Inspection on 19/04/05 for The Lindens

This inspection was carried out on 19th April 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 10/11/05

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 Announced 19th and 20th of April 2005 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. The Lindens Version 1.10 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 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 Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24th September 2004 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 service users 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an announced inspection, which took place over two days. Records, policies and procedures were examined and staff and residents were spoken to. Comment cards were sent to the home, in advance of the inspection, for distribution to residents, their families and other interested parties. Five comments cards from relatives were received and two comment cards were received from healthcare professionals. What the service does well: What has improved since the last inspection? There have been a number of improvements since the last inspection. The medication administration system is improved and the home has secured ongoing advice from a local pharmacist. The relationships with local General Practitioners have improved and the local practice is now caring for a larger number of residents. The gardens are now secure and residents can walk safely in a part of the garden. Residents are protected by improvements in fire safety and food storage. The Lindens Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Lindens Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Lindens Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5 Overall the arrangements for admission to the home work well providing potential residents with information and the opportunity to visit the home before they decide to move. There is room for improvement in the homes preassessment protocols and staffing levels to ensure that the manager is confident that residents’ care and social needs can be met, before they move to the home. EVIDENCE: The statement of purpose and service user’s guide meet the requirements of the National Minimum Standards. Residents’ contracts were seen in their files and specified the room to be occupied, the overall care to be offered and the terms and conditions of occupancy. The manager said that residents were assessed prior to coming to the home, in order to ensure that the home could meet their needs. No records of the assessment of the most recently admitted resident were available. The home would benefit from a formal pre- assessment document to guide the manager or deputy manager in their assessment, to ensure that the facilities, staffing levels and expertise within the home are sufficient to meet the individual needs of residents. The Lindens Version 1.10 Page 9 A plan of care is developed with input from the resident or their relative. Where the local authority sponsors a resident, a care management assessment is in the individual’s record. The home is registered to provide care for frail elderly residents. There is an active training programme to provide staff with the knowledge and skills required to care for this group of residents. The home is not registered to care for the frail elderly resident who has dementia. There are currently a number of residents with short-term memory loss, although none present challenging behaviour. The home must continue to monitor the needs of those residents with short-term memory loss to ensure that they can continue to meet their needs. They must be proactive in warning both families and the social care teams if the condition of a resident deteriorates and the home can no longer meet their needs. Security has now been improved at the home to protect frail residents from leaving unnoticed. Trial visits are offered. The home does not take emergency admissions nor is intermediate care offered. The Lindens Version 1.10 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) 7,8,9and 10 The content of the care plans has improved since the last inspection, however they do not yet consistently provide staff with the information they need to meet the needs of the individual residents. Medication is managed well, protecting residents and ensuring that their medication needs are met. The manager and assistant manager are developing better working relationships with the local general practitioner practice, ensuring that the healthcare needs of the residents are met. EVIDENCE: The care plans have improved since the last inspection. The documentation however is muddled and there is a need to identify a common core set of documentation, which is easy for carers to use. A separate daily record book and separate records of healthcare interventions are kept in addition to the care plans. This means that individual residents needs may be documented in The Lindens Version 1.10 Page 11 a variety of files. The carers and residents would benefit from a more orderly co-ordination of the care planning documentation and a reduction in the number of files in which information is kept. Residents were well groomed and attention is paid to their personal needs. No residents had pressure damage. There are limited opportunities for physical activity, although two residents enjoy walking in the garden. Residents are registered with a General Practitioner and have access to the full services that are offered by the local General Practitioner and Primary Care Trust. The nutritional needs of the residents are identified and in most cases their weight is monitored. There is a medication policy. No residents self medicate and medication is not given covertly. Pre-packed, dosette medication administration systems are prepared by a local pharmacist, who also audits medication