Inspection on 09/06/09 for Linford Park Nursing Home

This inspection was carried out on 9th June 2009.

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

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.

Other inspections for this house

Linford Park Nursing Home 30/11/09

Linford Park Nursing Home 25/06/08

Linford Park Nursing Home 30/01/08

Linford Park Nursing Home 24/04/07

Linford Park Nursing Home 24/04/06

Linford Park Nursing Home 25/01/06

Linford Park Nursing Home 22/09/05

Linford Park Nursing Home 19/12/04

Linford Park Nursing Home 13/07/04

Linford Park Nursing Home 10/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Linford Park Nursing Home Linford Road Linford Ringwood Hampshire BH24 3HX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 0 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Linford Park Nursing Home Linford Road Linford Ringwood Hampshire BH24 3HX 01425471305 01425471306 linfordpark@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Northdown Estates Limited Name of registered manager (if applicable) Mr Terence Walter Bailey Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 80 The registered person may provide the following categories of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following categories: Physical disability (PD) Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Linford Park nursing home is situated in Linford, a rural area of the New Forest, around three miles from the market town of Ringwood. The home is registered to provide care to people in the older person category with mental health needs, dementia, and Care Homes for Older People Page 4 of 35 80 0 80 Over 65 0 80 0 Brief description of the care home physical disability. Accommodation is provided in two separate units and is over two floors. A passenger lift in provided. The current fee charged is between £586 - £950. These fees do not include hairdressing, chiropody and other personal items. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit inspection to Linford Park Nursing Home, which was unannounced, took place over a one day period on the 9th June 2009 and was attended by one inspector who was assisted by the registered manager Mr Terance Bailey. For the purpose of this report and as a representative of CQC the inspector will be referred to throughout the report as we. The visit to Linford Park formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The focus of this visit was to support the information gathered prior to the visit. The judgments made in this report were made from information gathered prior to the visit from: The Annual Quality Assurance Assessment (AQAA)which was submitted to the commission by the service, information from the previous inspection report, which took place on 25th June 2008. The service history correspondence and contact sheets appertaining to the service were also taken into consideration. Care Homes for Older People Page 6 of 35 A number of comment survey cards were sent to service users, staff and visiting social and health care professionals prior to the visit, of which eleven service user surveys (half of which were completed by the relatives), four social and health care professionals were returned to CQC. No staff surveys were received by CQC. The returned surveys were generally very positive about the care and services in the home. Issues highlighted on the surveys are discussed in the main body of the report. Further evidence was gathered on the day of the site visit. The inspector toured the home and spoke to staff and residents who gave their views on the service. Residents in general stated that they enjoyed living at the home and liked the staff. A sample of care planning records and other records and documentation identified in the report were viewed. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? The home now has a registered manager who has instigated new systems and processes for all aspects of the management of the service. Staff, service users and relatives are complimentary about the changes the manager has introduced over the past twelve months and say he is very good and we have lots of training opportunities. The management of medication and storage of medication is well organised and meets the expected standards. A staff training matrix has been devised to identify the training provided to all staff and any training needs are identified through regular supervision by senior staff. The activities programme has improved and is more varied. Comments on surveys said: The home provides good activities. There is an increase in social activities. Care Homes for Older People Page 8 of 35 The home has an improvement plan in place for the redecoration and refurbishment of the environment which is currently in progress. All staff have now received training in Safeguarding of vulnerable adults and now have a good understanding about safeguarding the people who live in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective assessment procedures that include the provision of good information about the home enables people to move into the home confident they will receive the support and care they need and with an understanding about the running of the home. Evidence: The AQAA stated that a pre-admission assessment is undertaken on all service users prior to admission to ensure the home can meet their needs. A service user guide is given to each service user on their admission and a copy of this is kept in the reception area. Also Welcome pamphlets have been printed giving some information about the home and are placed in all new service users rooms to welcome them to Linford Park. Comprehensive details about the service provided by the home are included in the Care Homes for Older People Page 11 of 35 Evidence: statement of purpose and the service users guide, which was viewed by us. Both of these documents were in the process of being reviewed by the director of the organisation at the time of this visit, and were in draft format. The statement of purpose details that for every body wishing to move into Linford Park an assessment of their needs is undertaken. Once the decision has been made that the home can meet the persons needs and a place is offered, the service user guide is provided which gives further information about the home. We looked at documents belonging to five people living at the home. They all contained an assessment made of the persons needs before they moved into the home. The assessments were comprehensive and covered all aspects of a persons physical, psychological and social care. The files viewed contained social service care management assessments. The service user surveys said and service users spoken to at the time of this visit who could remember their admission process, told us that they had received information about the home and that for most, their relatives had organised the choice of home for them and relatives had visited the home prior to a decision being made about their admission. Intermediate care is not provided in this home. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process ensures that service users health, personal and social care needs are set out in individual plans. Improved medication practices and effective monitoring of these ensures that people using the service have their wellbeing protected. Good care practices means that a persons privacy and dignity is protected. Evidence: The AQAA states that the standard of care planning has improved but care profiles need further development. It states that service users or their representative are involved in the care planning process and the development of the care plans. We looked at care plan files belonging to five people living at the home, three living in Woodlands wing (mental health area) and two living in the Linford wing (general nursing). The files demonstrated a comprehensive assessment of residents needs and detailed care plans of how their needs should be met. The assessments covered all aspects of the persons physical needs and all care plans viewed had psychological assessments in place to describe their mental health well being. Care Homes for Older People Page 13 of 35 Evidence: There were risk assessments in place for nutrition, falls, tissue viability, moving and handling and alongside the risk assessments care plans had been formulated to manage any identified risk. Each resident had a moving and handling profile and a care plan to describe how the resident was to be moved and handled whilst in bed, in a chair or mobilsing. The care plans described service users choices of how they like their daily activities of living to be undertaken. There were documented choices of what foods they like, what their preferred form of address was, what clothes they preferred to wear, when they prefer a bath or shower and what group activity they prefer to be involved in. There religious preferences were also documented and if they wished to worship. There was an assessment for sleeping and bedroom comfort and this described what time the service user liked to go to bed, what their preferred attire was and if they had a bedtime drink or supper in their room and the frequency of being monitoring throughout the night. These care plans were evaluated by the night staff. It was observed that in most cases bed rails were being used on beds which were covered with bumpers to protect service users. The records showed the process of risk assessment for their use and a signed consent by the service user or their Representative, if the service user was unable to give informed consent, for their use. It was also observed in several bedrooms that free standing radiators were in use. There were care plans in place to describe how to use these but did not fully describe the risk to service users when they were fully operational and hot. Daily notes are recorded and describe the outcome of the care delivered on that day. The daily report is documented by each trained nurse for their group of residents and the report describes how the person has been, what and how they have spent their day and any events that have taken place. We observed that all care plan records had been signed by the service user or their representative to say they had been involved with the care planning and agreed to what the care plans said. Care plans were evidenced to be reviewed monthly by the primary nurse of each team. Care staff said that the care plans give them information they need on how to care for the residents they have been allocated. The care plans are stored in the medication rooms on each of the units and are available to all staff members. The AQAA told us that service users are registered with a general practitioner and have access to a dentist, audiologist, physiotherapist and other professionals allied to health. Care Homes for Older People Page 14 of 35 Evidence: The team of trained nurses working at the home facilitate the health care of people living at the home. Documentation evidenced the contact people have with doctors and other health care professionals. Instructions from doctors about a persons health care are recorded in the doctors notes of the care planning documentation as well as being incorporated into the care plan and medication administration record sheet if needed. A procedure is in place and used to refer people to the GP if there are any concerns about their wellbeing. This procedure means that non-urgent health care needs are attended to when one of the GPs from the local surgery visits the home twice a week and for urgent health care needs GPs are called out, as they would be if someone was living in their own private home. We received comments from the GPs who commented There has been more coordination of requests for medical assessments There have been improvements generally but there is still some way to go. There could be better preparation for doctors visits. It was identified through the surveys returned from the GPs said that there appears to be training needs for staff in wound care, palliative care and assessment of acute confusion. This was discussed with the manager as to the improving relationship with the local surgeries and he told us that he has worked to build up communication and relationships with the local doctors and to work with them to ensure that service users health care needs are met. The manager told us that the GPs review all residents living in Woodlands (the mental health area) and their medication monthly. It was also observed that a protocol for referring residents with wounds, through the community matron to the tissue viability nurse from