Care Home: Linden Manor Care Home

What the care home does well The staff give good care with dignity, privacy and they relate well to the residents. ` The staff are excellent` ` Very happy here and wouldn`t want to go anywhere else`` The residents live in a clean, pleasant and well - maintained home with bedrooms that are personalised and suit their needs. The home gives the residents a good and nutritious diet and they have choices in what they have to eat. ` The food`s very good, we can choose what we want to eat`. The residents benefit from a staff and a manager who are committed to their care. The home is committed to providing a staff who are well trained to give good and safe care to the residents. What has improved since the last inspection? There were no requirements or recommendations made at the last inspection. The company is improving the paperwork in the home and are requiring regular audits of all areas. There is a refurbishment programme in place and the residents are being involved in choosing the colours to be used. What the care home could do better: The care plans should be kept in a secure area so that they remain confidential. Pureed food should be presented in an attractive manner. Key inspection report Care homes for older people Name: Address: Linden Manor Care Home 159 Midland Road Wellingborough Northants NN8 1NF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anthea Richards     Date: 2 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 27 Information about the care home Name of care home: Address: Linden Manor Care Home 159 Midland Road Wellingborough Northants NN8 1NF 01933270266 01933229141 manager.linden@regalcarehomes.com www.regalhomes.com Regal Care Homes Ltd care home 28 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Linden Manor must only admit service users within the category of Dementia DE(E) One existing service user within the category of Mental Disorder MD(E) may remain at Linden Manor while their needs can be met The total number of service users at Linden Manor must not exceed 28 Date of last inspection Brief description of the care home Linden Manor is a care home providing personal care and accommodation for 28 older people who have a dementia related condition. The home is owned by Regal Care Homes who run a number of homes in the area. The home is situated close to the centre of Wellingborough and is easily accessible by private and public transport. Parking is available in the grounds of the home. The accommodation is a three-storey detached house set within its own grounds, which have been improved and are accessible for the residents. Care Homes for Older People Page 4 of 27 Over 65 28 0 1 4 0 1 2 0 0 9 Brief description of the care home There are spacious communal areas including an all weather conservatory. There is a mixture of single and shared bedrooms on all three floors, most of which do not have en-suite facilities. The first and second floors can be accessed by stairs or by a passenger lift. Further information about the home can be obtained by telephone, fax or email. The last report we wrote is available at the home on request. The following information about fees was obtained on 22nd January 2010 :Fees range from £389.00 to £450.00. There are extra charges for hairdressing, chiropody, special activities and personal items. Care Homes for Older People Page 5 of 27 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: two star good 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: This was a key inspection of a care home for older people, which ended with an unannounced visit to the service. Before the visit we [throughout the report the use of we indicates the Care Quality Commission], spent five hours reviewing information received by the Care Quality Commission [CQC] since the last Key Inspection on the 14th January 2009. The visit took place on the 22nd January 2010 and lasted seven hours. During the visit we checked all the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means that we looked at the care provided to two of the residents. To achieve this we spoke with the staff supporting their care and looked at the records relating to their health and welfare. We spoke with the residents and their families. With their permission the residents bedrooms were looked at. We also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. Care Homes for Older People Page 6 of 27 We looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them was checked. We looked at how prospective residents and their families are given information about the services the home can offer and whether they are suitable for them. We checked the Annual Quality Assurance Assessment [AQAA] that the home had sent to us. This describes the services provided at the home for the residents, how the home is hoping to improve services and statistics about the residents and the staff. The comment cards that we sent out were seen and comments made were noted. During the visit we spoke with the homes manager the deputy and regional manager, the staff, the residents and visitors to the home. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: 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 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 8 of 27 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 9 of 27 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 residents needs are assessed by somebody from the home, before moving in and they have good information to help them make the right choice about the home. Evidence: The residents or their families who were case tracked told us that they had seen the Statement of Purpose and Service user Guide. The Statement of Purpose contained thorough information that described the services that the home provided. This is reviewed and updated every 6 months so that people have accurate information. These documents could be made available available in other formats including large print and other languages to give as many people as possible the opportunity to read them. The manager or the deputy visits all prospective residents to complete a pre assessment of the residents needs, to make sure that the home can meet them. This also gives the resident the opportunity to meet someone from the home who they can Care Homes for Older People Page 10 of 27 Evidence: recognise when they are admitted. This makes sure that the home has a full picture of the resident before they are admitted. Prospective residents are given the opportunity to visit the home. Assessments by the home and social services were seen in the residents care plans and the residents and the families spoken with said that they had seen the manager or the deputy before they came in. The staff spoken with told us that they always knew about the resident before they were admitted and key workers are allocated to them. The manager tries to match the resident to a member of staff who may have interests/backgrounds in common. The current registration certificate from the Commission for Social Care Inspection (CSCI) was displayed in the entrance of the home with the latest report from the CSCI and an up to date public liability insurance certificate. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff meet the care needs of the residents well, with privacy, dignity and respect. Evidence: The records for the residents who were case tracked were found to contain good individual evidence of the care being given to them and reflected the care that they needed. There was evidence that the care plans are regularly reviewed and the residents and the families spoken with confirmed that they could be involved and were aware of the care to be given and that they were happy with it. There are records of the residents weight and a nutritional assessment in the care plans to make sure that they are eating properly and not losing weight. The home were making good progress with person centred care plans, making sure that the residents have their care as they would like it and that they continue their interests and involvement in the community. The families have been particularly involved in putting together the residents life history and past interests. Care Homes for Older People Page 12 of 27 Evidence: There are records of the involvement of G.P.s, district nurses, chiropodist and optician, where needed in the care plans, showing that thorough health care is being provided for the residents. The residents and their families spoken with said that they could see the doctor and other health professionals when they needed to. Survey from a District Nurse stated that although she was sometimes felt that there was a lack of staff a member of staff is allocated to the visiting professional staff it is a delight to visit the home Comments received on the day and in the surveys received by us included: The staff are excellent Looked after well Very happy here and wouldnt want to go anywhere else Nothing too much for the staff The daily record of care was up to date and a new daily record has been developed which reminds staff about what it needs to contain, so that there is a full record of the residents day or night. We saw residents being treated with dignity and respect when staff spoke with them and undertook their care, particularly when moving them. There were risk assessments in place to cover all the identified risks for the residents and how the staff should manage those risks. This makes sure that the residents and the staff are protected from any risks that have been identified, without restricting their activities. The care plans were being stored on open shelving under the stairs, which means that they are not being kept confidentially. Medication records for the case tracked residents were in order. Medicines are given by senior care staff who have regular updating in medicines. We saw that the medicines were administered individually and the residents were seen to be taking Care Homes for Older People Page 13 of 27 Evidence: them. Medicines are supplied in a monitored dosage system where each tablet is in a separate pop out card, which is a safe method of administration, helping to make sure that the resident is always given the right medicines. The staff spoken with were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. The manager carries out a monthly written audit of the medicines and the medicine sheets to make sure that they are correct. There were no controlled (dangerous) drugs in the home at the time of the visit but the staff spoken with were aware of the regulations for administration and storage of controlled drugs. There was a self-medicating policy in place but there were no residents looking after their own medicines at that time. Care Homes for Older People Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents enjoy the activities that they want to and have their spiritual and nutritional needs met. Evidence: The staff were seen to be spending individual time with the residents reading the newspaper, doing a jigsaw, looking at pictures, music, singing and dancing. Activities that were enjoyed by the residents included: sing- a- longs, pottery classes, keep fit and religious services. The residents, families and the staff told us about the activities and how they enjoyed them. They said that there was enough to occupy them. We did receive a comment from a resident through a survey that they would like to do more in the community, maybe helping young people. There is a regular religious service held in the home and the clergy may visit whenever the residents would like. A hairdresser visits fortnightly and 6-8 weekly for two residents with specialist hair needs. The families spoken with said that they were made very welcome in the home, which Care Homes for Older People Page 15 of 27 Evidence: we saw whilst we were there. The residents spoken with said that the food was good and that they had a choice of what they had. The menus were varied and had recently been changed. The home had recently employed a new cook who was very enthusiastic and the residents were enjoying home made cakes that she had cooked. The pureed food that was being produced was being presented as a single dish and the new cook told us that she would produce it as separate items. Comments made by the residents included: The food is good and I can choose what I want . We spoke with the residents during their lunch, which was served attractively and they told us that they were enjoying. The cook is happy with the quality and amount of food supplied, which is all bought locally. She is aware of different diets such as vegetarian and diabetic. The staff were seen to be sitting with individual residents helping them with their meals. Care Homes for Older People Page 16 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to support and protect residents and staff are aware of the processes. Evidence: There is a Complaints policy in place which gives the details of how to complain and who to complain to in the home if they needed to. There is an excellent form in place for recording all the details and dates of complaints and how they were resolved. The policy could be made available in a large print and other languages if it was required to make sure that as many people as possible could read it. The home has received two complaints since the last inspection on 14th January 2009. One of these has been resolved satisfactorily and the other is being investigated. The residents and the families spoken with were aware of the policy, of how to complain and who to complain to. They were happy that their concerns would be listened to and acted on. The staff spoken with were aware of how to handle any complaints. The staff spoken with were able to describe how they would deal with an allegation of abuse, knew the areas where abuse could happen and could describe the process that they would go through if they suspected any abuse. They confirmed that they had had training in safeguarding adults and whistle blowing and the manager and the records seen supported this. Arrangements have been made Care Homes for Older People Page 17 of 27 Evidence: for the staff to