Care Home: Lindly House

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What the care home does well This is the first inspection for this service since it was newly registered and there is no history of how the home is being run to refer to. However all current providers have a robust reputation for giving sensitive care to frail elderly service users. What has improved since the last inspection? Since the last inspection (under the previous providers) urgent strides have been made in redecorating the bedrooms of people who use this service. There has also been an implementation of the requirement to provide training about how medication should be stored and administered, and in the protection of Vulnerable Adults. Three people have already received training in Dementia Care, and evidence was seen off further courses arranged for the near future. The new providers have established that all their staff have Bona-Fide CRB checks, and the outstanding work to comply with fire regulations had been 95% completed by the previous providers. New bedcovers and curtains have been provided in most rooms, and new carpets in some. Arrangements for staff cover at night have been strengthened. A new medication trolley has been purchased to ensure safe storage of medication, and the Boots pharmaceutical company has been approached to provide initial and ongoing training in the storage and Administration of medicines. What the care home could do better: The new providers have already produced an improvement plan for this service, and intend to increase staff training, introduce a new form of documentation for care plans [and extend the input of people who use the service and their families to them], take a fresh look at the menus in conjunction with both the people who use the service and the staff who care for them, build an extension early in the New Year which will include new kitchen and laundry facilities, and complete the refurbishment of existing areas of the home where they feel improvements are necessary. They want to see chiropody available every six weeks instead of every three months, and to employ dedicated staff as cook, and also as domestic. In doing this they want to revisit the existing shift patterns to ensure that the hours and staffing levels are adequate to meet the needs of the people who use this service. In ensuring the gardens are landscaped and user-friendly, they plan to supply new seating areas, and fresh garden furniture. They say they are committed to introducing staff supervision and annual appraisals, and a recognised quality assurance system for the home. They feel the lives of people who use this service can be improved by ring fencing some hours for an activities coordinator, and being able to offer a formal activity each day of the week. CARE HOMES FOR OLDER PEOPLE Lindly House 241 Longton Road Trentham Stoke-on-trent Staffordshire ST4 8DQ Lead Inspector Berwyn Babb Key Unannounced Inspection 18th October 2007 12:00 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 Lindly House DS0000070722.V354317.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. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindly House Address 241 Longton Road Trentham Stoke-on-trent Staffordshire ST4 8DQ 01782 637 541 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) The Willows Blythe Bridge Ltd Yvonne Walker Care Home 10 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (10), Physical disability over 65 years of age (2) Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: care Home only - Code PC to service users of the following gender: either Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age (DE)(E) 3 Mental disorder over 65 years if age (MD)(E) 1 Physical Disabilities over 65 years of age (PD)(E) 2 Older people (OP) 10 The maximum number of service users to be accommodated is 10. 2. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 5 Date of last inspection 16/03/07 Brief Description of the Service: Lindly House is a small, private residential care home, registered for 10 older people. These can include three people with Dementia, 2 people with a physical disability, and one with sensory impairment. The home is situated adjacent to the Trent and Mersey Canal, on Longton Road in Trentham, a convenient location for a wide range of community resources. The accommodation is provided on two floors, with a stair lift to assist access to the upper storey. There is one shared and eight single rooms, two of these being located on the ground floor. People who use this service are able to furnish the rooms to their own taste if they wish, and the communal areas are comfortable and also display the choice of the people who reside in the home. There are two combined lounge dining rooms, and these reflected a homely atmosphere. There are bathing facilities on both floors. There is a small laundry room, and located off one of the dining areas is the kitchen from which all meals are served. The property has an attractive and well maintained appearance, with a large garden to the rear, mainly laid to lawn, but also providing a patio area for people who use this service to sit out during the summer months. Car parking is provided to the front of the building, and the new providers have included an extension to this in their future plans for the home. The home has recently been purchased by a small group of providers all of whom have previous extensive experience in running care homes for the elderly. The current range of fees for accommodation at Lindly house start at £370 per week for a local authority assisted place, rising to £385 per week for people paying privately. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place early in the life of the current registration after discussion with the new proprietors, who were eager for a baseline from which they could work to improve the home, after the low point in it had reached about a year ago. The previous providers had already done much remedial work, and this inspection found the home generally in good heart. The care manager and one of her co-proprietors were present throughout the whole of the inspection, as was their deputy care manager. In line with the rest of the staff on duty that day, they all gave helpful assistance and support in the commission of this inspection. All the people who use this service had access either individually or as a group, to the inspector, and no words of criticism or complaint were uttered by any of them. A full tour of the environment was undertaken, and a review of the required documentation included an in-depth study of four care plans chosen at random but with regard to triggers , observed during the day. In addition to consideration of the current situation in the home, time was spent discussing the plans of the new providers to enlarge this service, and to continue with the improvements already made by the previous owners. What the service does well: What has improved since the last inspection? Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 7 Since the last inspection (under the previous providers) urgent strides have been made in redecorating the bedrooms of people who use this service. There has also been an implementation of the requirement to provide training about how medication should be stored and administered, and in the protection of Vulnerable Adults. Three people have already received training in Dementia Care, and evidence was seen off further courses arranged for the near future. The new providers have established that all their staff have Bona-Fide CRB checks, and the outstanding work to comply with fire regulations had been 95 completed by the previous providers. New bedcovers and curtains have been provided in most rooms, and new carpets in some. Arrangements for staff cover at night have been strengthened. A new medication trolley has been purchased to ensure safe storage of medication, and the Boots pharmaceutical company has been approached to provide initial and ongoing training in the storage and Administration of medicines. What they could do better: The new providers have already produced an improvement plan for this service, and intend to increase staff training, introduce a new form of documentation for care plans [and extend the input of people who use the service and their families to them], take a fresh look at the menus in conjunction with both the people who use the service and the staff who care for them, build an extension early in the New Year which will include new kitchen and laundry facilities, and complete the refurbishment of existing areas of the home where they feel improvements are necessary. They want to see chiropody available every six weeks instead of every three months, and to employ dedicated staff as cook, and also as domestic. In doing this they want to revisit the existing shift patterns to ensure that the hours and staffing levels are adequate to meet the needs of the people who use this service. In ensuring the gardens are landscaped and user-friendly, they plan to supply new seating areas, and fresh garden furniture. They say they are committed to introducing staff supervision and annual appraisals, and a recognised quality assurance system for the home. They feel the lives of people who use this service can be improved by ring fencing some hours for an activities coordinator, and being able to offer a formal activity each day of the week. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 8 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. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 9 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 Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose needs to be amended to reflect recent changes, and requirements made on the previous providers. EVIDENCE: Discussion took place with the new Registered Care Manager and one of her co-proprietors about the comments made to the previous providers with regard to the Statement of Purpose. This is in process of being further reviewed to reflect the changes in ownership and management of the home, and the new providers need to include a schedule of the number and sizes of the rooms in the care home, as was required of their predecessors, in addition to their own details, contact points, and qualifications. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 11 New contracts have already been prepared and a sample was made available during the inspection. Four care plans were sampled, and it was stated by the providers that they are initiating the use of recognised documentation in these files, (as produced by a professional care company) and discontinuing the practice of using A4 ruled paper on which to make records. Whilst the previous providers had made improvements, there is still much work to be done and this will be reflected in the recommendations and requirements at the end of this report. This home does not provide intermediate care as detailed in National Minimum Standard number six, but has been in the habit of providing day-care for one person Weekly fee level for accommodation at Lindly House was given as £370 for local authority assisted places, and £385 for privately purchased places. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9, and 10. The quality outcome in this area was good. This judgment has been made using all available evidence including a visit to this service. Improvements have already been made in the care plans, and the new providers outlined further steps they intend to take to upgrade them even further. They have already achieved much in addressing issues surrounding medication. People who use the service experienced privacy and dignity, and spoke of the sensitivity with which they were treated by their carers. EVIDENCE: The new providers clearly stated their intention to refurbish files used to detail assessed needs, choices, health and social interventions, and all those things that happened to people who use the service during their daily lives, and to this end they have invested in professionally produced forms and data sheets, to assist with accuracy, and with making the care plans more user-friendly, informative, and accessible. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 13 A sample of four care plans were reviewed during the inspection of the home, and were found to commence with an information sheet giving pertinent details about the person, their condition, their contact with family and friends, and those professional medical and other third parties important to their lives. There were appropriate risk assessments, [in one plan a range of these reflected that persons visual impairment, and in another because of differing needs, there were risk assessments for the use of hot water, and the Independent use of the staircase]. In the care plan of somebody who had been diagnosed with dementia there was an emphasis on environmental dangers outside the home, and in two other care plans, there were risk assessments in regard to specific pieces of equipment that had been provided because of a persons mobility. Since the last inspection under the previous providers, a new medication trolley has been purchased and the arrangements for the storage of medication has been completely revised, and staff responsible for the