Inspection on 03/04/07 for Lindsay House Nursing Home

This inspection was carried out on 3rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lindsay House Nursing Home 23/01/06

Lindsay House Nursing Home 28/07/05

Lindsay House Nursing Home 07/02/05

Lindsay House Nursing Home 13/05/04

Lindsay House Nursing Home 16/03/04

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

CARE HOME ADULTS 18-65 Lindsay House Nursing Home 110 - 116 Lindsay Avenue Abington Northampton Northants NN3 2JS Lead Inspector Mrs Kathy Jones Key Unannounced Inspection 3rd April 2007 08:00 Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 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 Lindsay House Nursing Home DS0000012672.V333431.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 Adults 18-65. 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 House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindsay House Nursing Home Address 110 - 116 Lindsay Avenue Abington Northampton Northants NN3 2JS 01604 406350 01604 409689 lindsayhouse@rethink.org 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) National Schizophrenia Fellowship Mr Martin Anthony Gale Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service user numbers: No one falling within category MD may be admitted into Lindsay House Nursing Home where there are 15 persons of category MD already accommodated within this home. 23rd January 2006 Date of last inspection 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 fifteen adults with severe mental health problems. Purpose built, the accommodation for residents 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 residents to access local facilities and a further range of activities. Rear and side gardens are accessible to the residents and there is a parking area to the front and rear of the home. Information about fees was provided by the registered manager as being current at the time of inspection. Fourteen of the fifteen beds are block booked and funded under contract between Northamptonshire County Council (NCC) and Rethink. The current fees per resident paid to Rethink are £745.95. (The registered manager advised that this figure has been significantly reduced as from April 1st 2007 by the County Council) The fees quoted do not include the housing cost which is paid to Leicestershire Housing. This cost was not available at the time of the inspection. Additional costs to residents as stated in the statement of purpose are dry cleaning, personal clothing, bed linen, toiletries and other personal expense. If required private telephone installation and calls and insurance for personal belongings and purchases. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of the information held by the Commission for Social Care Inspection as part of the pre-inspection planning and an unannounced inspection visit to the service. The pre-inspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls, letters, and details of any complaints and concerns received. The report from the last inspection carried out on 23 January 2006 was also reviewed and the findings taken into account when planning this inspection. A pre-inspection questionnaire submitted by the registered manager provided information, which has been taken into account as part of the inspection. The views of two residents and five relatives who forwarded questionnaires have also been included in this report. The unannounced inspection visit covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’ which involves selecting residents’ and tracking their care and experiences through review of their records, discussion with care staff and observation of care practices and the environment. Residents were asked if they would like to talk to the inspector, however their right not to was respected. Brief conversations were held with four residents’ during the inspection and observations were made of their general well being, daily routines and interactions between staff and residents. A sample of staff files were reviewed to check the adequacy of the recruitment procedures. The findings of the inspection were discussed with the registered manager at the time of the inspection. What the service does well: Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 6 One of the strengths of the service is the staff team, who appear knowledgeable about residents needs and committed to doing their best to meet them. A relative described the overall atmosphere as safe and nurturing. There are good relationships and links with mental health services and workers, which helps to ensure that people involved in the residents care are working together in the best interests of the resident. On the day of the inspection the Community Psychiatric Nurse was working with staff to help support a resident who had become unwell following a change of medication. Residents stated that the home is always fresh and clean and one resident identified the cleaner as being a “great domestic worker”. What has improved since the last inspection? What they could do better: Further development of the statement of purpose to include the range of needs and age group would provide clearer information for prospective residents and their carers and also provide a clear focus for the service. The standard of the record keeping from care plans, accident records, medication records, staff recruitment and training records needs to be improved to provide better evidence of how residents’ needs are being supported and how they are being protected. While no specific shortfalls in care were identified it was of concern that although staff demonstrated a good knowledge of residents needs, if new or agency staff had to be brought in to cover staff illness the care plans did not contain enough information about the care needs of individuals to ensure they could be met. The care plans also need to include information about what residents want to do and how they are going to be supported to achieve it. At present they do not show how residents are encouraged or supported to take part in activities in and out of the home or to make decisions. For example residents meetings show that suggestions have been made about various outings and activities, however it was difficult to see how individuals have been supported in accessing these. