Inspection on 04/08/08 for Lindisfarne Residential Home

This inspection was carried out on 4th August 2008.

CSCI found this care home to be providing an Adequate service.

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 19/09/07

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Lindisfarne Residential Home Durham Road Birtley Chester le Street Co. Durham DH3 1LU Lead Inspector Karena M. Reed Key Unannounced Inspection 4th August 2008 10:00 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 Residential Home DS0000037820.V372259.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.V372259.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 cis@gainfordcarehomes.co.uk CLS@gainfordcarehomes.co.uk Gainford Care Homes Ltd 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) Elsie May Hanson Care Home 66 Category(ies) of Dementia (66) registration, with number of places Lindisfarne Residential Home DS0000037820.V372259.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 with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Dementia - Code DE, maximum number of places: 66 The maximum number of service users who can be accommodated is: 66 19th September 2007 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 has become registered to provide nursing care since the last inspection. 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. The home is equipped with aids and adaptations to help more physically dependent people in the home. 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. A Statement of Purpose and service user guide are available at the home. The guides describe the services and facilities provided by the home and how staff are trained to meet service users’ care and support needs. CSCI inspection reports are also available at the home detailing the quality of care provided. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 5 Fees payable for living at the home at the time of inspection in August 2008 are £400. Additional charges are payable for personal newspapers, private chiropody, toiletries and hairdressing. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. How the inspection was carried out Before the visit: We looked at: • • • • • Information we have received since the last inspection on September 19th 2007. How the service dealt with any complaints and 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 and their relatives, staff and other professionals. During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at other records that must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last inspection. We told the provider what we found. 10 surveys were sent to residents and relatives, 5 were returned from the same resident. 3 surveys were sent to care professionals, 0 were returned. 10 surveys were sent to staff, 2 were returned. 6 surveys were given out to relatives, 0 were returned. What the service does well: Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 7 Arrangements for service users to maintain contact with their family and friends are good. Detailed information is given to prospective residents about the services provided by the home. The home offers prospective residents whatever length of time they need to decide if they wish to live at the home. The level of staff training is good to give staff more understanding of the care and support needs of residents. Residents have the opportunity to pursue their religion if they wish to. Residents enjoy wholesome and home baked food. During the lunch time meal staff were observed treating the residents with dignity and respect. What has improved since the last inspection? What they could do better: Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 8 Ensure all requirements and recommendations are carried out in a timely manner. All care plans must set out the specific needs of each resident and provide clear, detailed guidance for staff in how to support these needs. A system of regular review of residents’ care needs must be introduced with monthly updates of their care plans or earlier if their needs change. Individual behavioural guidelines must be put in place to support staff to manage incidents of challenging behaviour. Staff should receive training about working with diabetes. Life histories must be completed for all residents to provide staff with more information about residents for when they may be unable to give this information themselves e.g. likes, dislikes, events of importance. Residents’ records should contain a record of when residents’ have been seen by a dentist, optician or chiropodist. Resident’ records should record the outcome of any intervention by health personnel. Residents’ choice must be balanced with maintaining their dignity e.g. ensuring their personal care is attended to; teeth cleaning, shaving, washing and ensuring residents wear appropriate clothing. Risk assessments must provide evidence as to why all residents’ bedrooms are locked throughout the day. Residents’ medication must not be allowed to run out. A supply of prescribed medication for residents’ must always be available within the home for administering when required. Medication records must accurately record the administration of medication to residents. More effective odour control is required in some bedrooms. More effective hygiene is required around the home. The home is showing signs of wear and tear and an improvement plan must be provided to show how the decorative work is to be carried out and the timescales. The cracked lavatory cisterns, broken lavatory seats, bath panels and broken glass in the balcony door must be replaced in the interests of health and safety. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 9 The identified soiled carpets must be made good or replaced in the interests of residents’ comfort and health and safety. The home must seek advice about the best environmental design and decoration within a home for people with dementia care needs. Vetting procedures must be more robust when employing new members of staff. Staffing levels should be kept under review in the interests of residents’ safety as they become more dependent. The fire log must accurately record the monthly visual checks for emergency lights and fire extinguishers. Any incident which effects the well- being of a resident must be submitted to CSCI within 24 hours e.g. any challenging behaviour, death, serious injury which necessitates a hospital visit or untoward event. 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.V372259.R01.S.doc Version 5.2 Page 10 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.V372259.R01.S.doc Version 5.2 Page 11 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, 4 and 5. (Standard 6 is not applicable to this service) People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are adequate procedures in place to ensure that prospective residents are making an informed choice about the home and that the home can meet their needs. EVIDENCE: The Home’s Statement of Purpose and service user guide were examined. They were interesting and informative and contained the necessary information as required by the Care Homes Regulations 2001. They were written in a way that might support people with dementia care needs. Records for six people who live at the home showed that when they were admitted to the home an assessment of their care needs had been carried out before their admission. A copy of each person’s social services assessment and Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 12 care plan had been obtained before they moved into the home. The person living at the home and relevant people who knew them were involved in the initial assessment. The assessment form encourages staff to explore issues relating to equality and diversity as it refers to gender and religious/spirituality preferences. It also looks at mood, speech, behaviour, mental health, risks, sexuality and living skills. There was little or no information about the social history of a resident or any information about their daily living preferences and likes and dislikes especially if they were no longer able to communicate this information for themselves to ensure staff could meet all their needs. We were informed at inspection a Life History Book was to be compiled for each resident, a blank book was available to show what was to be introduced. All this information and the care manager’s assessment of the resident’s care needs will be essential to help ensure the needs of the resident can be met by staff. The home is registered to provide care to people with dementia but there was little evidence to support that the home could provide this specialist care at this time. The accommodation did not encourage the independence of the person who may be suffering from memory loss. Not all signage was appropriate to assist residents’ in their movement around the home, there were no meaningful photographs or pictures to aid reality orientation. All corridors and doors around the home were carpeted and decorated in the same colours so it was difficult to differentiate and so did not aid orientation. The home is still not involved or associated with any local, regional or national dementia care groups so does not demonstrate that the service is based on current best practices. Residents have the opportunity to visit the home as often as they need in order to decide if they want to live there. A resident may come for meals, have overnight stays and be introduced to other residents at the home at a pace suitable to the individual. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ plans of care do not reflect the amount of care and support provided by staff. EVIDENCE: From the sample of care records looked at there has been some progress in introducing the new care plans but much more information was required to ensure that staff could provide the correct levels of care and support to people with dementia. The sample of care plans examined did not clearly outline each resident’s needs and how these should be supported such as what assistance was required with personal care or eating. Therefore new or agency staff would not be guided by care plans in how to support the individual needs of people who live in the home. None of the care plans checked described what outcomes the home hoped to achieve by their intervention. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 14 People’s records did not show how staff have reached “best interest” decisions on behalf of the people in their care. One resident who chose to stay in bed for three days did not have a plan to reflect this showing how their medical and nutritional needs were being met. Behavioural care plans were not in place to show the interventions required by staff to provide consistency for people who may present behaviour that was difficult to work with. It was observed that some residents were not clothed appropriately and personal and oral hygiene required attention, their care plans did not reflect what assistance was required to ensure the dignity of the person although it was accepted it was respecting the choice of the individual but this needs to be balanced with their capacity to make decisions. Residents’ care plans did not record much information about their social and leisure needs, this should be addressed when the Life Story Books previously mentioned are completed with the residents and their families, in order to obtain more life history about the residents if they are unable to speak for themselves. This will give some insight into their likes, dislikes, personal history, things that are meaningful and of interest to the person. The sample showed that some care plans had been evaluated at least three monthly and showed that there may be a change in need but the care plans did not reflect the amount of care and support that staff would need to give to residents as their needs changed. A care plan had been changed however for a resident who had become physically dependent and frail showing their increased dependency needs such as fluid intake