CARE HOMES FOR OLDER PEOPLE
Lingdale Lodge Lingdale East Goscote Leicestershire LE7 3XW
Lead Inspector Helen Abel Unannounced 20th April 2005, 10:00am 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 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. Lingdale Lodge Version 1.10 Page 3 SERVICE INFORMATION
Name of service Lingdale Lodge Address Lingdale East Goscote Leicestershire LE7 3XW 0116 2603738 0116 2603738 None Mr John William Nunn Mrs Barbara Elsie Nunn Acting Manager Care Home 46 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Dementia (9), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (10), Old age, not falling within any other category (37), Physical disability (8), Physical disability over 65 years of age (8) Lingdale Lodge Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: A named variation under the PD over 55 categories. The home currently offers only 8 places. The named variation will become the 9th such placement within the category PD Date of last inspection 23rd November 2004 Brief Description of the Service: The home is owned by the Registered Providers Mr and Mrs Nunn and is part of fifteen homes owned by the Broadoak Group of Care Homes. Lingdale Lodge is a large 46 bedded home set in a modern building on one level. The home is set back off the main road in a quiet location of East Goscote but is accessible to shops, and other amenities. The home is situated next to Primrose Residential Home, also owned by the same Providers. Lingdale Lodge Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day. The Acting Manager accompanied the Inspector for the duration of the inspection. All parts of the home were inspected. Service users were seen relaxing in their rooms and lounges and observed taking lunch in the dining room. In the afternoon the Inspector spent time viewing the documents. What the service does well:
Prospective service users have the information they need to make an informed choice about living at Lingdale Lodge. A Service Users Handbook is available to service users in the home. Social activities and meals are both well managed, creative, and provide daily variation and interest for people living in the home. Service users are able to take part in Residents Meetings every 6-8 weeks with relatives invited too. The Acting Manager confirmed she had approached the male service user group to see if there were any specific activities they wanted to do. Menus were inspected and found to be well balanced and interesting. Every Friday there is a party tea in the communal area with taped music, traditional party food, such as jelly, trifle, cakes and ice cream Relatives of service users confirm their confidence with complaints procedures and are listened to and taken seriously. Indoor accommodation is clean homely and comfortable. Communal spaces are kept clean and fresh. They reflected service users personal belongings magazines, books and newspapers. The staff group are able to meet the individual needs of service users. Staff are understanding of their roles and responsibilities to service users care. Staff are working towards the home’s training plan and undertaking a range of National Vocational Qualifications in Care and Management. Staff are being trained to provide a good safe service. Recruitment records were inspected and found to be in good order and meet this Standard. Visitors confirmed a trust in staff and felt able to go to any staff member. They confirmed events were regularly organised and they were always invited. Lingdale Lodge Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lingdale Lodge Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Lingdale Lodge Version 1.10 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 standard(s) 1 & 3 Prospective service users have the information they need to make an informed choice about living at the home. Assessments take place for all new service users before they enter the home. EVIDENCE: A Service Users Handbook is in place with copies available in the home. This provides comprehensive information about life at Lingdale Lodge. Assessments undertaken by the Acting Manager for new service users were inspected and meet this Standard. Lingdale Lodge Version 1.10 Page 9 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 standard(s) 7,8,9 11 Care plans have improved and are detailed and generally effective.. These shortfalls have the potential to place service users at risk. Medication management is generally satisfactory. Service users dying and death wishes are sought and formally recorded on their care plan. EVIDENCE: Service users care plans were inspected and include detailed records of the service users all round care needs. Risk assessments were evident and clearly set out within a risk assessment framework. Care staff have just started a new way of working with the reviewing of service users care plans. Senior care staff are responsible for checking care staff have undertaken all written records for individual service users. Written records for weighing service users as part of their care plan were examined and were incomplete. Nutrition records were not completed for a service user with special dietary/low weight needs. The care plan must include details around healthcare and nutrition. Lingdale Lodge Version 1.10 Page 10 Some gaps in medicine record sheets were noted, although the medicine had been administered. The Acting Manager agreed to investigate this matter further with the staff group. All staff that administers medication have undertaken accredited medication training. The Acting Manager confirmed the Pharmacists comments around the arrangements for cold storage of medicines as being acceptable practise. They are currently kept in a designated fridge, behind the home’s secure licensed bar. Other medicine records, policies and procedures were satisfactory. Lingdale Lodge Version 1.10 Page 11 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 standard(s) 12,13,15 Social activities and meals are both well managed, creative, and provide daily variation and interest for people living in the home. EVIDENCE: Service users are able to take part in Residents Meetings every 6-8 weeks with relatives invited too. The Acting Manager confirmed she had approached the service user group to see if there were any specific activities they wanted to do. A formal church services is held in the home once a month. A Lay Preacher comes into the home most evenings to take prayers and will move around the home talking with service users. Staff regularly escort service users to the nearby shops. Service users have recently been to a barge trip and are planning a fish and chip evening out, in June with the minibus. Menus were inspected and found to be well balanced and