Inspection on 26/01/09 for The Lindons

This inspection was carried out on 26th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lindons 12/03/08

The Lindons 07/01/08

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Lindons 120 Ashburton Road Newton Abbot Devon TQ12 1RJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrea East     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: The Lindons 120 Ashburton Road Newton Abbot Devon TQ12 1RJ 01626368070 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): info@newcaredevon.co.uk Lindons Care Home Ltd Name of registered manager (if applicable) Mrs Theresa Pepperell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 25. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability - aged 65 years or over on admission (Code PD(E)) Dementia (Code DE) Date of last inspection Brief description of the care home The Lindons is a detached property set about a mile away from the centre of Newton Abbot, near to a bus stop and with parking facilities to the front of the property. `Lindons Care Home Ltd?, are the registered Company for the home with the responsible individual named as Mr Nathan Ost and a registered manager Theresa Care Homes for Older People Page 4 of 29 care home 25 Over 65 0 25 25 25 0 0 Brief description of the care home Pepperelle. The home provides care for up to twenty- five older people with physical and mental frailty. The accommodation provided varies in size and shape with some rooms used as doubles for shared occupation. The home has a lounge, conservatory and dining rooms and has a chairlift to access the first floor rooms. Fees are charged weekly; at present fees range between #372 and #475 per person. The homes service users guide had been finalised and was displayed in the hall. The inspection report was displayed in the staff room. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection site visit was carried out over a day. A range of documents including staff and individuals files and policies and procedures were examined. People were spoken with in the homes lounge and private rooms and members of staff were also spoken with. The homes manager and the consultants acting on behalf of the responsible person were present throughout the inspection. The homes annual quality assurance surveys and a range of documents were also looked at and some of the information contained Care Homes for Older People Page 6 of 29 in those documents have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: Care planning and assessment while improved could be further improved by ensuring all documents are dated and signed and are detailed enough to ensure staff have all the information they need to meet peoples needs. Care plans and assessment should also be extended to ensure all informal and formal activities are recorded. This will help to ensure that everyone has an opportunity to take part in some kind of social and recreational activities. The recruitment process should be consistently followed for all staff so that everyone has up to date references and police checks. This will make sure that only staff suitable to work with vulnerable people are employed at the home. Medication administration and recording must be improved to ensure all medications given are fully recorded and when medication is not not given the reasons for this are clearly recorded. This would help to ensure people have the correct medication to meet their health needs. Care Homes for Older People Page 8 of 29 Concerns and complaints should be fully recorded and the complaints procedure updated to include the action to be taken if a possible abuse issue is raised. This will ensure the manager has the information needed to monitor concerns and improve areas that may have raised concerns. Extending policy documents provides staff with the information they need to care for people safely. The quality assurance system being introduced should include peoples views and ideas for how the service could be improved. This will help to provide services that meet peoples needs and expectations. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service can be confident that their care needs will have been assessed and agreed, so that their needs can be fully met right from the start of the service. The services provided to not include intermediate care Evidence: A service users guide which included a statement of purpose was available to people using the service and or their relatives and advocates. A copy of the newly updated guide was displayed in the hall and available on request. The manager confirmed that everyone in the home had received a copy of the new service users guide. The manager also said that people received a letter confirming the Care Homes for Older People Page 11 of 29 Evidence: services that could be provided and welcoming people to the home. Six out of eight surveys from the people living at the home said that they received enough information about the home, before they moved in. So that they were sure it was the right place for them. Three peoples files containing assessment and admission information were examined. Assessment records have continued to be extended since the last inspection, so that they contained more information on peoples individual needs. This included information on peoples nutritional requirements, how they should be assisted in moving around in the home and any concerns about skin care and areas of skin breakdown. A basic admission form continued to be completed for people arriving at the home and this was supported by information received from outside professionals such as social service assessments and the newly extended assessment format of the homes. The manager said that a senior member of staff would visit people in their own homes or in other settings such as in hospital so that the assessment of peoples needs could start before people moved into the home. The manager supported by a consultant were also exploring ways to further extend assessment documentation to ensure that social histories and personal stories were included in information for staff. