CARE HOMES FOR OLDER PEOPLE
The Lindens Market Square Haslingden Lancashire BB4 5PU Lead Inspector
Mrs Christine Mulcahy Key Unannounced Inspection 30th June 2008 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 DS0000071209.V363564.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 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 DS0000071209.V363564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Lindens Address Market Square Haslingden Lancashire BB4 5PU 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) 01623 473546 Mrs Roshni Moddia Mr Ragu Nachetram Moddia Care Home 15 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (12), Physical disability (2) The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP, (maximum number of places: 12) Physical disability - Code PD (maximum number of places: 2) Mental disorder, excluding learning disability or dementia over 65 years - Code MD (E) (maximum number of places: 1) The maximum number of people who can be accommodated is: 15 Date of last inspection Brief Description of the Service: The Lindens is registered with the Commission for Social Care Inspection to provide residential accommodation and personal care to 13 older people and 2 older people with a physical disability. The building is Grade 2 listed and accommodation is provided on two floors. There are 11 single bedrooms and 2 double bedrooms that can be shared. The first floor can be reached via a chair lift. There is a lounge dining area on the ground floor shared toilets and bathrooms are within short walking distance from bedrooms and communal areas. There are paved outdoor areas to the front and the rear of the home where the people who use the service can sit out in good weather. There is limited space for parking at the rear of the building. As the home is located in the town centre of Haslingden the residents have good access to nearby shops and local facilities such as public transport, the market, public houses, social clubs and the library. A copy of the homes Statement of Purpose and guide for people who use the service are available when people move into the home. The fee is £323.00 per week and there are no additional charges. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection included a visit to the home and took place on 30th June and 1st July 2008. Information was obtained from care plans, staff records, policies and procedures, management systems and observations of the care provided. The inspector also spoke to 7 of the people who live at the home, 5 care staff the homes registered manager and care manager manager. There have been no complaints received about the service since the last inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: What has improved since the last inspection?
The Lindens now has a new owner who has a clear understanding of the key principles and focus of the service. Since taking over the service in March both owners have work hard to improve services for the people who live there. They have already provide an improved quality of life for residents which focuses on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness.
The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 6 Residents have been consulted individually and in group meetings, about areas that affect their lives like the menu, activities, and equipment to promote their independence. Consultation has resulted in action to improve their accommodation and improve their living environment. The new managers have already identified and listed areas in the home that need immediate renewal. They have re carpeted eight of the 12 bedrooms with washable non-lip flooring to ensure comfort, safety and an odourless environment. Redecoration and replacement of old equipment continues throughout the home. There is a new hoist and a number of different sized slings to promote residents’ independence, safe working practices and health and safety regulations. Care plans and residents records are in the process of a full review and one care plan recently reviewed clearly focus on person centred care giving the residents more opportunity to shape their service and the way they want to live. The manager has strong values around the service being open and transparent in all areas of the homes management and delivery of care. All residents have undergone a continence assessment by the continence nurse and have received up to date hearing tests to improve communication. The existing service policies and procedures are still in use and both managers are working hard to ensure these are updated and reviewed to meet the National Minimum Standards and current thinking and practice. The staff team are much more positive about their roles and are given regular training. Staff also receives constructive feedback about their work through one to one supervisions and team meetings. This means that the staff are more aware of the philosophy of the home and are more confident putting theory into practice. Record keeping at the home has improved and the home’s financial and business plan shows regular financial investment. There is an improved quality monitoring system to ensure the efficient running of the home ensuring the best possible outcomes for the people who use the service. What they could do better:
New residents to the service must receive a full needs assessment before moving to the home so that residents and their relatives know that the home is able to meet their needs. Also staff know they have been trained appropriately, are competent and have the skills in place to meet these needs. Residents care plans must be generated from a needs assessment reviewed frequently and reflect their changing needs. The plan must set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the resident are met.
