Inspection on 19/09/07 for Lindisfarne Residential Home

This inspection was carried out on 19th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Residential Home 04/08/08

Lindisfarne Residential Home 05/10/06

Lindisfarne Residential Home 10/11/05

Lindisfarne Residential Home 13/06/05

Lindisfarne Residential Home 24/11/04

Lindisfarne Residential Home 27/04/04

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

CARE HOMES FOR OLDER PEOPLE Lindisfarne Residential Home Durham Road Birtley Chester le Street Co. Durham DH3 1LU Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 10:00 19 September, 2 & 4th October 2007 th nd 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 Residential Home DS0000037820.V338512.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 Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindisfarne 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 Mrs Elsie May Hanson Care Home 66 Category(ies) of Dementia - over 65 years of age (66) registration, with number of places Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia, over 65 years of age - Code DE(E), maximum number of places: 66 The maximum number of service users who can be accommodated is: 66 5th October 2006 2. Date of last inspection Brief Description of the Service: Lindisfarne Care Home is a large, purpose-built home that is registered to accommodate people over the age of sixty-five years with dementia who need personal care. The home does not provide nursing care. The home has three floors, each containing lounges, dining rooms, bathrooms and either 17, 24 or 25 bedrooms. All rooms are single occupancy with en-suite facilities, and residents are encouraged to personalise their rooms as they wish. There is level access into the home. Wide corridors, and spacious toilets and bathrooms, allow good access for people who use a wheelchair. A passenger lift serves all three floors. Access to staircases between each floor is controlled by a coded keypad. The home is located in the centre of Birtley, with local shops and amenities close by, and there are views of the local countryside to the rear. Transport links are good and there is ample car parking at the front of the building. At the time of the last inspection a new manager had been appointed. She has since been registered by CSCI. The weekly fee is £370 - £395. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • • • • • information we have received since the last visit on 5th October 2006 how the service dealt with any complaints & concerns since the last visit any changes to how the home is run the provider’s view of how well they care for people the views of people who use the service & their relatives, staff & other professionals The Visits: An unannounced visit was made on 19th September 2007. Two further visits were made on 2nd and 4th October 2007. During the visits we: • • • • • • • talked with people who use the service, relatives, staff, and the manager joined residents for two different meals to sample the food and to see how staff support the people who live here looked at information about the people who use the service & how well their needs are met looked at other records which must be kept checked that staff had the knowledge, skills & training to meet the needs of the people they care for looked around parts of the building to make sure it was clean, safe & comfortable checked what improvements had been made since the last visit The people who live here have dementia care needs and most find it difficult to express their views. The first visit was spent with residents, observing the care they receive. Throughout the visits we told the manager what we found. What the service does well: The home has a warm and welcoming atmosphere. One visitor stated that they are “always made to feel welcome”. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 6 There are activities everyday if people want to join in. The home has its own minibus and driver and there are weekly trips out to local places of interest. Some residents were able to describe how they enjoy the weekly hairdressing service and manicure sessions. Some ladies had been supported with make-up and nail varnish and were clearly proud of this. The quality of meals remains very good. The home uses local suppliers and local shops so that food is always freshly delivered. The owner does not restrict the catering budget, and the manager stated that many traditional dishes are provided. During discussions residents who were able to comment were very complimentary about the standard of the catering, for example one person said, “The food is always very good…it’s all home-made, including scones and cakes.” Residents who were able to comment said that the home is kept clean and tidy. One visitor also commented, “It always seems very clean.” The home has a good standard of decoration and furnishings. All bedrooms are a good size and all have their own private en-suite toilet. Lounges are comfortable, warm, bright and cheerful. Bathrooms are also well-decorated and warm. The owner makes sure that all checks and clearances are received before a new staff is employed. Most of the staff have training certificates in care. There are good arrangements for supporting residents to keep their personal monies in a safe place if they want. The owner makes sure that relatives can make suggestions and comments about the home and listens to what they say. What has improved since the last inspection? Staff and relatives said that there are more activities for residents now. There have been good improvements to trips out so residents have more chances to get into the local community. The manager has started to develop some information in pictures to help residents such as photographs of menu choices and the complaints procedure. (These need some more work to make them clearer for the people who live here.) Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 7 Staff said that there have been lots of improvements to the home over the past year. They said there is more training for them. They said that staff are happier and there is better teamwork. What they could do better: Each resident (and/or their relative) should have a copy of the Service Users Guide that should give them information about the service at this home. This was reported at the last inspection. Life histories, social care and religious needs should be completed on the assessment form so that staff would know how to support people in these areas. Monthly reviews of care plans should show any changes in a person’s care needs. Also care plans should show staff exactly how to support someone (for example if they are often aggressive or upset) so that each staff provides the right care in the same way. These points were reported at the last inspection. Medication records must always be filled in properly to show whether a resident has had their medication or not. Staff must make sure that residents’ rights to dignity and privacy are respected at all times, for example not talking over a resident’s head when helping them to eat and not talking about a resident’s health in front of other residents. Residents should be given information about menus in a way that they can understand. Residents should be able to make choices about which dishes they want, and should be able to help themselves if they can. There should always be condiments and glasses for water in the dining room for residents to use. Every resident (and their relatives) should have information about how to make a complaint if they are not happy with the service. This was reported at the last inspection. The home should find out about the best way to design the accommodation for people with dementia care so that they can find their way around better. Residents should have access to all parts of their home, including the outside patio areas and their own bedrooms, or there should be a clear record to show why they cannot. Lighting to bedrooms must be improved so it is brighter for residents. Protective equipment like gloves and pinnies used by staff to support residents should be discreetly stored in bathrooms so it is not on display. This was reported at the last inspection. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 8 All the care staff should have training in dementia care needs so that they know how to look after the people who live here in the right way. All staff must have refresher training in health & safety so that they are up-to-date with how to keep the home safe for the people who live here. Staff must have in-house training in fire safety at the right intervals. 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 Residential Home DS0000037820.V338512.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 Residential Home DS0000037820.V338512.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, 3 and 4 (standard 6 does not apply to this home). People who use this service experience adequate quality outcomes in this area. People are not able to make an informed choice before moving into the service as supporting information lacks detail and fails to adequately demonstrate that it can provide specialist support for people with dementia. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Lindisfarne care home sets out the aims and objectives of the service in a Statement of Purpose, which is available on request. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 11 The home has also developed a Service Users Guide that sets out the values of the home. This document makes frequent references to supporting the diversity of needs, cultures, and beliefs of all those involved in the home. In this way the home supports the principles of equality and diversity. However the Service Users Guide has not been given out to the people who live here, and its content does not include details of the actual service that is provided (e.g. mealtimes, and complaints procedure). Also it is not written in a style that might support people with dementia care needs. In this way current residents do not have clear information about the service. Before people to move to the home their needs are assessed to ensure that Lindisfarne can meet those needs. First, each potential resident is assessed by the Social Services Department to determine whether that person requires a residential care service. The home then uses a pre-admission assessment form, social work reports, and rating scales to assess each person’s individual needs. However, in the sample examined, pre-admission assessments were not sufficiently detailed, often providing brief, rather meaningless comments of a person’s care needs. For example, “personal hygiene – needs assistance”. In some cases, the name of the assessor and the date of assessment were not completed. The assessment records also refer to social care needs, but in the sample examined most of these had not been completed so there was little information about the peoples’ life history. In this way staff would have little information about their preferred routines, social activities, family connections, spiritual/cultural needs or important events or dates. At the time of these visits there were 63 people living in the home and 3 potential new residents were due to move in the following week. All of the people who live here have dementia care needs. Lindesfarne purports to specialise in the care of people with dementia care needs. However, the accommodation has not been designed for the orientation of people with dementia care needs. The home is not involved or associated with any local, regional or national dementia care groups. Few staff have had training in this area of care (although training is planned for the future.) In these ways the home does not demonstrate that the service is based on current best practices, and does not reflect relevant specialist guidance for services for people with dementia care needs. Lindisfarne Residential Home DS0000037820.V338512.