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 7 Efforts should be made to maintain a smoke free area for none smoking residents. 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. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process provides assurances that the needs of people admitted to the home can be met, however more information in the statement of purpose about the needs and age range of residents would assist prospective residents and their carers in making choices. EVIDENCE: There is a statement of purpose, which provides information for residents, prospective residents, their families and any other interested parties about the aims of the service and other key information. A sample contract of residence is included which gives information about the terms and conditions. A comment card received from a resident stated that they had enough information to make a decision about moving into Lindsay House. However advice was given to review and revise the document, as at present the only information about the people and the needs is that the care speciality is “nursing care for people with severe mental ill health”. As this can be quite wide ranging it would be more helpful to enquirers if more specific information about needs, age ranges etc were included to help them decide if they would wish to live there. It would also provide a clear focus for the service. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 10 Discussion with the registered manager confirmed that the needs and age range of existing residents and prospective residents would be taken into account prior to admitting a new resident to Lindsay House, to ensure all of their needs could be met. The statement of purpose identifies that prior to a resident moving into the home they are able to visit and sample the level of service and that they will have a months trial which will also ensure that their needs can be met. This was confirmed by review of a resident’s records, which identified that the admission process had included a weekend stay and a two night stay prior to a month trial period. There was also evidence in the records that the resident’s views had been sought about living at Lindsay House. A thorough assessment of residents needs is carried out prior to them moving into the home. Records show that information is gathered from the prospective resident and a range of health professionals currently involved with their care. This information enables a decision to be made about the ability of the service to meet the resident’s needs if they decide they want to move in. A recommendation was made at the last inspection to include the room that the resident would occupy within their contract. This has now been included, providing residents with some security in terms of the room that they occupy. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ individual needs and choices are not properly supported and evidenced through the care planning system. EVIDENCE: Positive feedback was received in comment cards from four relatives and two residents about the care and support that residents receive. For example “Looked after with as much care as possible” and “Overall atmosphere safe and nurturing”. Residents’ views are gathered about the care and support they feel that they need through completion of a ‘recovery plan’. Information is also obtained about residents’ needs through involvement in regular care planning meetings chaired by an allocated mental health worker from outside the service who has a responsibility for overseeing the mental health of individuals with a diagnosed mental health condition. Minutes of these meetings were held on Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 12 residents’ files and included recommendations. While it was positive that all of this information had been gathered, it had not consistently been included in residents’ plans of care, which are the documents in place to guide staff in providing the necessary care and support. One example of this was a recommendation that a resident should be supported in accessing social activity in the community and at Lindsay House, however there was no evidence of how this recommendation was being acted on. Care plans were signed by residents, however some were written in a very general way and did not focus on the specific needs of the individual making it very difficult for a new or an agency worker covering staff absence to provide appropriate care and support to residents with complex needs. A comment card from a resident stated that they were usually able to make decisions about what they do each day and another said sometimes. Discussion with staff identified that they understood and acknowledged the need to encourage residents to make decisions about their lives and that they felt that the residents had all progressed since moving to Lindsay House from a more institutional environment. However the care plans did not consistently include individual goals, evidence decision making and risk taking. While there were indications that residents are receiving some support in these areas the lack of planning may mean that they are not receiving the level of support they need. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff recognise residents rights to make decisions and choices about their daily lives, however it is difficult to evidence how they are supported to do this through the care planning process. EVIDENCE: During discussions with residents they talked about various work and leisure activities, for example, one resident said that they attended a work placement, twice a week, another talked about going shopping. A resident also said that one of the residents helped to keep the garden tidy. Regular residents meetings are held and the minutes show that leisure activities are discussed at the meetings and suggestions made by the residents about activities and outings. Two comments received from a resident and a relative in comment cards state that residents would like to go on holiday and Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 14 one said that they had not had the opportunity for two years. Discussion with staff identified that efforts have been made to arrange activities and holidays suggested by residents however this has proved to be particularly difficult when things need to be pre-booked as there have been a number of occasions where residents have decided on the day that they do not want to go. An example was given of eight theatre tickets that were booked and no-one wanted to go on the actual day. Staff advised that they were trying to book holidays for residents’ this year. While it is acknowledged that participation in the activities is very dependent on residents’ mental well being, the shortfalls in the care planning make it difficult to evidence that residents are receiving the necessary support and encouragement to make choices and access appropriate activities. Comments received from relatives confirm that residents are supported in maintaining relationships with their families and families are kept informed of important changes such as health. Discussion with staff confirmed that they understand the importance of maintaining these links. Five relatives who returned comment cards all confirmed that the service meets the different needs of people. Care records confirm that information gathered includes cultural and religious needs and there was evidence that residents are supported in their religion. Four residents spoken with during the inspection all said that they enjoyed the meals. A comment card from a relative also stated that they had eaten in the home on a few occasions and that the food was very good. The home made moussaka served for lunch on the day of inspection looked appetising. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ receive a very good level of healthcare support, however some shortfalls in recording could create a risk of needs not being fully met. EVIDENCE: Discussion with residents, staff and a visiting Community Psychiatric Nurse and feedback from relatives confirm that residents receive a good level of care and support. Staff were observed to have built up good relationships with the Community Psychiatric Nurse. They were monitoring closely the physical health and mental well being of a resident who had recently been unwell and were liaising with the Community Psychiatric Nurse and Consultant Psychiatrist regarding changes to medication. Residents’ records identify that appointments for residents are made with other healthcare professionals such as the optician and dentist. A sample check of accident records and discussion with staff identified that although there seems to be a clear rationale for decisions about the need for Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 16 further treatment based on regular observations, in some cases there is no written evidence of these observations. It is important that such information is recorded in order that staff on the next shift have sufficient information to continue appropriate monitoring and the rationale for decisions taken about the need for further treatment is clear in the event of a sudden deterioration in health. The registered manager confirmed that he would arrange staff training on accident recording. Staff were knowledgeable about residents’ medication and the effects of particular medications and were observed to be mindful of the times when residents required particular medication. Records show that they were signing appropriately to confirm administration of medication. At the time of the inspection none of the residents’ were managing their own medication. There was evidence in residents’ records that they had consented to receiving medication, however there was no evidence of an assessment to determine the need for staff to manage their medication. While it was acknowledged that residents’ may not be able to safely manage their own medication advice was given to assess this on an individual basis and review it regularly to ensure that residents rights are not unnecessarily restricted. A sample check of the medication system identified that it was stored securely in a locked trolley or locked cupboards. Additional security is in place for controlled drugs. However although records showed that in all except one case the quantity of medication received was recorded, it was difficult to carry out an accurate stock check without checking back to when the medication was first prescribed. Advice has been given to record any medication carried forward to the next cycle in order that there is a clear audit trail and any discrepancies can be easily identified. There was no evidence of the medication received for a new resident being checked or of quantities received being recorded. This is important in order to identify discrepancies but also to ensure that sufficient stocks of prescribed medication are available for the resident. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are procedures for dealing with concerns and complaints, which residents and relatives are aware of and staff are aware of their responsibilities for protecting the people in their care. EVIDENCE: There is no record of any complaints being received by the Commission for Social Care Inspection about the service since the last inspection. The registered manager advised that they have received no complaints. Details of how to make a complaint are prominently displayed on the notice board in the downstairs corridor, which is accessible to residents. Residents spoken with all said that if they had any concerns that they felt able to raise them with staff and that they would be listened to. Feedback from relatives in comment cards identified that they also were satisfied that if they had any concerns that they would be able to raise them. Residents spoken with had no concerns about how they were spoken to or treated by staff. Staff were observed to speak to and speak of residents in a respectful manner and were aware of their responsibilities for the protection of the vulnerable people in their care. Comments cards received from relatives confirm that staff treat residents with respect. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a clean and comfortable place to live; however a smoke free area should be maintained for the safety and comfort of residents. EVIDENCE: Residents’ all have single rooms with en-suite facilities. A resident said that it is their choice how tidy they keep their rooms and if necessary support is available for them in cleaning their rooms. Residents spoken with were happy with their rooms and confirmed that they had keys to their rooms enabling them to keep their belongings secure if they wish. An application to increase the number of beds to fifteen has recently been agreed, however advice was given prior to use for a new resident consideration should be given to the individual who may occupy the room and their needs. As the room was previously used as a staff room it contains kitchen units, a kitchen sink and a fridge, which may or may not suit the needs of a new Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 19 resident. The sign identifying the room as a staff room should also be removed from the door. Shared spaces consist of two lounges, dining rooms and a supervised kitchen (upstairs). Residents were observed to access all areas of the home as they wished. The downstairs lounge is acknowledged as the smoking area and staff said the upstairs lounge was a no smoking lounge. However first thing in the morning the upstairs lounge smelled strongly of smoke and there were two full ashtrays in the room. As there are three residents who do not smoke consideration needs to be given to their views and the risks associated with passive smoking. There is a kitchen upstairs, which was originally planned to be used to develop residents’ cooking and household skills, however staff advised that at present it is rarely used, as current residents prefer to have the meals made for them by the cook. Residents’ rooms were not seen during the inspection, however all other areas were observed to be clean. Comments cards received from two residents confirm that the home is always kept clean. A relative also commented that the home is always kept clean. Some concerns were raised at the last inspection about fire doors being propped open; these were all shut during the inspection. The registered manager understood the need for these doors to be kept closed. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are competent and appropriately trained to meet the needs of residents, however record keeping needs to be improved and closer scrutiny of applications for employment to ensure that residents are adequately protected. EVIDENCE: Observations and discussions with staff, residents and the Community Psychiatric Nurse indicated that there is a competent staff team who understand the needs of the residents. Comments received from five relatives all confirmed that they felt staff had the right skills and experience. Information received in the pre-inspection questionnaire supports the fact that staff are appropriately trained to meet residents’ needs. Seven registered nurses are employed with six of these having a nursing qualification in mental health. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 21 Of the six care staff employed, three of these have an NVQ at level 3 and two are studying for level 2. The NVQ provides staff with a basic understanding of care practices to assist them in meeting residents’ needs. While discussion with staff and feedback from relatives indicates that staff receive appropriate training it was difficult in some cases to evidence this as some of the documentation was not available. Staff had taken some of the documentation home for review or completion. The registered manager confirmed that an overview of the training undertaken by staff and the plan for the forthcoming year would be forwarded to CSCI following the inspection. Following discussion with the registered manager about the findings in relation to care planning and record keeping, the registered manager advised that he would implement some specific training for staff. Staff whatever their roles, presented as committed and caring. The cleaner involved residents in a word game as he went about his duties and had clearly built up good relationships with residents. The cook was also observed chatting with residents. Two staff files were checked to see the adequacy of the recruitment process in protecting residents. The registered manager advised that both of these staff members had worked in the home as ‘bank’ staff prior to being employed on a permanent basis. Details of the original start dates and original applications could not be found on their files. Discussion with the registered manager and review of the criminal record bureau clearance dates indicated that they had been received prior to them working as bank staff, however