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Inspection on 24/04/06 for Linford Park Nursing Home

Also see our care home review for Linford Park Nursing Home for more information

This inspection was carried out on 24th April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The atmosphere throughout the home was calm and service users appeared unhurried with care being given at their own pace. Service users spoken to confirmed that they were able to choose what time they got up and went to bed and confirmed they had a choice of food at mealtimes. Meals were served in quiet manner and service users requiring assistance were supported in an appropriate manner.

What has improved since the last inspection?

The staff working in the home appeared to be more prepared to approach the inspectors and speak with them. The standards of cleanliness of the environment have been maintained. Very positive feedback, including standards of care and staff attitude has been received from the latest questionnaires that were sent out in February 2006. Staff training is ongoing and the staff were able to confirm that they were enjoying the training and finding it appropriate to the care they are providing to the service users.

What the care home could do better:

Some requirements have been made to address issues identified during this inspection further to the requirements that have not exceeded their timescales. These include reviewing the home`s statement of purpose, ensuring that all care plans are relevant to the service users and staff are able to meet their needs. Staff recruitment procedures must be followed and documentary evidence has to be available that an interview has taken place. All staff are given the opportunity to achieve their NVQ level 2.

CARE HOMES FOR OLDER PEOPLE Linford Park Nursing Home Linford Road Linford Ringwood Hampshire BH24 3HX Lead Inspector Sue Maynard and Gina Pickering Unannounced Inspection 08.40 24 and 26th April 2006 th X10015.doc Version 1.40 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 Linford Park Nursing Home DS0000011430.V288924.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Linford Park Nursing Home Address Linford Road Linford Ringwood Hampshire BH24 3HX 01425 471305 01425 471306 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) Northdown Estates Limited Mr Robert Roberts Care Home 80 Category(ies) of Dementia (12), Dementia - over 65 years of age registration, with number (64), Old age, not falling within any other of places category (80), Physical disability (10), Physical disability over 65 years of age (80) Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. All service users in the DE category must be over 60 years of age. All service users in the PD category must be over 60 years of age. Current registered bed numbers will be subject to review on or after 21st August 2006. 25th January 2006 Date of last inspection Brief Description of the Service: Linford Park is part of a larger building complex, which was originally a small hospital. The home is situated in a rural area of the New Forest, around three miles from the market town of Ringwood. The home is registered to accept up to 107 service users over 60 years of age but currently has a condition which allows up to 80 service users to be admitted. The home can provide care for service users with mental health care needs, physical disability or care needs relating to old age. Accommodation is offered over two floors, a passenger lift is provided. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced statutory inspection for 2006/2007. The inspection took place over two days and was conducted by two inspectors. The inspection took a total of 12.5 hours. Some requirements made at the last inspection have not yet been complied with but have a time scale of 14-5-06. Additional requirements have been made from this inspection to address issues identified by the inspectors. A tour of the building was made and the inspectors noted that all areas seen were found to be clean and tidy. As part of the inspection process four service users were case tracked and documents were examined. Staff recruitment and training files were examined. The inspectors spoke to some service users and staff members including the staff responsible for the social and recreational programme. No visitors were seen on either day of the visit to the home. The inspectors also spent time observing staff interaction with the service users in the dining room and communal lounge areas. What the service does well: What has improved since the last inspection? The staff working in the home appeared to be more prepared to approach the inspectors and speak with them. The standards of cleanliness of the environment have been maintained. Very positive feedback, including standards of care and staff attitude has been received from the latest questionnaires that were sent out in February 2006. Staff training is ongoing and the staff were able to confirm that they were enjoying the training and finding it appropriate to the care they are providing to the service users. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The lack of accurate information does not provide service users with the opportunity to make an informed choice about where to live. Assessments are in place that ensure that all service users needs are met and not placed put at risk. Standard 6 does not apply to this home. EVIDENCE: The Statement of Purpose for the home has not been reviewed or updated to reflect the current changes that have occurred in the home. The lack of up to date information does not provide prospective service user with the opportunity to make an informed decision as to whether they may wish to come to the home to live. The manager stated that the document is under review and he hopes it will be available shortly. Currently the old version is available to visitors to the home. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 9 The pre-admission assessment includes all aspects of personal care and well being, their physical and psychological needs and personal safety. The information for this assessment is obtained from the resident, their families and other health care professionals who may be currently caring for the prospective service user. Of the four service users case tracked, evidence was seen that assessments had been undertaken prior to admission to the home. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users are put at risk because care plans and risk assessments do not reflect accurate and up to date information for their care. Members of staff who lack understanding of procedures to be followed for the safe handling and disposal of medication put service users at risk. The introduction of training for staff in English language skills ensures that they are able to understand and meet the needs of the service users. EVIDENCE: Records examined for one service user were found to be incomplete. A pre-admission assessment noted that the service user had pressure sores on various areas of his body. This was not adequately followed up after admission. There were no individual care plans to address each area of damage. There was no record of what type of dressing was being used or how often the wounds were to be re-assessed and re-dressed. Fluid intake and output record Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 11 documents were in use but the total of intake and output over a twenty-four hour period was not recorded. This was also noted on other fluid charts examined that were in place for other service users. A care plan identified catheter care was required for a service user but no action plan was identified to guide staff as to what specific care was to be undertaken. A nutritional assessment identified that service user, as being at risk from poor nutritional intake but again there was no action plan to address the risk. A risk assessment identified difficulties in safe moving for one service user. No specific details were documented as to how the moving of the service user was to be managed. Bed rails were in place for one service user but no record of an assessment was available and consent appeared not to have been obtained for their use from the service user or their representative. Service users records did demonstrate that other health care professionals such as opticians and chiropodists had been consulted and had visited the service users in the home. Medication record sheets were found to be incomplete for some service users. Signatures confirming that medication had been given were not recorded. One staff member spoken to was unsure of the new procedure to be followed for the safe disposal of drugs. Registered staff administering medication that required having a tablet broken in half were performing this procedure without the use of a pill cutter to ensure that the tablet was accurately divided. The remaining section of the tablet was being insecurely stored in the original packet. Service users confirmed that the staff were kind and considerate towards them but that at times the language barrier did not always allow the staff to understand some of their needs. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The management of the social and recreational programme is creating a positive, varied and interesting life for the residents, which meets their expectations for living in the home. The residents are supported and encouraged to make choices about how they live their lives including choosing from a daily menu that provides them with a well balanced and varied diet. EVIDENCE: The inspectors met with the person responsible for the social recreational programme. He confirmed that this continues to work well and that the service users are satisfied with the activities being provided. He also confirmed that both he and his assistant have attended a training day organised by the National Association for Providers of Activities for Older People (NAPPA). They found this to be very informative and have provided them with additional ideas that can be introduced to the programme within the home. Service users confirmed that they enjoy the programme provide and do not feel that they are forced to attend or take part. No visitors to the home were seen on either of the visits made to the home but service users spoken to confirm that their families visit. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 13 A menu is available and on both days that the home was visited the meals served were as stated on the menu. Choices were available and service users had been provided with alternatives that had been requested. Assistance with meals was given to those service users who needed it with sensitivity. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The current complaints procedure does not contain accurate information that will allow service users and their families to be confident that their complaints will be taken seriously and acted upon. Staff training and awareness ensures that service users are protected from abuse. EVIDENCE: It was reported to the inspectors that there was on going work regarding the complaints procedure and they were assured that the previous requirement would be met by the required timescales. Members of staff spoken to said that they have received training for the protection of vulnerable adults. They were able to tell the inspectors the procedure to be followed in the event that witnessed any action that constituted abuse. They were aware that there are different categories of abuse. Training records for the staff confirmed that this training had taken place. The manager reported to the inspectors that he was still working on the revision of the adult protection procedure and that he was confident that this work would be completed within the stated timescale. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems are place that ensure that the service users live in a clean and wellmaintained environment. EVIDENCE: On both days of the visit to the home all areas were found to be clean and tidy. Equipment including wheelchairs was clean and in good working order. Service records demonstrated that equipment such as hoists were regularly inspected and repaired as necessary. In one lounge area the inspectors observed a service user seated in an armchair with one side of his body supported by a seat cushion from another arm chair. This was brought to the attention of staff on duty in this area. The explanation given was that the service user had a weakness to that side of his body and that the cushion was the only way he could be supported. They did acknowledge that this method was not satisfactory but could think of no Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 16 alternative. A senior nurse stated that the service user’s doctor had been requested to ask an occupational therapist to visit the home to assess the suitability of the armchairs that are in use. There has been improvements regarding thermostatic valve checks and signs identifying “hot water” are visible around the home. Some areas of the home including bedrooms and communal lounge areas appeared to be very warm. This was brought to the attention of the manager who said he would speak to the maintenance man and ask him to alter the thermostats on the heaters. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staffing rotas demonstrate that the numbers and skill mix of staff on duty currently meet the needs of the service users. The staff’s training needs are identified and a programme of appropriate training ensures that the staff are competent to develop their ability to meet residents’ needs. The home is failing to adhere to the staff recruitment procedure and is putting residents at risk. EVIDENCE: Examination of staff rotas showed that on some days there appeared to be insufficient care staff on duty. There was no documentary evidence that staff had been moved from another area to cover these shortfalls in numbers. Service users spoken to stated that staff did attend when the call bell was activated and that they felt their care needs were met. Some staff members have undertaken NVQ training in Care and others are about to commence their training. At this time the home does not have 50 of their staff trained for NVQ level 2. A sample of staff recruitment files was examined. These demonstrated that appropriate checks had been undertaken with the Criminal records Bureau (CRB) and the Protection of Vulnerable Adults register (POVA). It was noted that the POVA checks that were sent directly from the department responsible were not dated. It is recommended that the home date the confirmation on receipt. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 18 From the sample of the staff records seen the inspectors noted that a record of an interview had only taken place for one applicant. This record was not comprehensive and contained very little information about the applicant’s past experience and work history. In one file that was examined the names of the referees submitted did not correspond with the actual references supplied. Requirements have been made previously about the home’s staff recruitment files. There has been some improvement in ensuring that all necessary checks are undertaken and application forms are in place but the manager must ensure that there is documentary evidence that past employment history is documented and any gaps in employment history are explored. There is a formal training programme for all the staff working in the home. Some of the training is provided by external training companies and some by the home’s manager. Records of all training undertaken by the staff are documented in their personal training files. Staff confirmed that they had found the training interesting and had increased their knowledge. They also confirmed that the training was relevant to the care they provided on a daily basis. The manager stated that at this time the care staff are still not receiving regular formal supervision therefore individual staff learning needs and objectives are not being identified or met. The manager has identified that the overseas staff require further assistance with their English language skills, both oral and written, and has addressed this by arranging for additional training to be given. Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager is able to demonstrate that he is suitably qualified to ensure that the home is well run and that the needs of the residents are met. A quality assurance system is now in place that ensures that home is run in the best interests of the service users. A new system is in place that ensures that the service users financial interests are safeguarded. Close monitoring of practices within the home safeguard the health, safety and welfare of residents, staff and visitors to the home. EVIDENCE: Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 20 Since the last inspection in February 2006 the manager has completed a successful interview with the Commission and is now the registered manager for the home. The inspectors saw the results of a quality assurance questionnaire undertaken by the home. Of the twenty comment forms seen all were very positive and confirmed that care in the home was good and that the staff were kind and considerate. Some comments were made about the security of the building and how easy it was to walk in unchallenged in the evenings and weekends, as there was no receptionist available at these times. The inspectors who entered the building at 08.40 on the first day of their visit and spent some time searching for a member of staff to let them know they were in the building confirmed this. This was discussed with the manager who stated that he too was concerned about the security but that he would have to discuss this with the owners of the home. The home is in an isolated location and free unchallenged access to the building during the day puts both service users and staff at risk. Since the last inspection a new system has been introduced for the storage of service users money. Service users now have access to their money, but not during the weekends and evenings This was discussed with the manager who stated that he make arrangements for service users to have access to their money at all times. Fire safety records were examined and were found to be in order. There was documented evidence that regular tests of the alarm systems had taken place. Fire safety equipment has been regularly checked. Staff training records showed that they had received regular training. Since the last inspection an independent fire safety company has reviewed the fire evacuation procedure for the home. All the staff have received regular training for safe moving and handling. Speaking to the staff, they confirmed that this training included the use of hoists and the use of the appropriate slings with the hoist for individual service users. They also confirmed that their training include the use of other equipment for the safe moving of the service users, including slide sheets and handling belts. A sample of documents showed that equipment and systems in the home are regularly maintained and serviced. Linford Park Nursing Home DS0000011430.V288924.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15(1) Requirement The service user’s plan must set out in detail the action to be taken by care staff to ensure that all aspects of care of the service user are met. A record of all medications that have been administered to the service user must be kept appropriately. A minimum of 50 of care staff must be trained with NVQ 2 or equivalent to ensure they are competent to do their job. An action plan of how this is to be achieved must be submitted to the Commission. Timescale for action 01/06/06 2 OP9 17(1)(a) Schedule 3(k) 18(1) 01/06/06 3 OP28 01/08/06 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 OP9 Good Practice Recommendations Staff should be aware of the procedure to be followed for DS0000011430.V288924.R01.S.doc Version 5.1 Page 23 Linford Park Nursing Home 2 3 OP9 OP29 the safe disposal of medication in line with current legislation. The manager should seek advice from the pharmacist who supplies medication to the home to discuss the correct storage of tablets that have to split prior to administration. The home should keep detailed records of all recruitment interviews undertaken Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Linford Park Nursing Home DS0000011430.V288924.R01.S.doc Version 5.1 Page 25 - 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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