Inspection on 14/03/08 for Lindum House

This inspection was carried out on 14th March 2008.

CSCI found this care home to be providing an Good service.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lindum House 03/08/06

Lindum House 04/01/06

Lindum House 18/08/05

Lindum House 27/09/04

Lindum House 19/05/04

Lindum House 26/11/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Lindum House 84 Bath Road Old Town Swindon Wiltshire SN1 4AY Lead Inspector Sally Walker Unannounced Inspection 14 March 2008 09:50 th Lindum House DS0000003208.V359003.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 Lindum House DS0000003208.V359003.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. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindum House Address 84 Bath Road Old Town Swindon Wiltshire SN1 4AY 01793 525299 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) lindum-house@hotmail.co.uk Mr Nathan Maysey Miss Claire Louise Thomas Mr Nathan Maysey Care Home 20 Category(ies) of Learning disability (20), Learning disability over registration, with number 65 years of age (20) of places Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated at any one time is 20 The home must not admit any service users aged 65 years and over. Service users admitted in the range 18 - 65 (category LD) may remain in the home after attaining their 65th birthday subject to the home being able to continue to meet the needs of the service user. 3rd August 2006 Date of last inspection Brief Description of the Service: Lindum House is a large detached property on the Bath Road in Old Town Swindon. The home is arranged on four floors and there is a detached bungalow in the grounds. The home offers accommodation and care to twenty men with learning disabilities. The bungalow accommodates four men who are working towards more independent living. The home provides a mix of single and double bedrooms. There is a dining area and kitchen in the basement, which is also used as a communal meeting area. There is a small lounge on the top floor and a large craft room that is used for in house daytime and evening activities. There is a minimum of three staff on duty at all times and two staff provide sleeping in cover at night. Residents have the opportunity to go on holiday and a range of holidays is offered to meet individual needs and preferences. Details of the current fees can be obtained directly from the home. Lindum House DS0000003208.V359003.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place on 14th March 2008 between 9.50am and 5.40pm. Mr Maysey and Miss Thomas were present during the inspection. We spoke to 4 residents and 2 staff. We looked at care records, medication records, quality assurance audits, staff records, training records and risk assessments. As part of the inspection process we sent survey forms to the home for residents, relatives, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. We asked the home to fill out an Annual Quality Assurance Assessment. This was received on time and filled out in full. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The home ensures that they know as much as possible about prospective residents before deciding whether their needs can be met. Residents have the opportunity to visit the home to see whether they like it and meet the other residents. Care plans detail all residents’ care, support and healthcare needs. Care plans are regularly reviewed and monitored. Residents have good access to a range of local activities, educational courses or jobs. Staffing levels enable residents to be supported in external activities as well as home based activities. Risk assessment does not necessarily restrict residents from doing the things they like doing. Residents enjoyed the meals provided. Residents are supported to maintain contact with friends and family. Residents have good access to healthcare professionals. Advice and guidance is acted upon. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 6 Residents know that they can complain about the service and they will be listened to. Residents are encouraged to use the local advocacy service. Staff know how to refer any allegations of abuse using the local safeguarding adults procedure. A robust recruitment process is in place. No staff member starts work without checks on their suitability to work with vulnerable people. Staff have good access to NVQs qualifications. At least 70 of staff have NVQ Level 2. Staff receive regular updated training in first aid, fire prevention, food hygiene and infection control. What has improved since the last inspection? What they could do better: Although continence advice has been sought in the past, further solutions need to be sought. Residents who may have continence problems need better support in managing accidents and enjoying a fresh environment. Staff must be trained in continence management and moving and handling. Eye drops should be dated when they are opened. This is to ensure that they are discarded after the appropriate time to avoid the risk of contamination. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 7 Staff must receive more training in the principles of meeting the needs of adults with learning disabilities. 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. Lindum House DS0000003208.V359003.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 Lindum House DS0000003208.V359003.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who want to live at Lindum have lots of opportunity to get to know the home and existing residents before they decide whether it is suitable for them. The home gains as much information as possible about people who want to use the service before deciding whether their needs can be met. EVIDENCE: Mrs Thomas said she would always visit prospective residents to meet with them and do her own assessment of their needs. The home ensures that care management assessments are considered as part of the assessment process. Information is gained from the resident, family, previous placement and any healthcare professionals involved in their care. Prospective residents visit the home as many times as necessary to meet the residents and discuss any issues. They can stay overnight and take meals with the other residents. Mrs Thomas told us about plans that some residents had about moving out to supported living enabling greater independence. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 10 In survey forms, seven residents said they were asked if they wanted to move to this home. They said they had enough information about the home before they moved so they could decide if it was the right place for them. Lindum House DS0000003208.V359003.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 good This judgement has been made using available evidence including a visit to this service. Residents benefit from having good detailed care plans that are regularly reviewed. Residents are encouraged to make decisions about how they are supported. Risk assessment does not restrict residents from new experiences and opportunities. EVIDENCE: All residents’ care and support needs were well documented in their care plans. Care plans were very detailed and showed good guidance to staff on how needs were to be met and monitored. The care plans showed residents social and medical histories. There was good evidence of encouraging residents to be self-determining, independent and make decisions about their daily lives. Risks had been assessed and management strategies were identified where necessary. Assessment of risk did not mean that residents were restricted from experiencing new activities. Care plans were regularly reviewed. Any Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 12 changes were highlighted in the care plan in red. Residents have regular care management reviews. Staff are required to sign up to each resident’s care plan. Daily reports relating to the care plans were recorded in individual books. Recording was detailed and showed that the care plans directed the care and support to residents. One staff in a survey form said: “Give clients lots of options to consider before making decisions.” Lindum House DS0000003208.V359003.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, 15 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have good access to local community and social facilities. Residents are encouraged and supported to keep in touch with family and friends. Residents enjoy the meals and are supported to have a healthy diet. EVIDENCE: Residents have an extensive programme of activities during the week and at weekends. Some residents attend different day services in Swindon. Some of the older residents attend a day service for the over sixties. Other residents went to college. Some residents have jobs, for example: work at a local post office, at a local scrap material and paper charity as a volunteer and at a local garden centre. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 14 We talked to residents about what it was like to live at the home and what they liked to do. One resident said they were looking forward to going to Madrid to watch football. They said they regularly went to support Swindon Town Football Club. Some residents said they had not decided what they would be doing for the coming weekend but would discuss options that evening. Other residents were going to see a tribute band in Swindon. Residents talked about their regular contact with family and friends. They told us about the telephone that they could use to contact family if they did not have a mobile phone. Residents have an extensive activities programme. The staffing rota identifies which staff is supporting residents with activities. At least two activities are provided each day. Activities take place at the home or in the locality. Residents go to pubs, bowling, shopping to church, out for coffee and to the cinema. They had recently been to Southampton to see the Queen Mary and Elisabeth liners. Residents are either taken in the home’s transport or use buses. There is a room at the top of the house used for activities. An activities coordinator is employed to provide arts and crafts sessions for residents on four evenings a week. Care staff provide activities at other times. Separate records were kept of individual residents involvement in different activities both at the home and in the locality. One of the residents showed us the wooden mobiles that they had made. Residents had made greetings cards and woodwork sculptures. Other activities included keep fit, music and singing, darts, collage making and puzzles. The programme provides for group work and one to one time. A foot spa had been purchased for residents’ relaxation. A further room at the top of the house had been made into a media room with a large television and comfortable chairs for residents to watch DVDs or listen to music. All residents have the opportunity to go on an annual holiday as part of the fee. Some residents choose to go abroad. Four residents had planned to go on a cruise later in the year. Six residents planned to go to Lyme Regis. Other holidays had included Wales, Cornwall, the Pennines and camping in the New Forest or at some nearby lakes. Some of the residents with an interest in gardening told us about their own separate areas of the garden where they were growing vegetables and fruit. There was a menu sheet for each resident which was compiled according to their preferences. Meals were varied and planned with a healthy diet in mind. Residents were asked what they wanted for lunch that day. Most had either cheese or beans on toast. Some residents prepared their own snack. Some residents liked to do baking as part of their activity programme. The evening meal was meat pie with mashed potatoes, vegetables and gravy with ice Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 