and moving and assisting needs. There was a system for the review of residents’ care needs but some of the reviews were out of date. Health care records were available on residents’ files to show that residents are supported to have access to health care services such as GPs, psychiatric services, district nurses and continence advisors. These records did not show residents access to chiropodists, opticians and dentists however evidence was available from another source to show residents had access to these services. There was an incident of a resident falling into a diabetic coma and emergency medical intervention was required records showed days when district nurses has visited, but there was a gap in recording over the weekend when this incident took place. At the time of inspection eleven residents have diabetes therefore it would be useful if staff had some training about diabetes awareness. Risk assessments are in place for residents. Moving and handling assessments have also been carried out to show the moving and assisting needs of more dependent residents. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 15 Technical aids and equipment are available for residents who are unable to move independently, one hoist is currently available for use over the three floors of the home. Training records showed senior staff members receive training about medication before they are able to administer it to residents. They study for a National Vocational Qualification at level 3 in medication. Medication records were looked at for eight residents. One resident’s records were not correctly recorded showing the medication had not been issued on the date it had been signed for by staff. Another record was not signed although the medication had been administered. Another resident’s pain relieving medication had run out and the new supply was not yet available in the home to be administered when required in the evening. Some medications such as eye gel and another medication that required storing in a fridge were inappropriately stored. A supply of a controlled medication was still on the premises after it was no longer required as the resident had died. No resident administers their own medication currently. Care records, conversation with staff and observation showed the privacy and dignity of residents is respected, however in order to maintain residents’ dignity this needs to be balanced with their capacity to make decisions such as in dressing inappropriately or not choosing to carry out personal hygiene tasks. Lindisfarne Residential Home DS0000037820.V372259.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 in this outcome area. This judgement has been made using available evidence including a visit to this service. Overall, residents have some opportunities to make choices about activities, daily routines and menus so that they lead a lifestyle that matches their social care needs. EVIDENCE: A full time activities organizer is employed by the home. She is very enthusiastic. Activities are available for residents these include: quizzes, bingo, exercises, ball games, coffee afternoons, videos, sing-a-long, manicurist and hairdressing. Various parties are arranged, which are supported by relatives and families. Church services also take place within the home. Residents have the opportunity to visit the local community with relatives and staff. The home has a mini bus so residents enjoy regular trips to the coast, country, local places of interest and meals out. Staff support residents to keep in touch with relatives or to visit them where possible. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 17 When the new Life History Book is completed for each resident it will supply information to ensure activities are more individual and person centred. It should help staff ensure that the social and cultural needs of residents’ are given as much attention as the residents’ health and personal care needs. This will make reminiscence more personal and help staff to engage and retain the involvement of people with memory loss. Staff ask each resident about their wishes, interests and choices. Most of the staff team have followed a twelve- week specialist course about memory loss. This training should help staff to ensure residents are given choice in order to maintain some control in their life. Residents on all floors did not have access to their bedrooms during the day as they were locked therefore they did not have a choice to sit in their bedroom if they wished to. The home’s menus are devised outside of the home but adopted from the award-winning menu of the chef of another home owned by the company. It is therefore not localized and based on the known likes and dislikes of the residents of this home however residents were very complimentary about the food. The cook was advised if she could attend residents’ meetings in order to hear about menu suggestions and food likes and dislikes of people just in case menus needed to be amended. At least two hot meals are provided each day, cooked breakfast is also available daily. Lunch on the day of inspection was: roast chicken and vegetables or pepper past bake and rhubarb crumble and custard. Residents also enjoy home baking. People have access to snacks and drinks between meal times. The inspectors participated in the lunchtime meal. The meal was tasty, nutritious and appetising. Staff responded to people’s needs in a caring and sensitive manner but they could not provide them with the assistance they needed to eat their meal until after everyone had been served sometime later, in the mean time some residents just sat looking at their food unsure of what to do and therefore it was not hot when they did eat it. Most people have a nutritional risk assessment. The home’s standard format for recording nutritional risk assessment information has not always been used to record the outcome. Currently, there are no people with a different ethnic or cultural background using the service. Accessible, pictorial menus are available to remind residents of food available at meal times, although they were not on display in the dining rooms. Staff informed people individually the day before to find out their menu choices. Napkins also were not available in each dining room for people to use. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. The home has a good, clear, user-friendly complaints and protections system. EVIDENCE: The home’s complaints procedure is given to new residents as they move into the home. The procedure assists and supports them to bring any matters to the attention of staff outside of the home in case they felt uncomfortable bringing any complaints or concerns to the attention of staff within their home. There is a complaints procedure on display within the home for the use of residents and their relatives. The home keeps a record of complaints. There have been five complaints received since the last inspection, which have been investigated by the home, and one safeguarding incident which is currently being investigated. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 19 The home has the Local Authorities Vulnerable Adults procedures. Staff have received training about Protection of Vulnerable adults from the local authority. Staff have received training about behaviour that may be difficult to work with as part of a dementia awareness course this should help them understand the different support needs of individuals. Most staff have completed a twelve-week Dementia Care course to give them more understanding of the needs of people with memory loss. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 20 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): 19,20,21,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a relatively comfortable and safe environment for those living there but not all areas are well maintained, clean, tidy and free from offensive odours. EVIDENCE: The home is accessible and is placed in the centre of a local community surrounded by houses and shops. A maintenance person works full time at the home. There is an ongoing programme of decoration and refurbishment around the home however there were several areas of the home that required attention due to general wear and tear. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 21 The home has an appropriate amount of sitting, recreational and dining space. Although there are enough rooms for a variety of activities to take place, each floor has a separate dining room and lounge, residents did not have access to their bedrooms during the day. I was informed this was to prevent a resident wandering into other bedrooms, however this restriction was effecting other residents in the home. Furnishings and fittings were domestic in design but the premises were showing signs of wear and tear throughout the home. Carpets in some communal areas and corridors were dirty and required cleaning or replacing especially by the kitchen. Some lounge chairs were soiled and required cleaning. More effective odour control was required in some bedrooms. Several bedroom walls were marked and the paintwork was damaged and chipped. Some en-suite bedrooms were in need of decoration and attention was required to the bath panels. On the top floor a lavatory water cistern was cracked and the sluice was used for storage. A ground floor lavatory was discoloured and loose, a first floor lavatory seat was stained. Communal soap was left in the shower room. The glass panel to the balcony on the middle floor was broken. Room sizes meet the minimum required. Residents all enjoy their own bedrooms and en suite facilities. Some of the bedrooms did not have a chair in case a resident wished to sit somewhere other than the bed. There was emergency lighting throughout the home. Laundry facilities appeared well organised. The washing machines have the specified programme to meet disinfection standards. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough staff for the current occupancy levels of the home, they are not all appropriately recruited. They are trained to meet the needs of the residents. EVIDENCE: Examination of staff rotas and discussion with the person in charge and members of the staff team showed the numbers of staff on each are as follows: 8.00 am- 8.00pm 3 staff to the top floor 4 staff to the middle floor 2 staff to the bottom floor 8.00pm- 8. 00 am 2 staff per floor These numbers do not include the manager. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 23 Other staff members are employed for duties such as food preparation, organizing residents’ social activities, maintenance and cleaning. A comment from a relative stated they were concerned about staffing levels and felt the home was often short staffed especially on the middle floor where there were more physically dependent residents; “never enough staff on duty, people being placed at risk.” Other comments from relatives include:”if it wasn’t for this place mother wouldn’t be here today.” “Sometimes staff let them down by ringing in sick. Lost dentures these things are bound to happen.” At the time of inspection two members of staff had come to work at the home from another home in the country, to cover for staff sickness. At the time of inspection the home had 3 staff vacancies. It had also advertised for a registered mental health nurse as it was to become registered for nursing care. A sample of staff records were examined, most of the necessary checks are being carried out prior to the workers being appointed. Two written references were available on the staff files examined from the most recent employers. An application form had been completed for each staff member. CRB checks are carried out before a person is appointed. Staff photographs were available on individual staff files however one staff file from the sample did not contain a photograph. Employment histories were not available on all staff files. Staff receive Skills For Care induction previously TOPSS. It was good to see all members of the care staff team have now achieved National Vocational Qualifications at level 2, several members are studying for level3. Most of the staff have received training about dementia care. Staff and their records showed that they also receive advice and /or training in other areas. Staff have received training in dementia care, challenging behaviour, health and safety, first aid, food hygiene, medication and person- centred planning. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 24 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): 31,33,35,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improvements have been made to the ways in which the home complies with the management and administration standards, further work in these areas is still required. EVIDENCE: Efforts are being made to improve the service provided but there is capacity for further improvement. Most of the previous requirements have been addressed apart from areas such as to demonstrate the home’s capacity to meet the needs of people with Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 25 dementia: care plans, behavioural care plans, design and decoration of the building for orientation, life history books and further work on systems to increase choice and decision making within residents’ lives. Staff and residents’ meetings are held regularly. Lockable facilities are available for residents to keep their own money if they wish. If a resident does not wish to keep control of their own money, the home is able to provide the facility to hold a small amount of money on behalf of the resident for everyday living. Individual records show the home has a suitable system for accounting any monies held on behalf of a resident. Documents detailing fire safety, risk assessments in the environment, water temperatures, maintenance contracts for equipment for moving and handling were all up to date apart from the fire log did not accurately record the monthly visual checks for the emergency lights and the fire extinguishers. From the sample of staff records looked at staff photographs were available on individual staff files however one staff file did not contain a photograph. Employment histories were not available on all staff files. CSCI regulation 37 notices to notify any event that effected the well being of a resident were not all received within 24 hours and did not notify of any incidents between residents. Staff training relating to health and safety was up to date and training being planned to renew any that required updating. Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 2 3 x 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 x x x 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x 2 2 Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement 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 01/02/07 and 01/01/08 not met.) Behavioural guidelines must be in place to support the staff to manage incidents of challenging behaviour. This is to ensure that staff provide support in a consistent and de-escalating manner. (Previous timescale of 01/12/06 and 01/12/07 not met.) Records of the administration of medication must always be fully completed. Instructions for the storage of medication must DS0000037820.V372259.R01.S.doc Timescale for action 01/10/08 2. OP7 13(7) 01/10/08 3. OP9 13(2) 01/09/08 Lindisfarne Residential Home Version 5.2 Page 28 always be complied with. A supply of prescribed medication must always be available for the use of the resident. 4. OP10 12(4)(a) Staff must ensure that their 01/09/08 practices and attitudes promote and uphold the dignity of residents at all times. This is to ensure that residents are valued and protected. A programme of decoration must 01/10/08 be supplied. Broken items as identified must be repaired in the interests of health and safety. The home must seek advice 01/12/08 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 orientation of the people who live here. (Previous timescale of 01/02/08 not met) More effective odour control is 01/09/08 required in the identified areas of the home. The fire log must accurately 01/09/08 record regular visual checks of emergency lights and fire extinguishers. The registered person shall 01/09/08 notify the Commission without delay any events which effects the wellbeing or safety of any service user including incidents between service users. Vetting procedures must include an employment history for any staff being recruited to work at the home to ensure that residents are protected from abuse as far as possible and to DS0000037820.V372259.R01.S.doc 5. OP19 23(2)(b)( d) 6. OP22 23(2)(a) 7. 8. OP26 OP37 16(2)(k) 4©(v) 9. OP37 37(1)(a)( b)(c)(d)(e )(f)(g) 10. OP37 17(2) Schedule 4 6(a) 01/09/08 Lindisfarne Residential Home Version 5.2 Page 29 ensure their safety. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP3 OP4 Good Practice Recommendations All parts of the assessment documents should be completed, including social care needs using the Life History Book. Serious consideration should be given to membership or association with local and regional resources and organizations that specialize in dementia care. This would support the home to keep up to date with current best practices. An individual record should be kept on resident’s files of dentist, chiropodist and optician’s visits and the outcome of any health personnel visits recorded. Napkins should be provided at meal times for residents to use. The cook should meet with residents to receive feedback about the menus. Accessible menus should be displayed in lounges or dining rooms so residents are reminded of the daily menu. Diabetes training should be provided to staff. Staffing levels should be kept under review. 3 4 5 6 7 8 OP8 OP15 OP15 OP15 OP27 OP27 Lindisfarne Residential Home DS0000037820.V372259.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region 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.V372259.R01.S.doc Version 5.2 Page 31 - 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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