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 and 10. People who use the service experience adequate quality outcomes in this area. While access to health care services are good, record keeping is inadequate and fails to demonstrate that needs are fully met and th behaviour of staff on occasion fails to promote individual dignity. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: There are individual care plan files in place for each of the people who live here. The home is currently working with two styles of care plan as the Provider has introduced a new, corporate care plan and these are now being used for new residents moving to the home. The new format is a clinical, nursing care model. It allows little space for specific areas of care to be recorded. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 13 Assessments used to identify people’s needs are not fully completed. Most gaps are about psychological, daily routines, social, and cultural needs. There are assessments in place around moving and assisting, risk of falls, and nutrition. However these are mainly given a number score rating and do not always identify what action should be taken to support the person. In some cases, important changes to a person’s needs had not brought a review of the assessment. For example, one person has recently experienced a number of falls and accidents but the falls risk assessment states “no change”. Another person has recently had their medication changed to crushable form. However the medication risk assessment states “no change”. The new care plan format contains a ticklist calendar for ‘general baths, shower, shave and bodywash’ and another calendar for bowel movements. This is inappropriate as the care plan fails to show what support the person requires and how this is to be provided. It is good practice that one care plan identified “making choices” as a goal for one person e.g. choosing their own clothes each morning. There have also been some improvements to identifying people’s mental health needs within care plans. However, care plans do not always demonstrate person-centred care, and some do not support people’s most important needs. For example, one person whose behaviour is sometimes aggressive had a walking stick removed as they were using it to strike people. There are no guidelines for staff in the care plan around the person’s behavioural needs, despite the frequent need for staff action. In this way different staff may be approaching the person in different ways, which could lead to an increase in the person’s behaviour. There was also “no change” to their moving and assisting assessment, despite the fact that they had previously used the walking stick for mobility. On the other hand in most care plans there is a ‘medication’ goal even where there are no issues around this support. The plan simply states that staff will administer it, and the monthly evaluations simply state that it has been administered. This is unnecessary. In most care plans, there is a ‘finances’ goal even where the home has no input or dealings with the person’s money. The monthly evaluations continually state that the family deal with finances. This is unnecessary. It is clear that staff spend time keeping care plans up-to-date in terms of monthly recording. However they are not describing the specific needs of residents, not outlining a clear plan of care to meet those needs, and not recognising when changes in need require a review of the assessment record. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 14 In this way, new or agency staff would not be guided by care plans in how to support the individual needs of the people who live here. This shows a lack of training in person-centred care. Also there is no firm keyworker system in place at this large home, and each staff could not be expected to know the specific and changing needs of 66 people. The home ensures that all residents are registered with the right community health care services, including GP, dental, ophthalmic and chiropody services. It is good practice that the home provides its own transport for resident who need to attend outpatient appointments. The home has good contact with district nursing services and asks the advice of specialist health care professional such as dieticians when required. It is good practice that the home and an occupational therapist are working together to support one person towards greater mobility with the intention of that person returning to their own home. However in some cases the record of GP input (kept in care files) had not been completed, even though the inspector found references in daily records to show that a GP had called and had prescribed new medication. When the records of medical input are not completed it does not support communication between staff, or between the home and family members, about residents’ health care needs. In one case daily records stated that a resident had “appeared in pain” but indicated that staff took no action because the person was not prescribed any painkillers. There is no record that the home gets consent from GPs for overthe-counter painkillers for those people who are not prescribed painkillers in case they require them in the future. The records of support for people with nutritional needs is mixed. In some cases there are definite links between the nutritional assessments, to care planning, to support or encouragement at mealtimes. For others there is a no care plan to show what support is required, despite nutritional assessments that identify a need. At this time some support with food and fluids is provided by staff who are not currently responsible for completing food/fluid records, and there are no clear lines of communication with catering staff. Medication is managed on behalf of residents. Senior staff are responsible for the administration of medication, and they are provided with training in the safe handling of medicines. There is secure suitable storage for medication, and administration of medication was carried out correctly. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 15 However there were some gaps to the records of medication administration. Also, codes had been used without describing why a medication had not been given. There are no photographs of residents on their medication records for new or relief staff to identify the correct resident when administering their medication. There were several occasions of good practice where staff supported residents in a sensitive and respectful way. For example, discreetly encouraging a resident to do up their blouse to protect their dignity; supporting people with their mobility at the resident’s own pace; and taking time to sensitively talk to a resident who was upset. During a tea-time meal staff in one dining room provided sensitive support to help people with their meal. Many residents are alert, chatty, can express some choices and have a good sense of humour. In this way their emotional well-being is being supported by the homes friendly, sociable atmosphere and their interaction with some staff and other residents in the home. Residents are supported with their personal grooming and appearance. Some residents were able to describe how they enjoy the weekly hairdressing service and manicure sessions. Some ladies had been supported with make-up and nail varnish and were clearly proud of this. However some staff practices do not promote residents’ dignity. For example, during a lunchtime meal one staff was physically supporting a resident to eat, but did not engage with the person, outpaced them by trying to feed them too quickly, and was brusque in their manner. The staff member repeatedly told the resident to “stop it” when they tried to pick up their own spoon. Staff constantly told some residents to “sit down and eat your lunch” as commands, rather than sensitive encouragement. Both staff talked loudly to each other across the dining room about being at work in a way that made it clear they view Lindesfarne as a workplace rather than the residents’ home. One staff carried on an inappropriate conversation about a resident’s health care needs over the resident’s head, and in front of other people present. These are poor practices, as staff treated those residents as if they were objects. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 16 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 and 15. People who use the service experience adequate quality outcomes in this area. While daily life experiences and opportunities to take part in activities for people are improving people are not consistently supported to keep full control over decision making in their everyday life. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home is flexible enough to meet some individually preferred routines, for example some people like a lie-in and so are supported to have a late breakfast. Residents make good use of the lounges and dining rooms for socialising, and people accommodated on two floors can make good use of their own bedroom for privacy. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 17 The home employs an activities co-ordinator who is enthusiastic in her role. There are now bright posters on each floor advertising activities for the week and other social events. The activities co-ordinator aims to arrange activities on each floor with the support of care staff. On the day of this visit care staff on the ground and first floor were engaged in activities such as dominoes and reminiscence chats with a small number of residents. During this visit there were not sufficient staff on the lower ground floor to engage residents in activities. The home has its own minibus and driver, and there have been good improvements to opportunities for residents to go out. There are weekly trips and chances for people to go out into the local community, and the outings records show this is popular. For example, on the day of this visit a small group of resident were going to a local garden centre for coffee and a look around. The home has a warm and welcoming atmosphere and there were some visitors to the home over this inspection. One visitor stated that they are “always made to feel welcome”. Relatives stated that they are able to visit at anytime convenient to them. Some relatives are still actively involved in the care of the respective resident and make regular visits to the home. The home now holds Relatives’ Meetings for relatives to make comments and suggestions about the care provided in the home. The home has tried to improve the information for residents about menu choices by developing a pictorial menu book. However the quality of the digital photographs is rather poor so most dishes are indistinguishable and look the same. There was no indication that this book is used by staff when asking residents for their menu choices. There are no written or pictorial menus in the dining rooms. Residents continue to be asked for their menu choices the day before so are unlikely to remember their choice the following day. However the manager stated that this is just to give the cook an idea of preferences, as people can be offered the alternative dish if they show that they do not want their original choice. During the lunchtime meal it was clear that some people were offered the second dish, and even a third alternative if they appeared uninterested in the meal. The quality of meals remains very good. The home uses local suppliers and local shops so that food is always freshly delivered. The Provider does not restrict the catering budget, and the manager stated that many traditional dishes are provided. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 18 During discussions residents who were able to comment were very complimentary about the standard of the catering, for example one person said, “The food is always very good…it’s all home-made, including scones and cakes.” One teatime meal was a buffet of sandwiches, crisps, scones and buns. Residents enjoyed their meal and most people found these finger-foods easy to manage by themselves. One person said, “I give 9/10. It would have been 10/10 but we had no serviettes so we all got sticky fingers.” As reported at the last inspection, even very able residents do not have many opportunities to serve themselves, to retain their independence and make choices. The buffet tea meal was plated-up by care staff so residents could not choose which sandwiches or scones they had. During the lunchtime meal all residents’ desserts were served to them with custard, instead of providing custard jugs on table, or at least asking residents if they wanted this. Residents were offered a choice of hot or cold drinks at mealtimes. However there were no jugs of juice on tables for residents to help themselves. There was no salt or sugar on tables until some residents asked for these. All dining rooms have ‘kitchenette’ areas for staff, residents and visitors to make drinks but the equipment is not always available for this. For example, there are water dispensers in each dining room but no glasses, only large mugs. The inspector was served water in a mug. Such a practice would have been very confusing for the people who live here, as they would have expected a hot drink to be in a mug. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 19 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 and 18. People who use the service experience adequate quality outcomes in this area. Good complaints and protection systems are in place and dealt with effectively when they are made but lack of availability of information means that some residents are unaware of the process and unable to bring concerns to the manager’s attention. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home has a written complaints procedure but has not provided this information to residents. There is one copy of the complaints procedure displayed in the hallway but this is not presented in a meaningful way for people with dementia care needs, and could not be discreetly viewed by visitors. The manager has developed a pictorial summary of the complaints procedure but this has not yet been provided or explained to residents. Some of the residents who were able to comment said that they would speak with the manager if they were unhappy. Residents and staff indicated that the manager is approachable and has an open door policy. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 20 Over the past year there have been two formal complaints about the service, both from relatives. The owner has investigated these complaints. The home keeps a basic register of complaints received, however this does not outline whether complaints have been resolved or not. The complaints file contains statements given by staff during investigations into previous complaints. The statements are not named, signed or dated so could not be considered as evidence. It is good practice that informal complaints and suggestions have also been recorded. However there are no records of the action taken or outcomes to demonstrate what the home has done to rectify those informal complaints. The manager and most of the staff have had training in safeguarding adults procedures from the local Social Services Department. Staff have also had internal training in protection of vulnerable adults. The manager is fully conversant with the procedures for dealing with reports of suspected abuse. She has taken correct action in the past to deal with an unsuitable staff by referring them to the Protection of Vulnerable Adults register so that they are barred from working in a care setting again. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 21 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 and 26. People who use the service experience adequate quality outcomes in this area. The building is clean, comfortable, easily physical access and well maintained. However, wayfinding/ signs to help people find their way around is limited and prevents people from finding their way around the building safely. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Overall the building is in a good state of repair and well maintained. The home benefits from having a full time maintenance staff to attend to minor repairs and redecoration. The home provides 66 good sized single rooms, all with ensuite facilities. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 22 The home consists of three units, one on each floor. There are 17 places on the lower ground floor, 24 places on the ground floor and 25 places on the first floor. On each floor there is a lounge and dining room, and a range of bathrooms and shower rooms. Most living areas of the home have a good standard of decoration and furnishings. Lounges are comfortable, warm, bright and cheerful. The sample of bedrooms examined were also comfortable, warm and well furnished. However several bedrooms have low wattage light bulbs so are dimly lit. The low lighting in bedrooms could present tripping hazards for the people who live here. This was being addressed by the third visit. The building is on a sloping site. Residents on both the lower ground and the ground floors have access to external patio areas. On each floor there are keypad locks on the staircases and the lift. This means that people are virtually ‘locked’ into the unit where they live. It also means that people living on the first floor cannot access the external patio area on the ground floor without staff help. This restriction of residents movement could be viewed as restraint. In discussions the manager described how some residents previously used the lift by themselves. However recently some people had overused the lift buttons (due to their confusion) and there was concern that this would lead to residents accidentally becoming trapped in the lift. However there are no risk assessments to justify or demonstrate why residents might be at risk if they were free to access all the communal areas of their home. All the bedrooms on the lower ground floor are kept locked. Staff stated that this is because one person has a tendency to enter other people’s bedrooms due to their confusion. However this means that residents on this floor are unable to access their own bedrooms whenever