15 cream for pudding. Fresh fruit was available. Residents told us they also went out for meals. Residents are encouraged to maintain contact with families. Mr Maysey would take residents to meet with family if they were local. In survey forms 5 residents said they always made decisions about what to do each day. Two residents said they sometimes made decisions about what they did each day. Seven residents said they could do what they wanted during the evenings and weekends. Comments from residents in survey forms included: “Some restriction due to need for me to have member of staff with me when I wish to go out. Would like to go to football but not always a member of staff available for one to one.” “This is the right place for me. I do like living at Lindum House. I like to go to my friends. I like to do the gardening on weekend and also go to town on weekends. I like to keep my bedroom tidy and also the kitchen. I get on well with the staff.” Relatives’ comments in survey forms included: “We have witnessed first hand the wonderful food they have, especially with Sunday dinner. On our visits the other boys at the home seem quite content. Staff at the home do an awful lot to occupy the boys and to stimulate them. The home takes them for birthday treats; holidays and they have quite a few celebrations there as well. They have gardening plots, also pots of bulbs in the house with each one’s name on. My [relative] is so happy and content there. This gives his whole family so much peace of mind.” “They always phone me with updates as agreed. He has made great progress since moving to Lindum House. They encourage [my relative] to phone regularly. We are also made to feel very welcome when we visit the home. He feels valued. I have always been impressed with the care [my relative] receives. [My relative] is now attending college once a week – a great achievement. I would say it does great, they have family functions and have attended regular meetings reviewing [my relative’s] progress. Claire and Nathan do a sterling job. They have great rapport with staff and residents. We are always made to feel welcome and part of the team. It always feels warm and welcoming just what [my relative] needed.” “Looks after and cares for my [relative] gives encouragement to go to college nice outings/holidays good meals.” “Take him out to different places, listen to him and make him feel at home.” Healthcare professionals comments in surveys included: “Clients live varied individual lifestyles supported by Lindum House staff. People are free to choose whether they join in of not and make choices about things they would like to do in the future. Creates many social opportunities – outings, trips, holidays. Truly values each person’s worth. Although Lindum House provides for a large number of men, this model is working well and enabling people to live valued lifestyles. I believe this is mainly due to Claire and Nathan truly valuing the people they support and constantly looking for ways to create social opportunities for the men which enables the men to be distracted from Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 16 their mental health needs or behaviour, they try to ensure everyone is having fun and enjoying their life as much as possible.” Staff comments in survey forms included: “Religious beliefs are encouraged clients attend their choice of church services. Outside activities, cinema, bowling, shopping pub outings.” “We try to make the clients more independent to be able to go out into the community meet up with other people.” Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 17 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 & 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans that detail how their healthcare needs are to be met and monitored. Residents have good access to healthcare professionals. Residents are encouraged to manage their own medication. Systems are in place to ensure safe administration and storage of medication. EVIDENCE: Care plans identified any medical conditions and how they were to be managed and monitored. The diabetic nurse was involved and had contributed to care plans. There was clear guidance about the parameters of blood glucose levels for these residents wellbeing. There was clear guidance about supporting those residents with a diagnosis of epilepsy in managing their condition. The psychologist and care manager had been involved in developing care plans for managing specific behaviours. The daily reports showed that the care plans directed the healthcare needs of residents. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 18 Residents have good access to the psychiatrist and psychologist when needed. One resident told us that they liked a member of staff to go with them if they had a GPs appointment. Separate records were kept of all contact with healthcare professionals showing outcome and any advice. Action had apparently been taken to address the requirement we made that one of the residents is referred to the continence advisor. However there was a smell of urine in the area of two residents’ bedrooms. We were told that the continence advisor had been involved in the past. Their assessment concluded that there were no medical issues presenting. We advised that solutions will need to be continually explored for the benefit of these residents. We also advised that cleaning strategies must be explored to improve the environment for those residents. Residents told us that many of them managed their own medication. The home operates a monitored dosage system for administration of medication. Residents who self medicated were given their medication in cassettes each week. These were stored in a lockable facility in their bedrooms. Records were kept of medication that was received into the home or returned to the supplying pharmacist. Staff cannot administer medication until they have passed their probationary period and then