manager and that she is aware of the way they do their work, there are no consistent arrangements for ensuring that staff receive formal supervision which should be recorded on individual files. However, it should be pointed out that the manager has little time to conduct regular supervision of all the staff as she has no deputy at the moment, which makes her work much harder. In order to ensure that service users are protected from abuse, all staff must receive training in protection of vulnerable adults. Practices were observed where the communication between the staff and the service users were less than satisfactory. Staff were observed to assist service users with their breakfast but there was little or no verbal communication between the staff concerned and the service users. This situation was also observed when service users were being taken to the dining room for their breakfast. In three situations there were no explanations given to the service
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 7 users and no communication between the staff member and the service users she was assisting. There was poor practice by a nurse in the way medicines are administered. Tablets were dispensed into three little pots and were carried to the dining room to be given to the three service users. There were no names on the pots to indicate who the tablets belonged to. Two of the pots were left on a table in the dining room unsupervised while the nurse took the tablets to the first person. The potential for giving the wrong tablets to the wrong people in this situation was extremely high. This is a practice that potentially compromises the health and welfare of the service users. On the first floor it was noticed that the bins in the two dining rooms had no lids and discarded food items were visible. There is the potential for a confused service user to go into the bin and eat food that has been disposed of. This seriously compromises the health and safety of the service users. The walls in the two dining rooms on the first floor were dirty with splashes of food particles. This is unhygienic and a potential source for food contamination. The manager should involve relatives in agreeing the care plans for some individuals, whose relatives are interested in being involved in the care of their loved ones. There were instances where the involvement of the relatives would have provided useful information about the care that the service users require. The fire risk assessment for the home was done in July 2004. This must be regularly reviewed to ensure that up to date safety measures are in place to ensure a safe environment for the service users, staff and the general public. The manager confirmed that the company would only fund three days paid training for the staff, which covers moving and handling, fire safety and first aid. Consequently, other equally important training such as infection control, food safety, dementia care and other training do not get the same priority. The manager stated that items are stored in the roof space. However, the fire report by the Tyne and Wear Authority stated that this should not be done. The manager was advised to consult with the fire safety officer immediately for advice on the matter. It was noticed that a standard care plan that was developed by the manager had been photocopied and used as standard care plan for a number of service users. This is inappropriate and must cease. Care plans must be specific to the individuals’ need. Five service users files were examined and none of these files had evidence of the company issuing contracts with the service users. It is important that the Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 8 company has contract with each service user so that both the company and service users are aware of their obligations and responsibilities. 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 Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service user guide provides good information about the service provided in the home. This helps prospective service uses make informed decisions about the home before coming to live there. Contracts between the company and the individual service users are lacking. This deprives the service users of the opportunity to have in writing their obligations under the terms and conditions of residence. The needs of all service users are assessed by the social worker or the nurse assessor and also by the home before they move into the home. These processes ensure that the care needs of the individual can be met by the home. EVIDENCE:
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 11 There is a service user guide, which provides good information about the home and the services offered. This is readily available in the home and is also made available to the service users and general public. The guide would however, need to be reviewed as the information does not reflect the current information about the Commission for Social Care Inspection. The company currently has no formal contracts with the service users. The company is required to have contract with each service user. Such contracts should set out the terms and conditions relating to the accommodation and also the amount to be paid for the provision of services and facilities. Examination of files showed that no such contracts have been issued to the service users. The home adheres to its written policy of obtaining full assessments from a social worker or the nurse assessor before admissions are arranged. The home also carries out their own assessment of the individual in their own setting to make sure that they can meet the prospective service user’s needs. These arrangements give confidence to the social worker/nurse assessor, the home, the prospective service user and the relatives that the service is able to support and care for the person before they move in. The inspector discussed the arrangements before admissions were confirmed, with some of the service users and relatives. They commented positively and said they found the assessment process and visits reassuring. Two relatives said “the opportunity to meet the staff in our house before admission was very reassuring”. Another relative said, “it gave us the opportunity to ask many questions which we found useful”. Relatives confirmed that they had the opportunity to visit the home when they considered looking for a care home for their loved ones. One service user described the visit to the home with her daughter. She found the experience extremely useful and said “I would advice anyone to visit a few homes before deciding”. The manager and staff stated that it is the policy of the home to ask prospective service users and their relatives to visit and assess the place for themselves before making up their minds. The manager stated that in the case of people suffering from dementia, it had not always been possible for them to come and visit the home before hand as this tends to upset most people. Relatives however, are encouraged to visit on their behalf and to use the opportunity to speak with staff and other service users. This provided a positive adjustment into residential care for some of the service users. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are generally good care plans in place but some aspect of the plans do not fully identify the social and healthcare needs of the service users. This fails to acknowledge individual differences and care needs and therefore some needs may not be met. The home has good procedures in place for the safe administration of medicines. However, observed practices showed that the correct procedures are not always followed, which seriously compromise the health and welfare of the service users. Although in general, the service users are treated with respect and dignity, some practices that were observed undermined this. EVIDENCE:
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 13 Following recommendations from the last inspection report, the manager embarked on a review of the current care plans and there is evidence that some progress have been made in some areas. Where progress has been made, the care plans set out detailed care needs of the individuals and action plans are put in place to address them. There are suitable arrangements for meeting the healthcare needs of the service users. There are individual records of contacts with healthcare professionals, including GPs, psychiatrist, chiropody service, dentist, optician and other healthcare services. There is evidence of risk assessments being carried out for the service users for whom there is a need for it. These include pressure areas care, falls risk assessment and aspects of mental health needs. The risk assessments are followed by risk management plans to ensure that all staff are aware of how best to manage a specific risk. These promote the service users rights to proper healthcare. Relatives and service users confirmed that their healthcare needs are met. The nurses are responsible for the administration of medicines and have had safe handling of medication training. The home has proper arrangements for the storage and administration of medicines. The drugs administration system was examined and there were no discrepancies. The effective drugs administrative system promotes the health and welfare of the service users. However, the practice observed in one case seriously undermines the otherwise good drugs administration system. Tablets were dispensed into three little pots and carried to the dining room to be given to the three service users. There were no names on the pots to indicate who the tablets belonged to. Two of the pots were left unsupervised on a table in the dining room while the nurse took the tablets to the first person. The potential for giving the wrong tablets to the wrong people in this situation was extremely high. There was also a high chance that while the two other pots were left unsupervised, a confused service user could have got hold of it and taken them. This is a practice that should never happen in any care environment. Service users confirmed that the staff treat them with respect and promote their right to privacy. Comments from the service users include “the staff are really nice and friendly”, “the staff treat us with respect here”, “they are always there when you need them”. Visiting relatives also stated that the staff treat them with respect and dignity. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy good social and recreational activities, which are in line with their lifestyle and culture. This promotes their sense of wellbeing and satisfaction. The service users are supported to maintain contacts with their families, friends and the local community. Such support has enabled the service users to continue to maintain close relationship with their loved ones and the community from which they come from. The service users generally receive wholesome and appealing diet. However, some relatives have expressed concerns that what is on the menu is not always what is provided. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 15 EVIDENCE: The staff were able to describe the social and recreational care needs of the service users. This was confirmed by the details in the care plans and in the daily report records. There are regular activities for the service users. One service user described the wine and cheese party that was recently organised for them. This was also confirmed by two relatives. Service users’ religious and recreational needs are fully met. Service users confirmed that they enjoy the activities organised for them, including visits to the home by the local vicar. On the day of the inspection, there was a church service. This was well attended by people who genuinely wanted to be involved in the service. Service users confirmed that they are free to join in social activities if they wish and that they are not made to join in activities if they do not want to. A number of art and craft materials and board games are available for service users to use, which has enhanced the recreational opportunities for them. Relatives commented that they are aware of the activities that the staff organise for the service users. These include individual trips to the local the shopping centre and the occasional social outings and in-house social activities. Relatives stated that they are able to visit at anytime convenient to them. They said the flexible visiting times make it easier for them to visit more often. Some relatives are actively involved in the care of their loved ones and make the regular visits to the home. The home supports the relatives to make positive contribution to the care provided in the home. There is a four-week rotational menu in operation in the home. Past menus indicate that the home provides wholesome and nutritious meals for the service users thus promoting good health. Service users were very complimentary of the food. They confirmed that they are provided with good choice and that there is always plenty of food for them. However, some relatives commented on the lack of fresh food and over-reliance on tinned food. It was also indicated that what is provided do not always reflect what is on the menu. Although, it was indicated that Sunday lunch is the best meal of the week. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedures are effective and provide good opportunity for service users and their relatives to use the complaints procedure if they wish. This protects the service users rights and sense of empowerment. EVIDENCE: The home has a written complaint procedure, but this needs to be reviewed to reflect up to date contact details and address of the local office of the Commission. A summary of the complaint procedure is included in the Service User Guide and is also displayed in the home for visitors and relatives to see. Some of the service users and relatives indicated that they are aware of the procedure and would know how to complain if they had a need to do so. Not all the staff have had up to date training on safeguarding adult. Less than half of the care staff have had this training. In order to ensure that service users are protected from abuse, all staff must receive training in protection of vulnerable adults. However, in discussion with individuals, it was evident that staff have good awareness of the procedures and how to deal with any abuse situation. The
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 17 provider’s adult protection policy is in line with the Gateshead Council adult protection policy. There is a record of complaints kept in the home. The last recorded complaint was in April 2004. However, in one of the questionnaires, a relative stated, “I make my complaints verbally but have not seen much progress”. There is no evidence of recent complaints or concerns being recorded. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 18 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, 20, 22, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers an accommodation and an environment that is generally clean, safe and well-maintained. This promotes the general welfare, dignity and comfort for the service users. EVIDENCE: The home provides a good standard of accommodation. This meets the needs of the service users. Service users are encouraged to furnish their rooms with personal items, making it pleasant and familiar environment for them. The bedrooms are large and spacious and allow service users to accommodate their personal belongings without the rooms looking cluttered.