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs had been set out in an individualized plan of care. People using the service had their health and social care needs met. It was not clear how people had been actively involved in the care and support provided. Medication administration and recording could be improved. Evidence: Three files holding a range of documents on peoples needs were looked at in detail. Care and assessment records in these files had continued to be extended and recording in this area had improved since the last inspection. This meant more consistent recording of peoples needs including more consistently completed weight charts, fluid and diet charts and potential risks for people. This gave much clearer information for staff to follow and gave a much clearer assessment of how peoples needs were being met. Care Homes for Older People Page 13 of 29 Evidence: Areas of improvement in care planning and assessment was in ensuring that printed care plans were signed and dated, ensuring the detail of why actions were needed were fully completed, so that staff were fully informed. For example one plan said monitor her toe but it was not clear what staff were monitoring for and what action to take if they were concerned. Assessments had not taken place on the use of bed rails in the home. The manager confirmed that they were used to protect people so that people did not fall out of bed and that there use had been discussed with families and their doctor. This was not recorded. The use of bed rails and how they are being used should be recorded as part of the assessment and care plan of individuals to ensure that they are used safely, appropriately and not as a means of restraint. People said that they felt well cared for that staff would always help and that the doctor was called when needed. six out of eight surveys from people living at the home said that they received the care and support they needed. Two surveys said that people usually received the care and support they needed. Professionals going onto the home said that they had observed an improvement in peoples appearance and that people looked cared for. Care plans and assessments had begun to detail how people were involved in care and had started to be considered from the person using the service perspective. Peoples involvement in their care and the involvement of advocates needs to much clearer and more consistently completed. This will demonstrate how people are involved and supported in their care. The recording and administration of medication could be improved. Recording in medication administration charts had not been consistently completed so that it was not clear what medications, creams or lotions people had received or when administered. For example on person should have received medication on four dates, they had not been signed to say as given, staff could not recall if they had been given or not and could not recall any reason for them not being given. Poor recording in this area means that people are at risk of staff re giving medication incorrectly, people not receiving medication needed and a deterioration in peoples health. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples lifestyles met their expectations and satisfied their needs. People who used the service were able to make some choices about their life in the home. Social educational and recreational activities did not meet people s expectations. People enjoyed the meals provided and they had a choice of foods and drinks that they received at times that suited them. Evidence: Care plans and assessment of peoples needs had been further extended to include more details on how people wished to spend their time, past social histories and interests. People had been involved in this process though relatives and discussion with staff and some of those discussions were recorded in some peoples care plans. Daily ongoing records gave more information about informal activities that had taken place on a one to one basis with one person and a member of staff. Such as applying make up and reading letters to people. Care Homes for Older People Page 16 of 29 Evidence: The manager said that that these informal activities tool place regularly. These activities were not always recorded so that it was difficult to say that everyone had had time spent with them. There was no record of more structured activities or plans for activities in small groups and the homes Annual Quality Assurance Assessment gave no detail of what activities were available in the home. The recording of peoples choices in activities and if they had participated in informal or formal activities was highlighted at the previous inspection. Surveys from people using the service said that there was usually activities arranged by the home that they could take part in. People said that they had regular contact with their family and friends and relatives said that they were into the home at any time. people said that they had a choice of foods and the cook and manager confirmed that choices of food and drinks were offered throughout the day and night. Records to show if people had been offered a choice of foods and the foods and drinks they preferred were in place. People were identified as needing special diets or assistance was also clearly recorded and monitored. The dining area had been much improved and so was a much more welcoming and pleasant area to eat. See environment section. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who used the service were able to express their concerns and complaints from those using the service relatives or visitors was treated seriously. People were protected from abuse. Evidence: The homes complaints procedure was included in the service users guide which was displayed in the hall. The complaints procedure does not include details of the procedures in place in the event that the complaint becomes a possible abuse issue. This is important for staff to be aware of so that they can take the action they need to protect people immediately. This was also highlighted at the previous key inspection visit. Seven out of eight surveys from the people using the service said that they always knew who to speak to if they felt unhappy. Eight of eight surveys said that people knew how to make a complaint. People consistently said that they felt able to speak with carers and the manager about any concerns or worries. Care staff were able to describe the homes complaints procedures and what to do if they had any concerns about poor care or possible abuse Care Homes for Older People Page 18 of 29 Evidence: issues. There was no ongoing record of the concerns and complaints and how they were addressed. This makes it difficult for the manager to identify repeated areas of concern and to demonstrate how they have resolved concerns. Since the last inspection there had been three safeguarding referrals that raised concerns about the care of three people in the home. The safeguarding strategy teams concluded that the home had failed to report and record incidents promptly. In that an internal investigation and disciplinary action was taken before referral to the safeguarding teams or other professional bodies. This is not in line with current good practice guidance and potentially puts at risk the the evidence available to outside agencies such as the police. The manager and consultants employed to support the manager responded positively to the concerns raised and introduced a number of changes to ensure good practice for the future. This included new policies and procedures, additional training and awareness for staff and extending recording systems. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a well maintained house that was clean hygienic comfortable and safe. Evidence: Since the last inspection there had been continued improvements in the decor and furnishings throughout the home. These continued improvements had resulted in clean bright pleasant communal and private rooms that people enjoyed spending time in. Some of the new items in the home included a new stair lift, new carpets throughout the home, new staff office arrangements, new storage areas, new beds, new furniture in the conservatory area, new double glazing to windows and doors. One of the most improved areas was the dining area that had been transformed into a pleasant welcoming area for people to enjoy meals. The area had been made safer by closing off one access to the room and had been personalized with flowers table clothes and wall decorations. The conservatory had also been much improved by the purchase of new furniture that people could easily use. An increase in domestic staff and new cleaning routines for staff had resulted in a Care Homes for Older People Page 20 of 29 Evidence: clean odor free environment. Staff were observed having access to a range of cleaning products gloves and aprons which indicated good hygiene practices in the home. Eight out Eight surveys from the people using the service said that the home was always clean and fresh. People commented on how nice and bright the home had become and professionals visiting the home were pleased with the improvements in the general appearance of the home. A consultant had been employed by the responsible individual to over see the improvements in the home and the consultant and manager continued to update us on the progress in the homes environment . Confirming the changes made had been sustained. The manager and consultant had created management plans that included maintenance and the consultant acted as project manager in the ordering purchasing and fitting of new furniture repairs and equipment. This included health and safety considerations in the environment. The main stairs leading to private rooms did not have a hand rail down one side, action was agreed to address this immediately. Making this area safer and easier for people to use Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service were supported by staff who were trained skilled and competent. Most staff had been subject to rigorous recruitment checks. Evidence: Peoples needs had continued to more fully and consistently met as the numbers of staff on duty had been maintained with support from additional management domestic and catering staff. Care staff continued to carry out a number of tasks such as medication administration recording in care records, providing care and some domestic cover. The continued increase in support staff, domestic and catering staff meant that staff had more time to spend with people on an one to one basis. Staff said that they were pleased with the introduction of more staff in key areas such as the kitchen and laundry. They also mentioned that the manager supported by the consultants in the home was able to spend more time with staff and the people living at the home. Staff said they felt much more supported by the manager and consultants since they had been able to watch the investment and work gone into changing and improving Care Homes for Older People Page 22 of 29 Evidence: the environment. People said that they staff were lovely helpful and kind. Staff recruitment had changed since the last inspection. An agency previously employed to recruit staff continued to provide supervision of staff and induction for new staff. Documents related to supervision and Induction were therefor not seen at this inspection site visit. The manager had taken over the recruitment of staff. The majority of staff had been subject to rigorous checks such as references police checks and an interview process. One member of did not have a police check or references a record of interview or a job description. This is very poor practice as without rigorous checks there is no evidence that staff working at the home are suitable to work with vulnerable people. This had been raised at previous inspections with the manager. The consultants employed at the home confirmed shortly after the site visit that this had been addressed checks were in place for all staff and that the manager was aware of the need to complete full recruitment checks. Staff training and support for staff had improved with structured and informal training for staff in place re established staff meetings and more structured routines and guidance for staff. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements, including the appointment of consultants to support the manager, was focused on the best interests of the people living at the home and to ensure people were safe. Evidence: The responsible individual had taken a more active role in overseeing the day to day running of the home. He had appointed a married couple with years of experience and skills in care management to act as consultants to support the manager initially in the changes in the environment and then later in the updating of policies and procedures in the home. The consultants and manager continued to update us with action plans and ongoing information on the progress made in the homes environment and the care provided. This was achieved through regular telephone updates and written documents. Care Homes for Older People Page 24 of 29 Evidence: The management issues raised at safeguarding meetings and previous inspections such as care records staff routines and structure the numbers of staff on duty and dealing with accidents and injuries had been addressed or partially addressed. Health and safety issues such as fire safety manual handling electrical checks and improvements to the environment had been monitored and addressed. The consultants and manager were continuing to work on ongoing quality assurance systems that would include information from the people using the service. This would continue to ensure ongoing improvements in the home based on peoples needs and wishes. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 ensure all medications administrered are signed for or when not given it is clear the reasons why it is not given. so that staff can be sure that people have recieved the medication they need to maintain there health 22/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 7 continue as planned to include details of how people are involved in their care and care planning continue as planned to extend care plan and assessment documents so that staff have detailed information on how to care for people continue as planned to ensure all records are dated signed and fully completed record the informal and formal activities available.So that it is clear everyone has had the opportunity to participate in activities in the home and local community. 3 4 7 12 Care Homes for Older People Page 27 of 29 5 12 Continue to extend care plans and assessments so that records on people interests and how they wish to spend their time is recorded for everyone living at the home. record complaints and concerns and how they are addressed Extend the homes complaints procedure to include how to deal with concerns that may be possible abuse issues. Follow newly introduced policies and procedures on reporting of concerns incidents and accidents Complete the quality assurance system with the involvement and contributions from the people using the service. 6 7 8 9 16 16 18 35 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!