Inspection on 08/06/05 for Lindsay Hall Nursing Home

This inspection was carried out on 8th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lindsay Hall Nursing Home 12/11/08

Lindsay Hall Nursing Home 13/12/06

Lindsay Hall Nursing Home 31/01/06

Lindsay Hall Nursing Home 07/01/05

Lindsay Hall Nursing Home 27/07/04

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

CARE HOMES FOR OLDER PEOPLE Lindsay Hall 128 Dorset Road Bexhill on Sea East Sussex TN40 2HT Lead Inspector Niki Palmer Unannounced 8 June 2005 09:45 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 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. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lindsay Hall Address 128 Dorset Road Bexhill on Sea East Sussex TN40 2HT 01424 219532 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Galleon Care Homes Ltd Mrs Lynda Burnett Care Home (CRH) 38 Category(ies) of Dementia (DE) 38 registration, with number of places Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only service users who have dementia type illness are to be accommodated. 2. Service users should be aged sixty (60) years or over on admission. 3. That no more than thirty eight (38) service users are to be accommodated. Date of last inspection 7 January 2005 Brief Description of the Service: Lindsay Hall is a Care Home providing nursing and personal care and accommodation for 38 older people with dementia. It is owned by Galleon Care Homes, who also own two other homes in the area. The home is situated in a quiet residential area of Bexhill-on-Sea close to local shops, churches, pubs and other community facilities. The building is a large, spacious home, providing a light and airy positive environment for its residents. There is a lift in the premises to reach all three floors and has assisted bathing equipment and hoists to assist transfer. There is a large garden to the rear which is accessible to service users and car parking for visitors at the front of the building Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Lindsey Hall will be referred to as ‘residents’. This unannounced inspection took place on a Wednesday between 09.45am and 3.30pm. The inspection began with discussions with the senior carer and registered nurse on duty (in the absence of the registered manager), in respect of progress made since the last inspection, followed by the examination of four residents care records, three staff files and a selection of the home’s policies and procedures. In order to gather evidence on how the home is performing, individual discussions took place with three residents, seven members of staff, two registered providers and three relatives. 38 residents were accommodated at the time of the inspection. A detailed inspection of the premises and its facilities took place. Since the last inspection the Commission for Social Care Inspection were involved in a complaint made in respect of the nursing and medical care provided to one resident. The outcome of the investigation was that the concerns were unsubstantiated. What the service does well: What has improved since the last inspection? All of the requirements and recommendations from the previous inspection report have been met. These include: the revision of the home’s Statement of Purpose, the maintaining of cleanliness throughout the home and ensuring that all new staff provide the home with details of any gaps of employment. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 6 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. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 5 and 6. Prospective residents and their family are provided with detailed information to support their decision to move to the home. The pre-admission assessment procedure does not identify all residents’ needs. EVIDENCE: Both the Statement of Purpose and Service User Guide were found to be very detailed and comprise the service user and relatives’ information folder, which is on display in the entrance hall. This file also contains details of the home’s complaints procedure, most recent inspection report and thank you cards received from relatives in respect of the care provided by the home to their loved ones. Residents and relatives spoken with said that they personally had chosen the home as it had been recommended to them by others and confirmed that they had visited the home prior to admission. Two relatives commented on the cleanliness of the home during their first visit, which had supported their decision to move their mother in to the home. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 9 Three pre-admission assessments were seen on the day of inspection. Residents and relatives said that the registered manager had visited them at home or in hospital initially to complete the assessment. All three assessments were found to be brief in nature, for example details of their mental state and cognition had not been recorded, which is imperative of a care home providing nursing support to residents with a dementia type illness. In addition the pre-assessment did not provide a risk assessment for falls, likes and dislikes, or details of how the home could meet their assessed needs. Intermediate care is not provided. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7, 8, 9 and 11. The home has developed a satisfactory system of care planning to ensure all residents care needs are met. Procedures for the safe and accurate administration of medicines need to be adhered to. EVIDENCE: Three care plans were seen, all of which were clear, concise and set out in detail the action which needs to be taken by care staff to meet individuals’ assessed needs. Risk assessments for the use of bed rails, maintaining pressure area care and nutritional screening were in place. Pressure relieving equipment is provided and new height adjustable beds have recently been purchased. Family and next of kin details are recorded at the front of the care plans, however daily records did not provide any evidence that family members were kept informed of recent outcomes of health appointments. For example, one resident had been supported to the hospital for an x-ray of her chest, yet there was no record that the family had been informed. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 11 The homes medicine storage and administration system was viewed. The records of medicine administration showed that several recent entries had not been signed for, therefore it was unclear whether or not the residents had been given their medicine. In addition it was concerning to note that loose vials (a small cylindrical glass for holding liquid medicines) were stored in the fridge without labelling, so it was not possible to know who the medication had been prescribed for. It is required that all vials are stored in their original containers with details of the residents name and date that it was prescribed. The home has a detailed policy statement and procedure in place for the care of the dying. Residents’ wishes are recorded in their care plans including details of their religious and spiritual needs and whether or not the funeral is to be a burial or cremation. One care plan of a recently deceased resident was seen which was found to be very detailed regarding the changing needs of the resident. All contact with the family was clearly recorded. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 15. The meals in this home are good offering both choice and variety and catering for special needs. EVIDENCE: The menus are rotated on a four weekly basis providing residents with two hot meals and puddings a day. A variety of cereals are available for breakfast, toast and porridge. Although the menus only offer one choice for lunch and supper it is clearly stated that alternative options can be made on request. Fresh vegetables are served with each meal and salads where necessary. Dairy free, diabetic and soft diets are also catered for. For a small fee visitors to the home can choose to stay for a meal. All of the residents and relatives spoken with spoke positively of the food provided. On the day of inspection two relatives were spoken with during lunchtime who had come to visit their mother. They said that they often visit during meal times as they like to sit with their relative and support her as necessary. The atmosphere in the dining room appeared relaxed, quiet and unhurried. There were sufficient staff on duty to support individual needs. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 and 18. The home ensures that the rights of residents are protected and encouraged and that they are safeguarded from harm. EVIDENCE: Many of the residents living at the care home are in the latter stages of dementia, and therefore lack capacity to make an informed decision about many aspects of their lives. They are reliant on others to safeguard their rights and act in their best interests. The home has an adequate policy in place to support residents in making decisions about their lives but it does not give guidance around assessing capacity or who should be involved in discussions around working in somebody’s best interests. A recommendation has been made for the home to obtain up to date information and guidance from the Department of Health. Policies for the Protection of Vulnerable Adults and staff Whistle Blowing are in place. All staff spoken with confirmed that they have undertaken training around safeguarding residents and said that they would feel confident in recognising signs of abuse and in using the correct procedures to report their concerns. Adult Protection training is facilitated by one of the senior carers and the registered manager. A video is used followed by a set of written questions for staff to answer. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25 and 26. Lindsey Hall provides residents with a safe, comfortable and well-maintained place to live. EVIDENCE: Lindsey Hall comprises of 18 single and 10 double rooms. All shared rooms have adequate screening to ensure privacy for personal care. Ten of the rooms were seen on the day of inspection, all were found to be comfortable and personalised by each of the residents. All radiators are guarded and hot water is distributed at safe temperatures throughout the home. Many of the rooms overlook a large well-maintained garden to the rear of the property; those on the lower ground floor have direct access to the garden by patio doors. Only one of the rooms is currently not carpeted. A recommendation has been made in respect of the resident being offered a choice as to their preference of floor covering. The home was found to be clean and tidy throughout with no offensive odours. A number of domestic staff employed by the home who were seen on the day of inspection to carry out their duties with care and efficiency. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29. Staffing levels are adequate to meet the needs of residents. The home has robust recruitment procedures in place to safeguard the welfare of residents. EVIDENCE: Both residents and relatives confirmed that there are always sufficient numbers of staff on duty within the home and that the turn over of staff is relatively small. Lindsey Hall employs four Registered General Nurses, three Mental Health Nurses and 20 care staff (five of which are trained to at least NVQ level 2 in care). In addition, two cooks, two laundry staff, a maintenance person and four kitchen staff are employed. Since the last inspection the home has adopted good systems to check for any gaps in employment. Three staff recruitment files were seen, all of which contained two satisfactory references, identification and Criminal Record Bureau checks. A recommendation has been made in respect of POVA First checks being stored in personal staff files as opposed to in the main office upstairs. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, and 37. Lindsey Hall has good systems in place to monitor the effectiveness of the running of the home. EVIDENCE: The registered provider makes monthly visits to the home to meet with residents, staff and visitors in accordance with Regulation 26. Details of these visits are reported to the Commission for Social Care Inspection. The home has in-house quality monitoring systems that are carried out on a six monthly basis. Copies of these are kept in the information file in reception for residents and visitors to the home to see. There is little involvement by staff in residents’ financial affairs. The vast majority of residents have a Power of Attorney (normally a close relative). The registered provider confirmed that should residents request any additional personal items such as a new pair of slippers, the person responsible for handling individuals’ money will be billed by the home the following month. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 17 Since the last inspection, the home has updated its Statement of Purpose and Service User Guide to inform residents that they can have access to their personal files and care plans kept in the home at anytime. Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 1 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 3 x x 3 x 3 x 3 x Lindsay Hall H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(2) Requirement That the homes pre-admission assessment record is reviewed and amended to include details of individual mental state and cognition, likes and dislikes, risk assessments and details of how the home can meet their assessed needs. That relatives are kept informed of residents well-being and a written record is maintained of the contact. That the system of medicine storage and administration adheres to the Care Homes Regulations 2001. Timescale for action 08/09/05 2. OP8 17(1)(a) Schedule 3(k) 13(2) 17(1)(a) Schedule 3 With immediate effect. With immediate effect. 3. OP9 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP17 OP24 Good Practice Recommendations That the home obtain up to date information and guidance from the Department of Health regarding assessing capacity, consent and working in peoples best interests. That residents are given a choice of their preferred floor covering. H59-H10 S14014 Lindsay Hall V228301 080605 Stage 4.doc Version 1.30 Page 20 Lindsay Hall 3. 4. OP28 OP29 That 50 of care staff are trained to NVQ level 2 by December 2005. That POVA First checks are stored in indivdual staff files. 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