The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 7 The manager and staff must adhere to the homes medication policy and procedure and seek advice and information from the supplying pharmacist regarding medicine policies within the home and medicines dispensed for individuals in the home. Thorough deep- cleaning systems are in place to keep the premises free from offensive odours throughout the home. There must be a thorough recruitment procedure that operates to ensure the protection of the people who use the service. 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. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 8 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 DS0000071209.V363564.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents were admitted to the home without undergoing a thorough needs assessment done by a care manager or the home. EVIDENCE: Residents’ needs assessments had not been done for two people recently admitted to the home. The registered manager said that he was still waiting for the Local Authority care manager to forward one residents copy of the needs assessment to him. A self-funding resident was also admitted without a needs assessment. In both cases temporary care plans had been drawn up based on information from their relatives and the resident. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 10 This means that the care staff will not be able to fully meet the needs of these people because they have not been properly assessed to determine if the home can meet their needs. Also the staff do not know the full extent of the residents needs and cannot be sure if they are meeting these needs properly. Intermediate care is not provided at this home. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health care needs of some residents were not recorded in a plan of care. This means that the care staff could not meet these needs properly. Resident’s were protected by the homes medicine policies and procedures but some practices did not safeguard all residents. The principles of respect and privacy were observed. EVIDENCE: All residents at the home had a plan of care. During the inspection three residents care plans were examined and it was noted that each residents care needs were recorded differently. The care plans seen were basic but the manager was in the process of systematically reviewing each care plan to make them more person centred. The manager had devised a care plan based on his own assessment of one residents’ need following admission to the home in March. The care plan is
The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 12 hand written, detailed and comprehensive and looks at areas of need like communication, dietary needs likes and dislikes orientation morning activities, motivation personal care, general mood relationships hearing dental care, medication and general mood etc. The plan tells the reader how the resident behaves and what he likes and dislikes. It does not set out how to action these needs to ensure a good outcome. The care plan did not include a risk assessment to address his behaviour, or a falls risk assessment. The care plan of a resident who was being cared for in bed due to ill health was examined. The manager had arranged for the resident to have a profile bed and pressure-relieving mattress. This means that equipment necessary for the promotion of healthy skin and prevention of pressure sores is provided. Fluid intake and output charts were in place and the daily diary was being kept up to date. However the residents’ care-plan did not include any information relating to the residents recent poor health. This means that it could not be shown how the care staff were managing the residents care and what actions they were taking to ensure that all aspects of the residents health and personal care needs were being met. People who use the service have access to health care services within and out of the home. Those unable to access local services can have visits to the home by health care professionals and these visits were documented in the resident’s daily record books. Care plans examined showed that the District Nurse was involved in the care of some residents who needed regular wound dressing, catheter care or support for diabetes. This means that residents have access to appropriate specialists to promote their wellbeing. Resident’s individual daily records were completed at each shift change and care staff was observed doing this during the inspection. Inspection of the homes medicine policy and procedure highlighted that medicines were being transcribed and should have been dispensed by the supplying pharmacist following instructions from the GP. This means that some residents might be at risk of mis administration. The manager addressed this practice immediately and advised all designated care staff to ensure that GP changes to medication are always passed to the pharmacist for dispensing prior to administration. Medication records examined were up to date and all medication was stored securely and correctly. 70 of care staff is trained in the safe handling of medication. Screens were provided in all shared bedrooms and residents were observed being taken to their bedrooms by the District Nurse to receive personal care. This means that resident’s privacy is not compromised where personal care is being given or at any other time. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff practices respect the human rights of people using the service and promote their individual rights and choices. Systems in place consider residents needs and support them to make informed choices about activities, meals and visitors. EVIDENCE: Observations made throughout the day highlighted that residents were comfortable within their surroundings. Activities were always available to satisfy the social cultural and recreational needs of the people who use the service. One resident was seen reading a newspaper others were seen watching TV throughout the day. The manager had asked residents at the last meting for activity ideas and said that residents said they preferred to be left alone. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 14 When asked residents confirmed they preferred to be left to watch TV or read. One resident said, “I’m quite happy, I like to read the newspaper see what’s going on”. Visiting was flexible and relatives of the people who use the service were seen at various times during the day. Menus were changed regularly and residents had contributed to the recent menu review, which always included fresh meat and vegetables. “There is always a choice of meals” said one resident, “It’s good food here,” said another. Hot and cold drinks were available throughout the day and these were given out when needed. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints policies and procedures were available and gave clear guidance to those using them. Care staff knew when and who to report complaints and abuse allegations to. EVIDENCE: The homes complaints procedure specifies how complaints can be made and who will deal with them. There is an assurance that complaints will be responded to within a maximum of 28 days. When asked one resident said that he knew who to talk to if he had a complaint. He said, “I’d talk to the people in charge if I wasn’t happy with something”. Care staff was confident that complaints would be taken seriously. One said, “The new managers are very thorough”. Care staff knew how to report incidents and allegations of abuse and knew where to find information on this matter. 70 of the care staff are trained in safeguarding adults. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new decoration improvement programme ensures the home provides a safe well-maintained environment appropriate to the needs of the people who live there. Carpets at the entrance of the home would benefit from a programme of deep cleaning to ensure a fresh smelling environment. EVIDENCE: The home provides a physical environment appropriate to the people who live there. It was apparent that the new manager had made much needed improvements to the resident’s living environment to ensure they were more comfortable in their home. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 17 A planned schedule of work is being followed and includes decoration of the main communal areas, recent purchases of new bedroom carpet and non-slip washable floor covering in 8 bedrooms, a new hoist with a selection of slings. The new manager said that he is planning to reinstate the unused shower room and has had quotes to provide a new bath that will better meet the residents needs. All bedrooms were fitted with locks suitable for resident’s capabilities and people who use the service are encouraged to personalise their bedrooms with their own possessions. Bathrooms and toilets are located near to bedrooms. The home was clean and tidy but would benefit form a programme of deep cleaning to eradicate the malodorous smell when entering the home. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care staff are qualified and competent to meet the needs of the people who use the service. The residents were not fully protected by the recruitment and induction practices. EVIDENCE: Examination of the staff rota showed there were enough staff on each duty to meet the resident’s basic needs. Both managers are now part of the duty rota ensuring best practice at all times. The manager recognises the importance of training and tries to support the staff development by encouraging staff training where necessary. Training for staff in health and safety topics was sufficient and a majority of care staff are trained to NVQ level 2 or 3 in care and mandatory training in dementia care. Case tracking and examination of staff records confirmed that the service has a recruitment procedure that meets the regulations of the National Minimum Standards. However the manager had not carried out appropriate safety checks before employing a new care staff and this was highlighted to the manager during the inspection. This means that residents were not fully
The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 19 protected by the recruitment procedure. This was highlighted at the last key inspection. Discussion with three care staff confirmed they were very happy with the new managers and felt more supported by them than previously. One said, “We’re really happy now, things here are much better”. Another said, “They are very good managers we get a lot more support”. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service policies and procedures ensure safe working practices, are effective and are reviewed regularly. Management processes ensure that staff and residents views are known through appropriate forums. EVIDENCE: The registered manager has the required qualifications and experience and is competent to run the home and ensure processes of the National Minimum Standards are met. He is aware of the need to keep up to date with practice and has already arranged and delivered training for the staff team. When asked about the manager care staff said they were more than confident about his abilities.
The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 21 The manager has developed an annual development plan and there are satisfactory mechanisms for auditing and developing the new care plan system to ensure it could properly identify the resident’s needs. Residents’ finances were managed and recorded correctly. The amount held for 1 resident was checked against the records and found to be correct. The money was kept securely. Supervision was being done regularly for staff. A record of this was seen in one staff file examined. Staff and residents meetings were being held frequently and notes of the meetings were examined. This means that the views of the residents and staff are taken seriously and influence the way the home is run. The homes policies and procedures are being reviewed along with the statement of purpose to help improve and develop the service. The manager is aware that more work is needed in this area to meet the homes philosophy, aims and objectives. The manager has great enthusiasm for the role and this reflects in the attitude and manner of the staff team towards the residents. Care staff work to a clear health and safety policy. All staff are fully aware of the policy. The home has access to professional business and financial advice and has all the necessary insurance cover to enable it to fulfil any loss or legal liabilities. The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 22 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 1 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 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 Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14(1) Requirement New residents to the service must receive a full needs assessment before moving to the home so that residents and their relatives know that the home can meet their needs. Residents care plans must be generated from a needs assessment that is reviewed frequently reflect their changing needs and include a risk assessment. The manager must ensure that staff adheres to the homes medication policy to prevent mis administration. Thorough deep- cleaning systems are in place to keep the premises free from offensive odours throughout the home. There must be a thorough recruitment procedure that operates to ensure the protection of the people who use the service.
DS0000071209.V363564.R01.S.doc Timescale for action 14/07/08 2 OP7 13(4) 14/07/08 3 OP9 Sch 3 17(1) (a) 13(2) 16 1 (K) 14/07/08 4 OP26 14/07/08 5 OP29 Sch 2 Reg 7, 9, 19 14/07/08 The Lindens Version 5.2 Page 24 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 The Lindens DS0000071209.V363564.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@csci.gsi.gov.uk Web: www.csci.org.uk
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