Salisbury, was displayed on the wall of the medication room. At the time of this visit there were no residents who had any pressure ulcers but care plans were in place for those with other wounds and were observed to being managed appropriately. Service users living in the mental health area of Woodlands have access to the community mental health team for assessment and the home receive support from this team for review and advice. A comment survey received from this team said The home is excellent at delivering an holistic service to clients with complex physical and mental health needs. The team have been impressed by the standard of care our clients have received and feedback from relatives have said how much they appreciate the care their loved ones receive. The AQAA told us that the home has policies and procedures in place for the control, storage, disposal, recording and administration of medicines which have been Care Homes for Older People Page 15 of 35 Evidence: reviewed within the last year. The trained nurses co-ordinate the ordering, receiving, storage and checking of medications. The manager audits this regularly. The prescriptions are checked before they are sent to the pharmacy. The home is being delivered the blister pack system from the local pharmacist, which the manager considers a safer system for administering medication. The medication that is unable to be put into blister packs is delivered in boxes or bottles and are stored in a locked environment with the blister packs. The medication is stored in four areas of the home, each having its own medication room. Two of the areas were visited. The medication is stored in a safe and well organised area. The medication fridge was locked and temperatures were being monitored daily. The trained nurse on duty talked through the ordering and administration procedures and showed us the trolley and cupboards which were observed to be clean and tidy. There was no evidence in the cupboards of over stocking of medication, which is used on an as needed (PRN) basis only. It was observed that when viewing the medication administration record (MAR) chart, one resident was prescribed pain killers on a PRN basis but it was being administered regularly. This was discussed with the trained nurse as to if there were care plans in place to guide when PRN medication should be administered and if this person was able to request this at every medication round, should it not be reviewed with the GP to be put onto a regular prescription. Conversely if the resident cannot advocate for themselves a care plan should be documented to guide on the signs, symptoms, and observation of when PRN medication may be needed. The trained nurse told us that one service users medication was being crushed and administered in their food. The service user was unable to take her medication and did not have the mental capacity to consent to it being put in her food. Therefore, a care plan had been drawn up and recorded that a discussion with the GP and relatives had taken place and it was agreed by all parties that this was being done in the best interests of the service user. The controlled drugs cupboards were viewed and were compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. The home was not storing any controlled drugs but were storing and recording the administration of the night sedations. These were checked by us and the balance being held was that recorded and records had been signed by two staff as evidence that these had been checked appropriately. Care Homes for Older People Page 16 of 35 Evidence: We looked medication administration record (MAR) charts and checked the details on the chart against the supply that was in the home. A clear audit trail is available for medications ordered, delivered and administered to people living at the home. All nurses have undertaken the safe handling and management of medications. There was a photograph of each service user on the front of their MAR chart to ensure safe practice. The trained nurse was observed to be administering medication and was following safe procedures and ensuring service users were taking their medication at the time of administration. The AQAA states that service users privacy and dignity is respected and they are called by their preferred name, wear their own clothes and receive their mail unopened. One service user was observed opening her post and told us that she always receives the mail unopened. All personal care, and if the service user sees a medical professional, it is within the privacy of their own room. Care plans document the service users preferred form of address and this is respected by the staff. Care plans detailed peoples wishes about personal care and their wish to have either a male or female carer supporting them with their personal care. Staff members were observed talking with and assisting people at the home in a friendly and pleasant manner. No breaches of privacy were observed throughout this visit and staff were seen to knock on a persons bedroom door and wait for a response before entering the room. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have the opportunity to take part in meaningful activities and to maintain contact with their family and friends. People living at the home are able to exercise choice and control over their life. People living at the home benefit from a varied and healthy diet. Evidence: The AQAA told us that a full activity programme is developed that reflects the needs and desire of current service users. Relatives are welcome to join in with the activities. The home said on the AQAA that is hopes to develop the activities programme more and have themed lunches throughout the coming year. Also they would like to provide more outings in the bus in the better weather and integrate more into the local community. A full time activity coordinator is employed by the home. She was spoken to and told us that she tries to obtained as much social history information about the service user that she can and sometimes the information comes mainly from relatives, if service users are unable to communicate and share information with her. The current care plans do not record a very detailed past social history at the initial assessment but the Care Homes for Older People Page 18 of 35 Evidence: coordinator tries to build on this and gain further information. She explained that it is an ongoing process to obtain information about the interests and life history of some people living in the home and she tries to organise activities that will appeal to people and relate to their past recreational pastimes. The coordinator told us that she now has new social history record forms to complete when there is a new admission to the home. She has not had the opportunity of using this to date. This information form will be completed with the service user and family or friends which, she anticipates, will enable her to obtain a more comprehensive social history about the service user. The activity organiser keeps a record of all residents interests, what activity they have taken part in and how they have reacted to the activity. People who are unable to leave their rooms or those with severe dementia, she told us that she spends time with them on a one to one basis, chatting, discussing things the person use to enjoy and she will do manicures, listen to music with them and says the residents respond to the one to one contact of voice and touch. During the morning she was observed interacting very well with people with dementia who were joining in an art session that she was supporting. Observation throughout the visit evidenced that the activities organiser, who has worked at the home for some considerable time as a carer before becoming the coordinator, has excellent relationships with the service users and joined a group of residents for lunch at the table and were overheard to be exchanging general news with each other. A two-week activity programme was displayed in the entrance hall detailing the activities available for people to choose from. Information is portrayed in large print and pictorial formats allowing people who have difficulties understanding the written word to be able to have some understanding of the activities available. The programme was seen to be displayed in other areas of the home and dining room. The activities include outside entertainers and musicians who attend the home once a week and the hairdresser attends the home weekly. Young people visit the home to perform dance which, the co-ordinator told us the residents thoroughly enjoy. These activities run alongside the programme arranged by the coordinator. Surveys returned from service users and relatives commented We are now having in house entertainment on a regular basis. The home does well with activities and communications with other residents There has been an increase in social activities lately. There was a photograph album on display in the front reception area that displayed Care Homes for Older People Page 19 of 35 Evidence: photographs of the events over the past year in chronological order. There were photographs of the service users enjoying the themed lunches, which are now a regular occurrence and at which time residents dress to the theme of the country that realties to the type of food they are having that lunchtime. Service users told us that they have enjoyed these occasions and the photographs evidenced this. The home has a mini-bus but only the current manager is able to drive this. There have been outings in this and one service user told us that she had been on the outing and enjoyed it tremendously. Another said she would like to go on the outings and wished there were more. This was identified in surveys returned from service users or their relative saying Would like to see organised mini-bus outings. More outside excursions would be nice and more use of the garden. The manager said he was trying to recruit another driver for the bus and stated that one of the improvements he hopes to make in the coming year is to increase the trips out for residents and have more contact with the community. The manager has invited the people in the local area to visit the home in an attempt to enable the home to become more integrated with the local community. The manager told us that the home is putting on a New Forest Day and people from the new forest area will come to the home and demonstrate their special areas of interest. Literature and information about the National Park the home is situated in is on display in the reception area for service users to look at. The home now holds more regular resident and relatives meetings which are recorded and seen displayed on the notice boards. These meetings give the service users and the relatives the opportunity to voice any suggestions about the running of the home and talk through any issues. Staff were observed throughout our visit interacting well with people living at the home, giving them reassurance and encouraging them to join in individual activities. Service user surveys returned indicated that the home usually or always have activities arranged that they can participate in if they wish. The statement of purpose details there are no limitations on visiting times. People at the home can choose when to receive their visitors. People living at the home, that we were able to hold conversations with, told us they are able to have visitors at any time. However, a survey returned from one service user commented that the home could do better to improve visitor access for evenings and week-ends. This is the result of the front door being locked from 17:30 each evening and the front door bell was not responded to as it was not heard owing to the geography of the large Care Homes for Older People Page 20 of 35 Evidence: building. This has now been resolved and if the front door bell is activated this comes up on the nurses bleeper system that they carry with them, and can be identified and responded to. Another comment from a relatives told us that the home welcomes me as a visitor anytime. We observed the lunchtime meal in the main dining room. The menus observed were giving choice at each meal time. The menu of meals available were also on display in an album with photographs of the various meals provided at the home to aid people visually with meal choices. The lunchtime meal was a choice of curry, pizza or omelet. Service user spoken to living on Linford wing confirmed that they have choices at meal times. It was observed that two ladies chose to have omelet and others the curry, which they said was very