this could not be evidenced as the start dates were not available. It is particularly important in protecting residents that checks are made prior to staff starting work. Records and discussion indicated that care is taken to ensure that prospective staff have the necessary documentation to confirm that they are able to seek work in this country. Checks are also made to ensure that the registered nurses hold a current registration and are appropriately qualified to meet the needs of residents. Review of the references for one member of staff identified that they had used a senior member of staff in the care home they had previously worked in as a referee rather than a manager. Another reference had been supplied by a care agency, which was not detailed on the employment history. Advice was given to be more thorough in screening references to ensure that the employer has provided them and that the application contains the full work history in order to provide as much protection to residents as possible. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42, 43. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Lindsay House is managed in the best interests of residents, however care needs to be taken to ensure that standards are consistently maintained and financial pressures do not compromise resident care. EVIDENCE: There is an experienced registered manager in post who has managed Lindsay House for five years. The registered manager is a registered nurse qualified in mental health and he has achieved a NVQ at level 4 in management and care. Two deputy managers’, who are also registered nurses and have achieved NVQ level 4, support the registered manager with the management of the service. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 23 The responsible individual who is the person responsible for overseeing the service and the care provided on behalf of the organisation has an office in the building. There was evidence that he carries out regular sample checks of aspects of the service, talks to residents and where applicable recommends improvements. In addition the organisation had carried out a quality audit in May 2006 and high scores were achieved in all areas checked. A recommendation was made about gathering the views of residents, which the registered manager had done. Shortfalls in record keeping have made it very difficult to evidence what seems from feedback from relatives, residents and a health professional to be good standards of care. The areas highlighted during the inspection, suggest some slippage in standards. Although there was no clear evidence of poor outcomes for residents at the time of the inspection, the shortfalls have the potential to lead to poor outcomes. The findings were discussed with and acknowledged by the registered manager who expressed a commitment to addressing the shortfalls and to implementing improved monitoring. At the last inspection it was identified that there were some out of date policies and procedures and these had been removed. No concerns were identified about health and safety matters during the inspection. Confirmation that regular maintenance and servicing of equipment to reduce the risk to residents’ is carried out, was received in the preinspection questionnaire submitted by the registered manager. A copy of the electrical wiring certificate was viewed during the inspection to verify that this was in place. Financial records were not viewed during the inspection, however the registered manager advised that Northamptonshire County Council who have a contract with Rethink for fourteen beds have from 1st April 2007 reduced the money paid by a total of £50,000 on the previous year. This reduction is likely to have a significant impact on the service, and would appear to be outside the control of the service. At the time of the inspection the organisation was in the process of exploring ways of minimising the impact on resident care. Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 2 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 2 3 3 Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 25 Yes 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 YA6 YA7 Regulation 12 (1) (2) (3) Requirement Care plans and related documentation must reflect resident’s individual health and welfare needs, taking account of their wishes. (A similar requirement with a timescale for compliance of 01/04/06 has not been met.) Care plans must demonstrate that residents are supported in accessing appropriate activities including social activities. A record must be kept of all residents’ prescribed medication received as part of a clear audit trail. The referees put forward by applicants and the adequacy of the information must be thoroughly checked as part of a thorough recruitment procedure prior to staff being employed. Timescale for action 15/06/07 2. YA12 16 (m, n) 15/06/07 3. YA14 YA20 13 (2) 30/04/07 4. YA34 19 (1) (a, b) (2) 30/04/07 Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 26 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 YA9 Good Practice Recommendations Care plans and risk assessments should demonstrate that residents’ are supported to take responsible risks and where limitations are in place there is evidence of consultation. Care plans should include residents’ personal goals and demonstrate how they are being supported to meet them. Efforts should be made to keep a smoke free area for residents’ who do not smoke. Record keeping should be reviewed and monitored to ensure that they support and evidence actions taken. 2. 3. 4. YA6 YA24 YA41 Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Lindsay House Nursing Home DS0000012672.V333431.R01.S.doc Version 5.2 Page 28 - 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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