CARE HOMES FOR OLDER PEOPLE
Lindisfarne Nursing and Residential Home Durham Road Birtley Chester le Street Co. Durham DH3 1LU Lead Inspector
Sharon McDowell Unannounced Inspection 10th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lindisfarne Nursing and Residential Home DS0000037820.V253410.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 Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lindisfarne Nursing and Residential Home Address Durham Road Birtley Chester le Street Co. Durham DH3 1LU 0191 492 0738 0191 492 1373 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 Care Home 60 Category(ies) of Dementia - over 65 years of age (60) registration, with number of places Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th June 2005 Brief Description of the Service: Lindisfarne Care Home is a 60 bedded purpose built home registered to accommodate people over the age of sixty-five years with dementia who need personal care. The home does not provide nursing care. A choice of lounges is available on all floors and there is a dining room on each floor. Access between each floor is controlled by a coded keypad. A passenger lift takes people to each of the floors. All rooms are single occupancy with en-suite facilities, and service users are encouraged to personalise them as they wish. The home is located in the centre of Birtley, with local shops and amenities close by, and the location also offers views of the local countryside. Transport links are good and ample car parking is to the front of the building, with additional parking to the rear. Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and carried out as part of an annual inspection programme. Pre-inspection planning included examination of Regulation 26 & Regulation 37 information, as well as information kept on file about any contact with the service. During the site visit, assessment information, care plans, staff records and Safeguarding Adults records were examined. Two inspectors undertook the inspection, with one inspector leaving mid afternoon. The manager’s ‘Fit Person Interview’ also took place during the inspection. What the service does well: What has improved since the last inspection?
Staff have received dementia care training since the last inspection and are using these skills to help service users with these needs. Staff told inspectors that the training was helping them to understand the condition and how it affects people differently. They said it helped them to understand service user’s behaviour and helped them to better plan their care. Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 6 There has been little turnover since the home changed it’s registration to offer personal care only and staff seem committed to improving the overall quality of the service they offer. 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 Nursing and Residential Home DS0000037820.V253410.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 Nursing and Residential Home DS0000037820.V253410.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&5 Comprehensive assessments are in place prior to and following admission which provide vital information for staff to help draw up care plans. Adequate opportunity is available for service users and their families to visit the home before making a permanent decision to move into the home. EVIDENCE: The manager confirmed that he visits prospective service users in their own homes to carry out a pre-admission assessment and case tracking reaffirmed this took place. However, there was no assessment information kept on file from the referring agency, (Durham Social Services) which could provide vital life history and other information to the home prior to admission. This also helps the service make sure they have the right facilities and skills to meet the persons need. This also ensures that people are not admitted to the home outside of the homes’ categories of registration. Relatives also confirmed that the home had visited and that their relative’s needs are well met by the home.
Lindisfarne Nursing and Residential Home DS0000037820.V253410.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 & 10. Care plans have improved since the last inspection and life histories are in the process of being developed but still lack specific detail to fully guide staff. Personal care and support by staff is offered to service users in a way that respects, protects and promotes their privacy and dignity. EVIDENCE: Care planning has improved since the last inspection and work has already begun on gathering information about service users life histories to help develop a more person centred approach. This helps to provide a full picture of who the person was before they moved into care and provide more in depth information about the persons likes/dislikes and their life experiences. However, while behavioural charts are in place for one service user whose behaviour sometimes challenges, there was no specialist guidance within the care plan about how to manage the person’s specific needs in relation to their specific physical health needs for example: Parkinson’s disease. Discussions took place with staff about approaching the Parkinson’s disease Specialist
Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 10 Nurse to provide support and further guidance, which can then be recorded in the care plan and followed by staff. In another plan it was recorded that the person was ‘prone to fall out of bed’ but no risk assessment was in place to help staff prevent such incidents. Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, & 15 Daily routines are flexible around individual needs and preferences. The activities programme is varied and accommodates a range of needs providing choice and stimulation to service users. Contact with family and friends and the local community is actively encouraged, with visitors made to feel welcome at anytime. The quality and presentation of food at mealtimes is good however, there was insufficient staff available to help people during the mealtime. EVIDENCE: An activity organiser is employed at the home and there was a lot of evidence of the work she does around the home. Service users and relatives were complimentary about the things she arranges and said there is something different every day. A notice board in the entrance hallway lets service users, relatives and other visitors about what is on offer for the week ahead. Notices are also displayed to let people know about how much money has been raised with organised events such as the ‘Bonfire Night’. Activities include: bingo, arts & crafts, pamper days, exercise to music, film video’s and manicures demonstrating that individual and group activities are arranged.
Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 12 Relatives and visitors were noticed coming and going throughout the day but comments were made about the main lounge being “too crowded” at times, particularly when the lounge on the lower ground floor was not being used. Discussions took place with the manager about using the lounge space effectively and deploying appropriate staffing levels for each lounge. One of the inspectors shared a mid-day meal with service users during the day. The food was attractively presented and served, and was nutritious in content. Staff were careful to ensure that individual catering and dietary needs are met. One example of this was for a service user who needs a soft diet. Instead of all the food being liquidised together, the cook had liquidised each food type separately and then arranged them to resemble the shape of the foodstuff. This is really good practice. Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 A clear complaints procedure is available to service users and relatives, which gives information about how to and to whom complaints can be made. This ensures that complaints are handled in a timely and objective way. Although adequate POVA procedures are in place and most staff have received training, not all staff were able to demonstrate knowledge of local authority procedures. This may potentially leave service users at risk. EVIDENCE: A complaints procedure is displayed in the home and is also available in the service user’s guide, which gives information about how to and to whom complaints can be made. Those service users and relatives spoken with stated they were confident about who they could make a complaint to and that they would be dealt with appropriately. Although the home has a Safeguarding Adults procedure to protect vulnerable adults against the risk of abuse and staff have received training in this area, staff spoken to were unable to explain what they would do should they need to raise an alert. Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Although some work has begun on the premises, parts of the building are starting to show signs of wear and tear. The home is clean, pleasant and hygienic. Domestic staff work hard to maintain the levels of cleanliness and hygiene. EVIDENCE: Works to convert the day centre area to increase existing beds by a further 6 are well progressed. This would enable further dementia care placements. However, the manager needs to ensure that this area of the home is fully used and staffed to accommodate the needs of service users. Redecoration of other parts of the home is planned as the paintwork in some areas looks shabby and worn. The manager has approached the Dementia Care Collaborative for advice on how to maximise the effectiveness of the environment for people with dementia. There was some evidence that work on orientating people had begun with pictures and familiar items on the doors, that persons with dementia would recognise.
Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 15 Domestic staff work hard to make sure the home is clean and stays free from offensive odours. The handyman is an obvious part of the team and was observed interacting positively with staff and service users, and attending to maintenance issues throughout the day. Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 Sufficient numbers of staff are employed to cover the rota. However, deployment of staff cover during mealtimes sometimes means that service users are unable to get the help they need to eat their meals. Recruitment and selection procedures are clear and robust and therefore, protect service users from risk of harm. EVIDENCE: Prior to the mid-day meal, many service users remained seated in the dining room after breakfast waiting to be taken either back to their room or to one of the lounge areas. Some were still waiting to have their breakfast. The hot lock trolley was still in place with breakfast food. At this time no staff were around in the dining room. It was later explained that a member of staff had left for a personal appointment and had arrived back at the home just after 11am. However, no cover was available during their absence. Several of the service users had to be helped by staff to eat their meal because of their level of dependency. However, only 2 members of staff were available in the dining room during the mid-day meal which inhibited the way staff were able to help service users. The home has robust recruitment and selection procedures in place which, ensures that specific checks are undertaken before employment begins. There has been little staff turnover since the last inspection.
Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 The manager possesses satisfactory qualifications and experience to enable him to fully discharge his responsibilities in a service user focused way. EVIDENCE: During the inspection, the manager undertook their ‘Fit Person Interview’ with one of the inspectors. He has the relevant knowledge, qualifications and experience and was registered as the manager following the inspection. He has worked hard to improve communication between staff in the home, with relatives and with service users. Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 18 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 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 3 X X X X X X 3 Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 19 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 OP3 Regulation 14(1)(b) Requirement The home must receive an assessment of need and care plan from the referring agency/authority prior to admission. Ensure that care plans contain adequate information to guide staff about service user’s specific needs / condition. All staff must be made aware of how to contact the Adult Duty Team or Protection of Vulnerable Adults Co-ordinator, should they suspect abuse. Adequate staffing levels must be deployed during mealtimes to ensure appropriate help and supervision for service users. Access to all communal areas must be enabled and staffed appropriately. Timescale for action 30/04/06 2. OP7 15(1) 30/04/06 3. OP18 18(1)(c) 30/04/06 4. OP14OP27 18 (1) (a) 10/11/05 Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 20 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. 4. Refer to Standard OP7 OP21 OP21 OP22 Good Practice Recommendations Contact the Parkinson Disease Specialist Nurse to provide specific advice around the care of someone with Parkinson’s disease. Consideration should be given to the design of sink taps particularly for service users with dementia to reduce the risk of accidental flooding. Toilet roll holders should be replaced with a user-friendly type. A loo system should be installed for the benefit of service users who have hearing difficulties. Lindisfarne Nursing and Residential Home DS0000037820.V253410.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection South of Tyne Area Office 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
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