Inspection on 10/11/05 for The Lindens

This inspection was carried out on 10th November 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.

Other inspections for this house

The Lindens 19/11/08

The Lindens 20/06/08

The Lindens 25/06/07

The Lindens 31/01/07

The Lindens 01/08/06

The Lindens 19/04/05

The Lindens 24/09/04

The Lindens 04/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Lindens Stoke Hammond Bucks MK17 9BH Lead Inspector Christine Sidwell Unannounced Inspection 10th November 2005 09:30 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 The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Lindens Address Stoke Hammond Bucks MK17 9BH 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) 01908 371705 01908 375075 Mr Michael Hannelly Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 2005 Brief Description of the Service: The Lindens is a privately owned care home and is registered to provide residential and personal care for up to 17 older people. The home is situated in a rural area on the outskirts of the village of Stoke Hammond and is within easy distance of Bletchley and Milton Keynes. The home is a large detached Edwardian House set in accessible, extensive grounds. The house has been subject to a programme of refurbishment to comply with the current standards. All rooms are single and have en suite shower and toilets. Additional assisted bathrooms and toilets are provided. There are two good-sized social areas for residents on the ground floor. There is a team of carers who provide support to residents during the day and two staff awake at night to assist residents who may need help. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of an unannounced inspection, which took place on the 11th November 2005. Care plans, medication records, recruitment files and other records were examined. Care practices were observed. The staff who were on duty at the time were spoken to. All residents in the home at the time were seen and a number were spoken to. The purpose of the report was to assess compliance with requirements made at the previous inspection, undertaken on the 19th April 2005, and to inspect the core standards, which were not covered at that inspection. This report should be read in conjunction with the previous report. What the service does well: What has improved since the last inspection? There is now a consistent set of care plan documentation, which is organised in such a way as to make it easier for carers to meet the care needs of residents. There is a pre-assessment document, which guides the manager when assessing potential residents. The care plans could be further improved by ensuring that all residents have appropriate risk assessments. Residents are weighed regularly and appropriate action is taken if they are found to be losing weight. Recruitment processes have improved since the last inspection and the staff records seen showed that Criminal Records Bureau checks are now undertaken before a staff member begins work. The staffing levels have also been increased. The manager has now registered with The Commission for Social Care Inspection. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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 The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection but were met or almost met at the previous inspection. EVIDENCE: The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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): 7 and 8 The care plans have improved greatly since the last inspection and there is now a systematic set of documentation in place, which contains good information to guide carers and to ensure that residents’ needs are met. The manager and deputy manager have developed good working relationships with the local general practitioners and resident’s healthcare needs are met. EVIDENCE: Two care plans were selected at random and examined to assess compliance with the requirements of the previous inspection report that a systematic pre assessment should be undertaken and that a consistent set of documentation should be agreed and adhered to when planning resident’s care. A preassessment document has now been developed and both residents had been visited before their admission to the home to assess their needs and decide whether the home could meet them. The findings from the pre- assessment had been incorporated into the care plan. Each care plan had an index and had information relating to the resident’s daily needs and risk assessments. There is a need to ensure that individual risk assessments are undertaken for all residents in a systematic manner. Separate medical and healthcare The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 10 intervention records were kept. A separate night book is still maintained and the deputy manager said that she wished to maintain this. The daily entries were signed and dated by the carers. There was evidence that care plans are reviewed monthly and evidence that the care manager had held an annual review with one resident and his family. There was evidence that residents have a nutritional assessment and those residents who could stand on the weigh scales are now weighed regularly. One resident had lost weight and had been referred to her General Practitioner and was now taking food supplements. Her weight had stabilised. It is recommended that the home considers purchasing scales on which resident can sit to ensure that the weight of frail elderly residents can be monitored. There was evidence in the care plans that residents had seen members of the local primary healthcare team and had access to hospital care when necessary. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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 the following standard(s): 14 The home’s routines are flexible giving residents choice as to how they spend their day. EVIDENCE: Residents are able to bring their own furnishings to personalise their rooms and it was clear that many had done so. Two residents were spoken to and they both said that they had some choice as to when they got up and went to bed and to how they spent their day. Both said that they recognised that staff had other residents to care for and that they could not always do things when they wished. The staff endeavour to walk with residents in the grounds if they wish and to assist residents in choosing where they wish to sit. One resident had chosen to stay in her room. The manager said that all residents were on the electoral role. A poster was displayed in the home telling residents and their families of the local advocacy services. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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 the following standard(s): These standards were not assessed at this inspection but were met or almost met at the previous inspection. EVIDENCE: The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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 the following standard(s): 25 Water outlets do not have functioning thermostatically controlled valves and residents are at risk from scalds. EVIDENCE: All rooms are individually ventilated and have natural light. The rooms are centrally heated. In those rooms which have them, the radiators have covers. The storage heaters, however, have not yet been covered. The radiators in the downstairs lounges have yet to be covered. These were both requirements of the previous report and have not yet been complied with. An immediate requirement was left at the home that the remaining storage heaters and radiators are covered. Emergency lighting is provided in the home with the exception of the lounge and the dining room. The manager or proprietor must seek the written advice of the fire safety officer as to whether emergency lighting should be provided in these areas. A number of showerheads were not working on the day of the inspection and the maximum temperature of those that were working ranged from 35c to 55c. A requirement was made at the last inspection that all showerheads should be The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 14 repaired and maintained in safe working order. This has not yet been complied with and the showerheads do not appear to be fitted with thermostatically controlled valves to ensure that the water runs close to 43c. The water temperature at a number of sinks in resident’s rooms was unacceptably high and in a number of cases reached 85c, posing a real risk that residents may scald themselves. One resident’s water had been turned off in his bathroom as he had got into the bath unaided although he had not turned the taps on. Immediate requirements were made that the registered provider must fit thermostatically controlled valves to all water outlets to which residents have access and ensure that water is provided at temperatures close to 43c. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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): 27, 28, 29 and 30 The homes staffing levels are sufficient to meet current resident’s needs. The recruitment processes have improved and residents are better protected from being cared for by unsuitable people. The number of staff completing an induction programme and the National Vocational Qualifications in Care is insufficient to ensure that staff have the knowledge and skills to care for residents. EVIDENCE: A staff rota is kept. The deputy manager said that the staffing levels have been increased to 370 hours per week to better meet Department of Health guidelines. There are additional staff on duty in the mornings and two waking staff at night. There are no staff providing personal care under the age of 18 and all staff left in charge of the home are over 21. There are sufficient catering and domestic staff. Three of the thirteen carers hold the National Vocational Qualifications in Care at Level 2 or above. The home will not meet the standard that 50 of carers hold this qualification by December 2005. Two recruitment files of staff who had started work since the last inspection were inspected. Both had the required documents and a Criminal Records Bureau check had been undertaken on both members of staff before they had commenced work. Two references had been sought. However the reference form that is currently used by the home does not have a space for the signature of the person who is completing the reference. If a proforma is to be used, it must have space for the referee to add their signature and name and address and preferably their company stamp in order that the manager can be certain that the reference is genuine. There is an induction programme The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 16 although not all staff have completed this. There is a need to adopt a systematic approach to induction and to ensure that staff have the necessary skills before they commence work. Where external training is commissioned course fees are paid but staff have to undertake the training in their own time. This should be reviewed and staff should have al least three days paid training per year. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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): 31,32, 33 and 38 The manager and deputy manager are experienced and approachable, supporting staff to meet the needs of residents. The proprietor’s quality assurance processes are not robust enough to ensure that that all aspects of home management are dealt with in a timely way and to ensure that the views of residents and staff are taken into account. The home’s health and safety policies are not comprehensive and do not fully protect residents. EVIDENCE: The manager has had at least two years experience as a deputy manager and has now registered with the Commission for Social Care Inspection. She is currently registered for the National Vocational Qualification In Care and Management at Level 4. The registered manager and deputy manager are approachable and work alongside the carers. There are regular staff meetings and minutes are kept. Staff have input into the home although their suggestions and requests are not always acted upon. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 18 The quality assurance system is in need of development. The assistant manager from The Linden’s sister home in Stewkley visits residents on a monthly basis to speak to them about their care and these records are kept in the care files. Although improvements have been made to the home in the last year, there is no formal annual development plan. There is no annual internal audit of processes to ensure that the homes own standards are met. There is no systematic approach to obtaining the view of families and other stakeholders although there is a welcoming and informal approach to asking relatives if they are happy when they visit the home. Not all the requirements of the previous inspection had been met and the action plan submitted by the provider had not been dealt with. The registered proprietor does not send monthly quality reports to the Commission for Social Care Inspection, as he is required to do. Repairs to resident’s rooms are not always undertaken in timely manner The home’s Health and Safety policy file was not available for the inspector to see at the unannounced inspection. There are moving and handling policies although not all staff have had moving and handling training and those that have have not had annual updates. The fire safety logs were inspected. There is no fire risk assessment. There were records to show that a daily check of fire exits is undertaken and that the fire alarms are tested regularly. The emergency lighting is tested. The last fire drill was held on the 30.10.05 and staff had fire training undertaken by an external company on 7.06.05. The fire equipment and fire alarms have been maintained during the last year. There was no evidence that the boiler had been serviced recently and an emergency call out has been necessary. The manager reported that a Legionnaires assessment has been undertaken although the report was not available at the time of the inspection. There were a number of outstanding repairs. The ceiling in room 3 is in need of repair as is the wall in room 4. The middle floor bathroom ceiling is in need of repair. The kitchen was clean and tidy on the day of the inspection and cleaning schedules had been developed and implemented. Food temperature records are kept and refrigerator temperatures are recorded. No care staff have had food hygiene training although they all handle food. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 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 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x 1 x x STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 x x x x 1 The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes 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 OP7 OP25 Regulation 13 13 Requirement Individual risk assessments should be devised for each resident The written advice of the fire officer should be sought as to whether emergency lighting should be installed in the lounge and dining room. All storage heaters and radiators should have low surface temperatures or be protected by covers. All showerheads must be repaired and maintained in safe working order. (Previous timetable of 31/08/05 not met) A plan must be submitted which gives details as to which staff will be undertaking The national Vocational Qualifications in Care at Level 2 and when the proprietor expects to meet the standard that 50 of care staff hold this qualification. The person who is giving the reference must sign the reference. All staff must have induction training (Previous timescale of 31.07.05 not met) DS0000028059.V266127.R01.S.doc Timescale for action 31/03/06 31/01/05 3 OP25 13 31/12/05 4 OP28 18 31/01/06 5 6 OP28 OP30 19 18 31/01/05 31/01/05 The Lindens Version 5.0 Page 21 7 OP33 24 8 OP33 26 9 OP38 13 10 11 12 13 OP38 OP38 OP38 OP38 13 23 23 13 14 15 OP38 OP38 23 13 A systematic quality assurance programme must be implemented (previous timescale of 31.07.05 not met). The responsible individual must make monthly visits to the home and send a copy of his report to the Commission for Social Care Inspection on a monthly basis. Previous timescale 31.07.05 not met. All staff must have manual handling training with annual updates (Previous timescale of 31/07/05 not met). A health and safety policy file must be set up and available to carers. A fire risk assessment must be undertaken The boiler must be serviced. The report of the Legionnaires assessment must be sent to The Commission for Social Care Inspection The repairs identified in this report must be completed. All carers who handle food should have food hygiene training. 31/01/05 31/12/05 31/01/06 31/01/06 31/01/06 31/01/06 23/12/05 31/03/06 31/03/05 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 OP3 Good Practice Recommendations The proprietor should make a positive decision as to whether he wishes the home to offer care for service users with dementia and apply for a variation in registration accordingly. Consideration should be given to purchasing sitting weigh scales. DS0000028059.V266127.R01.S.doc Version 5.0 Page 22 2 OP8 The Lindens 3. 4. 5. OP12 OP16 OP29 It is recommended that the activities programme is developed and circulated to all residents. A record of informal and formal complaints should be kept and analysed to ensure that residents and staff views are acted upon Exit interviews should be undertaken with all staff who leave to ascertain the reason why and to improve the working lives of staff. The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 The Lindens DS0000028059.V266127.R01.S.doc Version 5.0 Page 24 - 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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