deemed competent in the home’s procedure by Mrs Thomas. No controlled drugs were prescribed. No action had been taken to address the recommendation our pharmacist inspector made about dating eye drops when they are opened. This is so that they can be discarded after the appropriate time to avoid the risk of contamination. Miss Thomas said that staff had been doing this and it would be addressed from now on. Relatives comments in survey forms included: [To the question, does the home meet your relatives needs?] “Sometimes need prompting.” “He is looked after handsomely by all the staff at Lindum House”. Healthcare professionals comments in surveys included: “Lindum House are very person centred and work closely with CTPLD [Community Team for People with Learning Disabilities] in all areas and aspects of service users care and well being. Good recording and monitoring all healthcare need and dates readily available to CTPLD. Working practice at Lindum House is to respect privacy and dignity of all service users. Lindum House promote independence in this area [self administration of medication] if risk assessment allows. Service users are encouraged to pursue and be supported where necessary to live the life they choose – dependent on risk.” “All healthcare appointments are arranged on a regular basis and service users supported. Social needs are seen as individuals’ preferences and accommodated. Will adapt to accommodate different needs. Caters well to the individual service users i.e. health mobility, age of social needs, flexibility. Encourages independence in Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 19 personal care. Support through health needs. Good communication with CTPLD.” One of the GPs said “very caring environment”. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 20 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. Systems are in place for residents or their representatives to complain or comment on the service. Action is taken if anyone does complain. Staff know about the procedure for reporting any allegations of abuse of residents using the local Safeguarding adults procedure. EVIDENCE: The home has a complaints procedure which is given to residents and their representatives. Mrs Thomas said she reminded residents at their regular meetings that they could use the process to raise any issues. This was confirmed in the complaints log which recorded any investigations, interviews and response to complainants. Residents told us they would sort out differences or arguments between each other and did not have to rely on staff. They also told us that most of them managed their own money and were encouraged to save in their own named accounts. Cash could be stored in the office and records and receipts were kept of all transactions. Residents have access to their money at all times. Mrs Thomas told us about the local advocacy service that has supported different residents. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 21 Staff were trained in the local safeguarding adults procedure and recognising abuse. When we asked staff about how they would react to observations or allegations of abuse, they were confident in using the proper reporting procedure. In survey forms 7 residents said they knew who to talk to if they were not happy. Of these, one resident said they did not know how to make a complaint. Residents’ comments included: “I would speak to the manager or staff.” Relatives comments in survey forms included: “Have not had cause for concern regarding [my relative]. The home looks after my [relative] very well I have no cause for complaints. If I did they would know about it.” “I meet, phone or write.” “Never had any concerns about care.” Healthcare professionals comments in surveys included: “Service users have not raised any concerns or issues.” Staff comments in surveys included: “Follow procedures first report to my managers.” Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Gradual improvements are being made to ensure a comfortable and safe environment for residents. Some areas need attention to ensure residents have a comfortable and clean smelling environment. EVIDENCE: Planning permission has been granted for an extension to the rear of the building. This will provide three extra bedrooms, one with an ensuite and a bathroom. The number of registered bedrooms will not increase. However it will mean that residents who are currently sharing bedrooms will have their own single accommodation. All of the residents have their own keys to their bedrooms. They also have a small safe for storage of medication or valuables. Some new wardrobes and Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 23 bedroom furniture had been purchased. All of the radiators had been fitted with either guards or guaranteed low surface temperature radiators. Residents said that they did their laundry as and when it needed doing. There was no set rota for using the laundry. Residents told us that they cleaned their own bedrooms. They said that staff always respected their bedrooms as their own private space and would only enter if invited. We saw that some duvets, bed linen and mattresses were stained and needed replacing. Miss Thomas agreed to put these items on her action plan and monitoring audit. Action had been taken to address the requirement we made that the first floor bathroom must be redecorated. It had been retiled and a new bath panel fitted. Action had been taken to address the requirement we made that the bathroom in the downstairs bathroom must be repaired. This bathroom had been fitted with new flooring, new showerhead and new sink. It had also been redecorated. Consideration had been made to the recommendation we made about the possibilities of employing a maintenance person to assist with minor repairs and decorations. Mr Maysey told us that there was not sufficient work to keep a maintenance person employed and he would continue