Inspection on 27/03/08 for Saint John of God Care Services Lindisfarne

This inspection was carried out on 27th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Saint John of God Care Services... 03/03/09

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Saint John of God Care Services Lindisfarne Lindisfarne Court Haughton Village Darlington Durham DL1 2DZ Lead Inspector Mary Blake Key Unannounced Inspection 27th & 31st March 2008 09:40 Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 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 Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 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 Adults 18-65. 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. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Saint John of God Care Services Lindisfarne Address Lindisfarne Court Haughton Village Darlington Durham DL1 2DZ 01325 365428 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) lindisfarne@sjogcareservices.org.uk www.sjog.co.uk Saint John of God Care Services Vacant Care Home 13 Category(ies) of Physical disability (12), Physical disability over registration, with number 65 years of age (1) of places Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th July 2006 Brief Description of the Service: Lindisfarne Court is a care home providing personal care and accommodation for up to 13 people with physical disabilities. Lindisfarne Court is one of a number of care homes and care services throughout the country opened by the Hospitaller Order of Saint John of God. Lindisfarne Court was purpose built as a care home. It comprises 3 inter-linked bungalows, all suitably equipped to meet the needs of people with physical disabilities. All bedrooms are for single occupancy and are suitable for people who use wheelchairs. Two bedrooms have en-suite facilities. From information provided by the home, the current charges for staying at Lindisfarne Court range from £800 to £1,404 per week. The service user guide, statement of purpose and last inspection report are available at the main office. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on 16th July 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals, including surveys. The Visit: An unannounced visit was made on 27th March 2008 and a further visit was made on 31st March 2008. During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the manager what we found. What the service does well: Staff were kind and considerate when helping residents. Residents and relatives explained the admission process; this usually includes a visit from the manager. This helps new residents identify their own needs and enables staff to meet their needs during their stay. The service gives good support to enable individuals to make decisions and participate in the running of the home. The service gives good support to enable individuals to identify and access health care. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 6 The service gives good support to enable individuals to maintain and develop personal and family relationships and provides support to help deal with change. The home and organisation has good systems to enable residents to share their views and they continue to look at ways of involving residents and improving individualised services Residents said, and it was seen, that staff were kind, considerate and supportive. There is a complaints procedure and in addition resident views are actively sought. Residents felt their views were listened to and acted upon. The acting Manager has addressed all of the previous requirements and recommendations. What has improved since the last inspection? What they could do better: To continue to develop the care plans to make them all more user friendly as this will increase residents/family involvement. To consult with the pharmacist and GP to clarify the medication issues (identified and given to the acting manager). This will help protect residents. To continue to develop the staff training programme. This will enable the manager to have an overview of staff skills and knowledge and help them to provide individual care for residents. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 7 Internal quality assurance audits to be reviewed and undertaken consistently. This will help protect residents, relatives and staff. The fire safety testing and fire drills must be undertaken at the recommended timescales as this helps protect residents, relatives and staff. 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. The summary of this inspection report can be made available in other formats on request. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home are appropriately managed and residents know how their needs will be met. EVIDENCE: Lindisfarne Court is registered to accommodate up to thirteen people with physical disabilities. On the day of the inspection twelve people were living there, with a new person about to become resident after completing the preadmission process. As part of this process the resident had visited the home, with their relatives, had meals, stayed overnight and met other residents and the staff. In this way they got to know the home before moving in. Lindisfarne Court has a Statement of Purpose and a Service Users’ Guide to provide service users and potential service users with information about the home. All service users have been provided with a ‘Licence Agreement’ in a pictorial format, which sets out the terms and conditions of their occupation of the home. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are fully consulted about and enabled to participate in decisions about their lives. Their needs are met, though this is not always evident in their care plans. EVIDENCE: The care plan format is currently being reviewed and updated. The quality of the information was not consistent. On sampling the plans in the new format these were found to be comprehensive care plans that assist residents to receive the care they need. The acting Manager had ensured that all recorded information is reviewed and summarised on a monthly basis and that all residents will have the new format care plans. There is good liaison with supporting professionals. Professionals comments include: “Lindisfarne Court provide a good service and cares for the needs of the people” “Provide overall care to a high standard” “worked really well to Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 11 meet my clients needs and work with the family” “individual choice and support is a priority”. The residents have had the opportunity to participate in the selection of staff. Regular residents meetings are held. Pictorial questionnaires are used to obtain the views of residents who cannot verbally communicate. There is good advocate support. Risk assessments were in place but some had not been consistently reviewed and updated. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are part of the local community and participate in leisure activities. They have personal and family relationships and their rights are respected in their daily lives. They are offered a healthy diet and a relaxed and social mealtime. EVIDENCE: Residents are offered the opportunity to join in a range of social and leisure activities. Residents have the opportunity to use community facilities for leisure activities e.g. cinema, pub, meals, shopping etc. They are offered the opportunity to experience new activities and leisure pursuits as well as supported where necessary to continue with hobbies and interests. There had been issues raised about day care. Advocates commented “while considering others I feel more effort could have been made around getting more day activities for my client”. This had been addressed. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 13 Staff assist and encourage residents to maintain family links and previous friendships, respecting the individual resident’s wishes. Advocates commented “Strenuous efforts had to be made by Lindisfarne Court to find a solution to enable my client to remain in touch with family and ensure continuity for him” Staff support residents to maintain existing friend and social relationships. Staff seek permission prior to entering individual rooms and were communicating well with residents. Residents were observed to move freely around the bungalows. Residents had recently been involved in the review of menus and commented on the quality and choice of food available. Residents were observed having a leisurely breakfast, coffee and lunch in a relaxed and social setting with good staff support evident. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents receive personal support the way they prefer and their physical and emotional health needs are met. They are protected by the homes policies and procedures in dealing with medicines. Ageing, illness and death are handled with respect. EVIDENCE: Information from residents, acting manager, staff, supporting professionals and relatives showed that residents, who require personal support, are given this in a way that protects their dignity and maximises their independence. Residents are given personal choice and support in areas such as getting up, personal care and how they spend their time. Residents’ individual health needs are identified and residents are supported to access community health services such as doctor, district nurse, dentist, and optician. All residents have an annual health check. Staff are particularly skilled in identifying health needs considering some residents are unable to verbalise Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 15 any problems. Supporting professionals commented, “Staff are very aware of any changes and seek support” They receive physiotherapy, psychiatry and psychology health support. Staff training has been undertaken to provide awareness and additional support for health related needs. No residents currently self medicate. The ordering, storage, administration and disposal of medication was satisfactory and had been reviewed by the pharmacist. Issues identified in relation to medication no longer required were identified and it was agreed that the acting manager would address with the local pharmacist and GP. The changing needs of a resident have been well managed over the past year. Staff have provided additional support, sought professional advice and accessed appropriate aids/adaptations as necessary. Staff have dealt sensitively with the recent changing needs and death of a resident and have provided support to all residents and families. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives and residents views, where able to express, are listened to and acted upon are they are protected from abuse, neglect and self-harm. EVIDENCE: There have been no recorded complaints since the previous inspection. A complaint procedure is in place. Residents spoken to felt confident that their views would be listened to and acted upon if necessary. Staff have undertaken the one day training on the Protection of Vulnerable Adults with further training planned for April. Staff were aware of the whistle blowing policy and felt able to raise concerns if necessary. The acting manager was aware of the need to protect all residents and seek support if dealing with verbal or aggressive behaviours. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The facilities are designed to meet resident’s needs. It is homely, well maintained and clean. EVIDENCE: Lindisfarne Court was purpose built, to a high specification, as a care home to provide personal care and accommodation for up to thirteen people with physical disabilities. The home’s three inter-linked bungalows were designed to accommodate people who use wheelchairs. Each bungalow has a large lounge, kitchen-dining room and a conservatory. One of the home’s three conservatories has been furnished with sensory equipment. Furniture in hallways and corridors provides additional communal areas. The layout of the home is spacious for wheelchair access. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 18 Lindisfarne Court is comfortable and attractively furnished. Residents’ bedrooms are well presented and reflect their individual styles and tastes. The home has sufficient and suitably equipped bath / shower rooms. The home’s two bathrooms have been adapted and new tracking installed with a third about to be fitted. The home was very clean and tidy. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are adequate numbers of appropriately skilled and experienced staff to care for the residents. The recruitment processes in place protect residents. EVIDENCE: Staffing rotas showed that there are now enough staff on duty to meet the necessary staffing levels and that the previous issues with staff turnover is being resolved. The number of staff employed has increased from nineteen to thirty and the acting manager has changed how they are deployed. The following staffing is in place: Two support workers are available for each bungalow during the day with two waking night staff now in place. There is additional management support. Comments received from relatives six months earlier highlighted staffing issues: “There is an ongoing issue regarding staff shortages” “There seems to be sometimes a disregard to what the residents want as in the last five years the home has remained static” “They look after my grandson very well. They adore him” “I think they could have more staff to help care for people” “They Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 20 work very hard” “Find a way to keep staff from leaving”. The manager has made good progress in addressing these issues. Recruitment procedures within the home are safe. Records confirm that appropriate checks are carried out for all staff. Applicants for employment complete an application form and 2 references are obtained. A reference from the last employer is requested, plus another. Any gaps in employment are explored at interview. Each member of staff receives a contract of employment and job description. Staff undertake mandatory training, National Vocational Qualifications in Care and other training. This was clarified from the sample of records inspected and discussions with staff. Discussions with the acting Manager and staff and examination of individual staff training files confirmed that staff had undertaken refresher in mandatory training. Staff said that they are undertaking or had completed National Vocational Qualification in Care level 2 (NVQ) or over, with fifteen staff having NVQ 2 or above. The home has an induction programme and the acting manager is currently developing the training programme for all staff working in the home. Staff spoke knowledgably about the individual needs of residents. Staff meetings are used to provide additional in-house training. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The view of residents and their families and supported underpin the development of the home, but their health, safety and welfare are not always protected. EVIDENCE: The new manager has been in post since the turn of the year and has not yet completed the fit person process with CSCI. There have been a number of managers in recent years and this was commented upon by residents and relatives “Yet another new manager” “so it means all change yet again “Issues raised are rearing their heads again, no one seems to know who is responsible for what” “This is most important need a vision to move forward” Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 22 Observations of staff and residents showed that they felt confident with the openness and approachability of the acting Manager. The acting Manager is qualified and experienced and communicates a clear sense of direction and leadership and has already implemented positive changes. For example new bathing/tracking, new format care plans, re-establishing of resident meetings. In house quality audits were comprehensive but these were not carried out consistently with gaps where health and safety checks e.g. fridge temperatures and bed rails safety had not been undertaken over six month period. Fire system testing and fire drills were not being carried out sufficiently, with gaps over a six month period. The Fire Officer recommendations had not been fully met. The acting Manager was made aware of these concerns at the first visit and had began to address them as a matter of urgency. Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 4 2 X 2 X X 2 X Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 24 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 2 3 4 Standard YA6 YA20 YA35 YA37 Regulation 15 13(2) 18 8 Requirement The provider to ensure that all service user plans are updated and reviewed The manager to address this medication issues identified during the inspection The manager to prepare and forward a staff training programme to CSCI The Registered Provider must submit an application for the registration of the new manager The provider to undertake a review of internal quality assurance audit systems The manager to review fire system testing and fire drills to ensure they are carried out at the recommended timescales Timescale for action 01/07/08 01/06/08 01/06/08 01/05/08 5 6 YA39 YA42 24 23(4) 01/07/08 01/05/08 Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Saint John of God Care Services Lindisfarne DS0000068411.V360658.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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