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 19 Access into and within the home is good and meets the needs of those service users who have mobility difficulties or have use of walking aids such zimmer frames or wheelchairs. There are specialist bathing facilities to promote independent use by those who are capable of doing so. All the bedrooms and toilets have suitable lock on the doors to ensure privacy. This provides the opportunity for service users to remain independent and to enjoy good levels of privacy. There are sufficient numbers of communal areas for service users to choose from. These include a range of lounges, dining rooms, and communal spaces that service users can use. Window restrictors have been fixed to all windows and all radiators have suitable coverings, which ensure security and safety for the service users. Checks of hot water at randomly selected bathrooms confirmed that hot water did not exceed 43°c. thus protecting the service from accidental injuries. The home has written policies and procedures relating to safe handling of hazardous materials for staff to follow. The manager indicated that staff have had training in health and safety, infection control and food hygiene, although the training record shows that some staff need an update on the training in these areas. The home was noted to be clean and free from offensive odour. This enhances the self-esteem of the service users. The laundry machines have facilities for sluicing and washing foul linen at very high temperature to avoid the spread of infection. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff on duty, with a range of skills to meet the needs of the service users. The company generally provides good training to all staff, and there is ongoing training, which improves the quality of the service for the benefit of the service users. However there is a lack of a systematic approach to the induction of staff into the workplace, which if not addressed could negatively affect the quality of care provided to the service users. The home adheres to the company’s recruitment policies, by ensuring that the proper recruitment processes are followed. This protects the service users from bad practice and abuse from people who would otherwise be deemed as unsuitable to work with vulnerable people. EVIDENCE:
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 21 The home maintains good staffing levels, which ensured that service care care needs are met. Past rotas showed staffing levels being consistently maintained. The staffing level at the time of arrival for the inspection was; • 1 Manager • 1 Registered Mental Nurse • 2 Registered General Nurses • 12 Care staff, one of whom was providing special support to a service user on a one-to-one basis. It was however, clear from discussions with the manager that she would require the support of a deputy manager to relieve her of some of her duties so that she can undertake other duties such as supervision of staff and staff induction and training. Service users and relatives also indicated that there are always sufficient staff on duty to meet the needs of service users. The home has a long established staff team who have been provided with the necessary training to equip them for their job. The majority of the staff have attained NVQ Level II or above. Of the 38 staff, 24 of them have achieved NVQ Level II or above and 9 of them are in the process of doing their NVQ training. Staff spoke of the good training they have received and the benefits to them and the service users. However, examination of the staff training record showed there is general lack of up to date training in some areas. For example, of the 38 care staff only 9 have had up to date training in health and safety training; POVA 15; food hygiene 10; challenging behaviour 13; dementia care 15; infection control 9. Apart from fire safety and moving and handling which all staff have had up to date training on, these figures show lack of up to date training in some areas, which are necessary to ensure good quality care and to promote the safety and welfare of the service users. There is also general lack of proper induction of new staff into the workplace. There was no documentary evidence of induction training provided for all new staff. This must be addressed so that the registered persons can satisfy themselves that staff have received proper induction and have been assessed as competent to undertake their duties unsupervised. The records of the most recently appointed staff were examined. These contained evidence of good recruitment procedures being followed. This ensures that the service users are protected from possible abuse from people who would be deemed as not suitable to work with vulnerable people. Suitable references have been obtained and checks such enhanced CRB and ID checks have been carried out and were all in order.
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 22 Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager offers good leadership and direction to the staff so that they can consistently meet the needs of service users. There are good arrangements for handling the finances of the service users, thus protecting the service users from being financially disadvantaged. There is lack of formal one-to-one supervision of staff. Provision of regular supervision would enhance the professional and personal development of the staff for the benefit of the service users. There are generally good arrangements in the general management of the home, which safeguard the health, safety and welfare of the service users.