to do minor works. He told us he redecorated some bedrooms when residents were on holiday. He told us he had employed contractors to complete major works. We discussed the condition of some areas of the home. Particularly those areas that contained a smell of urine. It was agreed that new floor coverings that were easier to keep clean would be considered. Also the possibility of a specialist carpet cleaner. Mr Maysey agreed to send us a plan of action by the end of May 2008. He told us that he planned to paint the outside woodwork this summer. Action had been taken to address the recommendation we made that a maintenance and refurbishment plan was developed. Miss Thomas showed us the plans dated November 2007 that she had devised as part of her quality monitoring system. We noted that one of the toilet bowls had not been cleaned for some time. Mrs Thomas said that this was generally the night staff’s responsibility. She would check why this was not being carried out. She also said that the cleaning schedules for toilets would be changed from twice a day to three times. All the other toilets we found to be cleaned to a good standard. In survey forms 6 residents said that the home was always fresh and clean. One resident said that it was sometimes fresh and clean. Healthcare professionals comments in surveys included: “All bedrooms are very individualised with encouragement by Lindum House.” Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 24 Staff comments in surveys included: “Upbeat environment. [Could do better?] Improve the garden. Vegetable garden is up and running but need to get garden furniture for the bungalow and turf/patio areas. The kitchen in the main house is very tired looking and needs updating. But I think it will be replaced when the extension is built later this year.” Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 25 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 good. This judgement has been made using available evidence including a visit to this service. Staffing levels enable residents to live the life they wish. Good relationships are established and staff engage with residents. The majority of staff have NVQs. Some training has taken place that reflects the need of residents relating to learning disability and ageing. Staff benefit from regular supervision. EVIDENCE: The staffing rota provides for a minimum of three staff during the mornings, four during the afternoons and evenings. At the weekends this goes down to 3 staff during the day. The rota included for at least one member of staff in the bungalow during the twenty-four hour period. At night there are two staff sleeping in the main house and one sleeping in the bungalow. The rota was colour coded to show which additional tasks or responsibilities staff had during their shift and who was on call in emergencies. Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 26 Some progress had been made to address the requirement we made that staff must receive training in the principles of meeting the needs of people with learning disabilities. Some progress had been made to address the recommendation we made that training should be provided in meeting the needs of older people. Staff had received a half days training in dementia care. We talked about the possibilities of some training in continence management from the continence advisor. Mrs Thomas showed us her matrix of mandatory training needs. We noted that moving and handling was not included in the essential training. Mrs Thomas agreed that this would be sourced by the end of June. Other training included: first aid, food hygiene, prevention of abuse, safeguarding adults and dementia. Staff had recently undertaken training in managing behaviours and were awaiting certificates. Staff had also received training in podiatry from the community matron. At least 70 of staff have National Vocational Qualifications Level 2. Staff told us about their work at the home. They said they felt they had a good induction. One staff said they had NVQ Level 2 and had recently undertaken training in Safeguarding adults, conflict management, podiatry, risk management and infection control. They said there were regular staff meetings and they contributed to the agenda. Another staff told us they had NVQ Level 2 and were undertaking Level 3. They had also undertaken the same training as their colleague. Both staff told us that Mr Maysey and Miss Thomas were very accessible and that they could talk to them at any time. Residents told us that they could choose who they had as their keyworker. They also told us that they were included on the panel for interviewing potential new staff. A robust recruitment process was in place with all the required documents and information obtained before new staff can commence working. No staff commences duties unless checks are made to ensure that they are suitable to work with vulnerable people. All new staff have a period of at least two weeks induction depending on their previous experience of care work. Staff are involved in cooking, some cleaning and laundry as well as care and support. A housekeeper is also employed. We saw that staff engaged well with residents. Interactions were friendly, respectful and it was clear that good relationships were established. In survey forms 6 residents said staff always treated them well and always listened to and acted on what they said. One resident said staff sometimes treated them well and sometimes listened and acted on what they said. Relatives’ comments in survey forms included: [Staff have right skills and experience?] “I honestly do not know for sure. I just assume they have, as they all do such an excellent job in the care, attention etc my [relative] receives.” “I would like to congratulate Claire and Nathan on obtaining and Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 27 keeping such good staff and the way they all muck in and supply such a good service