CARE HOME ADULTS 18-65
Lindsay House Nursing Home 110 - 116 Lindsay Avenue Abington Northampton NN3 2JS Lead Inspector
Moira Mosley Unannounced 28 July 2005 10.00
th 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Lindsay House Nursing Home Address 110-116 Lindsay House Abington Northampton NN3 2JS 01604 406350 01604 409689 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) National Schizophrenia Fellowship \ Care Home with Nursing 14 Category(ies) of MD Mental Disorder (14) registration, with number of places Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th February 2005 Brief Description of the Service: Lindsay House is a home situated in the residential area of Abington in Northampton. The home is close to the main local bus routes in to the town centre where community resources include shops, pubs, leisure centres and restaurants. The home is managed by Rethink, which is the operating name of the National Schizophrenia Fellowship and is registered to provide nursing care for fourteen adults with severe mental health problems. Purpose built the accommodation to service users is provided across two floors. All bedrooms are single occupancy with en suite facilities; the home also has two sitting areas, two kitchens and two dining areas.The home has its own transport, which enables all the service users to access local facilities and a further range of activities. Rear and side gardens are accessible to the service users and there is a parking area to the front and rear of the home. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection. Two hours were spent collating information and preparation for the inspection and 3.5 hours were spent in the home. The care of two residents was reviewed to include their care plans, risk assessments, medication and other records. Discussions were held with four of the residents, two staff members and two visitors to the home to ascertain how care is provided. What the service does well: What has improved since the last inspection?
Care plans are written and agreed by the residents with evidence of regular review and updating of information. The care files have been re organised to ensure key information can be easily located. Risk assessments are completed for all areas of risk and are cross-referenced to the care plans where required. The medication profiles for residents are kept up to date to ensure that residents receive medication as prescribed. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 6 Maintenance records and regular hot water temperature checks are made to ensure the safety of the environment. Staffing levels have been reviewed and extra staff are allocated at weekends and when the needs of the residents indicate higher ratios needed. The recording of the menus and the meals eaten by residents is now monitored to ensure nutritional needs are met. 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 House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2. Resident’s needs are fully assessed and information provided to ensure they understand what to expect and that their needs can be met prior to admission. EVIDENCE: The Statement of Purpose contained the required information for residents to know what service is provided. A copy was not available within the communal areas however this was replaced at the time of the inspection. The pre admission assessment process is detailed and included information from previous placements and professionals involved in the care along with resident and their families to ensure needs are fully assessed and the necessary facilities are available prior to an admission. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 and 9. The care plans and risk assessments support residents needs however the lack of detailed action required by staff to meet these needs prevents a consistent approach. EVIDENCE: Care plans were available and were agreed with the residents. Regular reviews were evident for most care plans and needs identified. However there was a lack of detail to instruct staff in what action they should take in response to the identified need. An example was one resident who’s daily notes identified frequent episodes of aggression and inappropriate comments with no accompanying care plan to ensure a consistent approach by staff. Another resident had a care plan that identified paranoia and in discussion it was evident the resident was suspicious about some people. The staff spoken to confirmed the resident had a history of making unfounded allegations but there was no detail within the care plan of how staff could ensure both the resident and their safety against such allegations. The care plan stated only to record any comments made.
Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 10 The residents spoken to confirmed they are able to be involved in decision making and any restrictions made, for example in regard to smoking are risk assessed and the subsequent care plan agreed with the resident. Risk assessments were available and cross-referenced to care plans and discussions with staff showed they considered the impact of any identified risk against any unnecessary restrictions on choice and independence. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 and 17. Individual programmes are in place to ensure residents receive a varied opportunity to develop skills and experience a wide range of social opportunities. EVIDENCE: The residents have individual plans for daily activities and some attended work placements or were supported to access local facilities including the gym and outings to places of interest. The residents spoke about the support they receive in maintaining contact with family and friends. Visitors to the home said they were very pleased with the home and always felt welcome to visit their relative at any time. The kitchen was in good order with the necessary checks and recordings made to ensure the meals served meet the residents needs. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 12 The residents spoke highly about the quality of food and were seen to enjoy the lunchtime meal. Menus are planned with resident involvement and meals eaten are documented to ensure nutritional content. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20. The medication systems are effective to ensure medication is given as prescribed. Healthcare assessments do not demonstrate that the healthcare needs of the residents are being fully met. EVIDENCE: There was evidence of healthcare interventions for medical concerns including the GP and consultants where required. There was no evidence of referral to other healthcare professionals for example the dental, optical or podiatry services although staff state these are acted upon where required. One resident had a care plan identifying serious health concerns and gave detailed instructions for daily monitoring of vital signs, fluid intake and skin integrity, however since it was written in June 2005 there were no further entries or evidence of action being taken as per the care plan. The resident was spoken to and was in reasonable health at this time and had been followed up by the GP but the records did not support what action, if any was taken. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 14 This resident was also identified as being at risk of developing pressure ulcers however there was no evidence of pressure ulcer or other healthcare assessments for example nutritional assessments. The medication was cross-referenced to the medication administration recordings and these were fully completed. A system is in place to ensure a clear audit of all medication entering and leaving the home is possible. There are clear procedures for the storage, administration, recording and disposal of medication. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22. There is an effective system in place to respond appropriately to complaints made. EVIDENCE: The complaints procedure is clearly documented and available in communal areas and in the statement of purpose. The residents spoken to said they would be able to speak to the staff or to the manager about any concerns they had. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,26,27and 30. The safety of the residents in the event of a fire would be compromised and the bathing facilities are not meeting the needs for one resident. EVIDENCE: The home was clean and tidy and the domestic staff were seen to be working well with the residents to maintain the environment. The resident’s bedrooms were pleasant and were very personalised with the necessary furnishings and equipment to meet their needs. Many of the resident’s bedroom doors were propped open with furniture. When spoken to some said this was because they had lost their key and would be unable to gain entry if the door closed. The staff spoken to confirmed this was the practice and they did try to ensure doors were closed. All residents are given a key to their room but several are unable to manage this and frequently lose keys. One resident spoke about having to use the bath in another resident’s bedroom as they did not like to shower and were unable to use the bath in the general bathroom, as it did not have a bath seat.
Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 17 The home has a laundry room with both domestic style and commercial machines. They also have sluice facilities to ensure the safe handling of infectious materials. Staff have access to gloves, aprons and procedures for effective infection control. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35 and 36. The staff team have the experience, skills and knowledge and are supported by systems to ensure they are able to meet resident needs. EVIDENCE: The staffing levels are sufficient to meet the needs of the residents and staff confirmed that extra staff are employed at key times for example weekends and when appointments or outings have been arranged. Training is provided by the company on a wide range of topics to ensure the staff have the necessary skills and knowledge to meet the residents needs. Staff confirmed they receive regular formal supervision by their line manager and they felt supported by the systems in the home. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,42. There is a supportive management system in place and the overall health and safety of the residents is maintained. EVIDENCE: The staff spoken to confirmed they have received all statutory training including first aid, food hygiene and fire training. Maintenance records and the recording of hot water temperatures are maintained to ensure a safe environment. The feedback from residents and their relatives was very positive about the home the staff and the manager. The staff and residents spoken to were clear about the manager’s role and felt able to approach the management with any concerns or queries. There are regular resident meetings to ensure they are kept informed of changes and to express their views about the home.
Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 2 2 x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Lindsay House Nursing Home Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 3 x D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 21 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 6 Regulation 12(1)(a)( b) and 15(1) 12(1)(a)( b) 13(1)(b) 12(1)(a)( b) 13(1)(b) 15(1) and 17(1)(a) schedule 3 (3)(m) 13(4) 23(4)(a) 12(4)(a) 23(2)(n) Requirement Care plans must be written for all identified needs and give clear direction of action required by staff. Healthcare assessments must evidence that residents health needs are being met. Care plans and supporting documentation must be available to demonstrate action taken for healthcare needs identified. Timescale for action 01/09/05 2. 3. 19 19 01/09/05 01/09/05 4. 5. 24 27 The propping open of fire doors must be addressed to meet fire regulations. The bathing facilities must meet individual needs with equipment provided if needed. 01/09/05 01/10/05 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 26 Good Practice Recommendations The provision of door keys and the locking devices on
D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 22 Lindsay House Nursing Home bedroom doors should be reviewed to ensure residents are able to gain access to their bedrooms. Lindsay House Nursing Home D C51 C08 S12672 Lindsay House V241391 280705 Stage 2.doc Version 1.40 Page 23 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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