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Inspection on 18/01/06 for Linthorpe Nursing Home

Also see our care home review for Linthorpe Nursing Home for more information

This inspection was carried out on 18th January 2006.

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

The inspector 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 residents at Linthorpe Nursing home are happy and well cared for. Residents spoken to during the inspection said that their care needs were met and that they were happy living at the home. One resident said, "The home is very good at meeting my needs, I have been here for two years and I am very happy", another said, "staff do their very best for you".

What has improved since the last inspection?

It is evident following this inspection that the Manager and staff have worked very hard to address the many requirements identified at the last inspection. The Manager has developed policies and procedures, updated training and developed a system in which to ensure care staff receive supervision on a regular basis.

What the care home could do better:

Environmentally there are still many areas within the home that require upgrading, details of which are in the main body of the report. It was identified during the inspection that immediate attention was required in respect of the unrestricted windows on the first floor of the home and residents that had bedroom doors leading to a balcony area required a more robust locking system to ensure safety of all. The Manager must ensure a thorough recruitment practice is followed exploring any gaps in employment and ensuring that there are two written references are on file for each newly appointed staff member, one being from the last employer.

CARE HOMES FOR OLDER PEOPLE Linthorpe Nursing Home 36 Eastbourne Road Linthorpe Middlesbrough TS5 6QW Lead Inspector Katherine Acheson Unannounced Inspection 18th January 2006 13:40 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 Linthorpe Nursing Home DS0000000184.V251023.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. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Linthorpe Nursing Home Address 36 Eastbourne Road Linthorpe Middlesbrough TS5 6QW 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) 01642 850032 01642 824092 Linthorpe Private Nursing Home Mrs Carol Breeze Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum number of 5 service users aged 55 years and above can be accommodated within the home. 25th August 2005 Date of last inspection Brief Description of the Service: Linthorpe Nursing Home is registered to provide personal and nursing care to thirty people aged sixty-five and above. The home is situated on Eastbourne Road, Middlesbrough, and is close to Linthorpe Village and other local amenities. The home is set in its own grounds with gardens to the front and rear of the building. Internally, there are three lounge areas on the ground floor, one lounge on the first floor and two dining areas. There are twenty-two single bedrooms and four double bedrooms. Nine of the bedrooms have ensuite facilities, which comprises of a sink and a toilet. All bedrooms meet with size requirements of National Minimum Standards. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started at 13:40 and lasted for four hours. Three residents were spoken to individually at length, two other residents were spoken to briefly and a discussion took place with the Manager. Records examined during the inspection included, medication, complaints, staff training/recruitment and a number of policies and procedures. The Manager accompanied the Inspector on a tour of the home. Requirements highlighted at the last inspection in August 2005 were re-visited. What the service does well: What has improved since the last inspection? It is evident following this inspection that the Manager and staff have worked very hard to address the many requirements identified at the last inspection. The Manager has developed policies and procedures, updated training and developed a system in which to ensure care staff receive supervision on a regular basis. Linthorpe Nursing Home DS0000000184.V251023.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. Linthorpe Nursing Home DS0000000184.V251023.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 Linthorpe Nursing Home DS0000000184.V251023.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): The above standards were not inspected. EVIDENCE: Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 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 the following standard(s): The above standards were not inspected in full, however, a requirement highlighted at the last inspection in August 2005 was re-visited. EVIDENCE: It was highlighted at the last inspection in August 2005 that the home’s medication policy required further development to reflect the home’s new system for ordering and administration of medication. Examination of the policy confirmed that this had been carried out, however the home’s system for disposal of medication has now changed and the policy requires to be updated to reflect this change. Since last inspection the home has purchased a lockable fridge in which to store medication, records examined confirmed that the fridge temperature is recorded on a regular basis. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 10 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): The above standards were not inspected. EVIDENCE: Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 11 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 The home has an effective complaints procedure, which enables residents to make any complaints they feel necessary. EVIDENCE: The home has a complaints procedure, details of which are also available in the statement of purpose and service user guide. Residents spoken to during the inspection said that the Manager and staff at the home are approachable and if they felt the need to complain then they would do so. One resident spoken to during the inspection said, “I have no worries here, if I needed to I would speak to the Manager”. Standard 18 was not inspected in full, however, requirements highlighted at the last inspection were re-visited. The home has developed the adult protection procedure to include action that staff should take if abuse is suspected. Two staff files examined at random were observed to contain a certificate to confirm that they had received training in adult protection. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 12 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, 20, 21, 22, 23, 24, 25, 26 Some improvements to the décor of the home have been made, however a number of areas that are highlighted below do not provide residents with safe and comfortable surroundings. EVIDENCE: A tour of the home was carried out with the Manager during the inspection. The home has three lounge areas on the ground floor of the home and one on the first floor. Since last inspection two lounge areas on the ground floor of the home have benefited from re-decoration, new carpets and the purchase of new curtains. The home’s dining area has also benefited from re-decoration, a new carpet and the purchase of new dining room furniture. Fires in the home have now been guarded to ensure safety of residents. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 13 The Registered Person has commenced a programme to upgrade bathroom and shower areas in the home environment, one bathroom has been redecorated and benefited form the fitting of a specialist bath, the others are to benefit from upgrading during 2006. It was observed during a walk around of the home that bath chair seat in the bathroom near room 15 was rusty and required replacing and the ceiling in the bathroom near to room 22 requires repair. The Manager said that all exposed hot water pipes in resident areas have now been boxed in to ensure safety. Eight bedroom areas have benefited from re-decoration and new curtains and a number of bedroom carpets have been replaced. A walk around of the home during the inspection identified that a number of bedrooms still require to be upgraded, in particular bedroom 18 and 25 require re-decoration and bedroom 26 and 27 need the carpet replacing. A number of bedrooms and the lounge on the first floor of the home were observed to have broken window restrictors. The Manager at the time of the inspection said that she would take immediate action to address the situation and has since followed up with a telephone call to the Commission for Social Care Inspection to confirm that all windows on the first floor of the home have been restricted to ensure safety of all. A number of bedroom windows on the first floor of the home did not open, one resident spoken to during the inspection commented that it would be hot in his bedroom in the summer months if he could not open all of the windows. A number of bedrooms on the first floor of the home were observed to have a door leading to a balcony area. The Manager said that all residents in these rooms are risk assessed to ensure that they are safe to use the balcony area. One of the bedrooms doors did not have a robust locking system to ensure safety and security of the resident; the Manager said that she would take immediate action to address the situation. It has been highlighted at previous inspections that the flooring in the laundry must been replaced. Since last inspection the flooring in the laundry has been removed and the floor painted, however this is not acceptable as the floor is so uneven and as such cannot be washed sufficiently to prevent the spread of infection. The walls in the laundry also require attention, as they are not readily cleanable with the brick just being painted. A discussion took place with the Manager and Responsible individual in respect of this. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 14 The home has a large enclosed garden area to the rear, however this is not pleasant for resident use due to the large amount of rubbish, unused wheelchairs and other items requiring to be disposed of. The fence at the rear of the property has been replaced, however the area is not maintained and paving is uneven. A discussion took place with the Responsible individual and Manager regarding upgrading the area to provide a pleasant garden/seating area for residents. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 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 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): The home’s recruitment procedures are not sufficiently robust and as such do not provide protection for residents living at the home. Staff receive appropriate training to ensure that care needs of residents are met, however some staff still require updates in mandatory training to ensure health safety and wellbeing of all. EVIDENCE: Duty rotas examined during the inspection confirmed that the home were working with the correct amount of staff on duty, however three out of nine questionnaires received from relatives that were sent out in respect of the service provided at the home felt that there was not always sufficient staff on duty. Residents spoken to during the inspection felt that there were sufficient staff on duty to meet their needs. One resident spoken to said, “The staff are smashing anything you ask for they will get you, nothing is too much trouble”. The Manager said that 26 of care staff are trained to NVQ level 2 in care or equivalent with the a number of other staff registered and working towards their NVQ level 2 in care. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 16 Two staff files were examined at random during this inspection, both were observed to contain proof of identity, a photograph of the staff member and evidence to confirm that appropriate POVA/Criminal Record Bureau Checks had been undertaken prior to the commencement of employment. One of the staff files was observed to contain two references, one being from the last employer, however the other staff file had only one character reference on file. It was also observed that one of the staff members had a gap in employment and that the Manager had not explored this gap. Both files examined were those of staff who had been recently appointed and contained evidence to confirm that induction training had been undertaken. A discussion took place with the Manager regarding the new induction standards that are to come into force in September of next year. It has been identified at previous inspections that first aid and moving and handling training is out of date. Since last inspection a number of staff have attended such training with other training days planned for 2006, records were available to confirm that this is the case. Records were available to confirm that fire training has been provided at the home. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 17 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, The residents health, safety and wellbeing is promoted by a well managed home, however, there are some areas of potential risk to residents safety, highlighted within this report which need to be addressed. EVIDENCE: The Manager, Carol Breeze is a first level Registered Nurse who has also completed an NVQ level 4 in Management. Carol has worked in the nursing and social care environment for many years. Residents spoken to during the inspection said that they were happy at the home. One resident said, “Carol is smashing she is very very nice” another said, “They do the very best for you” another said, “I am very happy here, the girls are very nice”. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 18 It was identified at the last inspection that the Manager must develop a system to ensure that all care staff receive supervision on a regular basis; records were examined to confirm that this had been actioned. It was also identified at the last inspection that the home must carry out a fire drill that includes evacuation of residents on a regular basis. Records were available to confirm that since last inspection the Manager has carried out this practice. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 19 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 2 3 2 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 20 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 OP9 Regulation 13 Requirement The homes medication policy must be updated to reflect the home’s new system for disposal of medication The Registered Person must take immediate action to address the broken window restrictors and any other unrestricted windows on the first floor of the home The Registered Person must take action to address the windows in the home that don’t open The Registered Person must take action to ensure the safety and security of residents who are in bedrooms on the first floor of the home that have a door leading to a balcony The garden to the rear of the property requires attention to ensure safety and provide an attractive, accessible garden/seating area for residents The Registered Person must continue with the refurbishment of all bathrooms, toilets and showers • The rusty bath chair in the bathroom near to room 15 DS0000000184.V251023.R01.S.doc Timescale for action 30/03/06 2 OP19 13 18/01/06 3 4 OP19 OP19 23 13, 23 30/03/06 18/01/06 5 OP19 23 30/06/06 6 OP21 16, 23 30/07/06 7 OP21 16, 23 30/03/06 Linthorpe Nursing Home Version 5.1 Page 21 8 OP24 16, 23 9 OP24 16, 23 10 OP26 13 11 OP29 13 12 OP29 19 13 OP30 13, 18 must be replaced The ceiling in the bathroom near to room 22 must be repaired The Registered Person must continue with the plan of refurbishment in which to upgrade bedrooms in the home environment • Bedrooms 18 and 25 must be re-decorated • The carpets in bedroom 26 and 27 must be replaced The laundry requires refurbishment to ensure that floor finishes are impermeable and that wall finishing’s are readily cleanable The Manager must ensure that she explores any gaps in employment for newly appointed staff The Manager must ensure that she receives two written references, one being from the last employer for any new staff member prior to the commencement of employment The Manager must continue with her action plan to ensure that all staff receive mandatory training on a regular basis • 30/07/06 30/04/06 30/07/06 18/01/06 18/01/06 18/01/06 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. 2. Refer to Standard OP28 OP19 Good Practice Recommendations The Home Manager must continue with her action plan in which to achieve 50 of care staff trained to NVQ level 2 in care or equivalent Externally the home would benefit from re-painting and DS0000000184.V251023.R01.S.doc Version 5.1 Page 22 Linthorpe Nursing Home the woodwork requires attention and re-painting. Linthorpe Nursing Home DS0000000184.V251023.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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. 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