Inspection on 02/10/08 for Lindisfarne Seaham

This inspection was carried out on 2nd October 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 Seaham 21/09/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Lindisfarne Seaham King Edward Road Dawdon Seaham County Durham SR7 0BG Lead Inspector Andrea Goodall Unannounced Inspection 2nd October 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lindisfarne Seaham DS0000068621.V372534.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 Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindisfarne Seaham Address King Edward Road Dawdon Seaham County Durham SR7 0BG 0191 5812891 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) seahamgch@btconnect.com CLS@gainfordcarehomes.co.uk Gainford Care Homes Ltd Manager post vacant Care Home 61 Category(ies) of Dementia (51), Mental disorder, excluding registration, with number learning disability or dementia (10), Old age, of places not falling within any other category (51), Physical disability (10) Lindisfarne Seaham DS0000068621.V372534.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 categories: Dementia - Code DE maximum number of place - 51 Mental Disorder - Code MD - maximum number of places - 10 Physical Disability - Code PD - 10 Old people not falling within any other category - Code OP - 51 The maximum number of service users who can be accommodated is: 61 21st September 2007 2. Date of last inspection Brief Description of the Service: Lindisfarne Seaham is a large purpose-built home in a residential road in Seaham, which is a coastal town in County Durham. It is owned and operated by Gainford Care Homes Limited, which operates around 11 care services in the Tyne and Wear area. This home has been open for about 18 months. This home provides accommodation for a total of 61 people. The building is set on a slightly elevated site and has three main units. On the lower ground floor is a 10-place spacious, self-contained unit for people with a physical disability who may stay for short-breaks or on a longer term basis. On the ground floor is a 36 place unit that provides nursing care for older people with dementia care and mental health needs. On the first floor is a 15 place unit that provide personal care for up to older people with dementia care or mental heath needs. All the bedrooms are large, single occupancy rooms with private en-suite facilities. All three units have their own lounges and bathrooms. There is large, pleasant dining room on the lower ground floor for residents to join together, if they wish, at mealtimes. The weekly fee for the residential unit is £455.50. The weekly fee for staying in the unit for people with a physical disability is £486.50. The weekly fee for the nursing unit is £ 603.98 (this includes a continuing health care contribution.) This information was given at the time of the inspection visit. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 5 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. Before the visit: We looked at: • information we have received since the last visit on 21st September 2007 • how the service dealt with any complaints & concerns since the last visit • any changes to how the home is run • the provider’s view of how well they care for people in their selfassessment (this is called an AQAA) • the views of people who use the service & their relatives, staff & other professionals from surveys we received. The Visit: An unannounced visit was made on 2nd October 2008. For part of this visit an Expert by Experience joined the inspection. An Expert by Experience is someone who is familiar with using social care services. They can help inspectors to get a picture of what it is like to use social care services. She talked with residents and staff, joined them for a lunchtime meal and looked at parts of the house. Her comments are included in this report. Another unannounced visit was made on 6th October 2008 by a Pharmacy Inspector. She looked at how well medicines are looked after at this home. Her comments are included in this report. During the visit we: • talked with people who use the service, relatives, staff, the manager & visitors • the Expert by Experience joined residents for a meal and looked at how staff support the people who live here • looked at information about the people who use the service & how well their needs are met • looked at other records which must be kept • checked that staff had the knowledge, skills & training to meet the needs of the people they care for • looked around parts of the building to make sure it was clean, safe & comfortable We told the manager and provider what we found at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 6 – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: What has improved since the last inspection? It is very good that the home has arranged for a ‘Dignity Champion’ to visit the home regularly and report on whether the staff are treating people with respect and dignity. The home now has a full-time activities staff who arranges activities, entertainment and trips for the people who live here. The home has made changes to help people enjoy their meals more. For example, ‘protected mealtimes’ so that all staff are involved in supporting people at mealtimes, and later lunchtimes so that people who have had a late breakfast are more ready for a main meal. Memory boxes are being made that have a special meaning for each person and these are put outside their room to help them recognise it. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 7 There are also more decorations and signs to help people find their way around this large building. There is more garden furniture and the garden is now fenced so that it is safe and secure place for people to sit out. Most relatives felt that staffing levels had improved. The manager confirmed that there is an additional staff on duty now. There is a new manager at the home. One relative said, “I’ve seen the home improving since the newest manager has been here.” What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lindisfarne Seaham DS0000068621.V372534.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 Seaham DS0000068621.V372534.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (NMS 6 does not apply to this service). People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Prospective residents receive good information and their needs are appropriately assessed so that they can make an informed choice before moving into the home. EVIDENCE: People who come to stay here are given an information pack, called a Service Users’ Guide, which includes useful information about what they can expect from the service. The home has also developed a short brochure for the new unit which can provide 10 places for younger people with physical disabilities. This brochure has photographs to show people what the accommodation looks like. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 10 Everyone is encouraged to come and have a look around the home before making a decision. In this way people have good information to make a decision about whether to move to this home. At the time of this inspection there were 28 people living here and two people staying for a short-break. There are clear records to show that the needs of the residents were assessed before they moved in so that the home knows whether those needs can be met here. Care managers of the Social Services Department carry out most assessments and these are provided to the home. The manager also carries out assessments of prospective new residents, to make sure that the home can meet their individual needs. The assessments also include brief details of people’s spiritual and social care needs so that the home can plan to support them in these areas. The Expert by Experience commented, “The manager said she has made contact with all the local churches and synagogue, and that the clergy are all willing to visit if asked.” Lindisfarne Seaham DS0000068621.V372534.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Although residents have good support with their personal care, their medication is not well managed so their health care is not adequately protected and promoted. EVIDENCE: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. Lindisfarne has a care plan system that is easy to follow and is kept up-to date every month by staff to show any changes to each person’s well being. It is also good practice that staff and relatives are developing ‘Lifestory’ booklets for each person that will help staff understand the life history of each person and their social care interests. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 12 Care plans include a specific care plan about people’s dementia care needs. However these do not fully describe how staff should support someone with their behaviour and/or memory loss. In this way staff may not always be responding in the same, consistent way to someone’s dementia care needs. Care records show that the home makes sure that people’s health care needs are checked on a regular basis, for example their nutrition, and skin pressure. The home now makes sure that general nurses (called RGNs) and mental health nurses (called RMNs) are on duty at the same time so that people’s physical and mental health care needs can be addressed. It was evident that residents are also supported to have good access to health care professionals whenever they need this. For example some people have input from dietician, psychiatric and district nursing services. Discussions with relatives showed that the staff keep them informed of any change in health needs. One relative said, “They always let me know if he’s not well. They ring me at anytime to let me know if they are going to get the doctor, and they let me know what’s happening.” The home would support people to manage their own medication if they were assessed as capable and wanted to do so. There are small lockable safes in bedrooms for this. Most of the people who live here have significant dementia care needs so nursing staff manage their medication for them. A pharmacy inspector found several issues about the way that medication is managed in the home. One resident is given their medication disguised in a drink, and one person is given all their medication in porridge. Some tablets are crushed which can affect the properties of the medication. There is a brief care plan about why this medication is given in this covert way. However there is no risk agreement or capacity assessment to show why the person must have their medication this way and no agreement of other health care professionals (such as GP). The quantity of medication from one monthly cycle to another is not recorded on the new MAR (medication administration records) forms. This means it is difficult to have a complete record of medication in the home and to check if medication is being administered correctly. All MAR charts were handwritten which leads to problems with incorrect entries and changes made to medication. It is not good practice to handwrite monthly medication in this way (a computer generated MAR from the pharmacy is more accurate). Photographs of people living in the home were missing from the MAR chart dividers. It is important to have photographs to reduce the risk of medication being given to the wrong person. Also important information on medication administration, including details of those people where medication is being disguised in food, was not recorded on the divider. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 13 A system is not in place to check expiry dates of medicines or to add the date of opening when necessary. The medication store room temperature and fridge temperature are not accurately kept, and the storage room was very warm so medicines were not being stored according to manufacturers’ guidelines. The medication trolley was left unattended during medication administration. Liquid medication was given on a teaspoon so was not accurately measured by a 5ml spoon or oral dose syringe. Medicines that have been discontinued or are now supplied in blister packaging had not been removed from the trolley. The controlled drugs cupboard appeared to meet requirements, but records were incomplete and some did not match MARs records. It is excellent practice that the home has a Dignity Champion, which is a scheme that is being promoted in care services by the Department of Health. The Dignity Champion for Lindisfarne is a relative of a resident who lives at this home. She visits the home frequently and around once a month formally reports to the manager and provider on her observations of whether staff support residents in a way that respects and values their dignity. For example, whether staff explain to residents what they are about to do, and whether staff engage with a resident when supporting them at mealtimes. In discussions with the Dignity Champion, manager and provider’s representatives it was very clear that the home is committed to ensuring that residents are treated with dignity and respect at all times. They have been very responsive to the insights of the Dignity Champion and have used her reports to provide staff training in valuing the people who live here. During this inspection relatives made several positive comments about how residents are respected. One relative said, “I visit at all times of the day, and he is always kept clean and smartly dressed so I know they’re looking after him really well.” Staff addressed people in a respectful and sensitive manner. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents have excellent support with social and cultural interests and can make choices about their own daily routines so that they lead a lifestyle that matches their individual preferences. EVIDENCE: People are encouraged and supported to choose their own daily routines. For example, at the time of this visit some people were enjoying a lie-in or late breakfast. Residents who were able to express a view described how they lead their own lifestyle, such as going to bed when they want, choosing where to dine, and spending time in the privacy of their own rooms. It is very good practice that the home has recently employed a full-time activities co-ordinator who arranges a programme of different activities for the people who live here. There is daily range of activities such as reminiscence Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 15 chats, hand massages and music sessions which are also provided by care staff. The programme of activities is on display for people in the lounges. The Expert by Experience said, “The activities worker has a large room for her work and although she was not on duty there was plenty of evidence of work in progress.” Members of the Alzheimers’ Society visit the home about every six weeks with home loan equipment that people can try out. These include therapeutic activities and reminiscence material that are specifically designed for people with dementia care needs. The Expert by Experience said, “In one of the lounges a care staff was sitting with a 99 year old lady and they were looking at extracts from old newspaper photographs which had been enlarged and laminated. The resident was thoroughly enjoying looking at the old photographs of local shops with their staff outside and she could clearly remember many of their names.” There are also good opportunities for residents to enjoy the local community facilities. It is excellent practice that every week about six residents go to a local craft shop where there is a room set up for them to make greetings cards that they can give to their relatives. The home has its own minibus with a tail-lift which means that all of the people who live here can have the chance to go out on trips, and there are regular trips out to the local coast. It is very good practice that the minibus can also be used to pick up relatives if they have difficulty using public transport so that they can continue to visit the residents. Several relatives also gave very positive comments about the quality of the meals at this home. One person said, “The home provides excellent meals, with good choices and alternatives. The presentation is also superb.” Most people enjoy mealtimes in the pleasant dining room on the ground floor. Other people who need assistance have their meals in another lounge with staff support. It is very good practice that staff recognised when people are disinterested in their meal and offered them alternatives such as sandwiches. The Expert by Experience joined residents for their lunch. She said, “The dining room was very bright looking out onto a well-laid out back garden. The care staff and cook were very much in evidence helping residents who required assistance with their meals. Residents explained that they could have breakfast at any time after 8.30am – they just go downstairs to the dining room when they are ready and ordered what they wanted. Everyone enjoyed their puddings and I heard many requests for seconds.” Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 16 Comments from health care professionals had previously indicated that people were not always getting sufficient individual attention to eat their meals. Since then the home has made several changes to improve this area of care. For example, ‘protected mealtimes’ so that all staff are involved in supporting people at mealtimes; and later lunchtimes so that people who have had a late breakfast are more ready for a main meal. It was good practice that staff also offered snacks and drinks wherever people had chosen to spend their time. For example, some people sitting in the main hallway were offered snacks, fruit and drinks throughout the day. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents and their representatives have clear information so they would know how to make a complaint. The staff team have had suitable training so they know how to protect residents from abuse. EVIDENCE: All residents have information in their service users’ guide which refers to the complaints procedure. All relatives who took part in discussions said that they knew how to make a complaint and would feel very comfortable about talking to the new manager about any concerns. One relative said, “There have been very few times, but whatever the cause it is dealt with immediately by the new manager. “ Another relative commented, “The manager and administrator are always very helpful.” People have good opportunities to discuss their comments either directly with the manager, or with the provider’s representatives during their visits. There are also Relatives’ Meetings where many relatives are involved in commenting on the service here. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 18 The home’s complaints records show that five complaints have been received and dealt with over the past year. It is good practice that the home sends letters to complainants outlining how the complaint will be investigated and the timescales for completion and action to be taken to resolve it. This demonstrates that the home is very receptive to any comments and how changes can be made to improve the service for the people who live here. The home endorses the local authority Safeguarding Adults protocols, and the manager is aware of those protocols and her responsibilities. Since the last inspection all staff have had updated training in safeguarding adults so are aware of their responsibility to report poor practice or suspected abuse. The home has recently been involved in a safeguarding adults matter about the behaviour of a resident towards another resident. This matter was investigated by Durham Social Services Department. It is clear from the outcome reports that the home has made good improvements to staff communication and supervision of residents in order to minimise the possibility of a similar situation. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 19 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, 21, 22, 24 and 26. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The premises are well decorated, accessible, comfortable and well maintained so that people live in very good quality accommodation that meets their needs. EVIDENCE: Lindisfarne Seaham is a large, purpose- built home that has been open for about 18 months. The standard of accommodation is very good and the home remains well-maintained and well decorated. All areas of the home are accessible by the people who live here and there are some signs to support people to orientate around this large building. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 20 The Expert by Experience said, “The wide corridors contain sitting bays at intervals and all the corridors are themed with names such as Colliery Row and Coast Road, with all being decorated in an appropriate manner.” Since the last inspection additional garden furniture has been provided to the large, secure garden area at the back of the home. Access to the garden is via patio doors from the dining room on the lower ground floor. All bedrooms are spacious and have en-suite facilities. All bedroom doors are lockable from the inside so that service users can manage their own privacy if they choose. Several people were independently using their own bedrooms for privacy during this visit. Many bedrooms have been highly personalised by the people who live here. The Expert by Experience said, “The residents’ rooms had a large photo of that person and their names in large print which made identification very easy.” It is good practice that relatives and staff are helping to make ‘memory boxes’ for the residents to recognise outside their own bedroom doors. The memory boxes have familiar articles that have a special meaning for that person. For example photographs, brochures of previous holidays, pictures and cards. Along the corridors of the ground floor nursing unit there are some items of visual stimulation and interest for residents to look at and touch as they walk around, such as pictures, posters, and collages. These are to be introduced on the first floor unit as well. Since the last inspection the unit on the lower ground floor has been registered to provide accommodation for up to 10 people with physical disabilities. This unit is self-contained and has its own separate entrance although there is also access to the rest of the home via keypad locked corridor doors. The standard of accommodation and furnishings in this unit are very good. There are 10 spacious, single bedrooms with en-suite facilities. Two bedrooms have overhead tracking system in place for people who may need significant support with moving and lifting. This smaller unit has two lounge/dining rooms and a small kitchen with washing machine. It is the intention of the home to enable people to develop and retain domestic skills whilst staying or living in this unit. The unit also has two assisted bathrooms and an office. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 21 The standard of cleanliness and odour control was very good at the time of this visit. One relative said, “The home copes very well, especially considering the size of the building.” Another relative said, “It’s always spotlessly clean.” One relative also commented positively on the standard of laundry service at the home and how well people’s clothes are cared for. The Expert by Experience reported, “Everything is spotlessly clean and fresh.” Lindisfarne Seaham DS0000068621.V372534.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 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides competent, well-trained, suitable staff to ensure that the people who live here are protected and that their needs are met. EVIDENCE: The staff team compromises the manager, a deputy manager, five registered mental health nurses (RMNs), three registered general nurses (RGNs), six senior care staff, 19 care staff, five housekeeping staff, three catering staff, an activities staff, an administrator and a maintenance staff. The home also employs a small number of ‘bank’ staff to cover any gaps in the rota. At the time of this inspection there were 31 people living here. The staff rota allows for an RMN, a RGN, a senior carer and four care staff on duty throughout the day. This covers the two units for older people. At this time there is only one person living in the unit for people with a physical disability and that person tends to spend their time on the top unit or in their own room. There are currently sufficient staff to meet the number and needs of people living here, but any change in numbers, particularly to the unit for people with a physical disability, would require additional staffing. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 23 Most relatives felt that staffing levels had improved. The manager confirmed that additional staffing had been arranged following the recent concerns about the supervision of residents. One relative commented that the staffing levels here compare very favourably to another home. They said, “He used to have lots of falls at the other home but not here because there is always someone there to watch him.” Many relatives and health care professionals also commented on the high turnover of staff and the impact that this had on the people who live here. One relative said, “There have been lots of new staff which leads to confusion.” The manager acknowledged that there has been a significant turnover of staff since the last inspection (around 50 ) but is confident that the stability of management will now support a stable staff group. Comments from a Relatives’ Meeting the day before this inspection indicate that relatives feel that the continuity of staff is now improving. The Expert by Experience said, “I spoke to two of the nurses who had worked for the company for several years as had the care assistant. They spoke highly of conditions and training.” Gainford Care Homes Ltd is an equal opportunities employer, and this is evident from the good mix of age, experience, gender and ethnic background within the staff team. The recruitment and selection process used by the provider continues to ensure that only suitable people are employed. No new staff can start work here until satisfactory references, checks and police clearance (called a CRB disclosure) have been received by the home. All new staff receive “skills for care” induction training shortly after they begin working here. All care staff are offered training to achieve a professional qualification in care called NVQ. At this time 80 of care staff have achieved NVQ level 2 and the remainder are all working towards this award. All senior care staff have achieved NVQ level 3 and are going onto to further professional qualifications. In this way it is evident that the home promotes and encourages the professional development of its staff. Staff also receive training in appropriate areas, for example all care staff have had introductory training in dementia care needs and there are plans for more in-depth training in this are in the future. The provider has long-standing arrangements with an established training agency to deliver much of the training to staff. In this way all staff receive regular training in mandatory health & safety matters including infection control, fire safety, first aid and moving & assisting. There are good training records for each staff member that shows the training they have achieved and a training matrix that identifies future training needs. Lindisfarne Seaham DS0000068621.V372534.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, 32, 33, 35 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well-managed so it is run in a way that upholds the best interests of the people who live here. EVIDENCE: There have been a number of managers at the home since it opened about 18 months ago. However there is now a permanent manager who has applied to be the registered manager for this service. She is a qualified nurse who has many years experience in care service for older people and has been the deputy manager at another Gainford Care Home for the past 6 years. Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 25 The new manager has been in post for only a few months but several relatives had many positive comments to make about her impact on the quality of the service. One relative said, “I’ve seen the home improving since the newest manager has been here. Standards had previously dropped a bit….but it’s a good service now.” The provider visits on a regular basis and carries out observations of how staff support the people who live or stay here. This helps the provider to check the quality of the service at Lindisfarne, Seaham. Residents and their relatives have opportunities to comments on the service, either individually or at Residents’ Meetings. It was clear that residents and relatives find the manager very approachable. She has an open office door, and during this visit several residents and relatives joined her in the office for a chat. The Expert by Experience said, “One of the residents wandered into the office and it was lovely to see how he was welcomed. He was slightly agitated and although his speech was impaired the manager worked out what he wanted.” It is excellent practice that the home has listened to the views of relatives and residents and has made several changes to the home as a result. For example the home now operates as three distinct units so that residents are accommodated with other people with similar needs and interests. Also the lunchtime meals have been changed to meet residents’ preference. The home will support people to safely store small amounts of personal monies, if they request, and the home’s administrator takes responsibility for this. Records of this were clear, up to date and in good order. Peoples’ monies are kept in individual wallets in a secure place, and any transactions are clearly recorded and signed by two staff. In this way, residents’ monies are safely managed on their behalf. It is good practice that a record of each person’s transactions is kept on computer and each month a printed statement is sent out to relatives for their information. Health and safety checks are regularly carried out and all staff have training in health & safety matters. There were no significant health and safety issues noted during this visit. However there were several wheelchairs being stored in an open bathroom, which could have presented a tripping hazard to anyone trying to reach the toilet in this room. Hot water temperature checks are carried out but these only include a sample of baths and showers, rather than all the bathing facilities. Lindisfarne Seaham DS0000068621.V372534.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 3 X X X 3 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Lindisfarne Seaham DS0000068621.V372534.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 OP9 Regulation 13(2) & 13(4)c Requirement Where covert medication is assessed as essential to a person’s health care, there must be a record of the person’s capacity, the decision, the action taken, and the names of all parties concerned. This should be documented in the persons care plan and reviewed at regular intervals. This is to ensure that home follows best practice within the scope of the Mental Capacity Act and policy on the covert administration of medicines. All medication must be administered as prescribed. Accurate records must be kept for all medicines including controlled drugs. Handwritten entries and changes to MAR charts must be accurately recorded and detailed. This will make sure that people receive their medications correctly and the treatment of their medical condition is not Lindisfarne Seaham DS0000068621.V372534.R01.S.doc Version 5.2 Page 28 Timescale for action 01/12/08 2. OP9 13(2) 01/12/08 3. OP9 13(2) affected. Medication must be stored securely and safely, and must not be left unattended. A system must be in place to check expiry dates of medicines and add the date of opening when necessary. This makes sure that medication is safe to administer. 01/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Consideration could be given to developing a personcentred assessment of each person’s capabilities in their daily living skills. This would show staff what people can still do independently for themselves. It would be better if the care plans about peoples’ behavioural needs also included detailed guidelines for staff about how to respond so that all staff support the person in the same consistent, de-escalating manner. A system should be in place to record all medication received into the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. A current photograph of each person should be attached to their MAR chart. This helps reduce the risk of medication being given to the wrong person. The temperature of the medication room and fridge should be regularly monitored. This will make sure that medicines are being stored at the temperature recommended by the manufacturer. The kitchen in the unit for people with a physical disability needs some additional adaptation to allow better wheelchair access e.g. to use sink and access cupboards. Plans to provide handrails for toilets and raised toilet seats should continue so that residents’ safety is supported when using these rooms. DS0000068621.V372534.R01.S.doc Version 5.2 Page 29 2. OP8 3. OP9 4. 5. OP9 OP9 6. 7. OP22 OP22 Lindisfarne Seaham 8. 9. 10. OP22 OP38 OP38 It would be better if all doors, including cupboards and storage rooms, had signs or pictures to support people to distinguish between different rooms. Wheelchairs should not be stored in areas that are used by residents, such as bathroom, as they may cause a tripping hazard Routine checks of hot water to bathing facilities should always include every bath and shower. Lindisfarne Seaham DS0000068621.V372534.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 Seaham DS0000068621.V372534.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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