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 24 The lack of regular fire instructions and not adhering to the fire authority’s recommendations compromise the fire safety precautions in the home and thus the safety of the service users. EVIDENCE: The manager is a Registered Mental Health Nurse and has long experience of working in nursing home settings for older people and has the Registered Managers Award. The registered manager runs the home for the benefit of the service users in line with the company’s view to provide good standard of care for older people. The following words by service users, staff and relatives were used to describe her; “Eileen is very good with the staff and they know where they stand with her”; “She doesn’t just care, she loves the patients”; “She is a smashing boss”; “If I have any concerns she deals with them immediately”; “I have great confidence in her as a manager”; “She is more than a manager, she is also a friend”. The manager has regular staff meetings where practices in the home are frankly and openly discussed. The minutes of the meetings provide evidence of the manager tackling bad practices with staff and advising staff on the consequences of the bad practices. The home has a good system in place for managing the personal allowances for the service users. There are good control systems in place for accounting for the personal allowances for the service users. Details of purchases and receipts are available for those whose monies are held by the home. The company’s Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). There is evidence that staff adhere to the policies as set by the company. Servicing records confirm that all portable appliances have been tested. A record is maintained of regular water temperature tests in the home. Regular servicing of fire equipment, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. These included servicing of hoists, water treatment, electrical installation and gas servicing. Up to date servicing and maintenance of these services and equipments ensure a safe environment for the service users and the staff who work there. Records examined indicate that fire precautions relating to weekly fire alarm testing and record of inspection takes place.
Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 25 There is no evidence of staff receiving the regular fire instructions from a competent person. The manager was advised to adhere to the fire authority’s recommendation that all day staff should receive two fire instructions per year and the night staff receive four such instructions. This must be done and a record of these instructions to the staff must be maintained, indicating who had received the instructions. The last fire officer’s inspection report asked for the loft space not to be used as storage space. This recommendation has still not been addressed and items are still kept in there. However, there was a conflicting statement, that the Fire Safety Officer had no concerns about this as the necessary precautions are in place. The manager was asked to contact the Fire Safety Officer for written confirmation about the use of the loft for storing items. The home’s fire risk assessment was last done in July 2004 and has since not been reviewed to reflect the current fire safety precautions in the home. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 26 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 2 1 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 3 X X 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 9(a)(b) Requirement The service user guide must be updated to provide an up to date contact details of the Commission for social Care Inspection. The company must produce contracts with all service users setting out the terms and conditions of residence. The registered manager must continue to implement care plans that are specific to individual care needs. Currently, there are aspects of the care plans, which do not reflect the individual’s care needs. The use of standardised sample care plans that is used for all service users must cease. The practice of dispensing medicines to service user without means of identifying who they are must cease. This is unsafe and compromises the health and welfare of the service users. The menus must be reviewed to ensure that what is served reflects what is provided. If this
DS0000018174.V338518.R01.S.doc Timescale for action 30/09/07 2. OP2 5(b)(c) 01/11/07 3. OP7 15 (2)(b) 01/08/07 4. OP9 13(2) 20/07/07 5. OP15 16(2)(a) 01/08/07 Lindisfarne Nursing Home Version 5.2 Page 28 6. OP18 13(6) 7. OP26 13(3) 8. OP27 12(1)(a) 9. OP30 18(1)(c)(i ) 10. OP33 26.3 had to change, then a system must be put in place to advice service users of such changes. The registered person must ensure that all staff receive up to date training in safeguarding adults. The registered manager must ensure that cleanliness in the dining rooms on the first floor are up to standard. Bins with lids must be provided to promote proper hygiene and safety standards in the home. A number of staff need refresher training in areas such as infection control, food safety, dementia awareness and safeguarding adults. The registered manager must ensure that staff received properly documented induction training that meets the Skills for Care standards. The Registered person or their representative must visit the home each month and a report of these visits must be written. The Registered manager must ensure a system is in place for all staff to receive supervision at least six times each year. In-house fire instructions to staff must be carried out to levels specified by the Fire Brigade. Fire equipment checks must also be completed to the specified frequency. The fire risk assessment for the home must be reviewed to reflect the current fire safety precautions in the home. The advice of the Fire Authority
DS0000018174.V338518.R01.S.doc 01/11/07 01/08/07 01/11/07 01/09/07 31/08/07 11. OP36 18.2 30/09/07 12. OP38 23.4(v)&( d) 31/08/07 13. OP38 23(4()(a) 30/08/07 14. OP38 23(4()(a) 31/07/07
Page 29 Lindisfarne Nursing Home Version 5.2 15. OP30 23(4()(d) fire safety officer must be sought regarding the use of loft space for storage purposes. All staff must receive fire instructions from a competent person and a record of such instructions must be maintained in the home. 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP12 OP27 Good Practice Recommendations More staff in the home need to be approved to drive the minibuses to allow residents more trips out. It is recommended that the provider consider extra support for the registered manager in the form of a Deputy manager to assist with other management tasks such as training, staff supervision and development of care plans. Lindisfarne Nursing Home DS0000018174.V338518.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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
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