CARE HOMES FOR OLDER PEOPLE
Lindisfarne Ouston Institution Terrace Ouston Co Durham DH2 1QW Lead Inspector
Mrs Tanya Newton Unannounced Inspection 16th November 2005 09:00 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 Ouston DS0000046626.V257902.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 Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lindisfarne Ouston Address Institution Terrace Ouston Co Durham DH2 1QW 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) 0191 4922891 0191 4922897 Gainford Care Homes Limited Mrs Ann Woodhead Care Home 57 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (57) of places Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to 5 persons aged 55 years and over may be placed commensurate with the home`s Statement of Purpose. 5th May 2005 Date of last inspection Brief Description of the Service: Lindisfarne care home is registered to provide care for up to 57 older persons with dementia, five of whom may be under the age of sixty-five. The home is purpose built over two floors, and is situated in the quiet village of Ouston. The building is light, airy and spacious with views over green land. The grounds are pleasant and include an allotment, which is in the process of being developed for service users use. The home is part of the Gainford Care Home Group. Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection of the home was carried out on the 16th November between the hours of 9.00am and 4.00 pm. The inspector spent time with the manager and spoke to thirteen residents, four staff and one visitor. Comments from some of these discussions are included within the report. What the service does well: What has improved since the last inspection?
Financial records are maintained. Service users/relatives are now being involved within the assessment and care planning process and this is documented within their individual plan of care. Garden furniture was purchased and the garden was made safe and accessible for use during the summer months. There are still on-going discussions regarding how the allotment could be best used for residents. One relative said that they would like to see improvements with the laundry as clothes sometimes got mixed up or went missing. Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lindisfarne Ouston DS0000046626.V257902.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 Ouston DS0000046626.V257902.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): 3 Admissions are managed well by the home. EVIDENCE: New service users are admitted, only when an assessment has been carried out by the home. Evidence of service user/relative input is included within the assessment process where possible. Lindisfarne Ouston DS0000046626.V257902.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 There is a clear consistent care planning system in place, which provides staff with the information they need to satisfactorily meet service users needs. There is some evidence of service users involvement within these plans. Systems to store and administer medication could be further improved. EVIDENCE: The care plans examined contained detailed information on how each service users needs were to be met by staff. The care plans include risk assessments and are reviewed regularly by the manager; the home are encouraging relatives and service users to be involved within the care planning process. A check on the homes medication systems was carried out; the home uses the nomad system to dispense medication. The home must ensure that eye drops are dated when opened and stored in a refrigerator and disposed of after twenty-eight days, if this is the guidance from the pharmacist. The home must also ensure that medication is disposed of within the correct timescales. The home must implement a policy on the administration of rectal diazepam; records must be in place for those residents who have seizures so that their medical health can be appropriately monitored.
Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 10 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): 12, 13, 14 & 15 A variety of activities are provided to provide stimulation and social support to residents. EVIDENCE: A wide range of activities is provided and the home has an activities coordinator. Activities include trips to the theatre, a range of outings, dominos, quoits, sewing, reminiscence, exercise and visits from the clergy. There are clear records detailing who has attended activities and whether or not the person enjoyed them. Residents can choose whether or not they want to participate in activities, one resident stated “I don’t like to join in but I like to watch”. There is a choice of food daily and comments about the meals were in the main very positive. Comments from residents included “ I enjoyed my lunch, you get a choice of food” and “ I always enjoy my meals”. Staff commented “We get time with residents and get on well with visitors, residents get offered choices in all aspects of daily living”. Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 11 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): EVIDENCE: None of these outcomes/standards were assessed on this occasion. They were examined during the last inspection of the home. Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 12 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): 19 & 26 The standard of décor and furnishings within the home are high, providing service users with an attractive and homely place to live. EVIDENCE: The home is purpose built; it is well maintained with a range of large and small lounge and dining areas. The upper floor has a lounge, which leads onto an enclosed patio area. Suitable toilet and bathing facilities are provided throughout the home to support service users. Service users rooms are furnished to individual taste with personal possessions being used to create a more homely environment. The manager confirmed that there were plans to decorate the environment and to introduce some colour; at present all of the rooms are cream. The home has raised some money to make a sensory room for residents, which is an area where people can relax. Discussions are still taking place about how the allotment could be best used for residents. The home was clean and in the main free from any unpleasant odours.
Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 13 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): 27, 29 & 30 Staffing numbers are sufficient to meet the assessed needs of the service users. Some of the staff training records require updating. Training for staff is ongoing and based around meeting the needs of the service users accommodated. EVIDENCE: The numbers of staff on duty are sufficient to meet the assessed needs of the residents living within Lindisfarne. The home is staffed in the following way, in the morning there are normally ten or eleven staff on duty and in the afternoon there are usually nine or ten staff on duty. Five staff work during the night. Staff files and training records were looked at as part of the inspection; the staff files did not contain all of the information required within schedule 2 of the Care Homes Regulations. Staff files must be audited and updated so that service users are protected. Staff training files were in the main up to date; staff confirmed that there were lots of opportunities to attend training courses. Training has included manual handling, health and safety, fire, dementia care; focus on falls, and care of the dying. Adult abuse awareness training had also been provided for staff. Some of the induction programmes had not been fully completed; this must be addressed by the home.
Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 14 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): 34 Procedures to protect service users from financial abuse are in place. EVIDENCE: The home is still awaiting a business plan from the financial director who has been in post since October 2004. Financial records had been updated following the requirement in the previous inspection report for the home. Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 2 X X X X Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 16 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 2 Standard OP9 OP29 Regulation 13(2) 19(4) i Requirement Medication must be stored and disposed of in line with pharmacist directions. Staff files must contain all of the required information detailed within schedule 2 of the Care Homes Regulations. Inductions for new staff must be fully completed. The home needs to implement a business plan, which details information as to the financing and financial resources of the care home(previous requirement of 30/07/05 not met). Timescale for action 30/11/05 28/02/06 3 OP34 25 30/11/05 Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP18 OP18 Good Practice Recommendations Training in epilepsy and the administration of rectal diazepam should be provided for all staff. A record of all seizures should be maintained. Training in adult protection referral procedures should be provided for management. The policy on managing aggression should be further updated to reflect current practices within the home. Lindisfarne Ouston DS0000046626.V257902.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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