administration on a quarterly basis. The medication administration records are completed accurately. Staff are courteous and sought resident’s consent before giving care. There are no shared rooms. Five family members who returned the comments cards sent out as part of the inspection said that they were satisfied with the standard of care offered. The general practitioner who returned the comment card said that he was able to see residents in private and that his advice was incorporated into the service users plan. The Lindens Version 1.10 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) 12,13and 15 There is an activity programme in place, although this is inconsistent and does not meet the needs of the residents on a regular and reliable basis. The presentation and standard of food is high and meets the nutritional needs of the residents. EVIDENCE: Residents have a choice as how to spend their day, within the constraints of group living. Family members said that they could visit at any time and could see relatives in private if they wished. The residents’ rooms are personalised with their own belongings and those who were able to could maintain their hobbies. The standard of the food is high and mealtimes are an important part of the day. There is one full time cook and one part time cook, who has recently reduced her hours, providing insufficient cover if the full time chef is on holiday. In this event the care staff have to prepare meals. There is a choice of menu, most meals are “home cooked” and special diets can be catered for. The residents said they enjoyed their meals and lunch on the day of the inspection was tasty and nutritious. The Lindens Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 The policies and procedures to protect residents are in place, although the lack of entries in the complaints log gives rise to concern that a record of both formal and informal complaints is not being kept and the opportunity to improve the service for the benefit of service users is lost. EVIDENCE: There is a complaints procedure and a complaints log, although no entries had been made since 2002. It was a recommendation of the previous report that a record be kept of both formal and informal complaints. Four residents returned the questionnaire that was sent out prior to the inspection. All said that they were aware of the complaints procedure but had not had occasion to make a complaint. The Commission for Social Care Inspection has not received any written complaints in the last year although two anonymous contacts have been made. The home has a copy of the Buckinghamshire multi agency strategy for the protection of vulnerable people and the senior staff had received training in this topic. The manager said that all residents are on the electoral role. The Lindens Version 1.10 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,and 26 The accommodation is clean, tidy and well furnished, providing the residents with a comfortable and homely environment. The home has been adapted to meet the needs of the frail elderly although this could be further improved by adapting the bathroom on the top floor, to meet the needs of the residents on this floor. The unprotected storage heaters and broken showerhead pose a hazard to residents. EVIDENCE: The home is a three storey Edwardian building, which has been adapted for its present use. The rooms are spacious and light. The gardens have been made safe since the last inspection. The requirements made by the Fire Safety The Lindens Version 1.10 Page 15 Officer and the Environmental Health Officer have now been implemented. The communal space is well furnished and adequate for the number of residents. There are sufficient bathrooms and toilets. There are five rooms on the top floor with one bathroom that has not been adapted for use by the frail elderly and is therefore of limited use. It is recommended that this is adapted to meet the needs of the residents on this floor. There is a stair lift and disabled access to the building. There are no shared rooms and residents are encouraged to furnish the rooms with their own furniture and ornaments. All rooms are naturally ventilated and lit. Rooms are centrally heated by radiators or storage heaters. The radiators are covered and therefore residents are protected should they fall against them. The storage heaters are not covered and therefore pose a hazard. Thermostatically controlled valves have been installed to all water outlets. One showerhead was not working and is being repaired. The laundry is small and the driers are in a garage building in the grounds. The Lindens Version 1.10 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The procedures for the recruitment of staff are not robust and do not provide the safeguards necessary to protect the residents. The staffing levels, high turnover of staff and the lack of initial induction training does not provide continuity of care for the residents. EVIDENCE: The pre inspection questionnaire submitted by the home states that there are 326 staff hours provided and that at the time of the inspection seven residents had high needs, four medium needs and five low needs. This does not meet the recommendations of the Residential Care Forum guidance, which has been adopted by the Department of Health, which recommends 420 staff hours should be available. The staffing levels should be reviewed to more closely meet the recommendations of the Residential Forum. There are two waking night staff, which whilst satisfactory to meet the needs of 17 residents, can pose problems in a three storey building. There are 15 care staff and two have achieved the National Vocational Qualification in Care at Level 2. Fifteen staff members have left since the last inspection. There were no records of exit interviews and no records as to why there is such a