interesting. Every Friday there is a party tea in the communal area with taped music and traditional party fayre such as jelly, trifle, cakes and ice cream. Mealtime arrangements were flexible enough to accommodate individual preferences. Lingdale Lodge Version 1.10 Page 12 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 standard(s) 16,18 There is a satisfactory complaints procedure which relatives and service users have confidence in. Policies and procedures around Abuse are satisfactory and safeguard service users. EVIDENCE: Complaints policies and procedures are displayed around the home and in the Service Users Handbook. The complaints record book has improved and is updated and is easier to follow. Visitors confirmed “I can approach any staff member if I have a complaint and have done so. They are good and do help” Policies and procedures for Protecting Adults have are now in place for Whistle Blowing, and Physical and /or Verbal Aggression by Service Users. Lingdale Lodge Version 1.10 Page 13 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 standard(s) 19,20,22, 24, 25 Maintenance of the home is good. An identified aspect presents as a safety hazard and is potentially putting people at risk. Indoor accommodation is clean homely and comfortable. EVIDENCE: Significant improvements were noted since the last inspection particularly around the West Wing part of the home. This is now clean and tidy, and homely and comfortable. Both Fire and Environmental Health inspections have taken place recently with minor requirements for the Registered Provider to action. The Acting Manager confirmed the wooden blue outdoor garden furniture was soon to be maintained. The garden furniture at the front of the home is popular with service users in the warmer weather. All communal spaces were kept clean and fresh and reflected service users personal belongings magazines, books and newspapers. Lingdale Lodge Version 1.10 Page 14 Relatives of a service user spoke about him recently walking out of the fire exit door near the laundry. This is frequently left ajar and has no alarm on it. All other exits have alarms on. An alarm facility must be provided to this area to safeguard service users. Service users rooms were clean and comfortable with all the required fixtures and fittings. The laundry area was very well maintained and organised. Lingdale Lodge Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 The staff group are able to meet the individual needs of service users. Staff are understanding of their roles and responsibilities to service users care. The procedures for the recruitment of staff are good and protect service users. EVIDENCE: The staffing rota demonstrates sufficient staff on duty at all times of the day. Staff in their role as Key Workers will escort on a daily basis individual service users to go out for short periods. This may be for a walk or around the local shops. Key Workers are responsible for a maintaining their designated service users all round care and record keeping. Staff are working towards the home’s training plan and undertaking a range of National Vocational Qualifications in Care and Management. Staff are in the process of being trained to provide a good safe environment. Recruitment records were inspected and found to be in order and meet this Standard. Lingdale Lodge Version 1.10 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 & 38 Staff are not appropriately trained and supervised. This results in practices that do not promote and safe guard the health, safety and the welfare of people at the home. EVIDENCE: The Acting Manager confirmed staff receive regular supervision. This was not reflected in staff’s records. Staff must be appriately supervised. Bacon was observed defrosting on top of cartons of milk. A tray of food was left uncovered and undated in the fridge. The Acting Manager agreed staff training and development was required around food hygiene practice. Similar aspects were identified during the Environmental Health’s inspection in March 2005. Kitchen staff are also responsible for providing all meals for 15 service at Primrose Residential Home, situated opposite. Lingdale Lodge Version 1.10 Page 17 The Acting Manager ensures safe working practices through recorded checks of the fire, electrical systems, hot water, security of the premises, and central heating and risk assessments for service users. The staff group on some shifts patterns do not include a trained First Aider. Trained staff must be available at all times to provide knowledge of how to deal with accidents and health emergencies. The Acting Manager agreed to look into developing the current staff induction with the Training Organisation for the Personal Social Services (TOPPS) foundation training. Lingdale Lodge Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x 2 x 3 3 x STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x 2 Lingdale Lodge Version 1.10 Page 19 No 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 7 Regulation 15 Requirement The care plan must include details around healthcare and nutrition: To make changes around the use of Personal Record Sheet and Nutrition Record Sheet ensuring care plans are regularly reviewed The care plan must include details around healthcare and nutrition: Periodic weighing of service users must take place with records held. An alarm facility must be provided to this key area to safeguard service users. Ensure staff recieve regular formal supervsion The Registered Provider is required to arrange a competent person to undertake a check for asbestos and produce a report/risk assessment to this effect. (Indentified at the last inspection 23/11/04) The Registered Provider shall make suitable arrangements for the training of staff. The cook to recieve Advanced Food Hygiene Training. Timescale for action 20th May 2005 2. 8 14 20th May 2005 3. 4. 5. 22 36 38 23 18 12 20th May 2005 20th May 2005 31st May 2005 6. 38 13 30th June 2005 Lingdale Lodge Version 1.10 Page 20 7. 38 13 The Registered Provider shall make suitable arrangements for the training of First Aid for the Deputy Manager/senior staff. 30th June 2005 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 38 Good Practice Recommendations Discussed with the Acting Manager the Training Organisation for the Personal Social Services (TOPPS) foundation training. It is recommended this aspect of training for new staff be explored further with the new Training Providers. The training is around principles of care, safe working practices, the organisation and worker role, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. Lingdale Lodge Version 1.10 Page 21 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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