Inspection on 05/10/06 for Lindisfarne Residential Home

This inspection was carried out on 5th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 19/09/07

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 5 & 9th October 2006 th 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.V313549.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.V313549.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 Care Home 66 Category(ies) of Dementia - over 65 years of age (66) registration, with number of places Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: Lindisfarne Care Home is a large, purpose-built home registered to accommodate people over the age of sixty-five years with dementia who need personal care. The home does not provide nursing care. Since the last inspection a day care area of the home has been converted for use as 6 additional bedrooms. The home registration now reflects the increase for 60 to 66 places. The home has 3 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, and wide corridors and large toilets allow good access for people who use a wheelchair. A passenger lift serves all 3 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 the location also offers views of the local countryside. Transport links are good and there is ample car parking at the front of the building. The weekly fee is £365. Since the last inspection the Registered Manager has left. A new Manager has recently been appointed and an application for registration is awaited. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Lindisfarne took place over 2 days. Time was spent with the new Manager reviewing the service, looking at care records, staff records and health & safety checks. Time was also spent with several residents and visiting relatives to gain their views of the service. The Inspector joined residents for a teatime meal, and looked at a sample of the premises. Discussions were held with staff about activities, nutrition and medication. Prior to the inspection visits the Inspector looked at information received about the home since the last inspection, including the Providers monthly reports. Questionnaires were sent out to a sample of 10 residents, and 6 responses were received. Relatives comment cards were also sent out, and one response was received. Their views are incorporated into the report. Three complaints have been received about the service since the last inspection. The Provider has investigated the 3 complaints and, as a result of the findings, has begun to make changes to improve the service. What the service does well: In discussions, residents and their visitors said, The meals are very good. Visitors said that they are always invited to join residents for a meal if visiting at that time, and one visitor does join their spouse for lunch from time to time. It was good to see that some people enjoyed a later breakfast as they had had a lie-in. There are kitchenettes on each floor so that staff can get residents drinks and snacks whenever they want, and visitors can help themselves to drinks. Residents and visitors said it is good that the home has an activities coordinator who provides activities every day and trips out twice a week. There is a warm, friendly and sociable atmosphere in the home. Staff encourage residents with conversations and activities, such as dancing, and there was a great deal of lively chatter and laughter in the home. Visitors had many positive comments to make about being welcomed into the home. Residents are well supported with their appearance. One relative said, They are all kept very clean and co-ordinated so they look nice. Another visitor said, They always look smart and well-dressed. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 6 All bedrooms and bathrooms are lockable so that residents can be supported in private. All bedrooms are single occupancy and all have good sized, private ensuite toilets. The home offers safe, comfortable and cheerful accommodation for the people who live here. Over the past year all bedrooms have been repainted. Most rooms have photographs to help residents recognise their own room. Residents can move around all parts of the home whenever they wish. Residents emotional well-being is supported by the homes friendly, sociable atmosphere and their contact with staff and other residents in the home. The home is clean, and domestic staff do a good job of managing the cleanliness and odour control of this large building. Several relatives had good things to say about the homes cleanliness. One said, It’s a very clean home, and there are never any smells. Its one of the reasons we chose it because it means that residents are respected. What has improved since the last inspection? What they could do better: Residents should have written and photographic information about menus so that they can make an informed choice about their meals. Also residents should have the chance to choose their own from selections when served a cold buffet. Staff need to improve the time it takes to serve residents so that they are not waiting for a long time. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 7 Several staff need to have updated training in health & safety matters and electrical equipment checks also need to be updated. The information for residents about the home (in the Service Users Guide) is out of date so it needs to be revised and each resident given a copy. Residents and relatives should also up to date written information about how to make a complaint. It would be better if there were more information for residents around the home about forthcoming activities. Protective equipment like gloves and pinnies used by staff to support residents should be discreetly stored in bathrooms so it is not on display. Also staff notices should not be put up in residents bathrooms and there should be mirrors in bathrooms and WCs so residents can check their appearance. Some staff still need training in adult protection so that they would know exactly what to do if they suspected abuse. Also the home must take up at least 2 appropriate references when employing new staff to make sure that they are suitable people to work with residents. Care plans should set out exactly what each resident needs and how to support them in the right way. The care records should include what to do when someone is losing weight and should involve care staff and catering staff working as a team. The care records should also include how to support a resident if they become upset or angry so that all staff help them in the same way. All care staff should have training in dementia care to help them understand the needs of the people who live here. Medicated eye-drops should be stored in the medication refrigerator if the instructions say so. One bedroom needs more attention to keep it free from unpleasant odours. The Manager needs to make sure that the glass panel above bedroom doors do not let so much light in that it disturbs residents through the night. The cracked plastic laundry containers need to be replaced. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 8 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.V313549.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (Standard 6 is not applicable) Quality in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Information for potential and current residents is outdated so does not support their understanding of the service. The needs of all residents are assessed before moving to the home to make sure that their needs can be met. EVIDENCE: The home provides information for potential residents and existing residents in the form of a Service Users Guide. However this information is now outdated and does not reflect the actual service. In this way new or current residents do not have up-to- date information about the service they should receive. Also the information is not written in clear, accessible language. The people who live here have dementia care needs, but the information does not include short, plain points or pictures to support their understanding of the service. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 10 The needs of all potential new residents are assessed prior to them making a decision about moving to this home. Most residents have first been assessed by a Care Manager of the Social Services Department. Following the last inspection, copies of those assessment documents are now placed in new residents care file. The Manager of the home also carries out an assessment to ensure that a persons needs could be met at Lindisfarne. The home is now pro-active in recognising when a residents needs have changed so much that the home can no longer provide the required support. It is good practice that the home requests re-assessments by Social Services Department of residents whose dependency level can only be met by other care services. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Care planning is poor as care plans do not set out the specific care needs of each resident. Residents health care needs are met by community health care services, and the homes sociable, active atmosphere supports the emotional well-being of the people who live here. However nutritional health planning is unclear and uncoordinated, so nutritional needs are not adequately supported. Residents medication is managed and protected by the homes practices. Individually, residents are treated with respect and their rights to privacy are promoted by the home. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 12 EVIDENCE: There are care files in place for each resident. These contain several assessment documents relating to possible areas of need, for example pressure risk, mobility, and nutrition. However the assessment records provide only numeric scores, which do not then translate into care planning and do not show what level of support the residents actually need. For example, one residents needs had changed so now has a very high score in a pressure care assessment, and had even developed a small pressure area. However, there was no indication in the care plan of this change, nor any new instructions for staff in how to manage and care for this area of need. Lindisfarne is registered to provide care for older people with dementia, and all of the people who live here have dementia care needs. However none of the care plans relate to peoples dementia needs. It would not be possible to support residents specific care needs using the current care plans. In a sample examined, the care plan needs reflected general daily tasks that are already met by the home, for example support with medication, and using hot water. The monthly evaluation reports of these needs are equally uninformative, e.g. continue to give medication. In the sample of care plans, one resident has made several attempts (some successful) to leave the building as they do not know why they are here. The care plan for this area instructs staff to make the building secure but offers no guidance about using diversionary techniques, nor how to support the residents desire to go out. There is also a behavioural record of instances where the resident has threatened to break a door down, but no guidelines about how to support the resident during these incidents. In this way staff may use different and inconsistent approaches, which will confuse the resident further. The home ensures that all residents have access to appropriate community health care services, including GP, dental, ophthalmic and chiropody services. It was evident that the majority of residents are still very active, and many are able to walk around the home and able to take part in activities. Some of the activities provided by staff support residents with gentle physical exercise such as dancing, skittles and seated ball games. It was clear from observations that many residents are alert, chatty, can express some choices and have a good sense of humour. In this way their emotional well-being is supported by the homes friendly, sociable atmosphere and their interaction with staff and other residents in the home. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 13 Nutritional assessments are carried out on admission and every month residents weight and nutritional assessment is recorded. However even significant changes in weight do not prompt a specific plan of care, and there is little communication between care staff who assess residents and the catering staff who provide their nutritional intake. In a sample examined, weight records showed that one resident had lost a significant weight (16lbs) over 3 months. However the nutritional assessment does not direct staff to take any action, simply providing a numeric score with no guidance. However, a dietician was contacted and a fortifying powder supplement was prescribed for the resident. This was put in the main kitchen but catering staff were unaware of its use for the resident and had used it instead for 3 other people who were on soft diets. In this way there had been no communication between care staff and catering staff. Food and fluid intake charts are now used if care staff are concerned about the reduced intake of a resident, but it is not clear whether these are simply a retrospective record or whether they would prompt staff to take further action. Due to their dementia care needs, residents medication is managed by senior care staff who have had training in Safe Handling of Medication. It is securely stored, and lockable medication trolleys are used to transport it safely around the home. Medication was seen to be administered correctly. The home uses a recognised medication system, which includes records of incoming, administration and disposal of medication. However the list of staff designated to administer medication is now out of date, and eyedrops are not being stored in the medication refrigerator so are not kept at the correct temperature. During discussions, several relatives said that there have been improvements in the way that residents are supported with their appearance. One relative said, They are all kept very clean and co-ordinated so they look nice. Another visitor said, They always look smart and well-dressed. It was clear from observations that residents are supported to choose coordinated clothing and are supported to change as and when necessary. Residents appeared well presented and well groomed during both these visits. The home has a fully equipped hairdressing salon on the lower ground floor and several ladies were enjoying having their hair done by the visiting hairdresser. In these ways the home protects the dignity of the people who live here. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 14 However all the communal bathrooms and WCs had boxes of latex gloves, plastic pinnies and white Wellington boots on display. This equipment is necessary to hygienically support the personal care needs of some residents, but being on public display means it compromises the dignity and privacy of the people who live here. There were also unnecessary notices to staff in bathrooms, which does not present a homely or dignified image of residents accommodation. There are no mirrors in communal bathrooms or WCs so residents cannot check their appearance. All bedrooms and bathrooms are lockable so that residents can be supported in private. All bedrooms are single occupancy and all have good sized, private ensuite toilets. There is a communal pay phone in the corridor of one floor which does not allow residents to make or receive calls in private. However the Manager stated that the senior staff on each floor carries a portable handset for the homes main telephone line. In this way, residents could be supported to receive calls in the privacy of their own room. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents individual lifestyles are respected, and there is a growing range of activities for them. Residents are supported to maintain contact with their families, and some residents have opportunities to visit local community facilities. However, residents are not well-informed about their options, rights and choices. The quality and presentation of food at mealtimes is good, but residents have no information about menus and their independence is not actively promoted. EVIDENCE: It was clear from observations that the home is flexible enough to meet some individual residents preferred routines, for example some people like a lie-in and so are supported to have a late breakfast. There is also good freedom of movement around the home and a small number of residents use the lift to visit different floors. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 16 An activity organiser is employed at the home and residents and relatives were complimentary about her role. Relatives said, There seems to be more happening now. An activity record for each resident is kept that demonstrates all the events that the resident have chosen to join in, or not. A notice board in the entrance hallway shows what activities are on offer for the week ahead, such as bingo, skittles, and dancing. However only residents on this middle floor would see the notice, so not all residents have this information. Throughout the inspection visits there was a sociable atmosphere in the home. Staff engaged residents in conversations and activities, such as dancing, and there was a great deal of lively chatter and laughter in the home. There was a steady stream of visitors to the home during these inspection visits. Visitors had many positive comments to make about being welcomed into the home, being able to get their own drinks, and being offered the chance to join residents for a meal. Relatives recalled some instances when they were not kept informed about events that affected the respective resident. However relatives stated that this is beginning to improve. There are some opportunities for residents to go out either with family or with the care staff. For example, one lady is frequently supported by staff to visit a local church to light a candle. The home has a minibus that can seat up to 10 people. The activities coordinator described the twice-weekly trips out for residents, which have included trips to local parks and a local garden centre. The activities coordinator confirmed that it is usually the same residents who choose to go, but this may reflect how people are asked and whether they are given support with communication needs to make an informed choice. The home also has some visiting groups from the local community from time to time such as church services, entertainers, and school children. The activities co-ordinator agreed that community links is an area for development. Residents are encouraged to personalise their bedrooms and many rooms have photographs, pictures, ornaments and other familiar possessions to support residents to have some ownership of their own rooms. Most rooms also have a photograph of the resident to help them to identify which is their bedroom in this large building. Residents are asked for their meal choices the day before, so it likely that they have forgotten by the actual mealtime. There are no copies of menus in print or in pictures to inform residents or to support their decision–making skills. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 17 There is a pleasant dining room on each of the 3 floors where residents enjoy good quality meals. There are small kitchenette areas in each of the dining rooms that contain fridge, microwave, hot and cold drinks, and toaster so that staff can get snack and drinks for residents at any time. It is very warm in the home so it was good to see that residents are offered frequent drinks throughout the day. It was also good to see relatives help themselves to drinks during their visits. In discussions, visitors commented positively on the meals and said that they are always invited to join residents for a meal if visiting at the time. One relative does join their spouse for lunch from time to time. Residents who were able to comment and visitors had positive views about the quality of catering, and one relative said, The meals are very good. The 6 comment cards received from residents also indicated that they always or usually like the meals in the home. During the visits it was good to see that some people enjoyed a later breakfast as they had had a lie-in. In this way breakfast meals are flexible. Residents are offered a cooked breakfast every morning, and a choice of 2 main meals at lunchtime. Hot meals are transported to the dining rooms by hotlock trolleys to ensure that food is kept sufficiently hot until it is served to each resident. Some teatime meals are a cold buffet. During this visit the teatime buffet included 2 types of sandwiches, fruit scones, sausage rolls and a cake. However one of each item was plated by staff and given out to each resident. In this way there were no opportunities for residents to independently select from the choices. Several residents commented that they did not like fruit scones, others may not have liked both choices of sandwich. There are sufficient staff in the dining rooms to support those residents who need assistance with their meals. However it took 3 staff over 45 minutes to serve the plated food to the 24 residents in this dining room. In this way some residents were quite agitated by the time they were served. It is likely that most residents could have served themselves more quickly, and made their own choices, if a selection of buffet trays had been left on each table. A small number of people had soup, as they require a soft diet. These residents were served last, and had to sit while other residents at their table had already completed their meal. Lindisfarne Residential Home DS0000037820.V313549.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents do not have clear information about how to make a complaint. Relatives have previously not had confidence that their complaints were being heard, however this is now improving. Some staff have not had training in adult protection procedures, which does not protect the people who live here. EVIDENCE: The complaints procedure for residents is in the Service Users Guide, which is now out of date. In this way, residents do not have meaningful information about how to make a complaint. In discussions and from comment cards, relatives said that they generally knew how to make a complaint but, until recently, had little or no confidence in the management style of the home to make their complaints known. For example, some relatives had repeatedly raised concerns but had no response from the former Manager so they contacted CSCI. Other relatives stated that they had raised a concern with the former Manager but that his attitude had been defensive and that he would not acknowledge our concerns or comments. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 19 There have been 3 complaints received about the service since the last inspection. The complaints mainly related to lack of attention to personal care needs of residents, for example not making sure people had their dentures in so that they could eat properly; residents not being supported at mealtimes; residents not being supervised to prevent falls. The Provider has investigated all three complaints and found them to be upheld. As a result there have been a number of improvements made to the personal care of residents and there are further improvements planned, including staff training in customer care so that they can recognise and deal appropriately with concerns raised by relatives. In discussions, relatives stated that there have been recent improvements to the service, and one stated, Things seem to be getting better. The home endorses the local authority Protection of Vulnerable Adults procedures, which are robust arrangements for dealing with suspected abuse. However not all staff have had training in these procedures and so would not know how to deal with or report suspected abuse of residents. The new Manager is aware of this shortfall, as identified at the last inspection, and is making arrangements for remaining staff to have this training. Lindisfarne Residential Home DS0000037820.V313549.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The quality of the accommodation is good, and residents live in a safe, comfortable environment. Residents live in clean, hygienic accommodation. EVIDENCE: The home offers warm, bright and comfortable accommodation for the people who live here. Over the past year all bedrooms have been repainted. The skirting board and door surrounds have also been painted in a contrasting colour to support residents to get around the home. The home is well maintained and a maintenance report is sent to the Provider each week. There are glazed panel above each bedroom door. In the design of the building this may have been intended to borrow light from bedrooms into the corridors or vice versa. However it is possible that the light from corridors may disturb some residents during the night. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 21 The brass door handles to bathrooms are all tarnished, which may be due age or to cleaning products. The home is clean, and domestic staff do a good job of managing the cleanliness and odour control of this large building. One bedroom of the sample examined has some odour. There were no unpleasant odours in any of the communal areas, and relatives and other visitors had many positive comments to make about this. One said, It’s a very clean home, and there are never any smells. Its one of the reasons we chose it because it means that residents are respected. The home has a service area on the lower ground floor away from residents accommodation. This includes a large well–equipped laundry, with dedicated laundry staff. Washed clothes are currently placed in large plastic containers before drying, but the containers are cracked which could damage clothes. Lindisfarne Residential Home DS0000037820.V313549.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides enough staff to meet the number and needs of the people who live here. The Providers has robust recruitment procedures, but the homes management shortfalls in following these have not protected residents. There are not enough staff qualified in care or trained in dementia care needs but improvements are planned. EVIDENCE: The home provides 11 care staff during the day, 10 care staff in the evening and 6 staff on night duty. At all times there is a senior member of staff to each of the 3 floors to supervise the care staff. This level of staffing is sufficient to meet the numbers and needs of the current residents. Following the outcomes of some complaints there have been improvements to the deployment of staff. There is now good staff presence in lounges to supervise and engage with residents, and sufficient staff at mealtimes to provide assistance with dining. There are also now clear lines of responsibility so that each care staff has a key role in supporting an allocated number of residents with their personal care needs. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 23 Since the last inspection 9 staff have left the home. In the same period 10 new staff have been appointed. The Provider has robust procedures for recruiting new staff that includes all checks and clearances to ensure that only suitable staff are employed. However, in a sample of records of newer staff, it was evident that the former Manager had not followed the procedures and had employed staff without taking up appropriate references. In this way, the proper protection of residents had not been ensured. Over the past few months staff have had increased training opportunities. A training schedule is in place that demonstrates the home is trying to get staff trained in all statutory matters such as health & safety. Staff commented that they have had more training since the arrival of the new Manager than at any other time at this home. Of the 32 care staff, 10 have attained NVQ level 2 so at this time only a third of the staff team is qualified in care. However the Manager stated that 5 more staff are due to enrol on training towards this qualification, and there are longer term plans for other staff to complete induction training and then be nominated for NVQ training. Lindisfarne purports to provide specialist care for older people with dementia, but few staff have completed any training in dementia care needs. In this way staff are not fully equipped to manage the specific dementia care needs of the people who live here. The Manager indicated that certificated training in this area is to be pursued for all care staff over the next year. Lindisfarne Residential Home DS0000037820.V313549.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this area is good/adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home has not been well managed since the last inspection, but a new Manager is now in place. The Provider has listened to the views of relatives and made changes to the service that are in the best interests of the people who live here. Residents financial interests are safeguarded by the home. The Providers procedures promote the health & safety of residents, but shortfalls in staff training in health & safety do not support the protection of the people who live here. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 25 EVIDENCE: Since the last inspection the former registered Manager has left the home. A new Manager has been appointed and for the past 3 months has been responsible for the daily operations of this home. The new Manager has many years experience in care settings for older people, has completed the Registered Managers Award training and is due to complete NVQ level 4 in the very near future. The new Manager must now submit an application for registration as the manager of the home. The Provider has also recently appointed a General Manager who will take responsibility for overseeing the management of the care in all of the care homes operated by Gainford Care Homes. This is a positive step, as it will offer all Managers in the company some external supervision and support. 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, however residents need support from relatives or other independent representative to complete these. Relatives views are also sought through care reviews and through monthly Relatives Meetings. It is clear that recent concerns and complaints have influenced a number of improvements in the care service to the people who live here the views of residents or their representatives are now listened to. All of the people who live here are supported to keep small amounts of money at the home in order to purchase small items and to pay for hairdressing. The monies are securely stored in a safe in individual wallets and any transactions made by residents, or by staff on their behalf, are recorded with two staff signatures. All receipts are numbered and correspond to the relevant record. The Provider does not take responsibility for any residents financial affairs. Most residents have relatives who manage this on their behalf, and 5 people are supported by the Social Services Department to manage their fees and personal allowances. At this time the home maintains all record of residents personal monies within 2 large bound accounting books. However this may compromise confidentiality as residents or their representatives cannot view the records independently. The Provider intends that such records will be held on computer so that individual records can be printed off like a bank statement. All other checks will continue, such as keeping receipts. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 26 Health & safety audits are carried out to the premises and there were no hazards noted in the sample of the premises that was examined. The home has an on-site maintenance staff to attend to premises checks and these are recorded. The annual electrical equipment tests are now long overdue and the new Manager is aware of this. Staff training records show that there are several shortfalls to the statutory health and safety training for staff, including moving & assisting and infection control training. Also in-house fire instruction for night staff has not been carried out at the required intervals. The new Manager is aware of these gaps and has begun to arrange a training schedule so that all staff will have updated training in these areas. Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 27 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 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.V313549.R01.S.doc Version 5.2 Page 28 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 or Information pack for new and existing residents must provide up to date information about the service, and be written in a suitably accessible format to support the needs of the people who live here. Care plans must set out the specific needs of each residents and clear, detailed guidance for staff in how to support those needs. (Previous timescale of 30/04/06 not met.) Monthly evaluations must report a meaningful assessment of the progress or change in need. Behavioural guidelines must be in place to support the staff to manage incidents of challenging behaviour in a consistent and de-escalating manner. The nutritional assessment and planning for residents must be managed by a clear, coordinated approach involving care staff and catering staff, and this must be outlined in a specific plan of care. DS0000037820.V313549.R01.S.doc Timescale for action 01/01/07 2. OP7 15(1) 01/02/07 3. OP7 13(7) 01/12/06 4. OP8 12(1)a 13(1)b 16(2)I 01/12/06 Lindisfarne Residential Home Version 5.2 Page 29 5. OP9 13(2) 6. OP10 12(4)a 7. OP14 16(2)(i) 8. OP15 12(3) & 16(i) Eye drop medication must be stored at the prescribed temperature; and the list of designated staff must be updated to reflect those staff who are now responsible for the administration of medication. Equipment in bathrooms and WCs used for personal care support, such as latex gloves and pinnies, must be discreetly stored to protect the dignity of the residents. Residents must have information, in a suitable format that supports them to make an informed decision about the menu choices for each meal. Residents must have opportunities to independently choose from the meal selection e.g. for buffet meals. Residents (and their representatives) must have clear, written information about how to make a complaint that is in a suitable format to meet their needs. Remaining staff must have training in local Protection of Vulnerable Adults procedures so that they would know how to contact the Adult Duty Team or Protection of Vulnerable Adults Co-ordinator, should they suspect abuse. (Previous timescale of 30/04/06 not met.) Odour control to one bedroom must be managed to ensure it is free from unpleasant odours. The home must follow the correct procedures when recruiting new staff to include 2 written references, including one from a current or recent employer. 01/12/06 01/12/06 01/01/07 01/12/06 9. OP16 22 01/01/07 10. OP18 13(6) 01/02/07 11. 12. OP26 OP29 16(2)(k) 19, Schedule 2 (5) 01/12/06 01/12/06 Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 30 13. 14. OP30 OP31 18(1)(c)i 8(1) 15. OP38 13(3),(4) and (5) and 18(c)(i) 23(4)(d) 13(4) 16. 17. OP38 OP38 Arrangements must be made for care staff to receive training in dementia care. The Provider must submit an application for registration of a manager to CSCI in respect of the appointed manager. Arrangements for training must continue to ensure that all staff receive statutory training in all health & safety matters, including moving & assisting and infection control. Night staff must receive in-house fire instruction at the required 3 monthly intervals. PAT (Portable Appliance Tests) must be carried out on an annual basis to ensure the safe use of electrical equipment. 01/02/07 01/12/06 01/01/07 01/12/06 01/12/06 Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP10 OP10 OP12 OP13 Good Practice Recommendations Staff notices should be removed from residents bathrooms. Mirrors should be provided in bathrooms and communal WCs so that residents can check their appearance throughout the day. All residents should have access to information about forthcoming activities programmes. Consideration should be given to supporting residents to access more local facilities, such as community centres, to broaden their opportunities for social contact and activities outside the home. Consideration should be given to improving the serving of meals so that each resident receives their meal in a timely manner. Plans to provide Customer Care training for staff should be put in place so that staff know how to recognise, acknowledge and report any concerns raised by residents or relatives. The Manager should check whether the light from glazed panels above bedroom doors is disturbing to any residents during the night, and if so takes steps to cover those panels. The plastic laundry containers should be replaced to prevent any damage to residents clothing. Training plans should continue to ensure that at least 50 of the care staff team attain NVQ level 2. 5. 6. OP15 OP16 7. OP25 8. 9. OP26 OP28 Lindisfarne Residential Home DS0000037820.V313549.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V313549.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!