high turnover of staff. There is an active recruitment programme. The recruitment files of the last three people to be employed were examined and did not have the required references, Criminal Records Bureau or POVA checks in them. There was also no proof of identification nor records of induction. They had not The Lindens Version 1.10 Page 17 had manual handling training. These staff members had commenced working in the home without these necessary checks being in place. The Lindens Version 1.10 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) 31,33 and 35 The number of managers that have been employed at the home since it opened and the fact that none have as yet registered with the Commission for Social Care Inspection does not provide continuity and security for residents. Whilst there have been improvements in the organisation and management of the home, which benefits service users, the inconsistent approach to quality assurance means that the proprietor and his team are reactive to problems rather than proactive in identifying issues which may effect the well being of service users. Overall the health and safety procedures are in place, although there is a need to ensure that all staff have manual handling training and a robust induction programme to protect both staff and residents. EVIDENCE: The Lindens Version 1.10 Page 19 The home has had a number of managers since it opened three years ago and as yet none have registered with The Commission for Social Care Inspection. The current manager was appointed in 2004. The deputy manager has recently transferred from night duty. Both managers are experienced carers and are undertaking the National Vocational Qualification in Care and Management at Level 4. The staff interviewed reported that the manager and deputy manager were approachable. The manager and deputy manager have improved the day-to-day care and medication practices in the home and the four relatives who returned the questionnaire, said that they were satisfied with the overall level of care provided. The home’s proprietor has an informal approach to quality assurance and visits the home frequently, although on an ad hoc basis, to deal with issues as they arise. There is little formal audit of procedure or documentation. He does not provide the Commission for Social Care Inspection with the monthly reports of his visits, as he is required to do by Regulation 26 of the Care Home Regulations 2001. There is no annual residents or family satisfaction survey, although the assistant manager of the home’s sister home reviews the care records, on a quarterly basis. The home manages small amounts of residents’ personal allowance where they are not able to do so themselves and this was seen to be managed well The requirements of the fire safety officer and the environmental health officer have now been complied with. Not all the staff have had manual handling training nor an induction programme. The maintenance records were seen and were up to date. The Lindens Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 2 3 3 1 3 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 1 x 1 x 3 x x x The Lindens Version 1.10 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. Standard 27 Regulation 14 Requirement A pre-assessment document should be developed to assess potential residents before they move to the home. A consistant set of care planning documentation must be agreed and adhered to. Residents must be weighed regularly and action taken if they are found to be losing weight. Sufficient catering staff should be employed to cover annual leave and to ensure that the cleaning schedules in the kitchen are maintained. All storage heaters and radiators should have low surface temperatures or be protected by covers. All shower heads must be repaired and maintained in safe working order. The staffing levels should be increased to provide a minimum of 370 care hours per week. A criminal records bureau check and POVA check must be applied for before a new staff member begins work. The POVA first check must be received before a new staff member begins work. Two references must be obtained Version 1.10 Timescale for action 30.06.05 2. 3. 4. 7 8 8 15 12 12 30.06.05 30.06.05 30.06.05 5. 25 13 31.08.05 6. 7. 27 29 18 19 31.07.05 Immediate 8. 29 19 Immediate Page 22 The Lindens 9. 29 19 10. 11. 12. 38 38 31 18 18 8 13. 14. 33 33 24 26 before a new member of staff commences work. The recruitment files must contain all the information specified in Schedule 2 and Schedule 4 of the Care Homes Regulations 2001. All staff must have manual handling training with annual updates. All staff must have induction training A manager must be appointed who seeks registration with the Commission for Social Care Inspection. Previous unmet requirement, timescale 31.12.04 not met. A systematic quality assurance programme must be implemented. 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 unmet requirement, timescale 31.12.04 not met. 30.06.05 31.07.05 31.07.05 30.06.05 31.07.05 31.05.05 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. 2. 3. 4. Refer to Standard 12 16 29 3 Good Practice Recommendations It is recommended that the activities porgramme 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 stafff who leave to ascertain the reason why and to improve the working lives of staff. The proprietor should make a positive decision as to whether he wishes the home to offer care for service users Version 1.10 Page 23 The Lindens with dementia aand appply for a variation n registration accordingly. The Lindens Version 1.10 Page 24 Commission for Social Care Inspection 8 Bell Business Park Smeaton Close Aylesbury Bucks 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 Version 1.10 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. 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