they wish, except for one person who has been given a key. There are no risk assessments to outline why the rest of the resident on this floor cannot access their own bedrooms. All of the people who live here have dementia care needs, which can affect their communication skills and orientation. Some care plans identify ‘orientation’ (wayfinding) as a specific area of need for some residents. But there are no environmental clues for residents to find their way around. For example, there is very little signposting to support residents within this huge building, other than small brass numbers on bedroom doors and small brass plaques on bathrooms and toilet doors. All doors are the same colour (e.g. white) so residents are not supported to distinguish between bedrooms, bathrooms, offices, treatment rooms, laundry etc. Discussions were held with the manager about the use of colourcontrasting and methods of signposting to support the orientation of people with dementia care needs. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 23 Overall odour control is good and all areas of the home that were examined were clean. There are sufficient domestic and auxiliary staff to manage the housekeeping tasks in this large this building. Those residents who were able to comment said that the home is kept “clean and tidy”. One visitor also commented, “It always seems very clean.” There were continence pads and protective gloves on public display in bathrooms and toilets on the lower ground floor. This does not promote the dignity of residents and also compromises control of infection. In most other bathrooms there are cupboards for this equipment, and it was stated that more cupboards have been ordered. Dedicated laundry staff provides laundry services. The laundry area is well– equipped and satisfactory for the size of the home. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 24 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 and 30. People who use the service experience adequate quality outcomes in this area. Adequate systems are in place to ensure that enough competent staff are recruited and in place to fully meet the needs of residents. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Sixty three people with dementia care needs are currently living in the home. At least twelve people need two staff to support them with most personal care needs. The staff rota shows that on most days there are around 11 staff to care for residents, e.g. a senior and two carers on each of the three floors, and two general assistants. This drops to 10 staff from 4pm-8pm. The general assistants do not provide personal care but may support residents with eating and drinking. However, on the day of the first visit there were only 8 care staff on duty due to sickness. This was compounded by the fact that the deputy manager was responsible for the management of the home during the annual leave of the manager. This meant there was not enough senior staff on duty for each floor. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 25 It was apparent during these visits that poorer staff practices occurred in the area where no senior was present, when staff were not supervised in their care of the people who live here. A relative visiting the lower ground floor felt that sometimes there were not enough staff to provide sufficient time to encourage some residents with their meals. The relative said, “The home is kept clean but there’s not always enough staff to help the residents.” Overall residents seemed relaxed and comfortable when they had the opportunity to chat to staff. However staff do not wear name badges and none of the residents who took part in discussions knew the names of the care staff. The home does not have a keyworker system (e.g. a named carer for small groups of residents) and staff may work on different floors each day, sometime changing floor during the course of the day. In this way there is less chance for staff to be fully aware of a residents’ needs, or to recognise a change in needs, so less chance for continuity of care. There are at least 5 care staff on duty during the night. The staff rota showed that there is often 6, which is good because it allows two staff on each floor to manage any moving and assisting needs of residents during the night. The home employs good levels of domestic, laundry and catering staff. The home also has an administrator who manages administrative and financial matters. There have been a number of changes to staff over the past year, about a 26 turnover. However all posts have been filled, and there is a consensus amongst staff that there is improved team work and fairer working arrangements since the changes. The Provider is an equal opportunities employer and promotes good equality and diversity procedures when recruiting new staff. There is a good mix of age, gender, experience, culture and nationality amongst the staff team. The home ensures gender-appropriate support by making sure that the 5 male care staff do not provide intimate personal care for female residents. Staff records showed that suitable checks and clearances are received before a new staff is employed. In discussions staff were enthusiastic about training and commented on the improvements to training opportunities over the past year. However the home has had to change training provider recently, which has slowed down the home’s training plan and meant that some health & safety refresher training has not yet been delivered. There are records of individual training sessions attended by individual staff. These records currently do not include details of induction training for new staff. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 26 Over half of the care staff team (25 care staff) have achieved a recognised care qualification (that is, NVQ level 2 or above). More care staff are working towards this qualification. It is also good practice that catering and domestic staff have also achieved or are undertaking NVQ qualifications in their areas of work. About half of the staff team have had a one-day introductory course in dementia care awareness, however this is not sufficient for a home that provides only dementia care. The manager stated that arrangements have now been made for about 13 staff to engage in a 12-week course on positive dementia care. Around 4 staff already have this training. It is important that all care and management staff receive the same training so that the principles and best practices in dementia care can be applied consistently within the home. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 27 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, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. While management and administration of the home is improving but support for the manager is sometimes lacking. This affects the running of the home and quality of care delivered to people using the service. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The Manager has many years experience in care settings for older people, and has completed the Registered Managers Award training and NVQ level 4 in Care. She has been in post as a manager at this home for one year. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 28 Several staff commented on the improvements to the home since then, including increased activities for residents, increased staff training, and improved staff morale. The manager is supported by a deputy manager, who deputises in her absence. However it was clear that when the manager is away there is no extra senior staff arrangements to cover the deputy manager’s role or to ensure sufficient senior cover around the home. During discussions the Provider said that this would be addressed. Lindesfarne is an extremely large home with some complex issues that requires robust organisational management. Part of those arrangements is the support, supervision and oversight of the home by the General Manager of Gainford Care Homes. However it was clear that this has not been achieved over recent months due to the General Manager having to attend to other priorities in other care homes. The Provider has a comprehensive quality assurance system that includes a number of monitoring tools to check the quality of the service. For example health & safety checks, Providers monthly reports, CSCI inspections, and complaints. The views of residents are sought through a 6 monthly questionnaire, although residents need support from relatives or other independent representatives to complete these. Relatives views are also sought through care reviews and through monthly Relatives Meetings. It is clear that concerns and complaints over the past year have influenced a number of improvements in the care service. This indicates that the views of residents or their representatives are listened to. There are good arrangements for supporting residents to manage their personal allowances if this is requested. The home will support residents to keep their personal monies in a safe place. Individual resident’s monies are securely stored in individual, named wallets. There are clear computerised statements, which are managed by the home’s administrator, of any deposits or withdrawals. A sample of monies and records showed that these were upto-date and in good order. Accidents and falls are correctly recorded, and analysed on a monthly basis. These demonstrated that any required action is taken. Training records do not demonstrate that staff have received refresher training in health & safety matters, for example first aid and moving & assisting. It was stated that this was due to frequent postponements and cancellations of training sessions by the previously contracted training agency. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 29 The manager stated that, in some cases, staff had received the training but they had not yet received a certificate, so this had not yet been recorded on individual training records. In the meantime there is a training plan in place for training in these areas in the future. In-house fire instruction records are not sufficiently detailed to determine which staff have received this and whether this meets the required intervals. The extractor fans were furred up in the en-suites of the sample of bedrooms and bathrooms that were examined. This presents a potential fire hazard. There is a large laundry trolley stored in one bathroom that blocks access to the toilet. This presents a potential tripping hazard for residents trying to use this room. Records of hot water temperature checks were up to date but only show one record for each bathroom, so it is not possible to distinguish whether this is for the baths or washbasins. The home has a list of portable appliances that had recently been tested for safety by an electrician. However this did not include the name of the electrician or the date of testing. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 30 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 X 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 X X X 2 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 31 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 5 Requirement The Service Users Guide must be provided to all new and existing residents. It must be written in a suitably accessible format. This is to inform people about the service in a way that supports their communication needs. (Previous timescale of 01/01/07 not met.) Care plans must set out the specific needs of each residents and clear, detailed guidance for staff in how to support those needs. Monthly evaluations must report a meaningful assessment of the progress or change in need. This is to ensure that all staff know how to support people in the right way, and that any changes in need are identified. (Previous timescales of 30/04/06 and 01/02/07 not met.) Behavioural guidelines must be in place to support the staff to manage incidents of challenging behaviour. This is to ensure that DS0000037820.V338512.R01.S.doc Timescale for action 01/01/08 2. OP7 15(1) 01/01/08 3. OP7 13(7) 01/12/07 Lindisfarne