to [my relative] and the other boys.” Healthcare professionals comments in surveys included: “To my knowledge staff are appropriately trained to manage all needs of the service users.” Staff comments in surveys included: “No work undertaken until all checks were done. Ensure clients are well looked after, happy, well fed, well clothed ensuring lots of activities.” “I was shadowing until I was fully trained in all aspects of my job. Regular appraisals I can approach my managers on any queries or seek advice. The rota always ensure that three staff are on shift at any time. My managers and colleagues support each other and myself to meet the needs of the people who use the service. I am very happy to be working at Lindum House.” “I started at Lindum House with no previous knowledge of working with adults with learning disabilities. Both Nathan and Claire gave me every possible help and information whenever required. I feel my induction was very thorough. [They] ensure staff receive in house courses as training very relevant to our roles. They always support and listen. There is always sufficient staff to cover in house or any outside activities. I would like to say Lindum House is a very happy house. I find it only gets better both for clients and staff.” “Very thorough induction lots of time taken to ensure all was understood. Daily record sheets and clients’ notes discussed at each handover. Maintains an atmosphere of respect between clients and staff. Ensures clients are always well presented.” Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 28 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 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home. Quality monitoring is now in place and residents are consulted about different aspects of the service. Action is taken when necessary. Systems are in place to ensure residents’ and staff’s health and safety. EVIDENCE: Mr Maysey has the Registered Managers Award. Miss Thomas has completed NVQ Level 4 and is awaiting final assessment of her work. They told us that they keep themselves up to date with current good practice by attending the same training that staff undertake. They also attended meetings of the Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 29 Swindon Care Homes Association, Swindon Council and the Learning Disabilities Forum. Action had been taken to address the requirement we made that stakeholders’ views are sought as part of the home’s quality monitoring system. Miss Thomas showed us the home’s quality monitoring system. Surveys had been sent to residents, staff, relatives, GPs, social workers, nurses and tutors for their comments on different aspects of the service. Results of the surveys were displayed on notice boards. An action plan was being drawn up. Each year the surveys have focussed on different aspects of the service, for example, cleaning and maintenance, medication, money and activities. Action had been taken to address the requirement we made that Control of Substances Hazardous to Health risk assessments are reviewed annually. The last review was May 2007. Risk assessments are carried out on the environment and any task that staff may be involved with. Relatives comments in survey forms included: “Nathan and Claire staff have not got an easy task, but they do very well given the circumstances.” Healthcare professionals comments in surveys included: “Nathan and Claire treat all the men with the utmost dignity and respect. [They] work as a good team and have the abilities and knowledge to appreciate the expectations we have of them. [They] are very open about what happens at Lindum House. They are intelligent young people who understand the philosophies that underpin what they do.” A care manager wrote: “Both Claire and Nathan are approachable and listen to advice when suggested. Staff comments in survey forms included: “Manager listens and talks with clients and staff.” “The home provides client surveys so if they have any concerns they can put this in writing to the managers and also the relatives have a survey so if they have any concerns about their family they can also get in contact with the managers.” Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 30 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 X 2 3 3 X 4 X 5 X 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 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 31 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 YA19 Regulation 13(1)(b) Requirement The registered person must ensure the resident identified during the inspection is referred to the continence advisor. (Outstanding since the last inspection). The registered person must ensure staff receive training in the principles of meeting the needs of adults with learning disabilities. (Outstanding since the last inspection). Timescale for action 14/03/08 2. YA35 18(1)(c)(i) 01/06/08 3 YA30 16(2)(k) 4 YA26 16(2)(c) 5 YA35 18(1)(c)(i) The registered person must 01/06/08 ensure that systems and equipment are in place to deep clean carpets and areas that smell of urine. If these areas do not respond to deep cleaning alternative floor covering must be installed. Toilets in the bungalow must be cleaned more regularly. The registered person must 01/06/08 ensure that residents are provided with new duvets, bed linen or mattresses when theirs has become stained. The registered person must 01/06/08 DS0000003208.V359003.R01.S.doc Version 5.2 Page 32 Lindum House ensure that staff receive training in moving and handling and continence management. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 3. Refer to Standard YA35 Good Practice Recommendations The registered person should provide training in the needs of older people. (Identified at the last inspection). Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Lindum House DS0000003208.V359003.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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