Inspection on 04/01/06 for Lindum House

This inspection was carried out on 4th January 2006.

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

The inspector 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lindum House 14/03/08

Lindum House 03/08/06

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 Bernard McDonald Unannounced Inspection 4th January 2006 09:15 Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 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.V275117.R01.S.doc Version 5.1 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.V275117.R01.S.doc Version 5.1 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.V275117.R01.S.doc Version 5.1 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. 18th August 2005 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. Service users have the opportunity to go on holiday and a range of holidays is offered to meet individual needs and preferences. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven and a quarter hours during which time the inspector met with the majority of service users and three care staff. Before the inspection commenced the home supplied the Commission with various pre-inspection documentation including comment cards from service users and their relatives. Opportunities were provided to meet with service users in private and in small groups to obtain their views on the care they receive. The inspector examined four service users care plans, risk assessments and polices in relation to health and safety and the protection of service users. The inspector viewed all communal living areas and the majority of service users bedrooms in the main house. In addition the inspector viewed the communal living areas in the bungalow. The jointly registered providers one of which is the registered manager were available at the end of the inspection when feedback was given on the inspector’s preliminary findings. Two requirements had not been met from the previous inspection. What the service does well: What has improved since the last inspection? Repairs have been made to the broken window in one service users bedroom. In addition a large metal sheet has been removed from the wall of a service users bedroom. To ensure the safety of service users window restrictors are in place on windows above the ground floor. The home has made some progress in supporting service users in the bungalow with the preparation of meals though this is a mainly ad hoc Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 6 arrangement, which needs to be more consistent to be of benefit to service users. 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. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 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 the following standard(s): 2 The home is aware of the need to ensure service users needs are assessed prior to moving. EVIDENCE: No service users have been admitted since the last inspection. At the previous inspection in August 2005 this standard was met. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 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 the following standard(s): 6, 9. The home is making every effort to ensure service users needs are reflected in their care plans and that they are supported to take appropriate risks. EVIDENCE: The inspector examined the care plans of four service users. Care plans were clearly written and all had been reviewed a minimum of once every six months. Care plans were comprehensive and covered areas of personal, health, cultural and social needs. Goals and outcomes were clearly documented and identified a member of staff responsible for ensuring these are followed through and remain appropriate. Conversations held with service users confirmed they had attended their care review and were happy living at the home. The home operates a key worker system and service users knew who their key worker was. The records of one service user demonstrated they had been offered a choice of key worker following the retirement of one member of staff. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 10 Service users personal risk assessments are in place and are reflected in the service user plan. As a matter of good practice risk assessments were being reviewed ever six months. Discussion with staff demonstrated an understanding of the risk and associated care needs of service users. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 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 the following standard(s): 11, 13, 14, 16. Service users are encouraged to become part of the local community and to engage in appropriate leisure activities, however, more attention needs to be given to promoting service users independent living skills. EVIDENCE: Service users care plans provide clear details on how they are supported to develop and maintain independent living skills. Since the last inspection extra staff hours have been allocated to the bungalow at the rear of the home to support four service users in the planning and preparation of meals. Discussion with the service users would indicate that this is more of an ad hoc arrangement, as it does not take place every night. One service user stated, “ I don’t know what is happening tonight”, another service users stated, “we just wait and see”. Discussion with the manager indicated that there has been some reluctance on the part of service users to become involved in this new routine. However the lack of consistency in the arrangement means service users cannot be clear on the routine or it’s purpose and consideration should be given to ensure this arrangement is made an integral part of the homes daily routine. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 12 The home employs an activity co-ordinator who has responsibility for engaging service users in community and social activities and the notice board contains details on future trips to the theatre. Clear records are being kept on in house and community activities. Records show which activity has taken place and which service users participated in the activity. One service user stated “ there is always something to do”. Another service users stated they “enjoyed going to the pub”. Records confirmed service users have participated in trips out for shopping, coffee mornings, cinema and bowling. Service users spiritual needs and attendance at church services had been addressed in the service users care plan. There is a small staff team that appears to have established a good rapport with service users. Staff were observed knocking on service users bedroom doors before entering and interacting with service users in a unhurried and relaxed manner. One service user stated, “I like the staff” another service users stated they were “good”. Responsibilities for household tasks are documented in service users care plans. Service users are supported and encouraged to keep their rooms tidy. However the standard of cleanliness found in some service users bedrooms would indicate insufficient attention and support is given to this task. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 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 the following standard(s): 20, 21. The home is failing to ensure medication is accurately recorded when it is administered. Service users wishes regarding death and dying have been obtained and noted. EVIDENCE: Following the last inspection the home has contacted the practice nurse for training in the use of Epistatus. Medication returned to the pharmacy is now being recorded. Examination of a sample of medication records demonstrated medication was being recorded when administered to service users. However there has been a recent medication error at the home, which was reported to the Commission. The medication records did not show any evidence of the error and was therefore not considered to be an accurate record of medication that was administered on that day. Medication is held secure in the home and on the day of the inspection five service users were responsible for their medication. Service users care plans provide details of their wishes regarding death and dying. One staff confirmed the home would support any service users who required terminal care as long as their needs could be safely met in the home. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 22, 23. The home is making every effort to ensure service users are protected and their views are listened to. EVIDENCE: The home has received one complaint since the last inspection. The complaint was made by a service user, which would indicate service users are aware of the homes complaints procedure. The inspector did discuss the complaint with the service user who confirmed this had now been satisfactorily resolved. Several service users were asked who they would tell if they were unhappy or had a complaint. One service user stated “the staff” another service user indicated the manager or the joint registered provider. All service users said they felt safe in the home. Discussion with staff confirmed they would feel confident and able to report any concerns regarding the welfare or protection of service users. One member of staff confirmed they had received in house training on abuse awareness. Discussion with the manager confirmed all staff would be put forward for further training with the vulnerable adults team over the coming year. The home was holding money on behalf of service users. A sample of four records were examined. Records showed money was being accurately recorded and receipts were being kept for money that had been spent. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 24, 26, 27, 28, 30. The lack of progress in repairs to the fabric of the building means the home is failing to provide service users with a clean, comfortable and safe living environment. EVIDENCE: The home is situated in it’s own grounds close to Swindon town centre. The main home accommodates a maximum of 16 service users with a further four service users accommodated in a separate bungalow in the grounds. The inspector viewed all areas of the bungalow and the majority of service users bedrooms in the main home. Discussion with the manager and registered provider confirmed they have yet to consider how the home will be split into small living groups not exceeding ten people by 2007. It is recommended that an action plan be provided to the Commission on how this will be achieved. A number of requirements were made at the previous inspection relating to the environment. Improvements have been made to repairing the toilet seat and broken window in one service users room. In addition a large metal sheet that had been attached to the wall in one bedroom had been removed. There still however remained an odour in the bedroom of one service user. The manager Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 16 confirmed that their are plans to move the service user to another room within the next two weeks and provide a more suitable floor covering in their room. In view of the progress made in addressing the requirement the inspector has agreed to extend the timescale relating to the odour in one room. The manager and joint registered provider were informed that failure to meet the revised timescale would result in the Commission taking enforcement action. While progress has been made in replacing furniture and carpets at the home the inspector found there remains an urgent need to improve the overall standard of accommodation at the home. The inspector found mould on windows and widow sills and some service users rooms in need of a good clean. In particular one service users room had cigarette ash ground into the carpet and the radiator cover and the sheet on the bed was in urgent need of washing. This was brought to the attention of the staff and the room was cleaned and bedding changed before the end of the inspection. In addition the lock on one service users door was broken and the bathroom on the first floor was in need of painting. There were four wash hand basins without water. The manager stated that a plumber had been contracted to complete the repairs to the plumbing but due to personal circumstances had not been able to start work. The manager was made aware of the need to ensure this work is completed. The inspector found that one service users bedroom radiator had not been fitted with a guard to ensure the service users safety. The guard was found in the service users room waiting to be assembled. One bedroom had wallpaper torn off the walls. The manager stated this room should have been decorated while the service user was away but that they had returned early. The service user did confirm their room was due to be decorated. The en suite bathroom on the ground floor was being replaced and the manager stated work should be completed over the coming month. The laundry is situated in a separate room on the ground floor. There was a commercial washer and dryer and discussion with staff confirmed these were sufficient for the needs of the home. To further reduce the risk of infection the home should purchase “red alginate bags” for soiled and infected laundry. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33. The home is ensuring staff have to access NVQ training, but needs to consider providing additional training in meeting the needs of service users. In order to remain effective in meeting the needs of service users a consistent approach should be adopted for supporting service users in the bungalow. EVIDENCE: National Vocation Training (NVQ) is progressing to the point that 50 of all support staff have now achieved NVQ level 2 in care. Focussing on achieving this standard has resulted in other training not being given priority, especially in the principles and philosophy of caring for adults with learning disability. In view of the age range of service users at the home consideration should also be given to providing training in the care of the elderly. Discussion with staff demonstrated a good understanding of the needs of service users and there was an obvious rapport between staff and the people they care for. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 18 Examination of the rota demonstrated there is three staff on duty throughout the waking day. In addition two members of staff provide sleep in cover at night. Discussion with staff indicated that they felt there is sufficient staff on duty to meet the needs of service users. However the planned arrangements for deploying one member of staff to the bungalow to help service users plan and prepare their evening meal is not consistently being followed. To enable service users develop and maintain independent living skills there needs to be a more structured and consistent approach to this arrangement if necessary by providing extra staff. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42. The home is failing to ensure an effective quality audit is completed and that service users views are fully considered in the running of the home. More effort is needed to ensure service users health and welfare is promoted. EVIDENCE: The inspector met with both of the registered providers, one of which is the registered manager. Both registered providers take an active role in the running of the home and both hope to complete the registered managers award over the coming months. The last audit of service users views was completed earlier in 2005. The inspector was informed there are plans to develop a quarterly review of service users views on the care they receive. This is seen as the first step in the development of an effective quality assurance monitoring system. Improvements have been noted in safe working practices. Environmental risk assessments were reviewed in July 2005 and infection control training is in Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 20 progress. Windows have restricted openings above the ground floor to ensure the safety of service users. Fire risk assessments were being reviewed every six months and the last recorded fire practice was held in November 2005. For the safety of service users hot water temperatures are regulated close to 43c, though regular checks on the hot water still needs to be implemented at the home. The poor standards of cleanliness have the potential to create an unhealthy or unsafe environment in which to live. Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 21 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 1 25 X 26 1 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 2 12 X 13 3 14 3 15 X 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 3 X X 2 X X 2 X Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 22 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 YA20 Regulation 13(2) Requirement The registered person must ensure an accurate record is kept of all medication administered to service users. The registered person must ensure the bedroom identified at the inspection is free from odour. Timescale for action 05/01/06 2. YA24 16(2)(k) 01/02/06 3 YA26 23(2)(c ) (j) 4. 5 YA26 YA26 23(2)(d) 23(2)(b) This was a requirement at the previous two inspections and enforcement action will be taken if compliance is not achieved within the revised timescale. The registered person must 01/02/06 ensure the four service users bedrooms without water connected to their wash hand basins is repaired. This was a requirement at the previous inspection and enforcement action will be taken if compliance is not achieved within the revised timescale. The registered person must 01/02/06 ensure all parts of the home are kept clean and tidy. The registered person must 01/02/06 repair the lock on one service users bedroom door. DS0000003208.V275117.R01.S.doc Version 5.1 Page 23 Lindum House 6. YA26 7. YA26 23(2)(b)(d) The registered person must investigate the case of the growth of mould and take necessary measure to prevent it occurring. 23(2)(b) The registered person must decorate the service users bedroom identified at the time of the inspection. 23(2)(b)(d) The registered person must redecorate the bathroom on the first floor. 24(1)(a)(b) The registered person must develop and effective quality monitoring system based on seeking the views of service users, staff and stakeholders. 01/02/06 01/03/06 8. 9. YA27 YA39 01/03/06 01/04/06 Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3. 4. Refer to Standard YA33YA11 YA16 YA16YA26 YA24 Good Practice Recommendations The registered person should ensure service users living in the bungalow receive daily support in the preparation of their evening meal. The registered person should ensure service users receive sufficient support from staff to keep their rooms clean. The registered person should consider employing a cleaner. The registered person should provide the Commission with an action plan on how the home would be separated into living areas accommodating a maximum of ten service users. The registered person should ensure all radiators are guarded or have low surface temperatures. The registered person should consider purchasing red alginate bags for soiled and infected laundry. The registered person should provide training in the needs of older people and the principles of caring for adults with learning disabilities. The registered person should keep a daily record on hot water temperatures at the home. 5. 6. 7. 8. YA42YA26 YA30 YA32 YA42 Lindum House DS0000003208.V275117.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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.V275117.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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