good The meal was well presented and drinks were being offered regularly. The manager told us that the current menus are being reviewed and costed. People living at the home can make choices where they take their meals. A large dining area in the Linford wing is available for people living on that wing to take their meals or they can take them in the privacy of their own bedrooms. Smaller dining areas are available on the Woodlands wing for people living there. Care plans details the assistance people need at meal times, whether they need assistance with feeding or they need their food prepared in a certain way that enables them to eat their meals independently. The cook told us that she is aware of the service users food likes and dislikes and is able to prepare special diets for diabetics and one service user is a vegetarian. She also reported that snacks and drinks are available throughout the 24 hour period from the kitchenette areas around the home, food for which is supplied by the kitchen daily. Staff were observed to be assisting people with their meals with sensitivity. Documents were seen in the kitchen evidencing that records are kept of the meals provided to people living at the home. No concerns were raised by any person we talked to about the quality and quantity of the meals provided at Linford Park. Surveys returned from service users and relatives on their behalf indicated a high level of satisfaction with the meals served at the home. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are confident that complaints will be taken seriously and responded to promptly. Service users are protected from the effects of abusive practices by staff who have received appropriate training and who understand the safeguarding procedures. Evidence: The AQAA says that the home has a complaints procedure in place and that complaints are investigated and responded to within a 28 day timescale. A complaints procedure is displayed in the entrance hallway to the home and information about the complaints process is detailed in the statement of purpose and service user guide that is supplied to all people moving into the home. The complaints log was viewed by us. All complaints are logged and action outcome from the complaints are detailed. Also in the log is a copy of any responses made by the manager to the complainant as a result from the investigation. One complaint has been reported to CQC and responded to accordingly. Service user surveys returned to CQC indicated that service users and relatives know who to speak to if they have concerns. One comment was that The managers door is always open to get reassurance to make any enquiries. Care Homes for Older People Page 22 of 35 Evidence: The AQAA states that the home has a comprehensive safeguarding policy and staff receive safeguarding training. Policies and procedures about safeguarding adults are in place. The training matrix developed by the manager indicates that all staff members have received training about the protection of vulnerable adults. The safeguarding and protection of vulnerable adults from abuse is part of the induction programme training and this information and training is followed up with further safeguarding training for staff. This has been evidenced on the training matrix which was seen by us and also in the staff training certificates. The manager told us that the safeguarding training will be a mandatory yearly update for all staff. There have been no safeguarding investigations in the last year. Discussion with staff evidenced that they have a good understanding about different types of abuse and how to recognise abuse if it is happening. Staff acknowledged that abusive practices are unacceptable and they would inform the manager if they suspected abusive practices were occurring. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from living in a safe and comfortable environment, which is adequately furnished and maintained. Evidence: A tour was made of the environment looking at a sample of bedrooms, bathing facilities, communal areas, the kitchen and the laundry. Bedrooms were to varying degrees personalised with the persons own belongings such as ornaments, pictures and small items of furniture. Some of the bedroom furniture was in need of replacing or repairing but the manager told us that there is a programme of refurbishment in progress. There are a variety of communal areas for the use of people living at the home including separate lounge areas on Linford and Woodlands wing of the home, a large dining area service the people living on the Linford wing. This area is also used as a recreation and activity area. Separate dining areas in the Woodlands wing are for the use of people living in those wings, although people are able to eat their meals in the large dining room if they wish. We observed people who use the service moving freely with or without support from the staff between the communal areas and their bedrooms making the choice about where to sit and how to occupy themselves. The fact that people are able to choose Care Homes for Older People Page 24 of 35 Evidence: where to spend their time was confirmed in conversations that we had with people living at the home. There are sufficient bathing and toileting facilities for people who live at the home. It was discussed with the manager whether the service were going to replace some of the old adjustable beds with profiling beds. He told us that this is one of his aims in the coming year was to start a programme of replacement. Policies and procedures are in place about hygiene practices and the control of infection. A team of housekeepers are responsible for the cleaning of the home. During this visit the home was observed to be clean and tidy and only one room had a slight odour. The housekeeper told us that they have a carpet cleaning schedule and that carpets are cleaned at regular intervals and more frequently if an accident occurs. The training matrix evidenced that staff have received infection control training. Housekeeping staff spoken to were aware of the infection control principles and gloves and aprons were available for staff use. Surveys returned to CQC and talking to people who live at the home told us the home is always clean and fresh. This indicates that there are sufficient housekeeping