administration of medication have been on an appropriate training course provided by the Boots pharmaceutical company. No errors or omissions were discovered during the inspection, and it is understood that further refresher training has already been sourced. In discussion with people who use this service and there was nothing but praise for the staff of the home. One person said, They cannot do enough for you, theyre very discreet, but I know theyre checking to see if Im all right. Another person said They often have to do something different (we were speaking about meals) for me at short notice, and they never mind, theyre always very good about it. she confirmed that they always knocked on her door before entering, and always respected her privacy. During the formal interview, a member of staff when speaking about the personal task of giving somebody a bath, started with the premise that the choice lay with the person who uses the service, and that if they didnt want a bath, they would be offered the alternative of having a full body wash in bed, and arranging a bath for another time. The rest of her report demonstrated not only her care for their health and safety, but also how their dignity and privacy were respected and enhanced, whilst at the same time ensuring they were not disabled by doing things for them that they were able to do themselves. The new providers clearly stated their intention to refurbish files used to detail assessed needs, choices, health and social interventions, and all those things that happened to people who use the service during their daily lives, and to this end they have invested in professionally produced forms and data sheets, to assist with accuracy, and with making the care plans more user-friendly, informative, and accessible. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 14 . In the improvement plan deposited with CSCI, the new providers have stated their intention to introduce a private chiropody service to provide foot care every six weeks instead of the current 12 weekly service provided by the NHS. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14, and 15. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People who use the service stated the life within the home met their expectations. Regard for the choice of a resident was observed, and everybody spoken to said that the food was extremely satisfactory. The programme of activities was confirmed as being appropriately robust and appreciated. Family and friendship links were being appropriately maintained. EVIDENCE: At the outset of this inspection the people who use the service were engaged in a session of progressive mobility. An activities person who visits the home on a weekly basis for this purpose was leading this. During discussion later in the inspection, one lady told us: I would like to have more activities such as outings, but that I would not partake in them if that were provided because of my condition . Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 16 Other people said that the programme of activities suited their chosen lifestyle, and referred with pleasure to the fortnightly visits of the hairdresser, with one person citing a long-standing back problem for his preference to spend time each day lying on the bed, and applying gentle heat to the affected area. One person received visitors during the inspection, and others talked about various friends and relatives who came to see them in the home. (This included a two weekly provision of Holy Communion that was very much appreciated by one of the people who spoke to us). A formal interview was undertaken with a member of staff, during which she was asked to describe how she would assist somebody in the home with a personal care task. Without prompting, she gave an account that included sensitive appreciation of the rights of people who use this service to exercise autonomy and choice, and to receive care in privacy and with dignity. She described how she would support someone to undertake whatever tasks they were able to do for themselves, and to make choices about what clothes they wore, what time they got up all went to bed, when, (and whether or not) they would have a bath, and about making space for people to be able to spend time on their own if that was their wish. When asked, she stated that she believed that all her colleagues followed similar ethical practices, and reflected: We are a good team here, yes, I think I can say, we are a good team . During the tour of the environment it was seen that many people had brought personal items with them so that their rooms reflected who it was the lived in them, to the extent that one lady had been helped by her son to completely furnish her room with her own furniture and possessions. People whom use this service told us that they very much appreciated the food they were given, and the willingness of the staff to find an alternative even at short notice. The person doing the cooking on the day of the inspection said: The menus are used as a basis for the variety of food we provide to our residents. We know most peoples likes, and try to meet these . During the inspection it was noted that the storage facilities were clean and neat, and all the containers were in good condition with adequate quantities of good-quality foodstuffs, and in adequate variety to meet known tastes (one person only eating pink salmon whilst another person would only have red salmon) and provided reasonable alternatives, such as warm beverages of tea, coffee, Ovaltine, Horlicks, cocoa, or drinking chocolate. In addition to the normal hand washing facilities, catering packs of hygienic wipes were available for that person undertaking the cooks role, and cooking and heating were both provided by an Aga cooker. There was a record of what each person had said they would like for their evening meal when they were individually asked this earlier in the afternoon. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 17 Cook stated that people who use this service have a little supper about seven oclock, which judging by the huge variety of biscuits available must be a very enjoyable event. Fruit and vegetable were seen to be stored off the ground, and in appropriate containers. Cook also stated that anything that had been opened was then wrapped in foil and labelled with the date, and she pointed to the appropriate hand washing facility. A sample of checks on such things as food supplements and packet goods showed everything to be well within date, there were substantial quantities of fresh eggs and fresh meat and cheese, ready for subsequent meals. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 18 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were seen to have access to an appropriate complaints procedure, and be in the care of staff dedicated to their protection. EVIDENCE: A formal interview was undertaken with a member of staff during which the subject of the protection of vulnerable adults was discussed, and how they would be assisted to complain if they had any concerns. (At the last inspection under the previous providers, this section had only been scored as adequate, so it was considered appropriate to review it in depth with somebody who worked in the home.) A member of staff concerned was clearly aware that the vulnerable people living in this home could be abused by absolutely anybody who had access to them, and that it was a paramount part of her duty to ensure that this did not happen. She correctly identified a range of actions or lack of actions, that constitute an abuse on somebody, one example being: Making somebody frightened of you . She further knew the agreed action that she should take should choose suspect anybody in this home to be ought to have been experiencing abuse. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 19 She said that she believed that everybody else who worked home was as dedicated towards protecting vulnerable people as she was, and towards helping them to make their voice heard, should they be concerned about anything. Since the last inspection a book has been opened to record any minor concerns that did not require investigation under the homes official complaints procedure, but everybody who spoke to us, said they had nothing to complain about anyway. Information about how to raise a concern was displayed in the hallway, and was to be found both in the service users guide, and the statement of purpose. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 20 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): 19, 20, 21, 22, 23, 24, 25, and 26. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Much work had obviously been undertaken both by the previous providers, and by the new providers to meet the requirements of the fire officer, and to improve the quality of life for people who use this service. As well as a crash programme of redecoration and replacement of furnishings, the new providers have produced an improvement plan to accelerate the upgrading of the home. Cleanliness, infection control, and odour control were good. EVIDENCE: A full tour of the internal environment of the home was undertaken. A cursory of visual examination of the grounds and exterior of the home was also undertaken. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 21 The two proprietors at the home at the time pointed out where they planned to extend the car park, and to site a 10 bedded extension to the home in the near future. In their improvement plan they also identified that they would want to supply more seating areas, and to generally landscaped gardens to make them more friendly for the people who use this service. [There was an appropriate ramp with safety rails for the purpose of accessing the garden area from the French windows into the dining room]. Nothing of concern was noted in the current kitchen and associated areas. There were deep cleaning programs to supplement the daily cleaning duties being carried out, and food was being stored in good-quality containers, with appropriate programs being in place to check and record fridge and freezer temperatures, and to ensure that all was always a sufficient supply of crockery, cutlery, and cooking utensils. There are plans for the refurbishment of one bathroom to provide ensuite facilities for an adjacent room and a communal toilet. There is a further bathroom on the ground floor equipped with a walk-in shower, and we were told that this room is very high on the priority list for refurbishment. Both facilities had the appropriate emergency call systems available and mobility aids to the toilet. Both on the ground floor and either side of the head of the stairs, fire doors had been fitted in response to the fire officer’s report of June 2006. In the lounge there was clear evidence of a new carpet, new cushions for all the chairs, (some with a Pro Pad extra cushion), and new curtains at the windows, with both a television that was appropriate for the size of the room, and a shoulder height bubble lamp which one person said they found very stimulating and relaxing. There was an appropriate door guard intumescent strips had recently been fitted to reduce the incursion of smoke should a fire break out. All bedrooms were visited, and had new curtains and bed covers, and several also had new carpets. In the shared room there was appropriate screening, and appropriate aids and adaptations were seen including lifting hoists, commodes, talking books, telephones, extractor fans, and in other parts of the home there were appropriate handrails to assist mobility. A number of thing still remained to be attended to, including ensuring that radiators do not present the danger of somebody becoming burnt if they fell against them, the fitting of privacy devices in one room where the window was in a non standard size (thus defeating the providers current attempts to find a blind that would meet the occupants approval), the replacement of a cracked window pane, and redecoration of those rooms not already attended to. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 22 All the bedrooms displayed a high degree of personalisation, with pictures, ornaments, photographs, and items of furnishing that reflected not just the past of the person occupying the room, but also their interests, affiliations, and particular favourites. They visit was made to the laundry and it was seen to have recently been decorated, with impervious paint to the floor, and a coat of water-based paint the walls. The new providers have purchased a second dryer to assist with the turnaround of clothes and bedding, and whilst there is no sluicing facility on the washing machine, there are two separate stainless steel sinks that are available for this task, and for hand washing. There was a locked cupboard in the room where cleaning materials were kept (under containment of substances hazardous to health regulations), and another locked cupboard for the soap powders and the iron. The room was clean and tidy and free from any extraneous items. Measures were seen to assist with the containment of any threat of infection, and the whole of the home was clean, warm, neat, and tidy, with out any incidence of malodours. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29, and 30. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The needs of residents was being met by an adequate number of staff with appropriate experience and skill, who had commendable thirst for improvement to enable them to perform their duties to the highest level possible. EVIDENCE: Requirements in the last report for the previous providers had identified a range of training necessary for staff. As well as mandatory training, this targeted knowledge about the protection of vulnerable adults and the care of the person with Dementia. The inspector at that time was also unable to find any evidence that staff had had the enhanced CRB checks carried out, or that they had received formal supervision. It is pleasing to record that in response two members of staff have already received training in dementia care, and two others have been on an external course to make them more aware of issues of abuse. They had then used this knowledge to supplement in-house training on the protection of vulnerable adults/abuse course, that had been made available to all staff. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 24 Further courses have been undertaken in tissue viability and infection control, nutritional awareness, and the deputy manager has been on infection control course. In addition to this training has been booked for fire risk assessment, food hygiene, general risk assessments, and two more people will undertake external training on the recognition of vulnerable adults issues with a further person undertaking external dementia awareness training. For the nine people currently in the home, there is one member of staff available awake and watchful between 10 p.m. and 8 a.m. supplemented by a further person sleeping in and on call. At other times there are always two carers available, supplemented to meet identified necessities. The new providers have stated that it is their intention to employ a dedicated cook in addition to the care staff and also to employ a separate domestic. They also want to introduce daily activities, which they consider will necessitate the employment of an activities co-ordinator. Observation of the dynamic within the home during this inspection did not identify any point where staff were under pressure to meet the assessed care needs and personal choices of the people using this service, who themselves had nothing but praise for the members of staff who were looking after them. They said that if ever they needed to use the buzzer it was always promptly answered. The providers have stated in their improvement plan that they want to review shift patterns to ensure the hours and staffing levels are adequate to meet the needs of people using this service, and, to support their staff, by introducing regular formal supervision, and annual appraisals. During the formal staff interview, a carer confirmed that she had undergone appropriate recruitment and training She stated that it was a happy home, and that she very much look forward to working there for many years to come. Everybody in the home has a CRB check, [they showed us proof of this). Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety, and welfare of residents was being promoted, by appropriately qualified and experienced care manager and staff, with systems to obtain their views about the service, and to incorporate these into any future provision. EVIDENCE: The Registered Care Manager (who has recently been approved as a fit person to carry out her role) has substantial previous experience both as a proprietor, and in “hands on” care and management in homes providing sanctuary for the frail elderly. Her co-proprietors similarly all have well-established reputations in providing quality care in this field. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 26 They have already introduced a questionnaire for people who use this service, and their families, their representatives, and other professionals who visit the home. The sample seen was felt to address all the areas pertinent to the provision of good care. It was established that the majority of people who use this service receive assistance in managing their money from members of their family. Additionally, the new providers have implemented an expanded contract that clearly states what obligations each party has, in return for the provision of accommodation and care, and the financial recompense for this. During the course of the inspection of the home, records and measures were extensively reviewed without finding anything amiss. Additionally, there has been the introduction of an external professional body to provide regular health and safety audits. During the inspection of the environment there was evidence that issues raised in previous reports under the outgoing providers had been addressed, though a couple of matters will be referred to in the requirements and recommendations, one being ensuring the safety of people who use this service from accidental burns should they fall against a radiator, and the other being an audit of the existing safety measures on the first-floor windows. The manager has confirmed that it is the Home’s intention to cover all radiators, however in the meantime they need to risk assess all of the radiators and make sure precautions are being taken to keep people safe. Generally, with these exceptions, it was felt that the people who use this service enjoyed considerable benefit from the current management of the home, who if they are unable to fulfil all the improvements they envisage, will be able to provide an even more desirable place to live. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 27 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP36 Regulation 13 [2] Requirement Timescale for action 18/12/07 2 OP25 13 [4] [a, b, and c] Staff are to receive formal supervision six times a year (this was a requirement made against the previous providers) The registered provider shall 18/03/08 review their provisions and procedures to ensure that people who use this service do not come to harm from contact with unguarded surfaces that exceed the recommended health and safety level of 43°C. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations The registered provider shall undertake an audit of their provisions and procedures to ensure that people who use this service do not come to harm from life expired safety measures on upstairs windows. Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 29 Lindly House DS0000070722.V354317.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stevenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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