Residential Home Version 5.2 Page 32 4. OP9 13(2) 5. OP10 12(4)(a) 6. OP15 12(3) & 16(i) 7. OP16 22 staff provide support in a consistent and de-escalating manner. (Previous timescale of 01/12/06 not met.) Records of the administration of medication must always be fully completed. This is to show whether a resident has received their medication, or to show the reasons why not. Staff must ensure that their practices and attitudes promote and uphold the dignity of residents at all times, including meal times. This is to ensure that residents are valued and respected. Residents must have opportunities to independently choose from the meal and drinks selections (e.g. from buffet meals, sauces, side dishes and soft drinks) and to serve themselves wherever capabilities allow. This is to ensure they make they retain their rights to choice and independence. (Previous timescale of 01/12/06 not met.) Residents (and their representatives) must have a clear, written complaints procedure that is in a suitable format to meet their needs. 01/12/07 01/11/07 01/12/07 01/12/07 8. OP22 23(2)(a) This is to ensure that everyone has information about how to make a complaint. (Previous timescale of 01/01/07 not met.) The home must seek advice 01/02/08 about the best environmental design and decoration within a home for people with dementia care needs. This is to ensure that the home considers the best ways it can support the DS0000037820.V338512.R01.S.doc Version 5.2 Page 33 Lindisfarne Residential Home 9. OP24 17, Sch.3, 3(q) 10 OP25 23(2)(p) 11 OP26 12(4)(a) and 13(3) 12 OP30 18(1)(c)i 13 OP38 13(3),(4) and (5) and 18(c)(i) 14 OP38 23(4)(d) orientation of the people who live here to There must be risk assessments to demonstrate why residents on the lower ground floor do not have access to their own bedrooms. This is to show whether residents’ freedom to use their own rooms is unnecessarily restricted. The lighting to all bedrooms must achieve a minimum of 150 lux (e.g. the equivalent to a 100 watt light bulb). This is to ensure that these rooms are bright enough for the people who live here. Continence equipment and protective equipment must not be left out on display in bathrooms and toilets. This is to ensure the dignity of residents, and also to protect equipment from possible crosscontamination. ((Previous timescale of 01/12/06 not met.) The proposed training arrangements must continue to ensure that all staff have suitable training in dementia care. This is to ensure that staff are equipped to provide the right type of care for the people who live here. Arrangements for training must continue to ensure that all staff receive statutory training in all health & safety matters, including moving & assisting and infection control. This is to ensure the health and safety of the people who live here. Night staff must receive in-house fire instruction at the required 3 monthly intervals. This is to ensure that they are trained and DS0000037820.V338512.R01.S.doc 01/12/07 01/01/08 01/11/07 01/02/08 01/01/08 01/12/07 Lindisfarne Residential Home Version 5.2 Page 34 15 OP38 13(4) competent in the fire procedures. (Previous timescale of 01/12/06 not met.) Extractor fans to en-suites and 01/12/07 bathrooms must be regularly cleaned. This is to prevent a potential fire hazard. Bathrooms must be kept clear, and laundry trolleys must be stored in such a way that residents’ access to toilets is not impeded. This is to prevent a tripping hazard for the people who live here. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Each resident could be provided with an information pack in their bedrooms that they could refer to at any time that could include a revised Service Users Guide, menus and activities timetable. All parts of the assessment documents should be completed, including social care needs, name of assessor and date of assessment. Serious consideration should be given to membership or association with local and regional resources and organisations that specialise in dementia care. This would support the home to keep up-to-date with current best practices. Serious consideration should be given to developing a keyworker system to allow staff to concentrate on managing the care plans of a small number of residents. Staff should be provided with training in person-centred care to support them in developing individualised care plans for the people who live here. Records of GP visits and any outcomes should be completed. The medication administration records should include a DS0000037820.V338512.R01.S.doc Version 5.2 Page 35 2. 3. OP3 OP4 4. 5. 6. 7. OP7 OP7 OP8 OP9 Lindisfarne Residential Home 8. 9. 10. OP15 OP15 OP16 11. 12 13 OP28 OP31 OP38 14 OP38 photograph of each resident so that new or relief staff can identify the correct each resident Tables should be set with condiments and sugar for residents to use. Kitchenettes should be provided with glasses for residents and visitors to help themselves to water from the dispensers. Any statements taken from staff or others during the course of a complaints investigation should be named, signed and dated. The records of informal complaints should include action taken, outcomes and resolution. Training records should also include details of induction training for new staff. Serious consideration should be given to the provision of an additional senior staff to cover the deputy manager’s role when she is deputising in the absence of the manager. PAT (Portable Appliance Tests) certificates should include the name of the assessor and the date that the tests were carried out. This is to demonstrate that the testing was carried out competently. Hot water temperature records should distinguish between baths and washbasins. Lindisfarne Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 36 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 © 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 Residential Home DS0000037820.V338512.R01.S.doc Version 5.2 Page 37 - 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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