staff on duty at any one time to ensure the cleanliness and hygiene of the home. The homes laundering facilities are on the ground floor. The position of laundry and good laundry practices reduce the risks of cross infection from dirty laundry. The laundry floors and walls are easily cleanable and were clean and tidy on the day our visit. The building is large and is surrounded by grounds and although the distance views are over the New Forest and are very good , the immediate grounds need to be cleared and made fit for service users to sit in pleasant surroundings. The manager told us that an old aviary is being dismantled and a summer house will be put in that position for service users to use. A number of residents had bird feeding platforms outside their windows and many take delight in feeding the birds and watching them. The manager told us that the home has an improvement programme for refurbishment and redecoration and currently the home is in the process of undertaking redecoration of some areas. The manager told us that when the Woodlands areas are redecorated it will be with the dementia care guidance of what colours are more stimulating to service users with dementia and what they will respond to more readily. The AQAA tells us that the home has installed a new fire alarm system and that the Care Homes for Older People Page 25 of 35 Evidence: improvements over the next twelve months will be to continue to refurbish the home. The home does employ one maintenance gentleman to undertake the day to day repairs to the home. He was present in the home on the day of this visit. Comments on surveys returned from service users or their relatives said. I think the home does a good job in a building that is not always ideally suited for it purpose. I think some of the fixtures and fittings could do with renewing beds, wardrobes and some dining chairs. Improve some aspects of the building however I understand that this work is ongoing. Service users spoken to said they were happy with their rooms and they had their personal belongings around them. Care Homes for Older People Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users care needs are met by sufficient numbers of staff who are competent to do their jobs and who have received appropriate training. Service users are protected by the homes recruitment policies and procedures when recruiting staff. Evidence: We viewed staff rotas. The rota detailed who and in what capacity, such housekeeping, kitchen or care staff, was on duty at any one time. On the day of this visit there was one mental health trained nurse on duty with six carers for Woodlands to care for 29 residents for all day.At night there was one trained and 3 carers for the night shift. On Linford wing there was one trained nurse and 4 carers on in the morning shift going down to 3 carers in the afternoon shift and one trained and 2 carers for the all night shift. The registered manager is also in the home five days a week and is on call every day. Service user and relatives who returned the surveys to CQC indicated that there was always or usually staff available when they were needed. On the day of this visit there was no evidence that there were not sufficient staff on duty to meet the needs of the current service users. The manager told us that as he expects, in the near future, to admit a number of people to the home from various authorities, an increase in trained staffing levels would be essential and that he was currently in the process of recruiting more staff. Care Homes for Older People Page 27 of 35 Evidence: Comments from service users spoken with said staff are very kind and if I cannot be at home I would choose to be here at Linford. Other comments on surveys said I wish the staff would visit the room more often. The toilet situation is a problem having to wait a long time to be taken to the toilet and going to bed early and not getting up until 10.30. The home could have better toileting arrangements, some residents have to wait up to an hour to be toileted and understand staff need their breaks but there should be more staff to accommodate these facilities, but I must say that since the new manager has been appointed the home has improved considerably. There needs to be a higher staff to service user ratio as there are occasions when there have been residents in the lounge unsupervised and it is not easy to find a member of staff. We get all round general care and attention but sometimes the staff should pay better attention to toileting and understand that waiting is not always an option. A friendly staff looks after my husbands needs. A survey returned from the community team said The staff have a warm, friendly and relaxed approach which is welcomed by clients and visitors. It was noted that the call bell system was responded to quickly when activated. The manager told us that as part of his quality monitoring he audits the bell response times as these are recorded for each call and he is able to identify the waiting time for response and who is responsible. The rotas demonstrated that four cleaners are on duty and one person who undertakes the laundry. There are two administrative staff in the home during the week days. One comment from a relative said excellent administrative coordination with relatives in addressing arrangements for hospital visits and GP input if necessary. The training matrix and individual training files demonstrated that staff have undertaken a variety of training in the past year, those recorded were moving and handling, fire, infection control, abuse, health and safety, food hygiene, continence, wound care, medication, care planning, the mental capacity act, nutrition and COSHH guidance.Training takes place in the home and also at external venues. The staff are fully funded for any training they undertake. A number of staff spoken to at the time of this visit confirmed that there is a variety of training made available to them especially since the new manager has been in post. The notice board in the medication rooms advertised a wide range of training that the staff could attend and which were in relation to the client group they care for. The manager has undertaken supervision for some staff and the records were viewed. Care Homes for Older People Page 28 of 35 Evidence: The manager told us it is at the time of supervision, whether it be a meeting or a practical session, training needs are identified and discussed. He admits that no appraisals have taken place to date but he has comprised a programme for the coming months. The AQAA records that the home employs 30 staff of which 21 have achieved the NVQ level 2 or above. The manager confirmed that induction programmes follow Skills for Care common induction standards. We saw a completed copy of the induction programme used by the home to confirm this. A sample of 5 recruitment files were viewed by us.Those viewed were well organised and demonstrated that good recruitment practices are followed to ensure that no person commences employment at the home prior to two written references being received,the Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) information being obtained, and documentation being obtained to confirm that a person from overseas is eligible to work in this country. These processes protect the welfare of those living at the home. The files also contained interview notes. The manager told us he recruites and interviews, with one other person, the people that have been short listed for selection. Care Homes for Older People Page 29 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is being effectively managed and is seeking the views of those using the service to influence the development of the home. Robust procedures ensure that the finances of people using the service are protected. Good health and safety practices protect all people at the home. Evidence: The registered manager has been in post for one year. He is a registered general nurse with a wide experience of managing a nursing home. He was a nurse tutor and has a foundation degree in management and is therefore well qualified to undertake his role. The report of last June stated that the manager spoke of his developing working relationship with the registered providers evidencing that they would work together to improve the service at the home and consequently outcomes for those living at the home. For example he was developing a business plan that included the development of staff, improvement of the environment and the plan for increasing the number of people living at the home to included recruitment and training of extra staff. Care Homes for Older People Page 30 of 35 Evidence: There was evidence that the manager has a development plan in place for the improving fabric of the building, he has put in place a staff training progrmme and in the past year staff have undertaken a wide range of training. He is in the process of recruiting more staff and is building relationships with the PCT and associated authorities. Staff, visitors and people who live at the home spoke highly of the manager. Both staff and people living at the home told us that they feel able to approach the manager with any concerns they might have, they are listened to and their thoughts and views will be considered and will influence the running of the home. Talking to staff and comments on the surveys returned to CQC by visiting professionals said. Linford Park has good communication skills and has greatly improved since the new manager has been in post. There has been a general improvement so far. There is more coordination of requests for medical assessments. Since the new manager has taken over things have improved vastly. He runs a tight ship and has meetings for relatives on frequent occasions and his office is always open for enquiries and reassurance. Good well managed home since the new manager has taken over and he also gets involved with the social side of the home. Since the new manager has been appointed the home has improved considerably. The manager has put a quality assurance system in place. Questionnaires have been distributed to service users, relatives and other stakeholders. These have been returned and the analysis and outcome of this survey was viewed and quite positive. The issues that the survey raised were discussed with staff at staff meetings and feedback was given at the residents and relatives meeting. The results of the surveys and issues raised will contribute to the improvement of the home. The surveys are to be distributed every six months. The manager audits the complaints records, accident records, care plans, medication, equipment and the systems in the kitchen monthly. The accident records were viewed and audit trailed through the records to daily notes. The manager identifies emerging themes from the monthly audits of these records. All policies and procedures have been reviewed over the past year. The manager told us that one of his long term plans is to apply for the investors in people accreditation to assist and evidence the auditing of staff development. Care Homes for Older People Page 31 of 35 Evidence: Procedures are in place about the handling of money for people who live at the home. People can make use of a safekeeping facility if they wish. Records are kept of monies held for people including details of income and expenditure and people can access their money whenever they wish. A sample of two service users monies was checked against the records and these balanced, with receipts in place for all expenses. Service users monies were stored in separate containers in a safe environment. Health and safety procedures are in place. The training matrix evidences that staff have received training about various aspects of health and safety, for example 100 staff have undertaken training about fire safety, 100 about infection control and 98 about the control of substances hazardous to health. Suitable moving and handling equipment is available. The fire log evidenced that fire safety checks are carried out in accordance with the Fire and Rescue Services guidelines. The home has a policy for the control of substances hazardous to health known to staff. Chemicals and other items are securely stored in locked cupboards. We looked at a sample of service certificates that evidenced that the servicing of systems and equipment are maintained and current. This protects the wellbeing of all at the home. The fire risk assessment was viewed. Care Homes for Older People Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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