have training in the Mental Capacity Act and the Deprivation of Liberty. They were confident that the management would handle any issues correctly. Since the last inspection the home has had one referral for safeguarding which was investigated and resolved by Social Services. We looked at the accident book, which had been completed correctly. These practices make sure that the residents are safe from any abuse and that any concerns are handled correctly. Care Homes for Older People Page 18 of 27 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. The residents are protected by the policies and procedures in the home to provide a safe and pleasant environment. Evidence: Linden Manor is three storey, converted house close to the centre of Wellingborough in Northamptonshire. There are bedrooms on all floors and the first and second floors can be reached by the stairs or a passenger lift. There are lounges and a dining room on the ground floor giving the residents a good choice of where they wish to sit. The lounge and dining rooms have been redecorated and the residents chose the colours for them. The home was clean, warm and welcoming with all areas being furnished well and suitable for the residents. All of the bedrooms seen had been personalised and were found to be clean and well decorated. The residents spoken with were happy with their rooms and said that they were able to bring their own belongings in with them. Care Homes for Older People Page 19 of 27 Evidence: There was evidence of equipment in the home to help the residents, such as wheelchairs and special mattresses. There was a good provision of bathrooms in the home and most were were found to be clean and clear of any items that could cause a hazard for the residents. One of the bathrooms did contain toiletries that could create an infection control risk or a hazard if anyone drank them but these were removed before the end of the visit. There was a patio area and garden that were easily reached by the residents and made a pleasant place to sit for them. The residents and the families spoken with were happy with the cleanliness of the home, and told us that the staff worked hard to keep it clean. There are staff employed to complete the cleaning in the home and they have had training in health and safety. The cleaning products are stored in a locked cupboard, which we saw. The records for hot water testing had been completed and all the temperatures were within the recommended levels. The fire records for testing alarms and fire drills and training were looked at and found to be up to date. The staff spoken with told us that they had regular training and fire drills. The home has been awarded 3* Scores on the doors and the Heartbeat award from the environmental health officer. There was an up to date registration certificate and public liability insurance certificate displayed in the entrance Care Homes for Older People Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment policy and the staff training meet the residents needs and protect their safety. Evidence: We looked at two staff files and the required information was complete in all of them. This included evidence of identification, adequately completed application forms, two written references, a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adults check. The manager makes sure that all the required documentation is in place before an employee starts work. This was confirmed by the staff spoken with, who told us that they could not start until they had all the paperwork in place. The staff spoken with confirmed that they had received recent training in moving and handling, dementia awareness, health and safety and safeguarding. The manager has a matrix with all the training courses on it so that she can keep their training up to date. The residents and the families spoken with felt that the staff were well trained to do their job and that there were enough staff to look after them. Care Homes for Older People Page 21 of 27 Evidence: The induction programme that all the staff complete contained all the required mandatory training needs. The numbers of staff holding a National Vocational Award (NVQ) at least at level 2 or above complies with the required numbers. The home encourages the staff to progress and achieve these awards. The National Vocational Qualification is a qualification for care staff to make sure that they receive training in the needs of the resident group whom they are caring for. Care Homes for Older People Page 22 of 27 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 residents safety is well protected by the practices in a home that is run in their best interests. Evidence: The manager is well supported by a deputy manager who assists in staff training and with pre-admission assessments for the residents. She has achieved a level 4 in management and both her and the deputy are undertaking the Leadership and Management Certificate. There are regular meetings held for the residents and for their families, to discuss activities and menus in addition as to how the home is meeting their needs. One of the management team is available to talk with the residents and the visitors every day. The residents and the families spoken with told us that they saw them daily. Care Homes for Older People Page 23 of 27 Evidence: There were quality questionnaires and food questionnaires sent to the residents and their families every four months and the questionnaires that we saw on the visit confirmed this. The families and the residents told us that they had completed the questionnaires. Staff are asked to complete a questionnaire monthly. We saw the results of the questionnaires which were found to be positive. The regional manager visits the home weekly and completes regular audits of all the activity in the home. She visited the home on the day of the visit and discussed the changes and improvements that we saw in the paperwork and in the regular audits. We received positive comments from the residents and the families at the visit, amongst which were that the staff were very supportive of them and their relative. The residents accounts were found to be in order. There was evidence from the staff spoken and from the records seen with that they are having regular formal supervision with their line manager. There are regular staff meetings held, confirmed by records held and by the staff spoken with. All the areas of health and safety such as hot water temperatures and fire drills and alarm testing were found to be in order. Care Homes for Older People Page 24 of 27 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 25 of 27 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 7 17 That the care plan records are kept securely in the home. To make sure that records with resident details are stored so that confidentiality is maintained. 28/02/2010 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 15 That pureed food is presented in an attractive manner Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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