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Inspection on 25/08/05 for Linthorpe Nursing Home

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

This inspection was carried out on 25th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Residents spoken to during the inspection said that they were happy and that they received a good standard of care. One resident said, " The staff are lovely, I couldn`t fault anybody" another said, "The staff are very good and very helpful. Relationships with families of residents are very good and visitors are made to feel welcome at any time.

What has improved since the last inspection?

The Manager has commenced a programme of refurbishment in toilets, showers and bathrooms areas within the home, improvement was noted in respect of the standard of cleanliness within these areas. The home`s complaint system has also been developed further to ensure that all complaints are recorded individually and as such ensures confidentiality and data protection

What the care home could do better:

A large number of requirements identified at the last inspection in December 2004 have failed to be addressed. A discussion has taken place with the Manager and Responsible individual to ensure that immediate action is taken to address outstanding requirements. The home`s medication policy/procedure requires updating to reflect new systems that are in place at the home. The home must purchase a fridge in which to store medication. Action must be taken to ensure that fires in the home are guarded appropriately to ensure safety of residents.

CARE HOMES FOR OLDER PEOPLE Linthorpe Nursing Home 36 Eastbourne Road Linthorpe Middlesbrough TS5 6QW Lead Inspector Katherine Acheson Unannounced 25 August 2005 10:40 am 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. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Linthorpe Nursing Home Address 36 Eastbourne Road Linthorpe Middlesbrough TS1 6QW 01642 850032 01642 82409 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) Linthorpe Private Nursing Home Mrs Carol Breeze Care Home with Nursing 30 Category(ies) of Old age (OP) 0 registration, with number Physical disability (PD) 0 of places Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 08/12/04 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 B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection started at 10.40 am and lasted for six hours. During the inspection five residents and one relative were spoken to. Staff members were spoken to informally and a discussion took place with the Manager. Numerous records including care plans, policies/procedures maintenance and staff records were examined. A brief tour of the premises was carried out. A frank discussion also took place with the Manager and Responsible Individual of the home in respect of the large number of requirements highlighted at the last inspection that have not been addressed. What the service does well: What has improved since the last inspection? The Manager has commenced a programme of refurbishment in toilets, showers and bathrooms areas within the home, improvement was noted in respect of the standard of cleanliness within these areas. The home’s complaint system has also been developed further to ensure that all complaints are recorded individually and as such ensures confidentiality and data protection Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 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 B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 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 Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 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) 2, 3, 6 Appropriate assessments of prospective residents are carried out to ensure that the home can meet the needs. Residents and/or their families are issued with a contract and as such are aware of the home’s terms and conditions of admission. EVIDENCE: Before moving into the home, prospective residents receive an assessment that is carried out by a Social Worker or other Health Care professional to ensure that the home can meet their needs. The home does not carry out their own pre-admission assessment. The Manager said that the home receive this assessment prior to admission, staff then review the assessment and determine if the care needs of the person can be met. Records were available on residents files examined during this inspection to confirm that this is the case. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 9 Residents files examined conditions/contract. also contained a statement of terms and The home does not provide intermediate care. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The home provides a good standard of care to residents and ensures that the health, personal and social care needs are met. Arrangements for dealing with medication are appropriate for the needs of the residents and are managed in a safe manner, however, the home’s medication policy/procedure requires further development. EVIDENCE: Two residents plans of care were examined during this inspection. Care plans were found to be comprehensive, well presented and individual to the needs of the resident. Files examined contained a record of visits carried out by chiropodists, G.P’s, opticians and other health care professionals. Care plans examined contained signatures of residents or their family to confirm that they had been involved in drawing up the plan of care. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 11 Residents spoken to during the inspection confirmed that they were well cared for and treated with respect and dignity. One resident said, “ The staff here are so kind, I love the people they do their best for you”. Another resident said, “The Manager and staff are very supportive”. The home has a policy/procedure in place in respect of medication, however, this needs to be updated to reflect the home’s new systems for ordering and administration of medication. The home keeps a record of medication ordered for each resident and that returned to pharmacy. Records examined indicated over ordering of some prescription medication for residents, the Manager said that this would be rectified by the introduction of the home’s new monitored dosage system. It was highlighted at the last inspection in December 2004 that the home must obtain a medication fridge in which to store medication. The Manager said that she did purchase a fridge, however it has since broken. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Activities in the home environment are limited, however, do enhance the lives of the residents residing at the home. Resident’s lives are enhanced by the welcome that the home extends to its visitors. The food provided by the home is varied and enjoyed by most residents EVIDENCE: The home does not employ an Activity Co-ordinator, however, the Manager said that activities are carried out on a regular basis by Care Assistants that work at the home. Staff at the home spoke of bingo, cards, a monthly gentle exercise class and a recent trip out to Redcar. One resident interviewed during the inspection said, “I like The Evergreens, they come in to sing and entertain us three to four times a year and the gentle exercise classes are very good”, the same resident said, “I enjoyed the recent trip to Redcar, I am waiting to have my photographs developed. Another resident said, “I choose not to join in the activities, I like to watch the television and read my paper”. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 13 Residents spoken to during the inspection said that activities were limited due to the limitation and frailty of the residents residing at the home. Residents interviewed spoke of flexibility in routine and freedom of choice. Contact with family and friends is encouraged and visitors were made to feel extremely welcome. One resident said, “My family visit me a lot, and often take me for a walk out”. The Manager said that the home support residents to practice their religion and that visits from clergy are available to the home, residents spoken to confirmed that this was the case. The home operates a four-week menu plan with an alternative choice offered at each mealtime. Records were available to confirm that appropriate temperature checks are carried out on fridge and freezers. Temperature checks were also recorded of food that is served to residents. One resident spoken to during the inspection said, “I like the food it is very good”. Another resident spoken to during the inspection said that she did not like all of the food that was prepared at the home, however said, “I’m only fussy, food is there for you if you want it and there are choices available. The home do try an accommodate me” Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff are trained in adult protection, however, the homes policy procedure in respect of adult protection requires further development to ensure that staff are aware of procedure to follow if abuse is suspected. EVIDENCE: This standard has been inspected at previous inspections it was highlighted that the home’s adult protection policy/procedure required further development; this had not been carried out. The Manager said that staff at the home had received training in respect of adult protection. She said that staff had watched a video on different types of abuse and that this video included steps that staff should follow if abuse is suspected. After the video the Manager said that she was involved in a discussion with staff to clarify points covered and answer any queries. Certificates of this training and the content were not available on staff members files. Standard sixteen was not inspected in full, however, it was highlighted at the last inspection that the Manager must develop a system in which to record complaints individually, this had been addressed. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: The above standards were not inspected in full, however requirements highlighted at the last inspection in December 2004 were re-visited, a number of which had not been addressed and are highlighted in the requirements section of this report. A brief tour of the premises was carried out in order to re-visit previous requirements, this tour identified a number of areas in the home environment, communal and bedroom areas that were in need of refurbishment and renewal of furniture. It was highlighted at the last inspection that fires in the home environment must be guarded to ensure safety of residents; this had been carried out, however the guards were not high enough to cover all of the fire and ensure safety of residents. The Manager said that she would take immediate action to address this. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 16 During the inspection a frank and firm discussion took place with the Manager and Responsible individual of the home in respect of this. The Responsible Individual agreed to take immediate action to plan a programme of refurbishment and renewal of furniture. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) EVIDENCE: The above standards were not inspected in full, however requirements highlighted at the last inspection were re-visited and as yet had not been addressed. Details of outstanding requirements are documented in the requirements section of this report. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 18 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) 35, 36, 38 Staff do receive training relevant to the job that they do, however, moving and handling and first aid training is out of date for some staff and as such does not ensure safety of staff and residents. Formal supervision of staff is also not carried out as often as it should be. Fire practices, including evacuation of residents has not taken place and as such does not ensure that safety of residents is promoted and protected. Systems are in place to ensure resident’s money is managed appropriately. EVIDENCE: The home operates an effective system in which they look after the personal allowance of a number of residents. Records of transactions and receipts were available for examination. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 19 It was highlighted at the last inspection that staff should receive formal supervision on a regular basis, although supervision is taking place it is not as often as it should be. The home operates a rolling programme of servicing appliances and equipment. Records examined at random confirmed that the homes fire extinguishers, fire alarm, gas boilers, emergency lighting and portable appliance testing are serviced on a regular basis. Records were available to confirm that the fire alarm system is tested on average weekly and that water temperature checks are also carried out. It was highlighted at the last inspection in December 2004 that the home must carry out fire drills that includes evacuation of residents from one zone to another, this had not been addressed. The Manager said that she has spoken to the Fire Safety Officer for the home and that he is to oversee an evacuation process. Records of staff fire training were available for inspection Records were available to confirm that some staff have received training in respect of moving and handling, however other staff’s moving and handling training was out of date. Training in respect of first aid was also observed to be out of date. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x 3 2 x 2 Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP9 OP9 Regulation 13 13 Timescale for action The homes medication policy 30th must be reviewed and updated October 2005 The home must obtain a fridge in 30th which to store medication September 2005 An appropriate area must be identified for the storage of the medication fridge Temperatures of the medication fridge must be recorded on a daily basis The homes adult protection policy requires further development (Previous timescale for action of 30th September 2004 not met) Certificates or proof/evidence of training must be available on staff members files Fires in the home environment must be guarded to ensure safety of residents The Registered Person must plan a programme of refurbishment and for the renewal of furnishings within the home environment (Previous timescale for action 30th April 2005 not met) Requirement 3. OP18 13 30th September 2005 30th September 2005 Immediate 30th September 2005 4. 5. 6. OP18 OP20 OP20 17 13 16, 23 Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 22 7. OP21 16, 23 8. OP21 13 9. OP26 23 10. OP28 19 11. OP30 13, 18 12. OP29 17 13. OP36 18 14. OP38 13, 23 The Registerd person must continue with the refurbishment and re-decoration of bathrooms, toilets and shower areas (Previous timescale for action of 30th April 2005 not met) Exposed hot water pipes must be boxed in to ensure safety of residents (Previous timescale for action 30th January 2005 not met) The flooring in the laundry must be replaced (Previous timescale for action of the 30th March 2005 not met) Copies of certificates in respect of those staff who have achieved and NVQ must be available within the staff members file (Previous timescale for action of the 30th January 2005 not met) The Manager must ensure that all staff receive mandatory training on a regular basis (Previous timescale for action of the 15th February 2005 not met) Records as required in schedule 2 and 4 of the Care Homes Regulations 2001 must be on each staff members file (Previous timescale for action of the 30th September 2004 not met) The Home Manager must ensure that all care staff receive formal supervision at least six times a year. The home must carry out fire drills that includes evacuation of service users from one zone to another (Previous timescale for action of 30th January 2005 not met) 30th December 2005 30th October 2005 30th October 2005 30th September 2005 30th October 2005 30th October 2005 30th October 2005 Immediate Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 23 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 develop an action plan in which to achieve 50 of care staff trained to NVQ level 2 in care or equivalent by 2005 The fence to the rear of the property would benefit from staining· Externally the home would benefit from re-painting and the woodwork requires attention and re-painting. Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit B, 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. Extracts may not be used or reproduced without the express permission of CSCI Linthorpe Nursing Home B51 B01 S184 Linthorpe Nursing V246332 250805 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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