Care Home: Lindsay House

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What the care home does well People were given sufficient information so they could make informed decisions about whether Lindsay House was suitable place for them to live. Detailed information was collected about residents before admission to determine whether they could be looked after properly. Each resident had a plan of care that told staff what they needed to do to ensure individual`s needs were met. Residents and their relatives were kept up to date and involved in decisions about care; this would ensure residents received the care they needed and wanted. Residents were treated with respect and kindness and their dignity and privacy was respected. There were many positive comments made about the care people received. Visitor`s comments included `my mother is very happy and I think the care is good`, `there is a friendly, caring and welcoming atmosphere`, `staff have the skills, experience and most of all they care` and `staff are pleasant, easy to talk to and approachable`. One resident said `the girls are very good, they look after me properly`.Routines were flexible and residents were able to make choices in all areas of their lives; one resident said `I can choose what I want to do`. Meals were well balanced and nutritious and resident`s dietary needs and preferences were met. Residents said they enjoyed the food and were offered a choice of meal; one resident said `the food is lovely, there is always something that you will like`. The complaints procedure was clear and accessible to people; people knew how to complain and were satisfied that their complaint would be dealt with appropriately. Staff were aware of action to be taken if they suspected abuse and training had been provided to ensure they were able to recognise abuse and respond appropriately Resident`s rooms were clean and bright and most had been personalised with treasured possessions; one resident said ` I have a lovely view`. One visitor commented `they keep the home clean, tidy and sweet smelling`. One resident said `there are enough staff around, they answer the `buzzer` and come almost straight away`. The recruitment procedure was clear and had been followed to ensure that residents were protected from unsuitable people and staff had received appropriate training to help them to keep them and others safe and to understand the needs of residents in their care. Residents benefited from a well managed home and were consulted about how the home was run. What has improved since the last inspection? Residents were able to enjoy a full and stimulating lifestyle and their views had been sought about their interests and daily routines. There had been a range of suitable activities and residents now had use of a minibus and had been involved in decisions about destinations for outings. Time had been set aside each month to give residents` families and friends the opportunity to meet with the registered manager and raise any areas of concern; this showed that the service welcomed suggestions or complaints to help them to improve the service. A relatives survey had been introduced to determine people`s views and opinions about whether the service was meeting their needs and expectations; this showed that people were involved in making decisions about how the home was run. There were systems in place to check whether staff were doing their jobs properly. What the care home could do better: Some aspects of the management and storage of resident`s medicines needed to be improved to ensure residents were not at risk. There were no records to support that further improvements to the home were planned and whilst it was clear that some areas of the home had been improved there were a number of other areas in need of attention to provide a safe and pleasant place for residents to live. CARE HOMES FOR OLDER PEOPLE Lindsay House Parbold Hill Parbold Lancashire WN8 7TG Lead Inspector Mrs Marie Matthews Unannounced Inspection 3rd July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lindsay House DS0000071070.V365916.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. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lindsay House Address Parbold Hill Parbold Lancashire WN8 7TG 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) 01257 464177 01257 464177 www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd Mrs Lindsay Jane Craddock Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Lindsay House DS0000071070.V365916.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: Old Age, not falling within any other category, Code OP - maximum number of places 31 The maximum number of service users who can be accommodated is: 31 19th June 2007 2. Date of last inspection Brief Description of the Service: Lindsay House is a detached older property that has been extended to provide accommodation on two floors for up to thirty-one residents who need personal care. The home is situated close to the summit of Parbold Hill, near the villages of Appley Bridge and Parbold and is set in its own private, extensive grounds. The grounds are well maintained and accessible to service users. Accommodation includes two comfortable lounges and dining rooms. The first floor can be accessed by a passenger lift. Most of the bedrooms have en-suite facilities and all are currently used as single occupancy rooms. Ownership of the home has changed since the last key inspection. A company called Southern Cross, who have a number of homes nationwide, now owns the home. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £329.00 to £469.00. Items not included in the fee include newspapers, toiletries, hairdressing and private chiropody. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The key unannounced inspection, including a visit to the home, took place on 3rd July 2008. The inspection process included looking at records, a tour of the home, discussions with the registered manager, deputy manager and two residents who lived in the home. Information was also included from survey forms filled in by seven visitors and fourteen care staff. The inspection also looked at things that should have been done since the last visit and a number of areas that affect people’s lives. There were twenty-two residents living in the home on the day of the inspection. What the service does well: People were given sufficient information so they could make informed decisions about whether Lindsay House was suitable place for them to live. Detailed information was collected about residents before admission to determine whether they could be looked after properly. Each resident had a plan of care that told staff what they needed to do to ensure individual’s needs were met. Residents and their relatives were kept up to date and involved in decisions about care; this would ensure residents received the care they needed and wanted. Residents were treated with respect and kindness and their dignity and privacy was respected. There were many positive comments made about the care people received. Visitor’s comments included ‘my mother is very happy and I think the care is good’, ‘there is a friendly, caring and welcoming atmosphere’, ‘staff have the skills, experience and most of all they care’ and ‘staff are pleasant, easy to talk to and approachable’. One resident said ‘the girls are very good, they look after me properly’. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 6 Routines were flexible and residents were able to make choices in all areas of their lives; one resident said ‘I can choose what I want to do’. Meals were well balanced and nutritious and resident’s dietary needs and preferences were met. Residents said they enjoyed the food and were offered a choice of meal; one resident said ‘the food is lovely, there is always something that you will like’. The complaints procedure was clear and accessible to people; people knew how to complain and were satisfied that their complaint would be dealt with appropriately. Staff were aware of action to be taken if they suspected abuse and training had been provided to ensure they were able to recognise abuse and respond appropriately Resident’s rooms were clean and bright and most had been personalised with treasured possessions; one resident said ‘ I have a lovely view’. One visitor commented ‘they keep the home clean, tidy and sweet smelling’. One resident said ‘there are enough staff around, they answer the ‘buzzer’ and come almost straight away’. The recruitment procedure was clear and had been followed to ensure that residents were protected from unsuitable people and staff had received appropriate training to help them to keep them and others safe and to understand the needs of residents in their care. Residents benefited from a well managed home and were consulted about how the home was run. What has improved since the last inspection? Residents were able to enjoy a full and stimulating lifestyle and their views had been sought about their interests and daily routines. There had been a range of suitable activities and residents now had use of a minibus and had been involved in decisions about destinations for outings. Time had been set aside each month to give residents’ families and friends the opportunity to meet with the registered manager and raise any areas of concern; this showed that the service welcomed suggestions or complaints to help them to improve the service. A relatives survey had been introduced to determine people’s views and opinions about whether the service was meeting their needs and expectations; this showed that people were involved in making decisions about how the home was run. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 7 There were systems in place to check whether staff were doing their jobs properly. What they could do better: 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. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People were given sufficient information so they could make informed decisions about whether Lindsay House was suitable for them. Detailed information was collected about residents before admission to determine whether they could be looked after properly. EVIDENCE: Detailed information about the services available at Lindsay House was available to prospective residents and their families and in resident’s rooms and the entrance hall; this would help people to make informed decisions about whether the home was suitable for them. A monthly newsletter was also included and this gave people up to date information about what it was like to live at Lindsay House. Survey information indicated people were given enough information about services. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 10 Residents were issued with contracts to inform them of their rights and obligations whilst living at Lindsay House. The contracts were clear and had been discussed with residents and their families and kept under review when circumstances changed. Information was collected about prospective residents from various sources to determine whether their needs could be met. Letters confirming residents’ needs could be met had been introduced for new residents. All residents were allocated a member of staff or key worker to help them to settle into the home. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents’ received was based on their individual needs. Policies and procedures provided safe guidance for staff in all aspects of management of medicines although staff had not always adhered to the procedures and this could put residents at risk. EVIDENCE: Three residents care plans were looked at in detail. A new care plan format was being introduced; some staff had received training to assist them with ‘person centred’ care planning. The plans were clear, developed from information obtained prior to admission and included details about how residents care needs would be met. Records showed that residents and their relatives had been involved in decisions about their care. Relatives said they were kept up to date and consulted about changes to care; this would ensure residents received the care they needed and wanted. It was noted that staff Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 12 had not always recorded when there were changes in resident’s needs and this could put residents at risk of not receiving the right care. Any risks to residents had been assessed although staff needed to ensure these were updated in line with any changes to the care plan; this would ensure that appropriate action was taken to reduce or remove the risk. Staff were trained in a range of health care matters and could recognise and respond to changes in residents health; records showed that health care professionals had been contacted for advice and support. One visitor commented that ‘‘my mother is very happy and I think the care is good’. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. There were no systems to check whether staff were recording residents health and care needs properly although these were expected to be introduced. The medication policies and procedures provided safe guidance for staff in all aspects of management of medicines. The registered manager said a new medication system was due to be introduced by the company and training would be provided for all staff to ensure medication was managed safely. Current records were accurate and showed that medicines had been managed safely; it was recommended that protocols or guidance to help staff with their decision to administer ‘PRN’ or ‘as needed’ medicines should be developed and prescriptions should be seen prior to dispensing to prevent any risk of error or mishandling. Medicines were stored securely although there were concerns regarding the temperature of storage areas and lack of ventilation; the registered manager said this had been discussed at a health & safety meeting and referred to head office. Also the fridge lock was broken and had been referred for repair. It was noted that unlabelled medicines were being administered to residents as a homely remedy; this practice was unsafe and the deputy manager and registered manager were advised to remove these medications immediately as all medicines must be clearly labelled. Staff who administered medicines were trained and competent in the safe handling of residents medicines; update training was planned. Regular checks of medication management had been introduced and any areas requiring attention had been responded to. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 13 It was observed that staff treated residents with respect and kindness and their dignity and privacy was respected. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 14 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 excellent. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities met resident’s diverse needs and expectations. Residents received a healthy, varied diet that was suited to their individual preferences and requirements. EVIDENCE: There had been comments from the survey information that there were not enough activities; the registered manager was aware of these comments and said that improvements had been made. Information about a range of recent activities, entertainments and excursions was displayed around the home and included in the monthly newsletter; it was clear that residents were able to enjoy a full and stimulating lifestyle and their views had been sought regarding their interests and daily routines. Activities for June included crafts, film shows, sing a longs, stories, arts, zoo craft, board games, mini golf, keep fit and gardening. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 15 There was no activities person employed although two staff were responsible for ensuring suitable activities were available. The home had use of a minibus and had involved residents in decisions about destinations for outings. Routines were flexible and residents were able to make choices in all areas of their lives; one resident said ‘I can choose what I want to do’ another said she can get up when she likes, stay in her room or join others in the lounges. Friends and families were welcome at any reasonable times and could visit in any area of the home. For residents who needed advice and support from someone other than a member of their family or staff there was information about how to contact advocacy services. The menu showed that meals were well balanced and nutritious and resident’s dietary needs and preferences were met although records were often incomplete and did not support that residents had been offered alternatives. The meal on the day of the inspection visit looked nutritious and healthy and was well presented; residents said they had enjoyed their lunch. Residents said they enjoyed the food and were offered a choice of meal; one resident said ‘the food is lovely, there is always something that you will like’ and one carer said ‘residents get a varied menu’. Staff were seen supporting residents who needed assistance at mealtimes; residents were given unhurried support and encouragement. The dining areas were pleasant and tables attractively set and special occasions were celebrated. There were concerns regarding the flooring in the kitchen as it presented a trip hazard and the screening to the doors was missing which was a health risk (see standard 19). Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents had access to a robust and effective complaints procedure and were protected from abuse by staff awareness and policies and procedures. EVIDENCE: The complaints procedure was clear and accessible to people; people knew how to complain, whom to complain to and were satisfied that their complaint would be dealt with appropriately. One visitor said ‘if we have any issues we have spoken to the manager and she has acted accordingly’. Time had been set aside each month to give residents families and friends to meet with the registered manager and raise any areas of concern; this showed that the service welcomed suggestions or complaints to help them to improve the service. Audit systems to monitor the number and nature of any complaints had been introduced; this would help them to improve their service. The safeguarding adults procedure was clear and provided staff with safe and appropriate guidance; it was recommended that the telephone contact information was included in the procedure to direct senior staff to local support agencies. Staff were aware of action to be taken if they suspected abuse and Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 17 training had been provided to ensure they were able to recognise abuse and respond appropriately. One carer said ‘staff make residents feel safe’. Staff had access to procedures to them with management of resident’s finances, responding to verbal and physical aggression, whistle blowing and safe use of restraint. Consideration should be given to ensuring staff were trained to respond appropriately to physical and verbal aggression to ensure peoples safety. Any limitations on choices and freedom were discussed with residents and their relatives, clear records kept and the situation regularly reviewed. Some staff had received training in the provision of bed rails as a form of restraint. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 18 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, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable; however records did not support that further improvements were planned to develop the home and provide a safe and pleasant place for residents to live. EVIDENCE: A tour of the home was undertaken. Not all areas were viewed. It was clear that some areas had been improved although other areas needed attention to provide a safe and pleasant place for residents to live. The registered manager was aware that some of the areas as noted during the tour had already been forwarded to head office although others were not recorded at all. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 19 There had been changes to the way in which repairs were reported and dealt with since the change of ownership. Any identified work required a referral to the estates department for approval and then the repair to be arranged; consequently there were a numbers of repairs outstanding. It was recommended that a tour of all areas of the home be undertaken and areas requiring repair or replacement (including those noted at the inspection visit) were dated and recorded in a book for the handyman or referred to the estates department; this would ensure that minor repairs were identified and responded to promptly. Grounds were attractive, well maintained, safe and accessible to residents and their visitors. Seating was provided and residents had enjoyed the gardens in the warmer weather. The signage outside the home had blown down recently and planning permission was being sought to replace it; this meant it was difficult for new visitors to identify the location of the home. There were no serious issues raised from environmental health and fire safety visits although it was noted that the fly screens in the kitchen had been removed, the kitchen flooring was damaged and presented a serious trip hazard, a number of fire doors had had the locks removed and had been rendered useless in the event of a fire and an electronic fire door closure that would not operate when the fire alarm sounded was awaiting repair. A health & safety committee met each month and reported any risks and concerns to head office and an external heath & safety visit had taken place; areas of risk had been identified and were awaiting action. The home was clean and comfortable but records did not support that further improvements were planned to develop the home and provide a safe and pleasant place for residents to live. Communal areas were comfortable and bright and met residents needs. The registered manager said there were plans to improve these areas. Most rooms had en suite facilities otherwise toilets and bathrooms were located close to bedrooms and communal areas. It was noted that a number of bathrooms were in need of attention including redecoration, replacement of stained baths, repair of shower seals, replacement of locks to doors, replacement of broken tiles and damaged bath panels and repair of a broken light fitting. Sluices were located separately to prevent the risk of cross infection. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. There was a passenger lift to the first floor and ramps and rails were provided on the corridors where residents may need extra support. The roof of the lift had been damaged and the panels should be replaced. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 20 There was a call unit located in every room although not all residents could access this to summon assistance from staff as wander leads were not always provided; all residents should have access to an alarm facility unless a risk assessment suggests otherwise. Resident’s rooms were clean and bright and most had been personalised with treasured possessions; one resident said ‘ I have a lovely view’. The standard of furnishings varied from each room and the registered manager said that one set of bedroom furniture was being replaced each month; the new furniture should have lockable storage for resident’s personal items. Resident’s rooms were not fitted with suitable locks and some of these had been removed as noted above, rendering the fire door useless. It was noted that the vanity units were in need of repair or replacement as some were ‘shabby’ or damaged. Windows to the front of the house had been replaced and were in keeping with the building. However there were a number of window frames that were rotted and one that was leaking in a residents room; the resident said she used tissues to mop up the water when it rained. The registered manager said that the replacement of all other windows had been requested but had been put on hold until approval was given from the estates department. A number of window restrictors were removed or broken and risk assessments were not in place to support lack of provision; the manager said new locks had arrived and were waiting for the handyman to fit. Radiators were covered and the home was warm and clearly lit although it was noted that a linen room had a ‘makeshift’ aluminium pie dish casing; the reasons for this were unknown. The registered manager was advised this was replaced with an appropriate electrical fitting. The home was clean and free from odour and gloves and aprons were provided to protect staff and residents from the risk of infection. The laundry was suitably equipped although the radiator was badly rusted and should be replaced or repainted to reduce the risk of cross infection. One visitor commented ‘they keep the home clean, tidy and sweet smelling’. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 21 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 excellent. This judgement has been made using available evidence including a visit to this service. The staff team were experienced, well supported, competent and provided in sufficient numbers to meet resident’s needs. The recruitment procedure was clear and had been followed to ensure that residents were protected from harm. EVIDENCE: Rotas showed the home was staffed with sufficient numbers of staff to meet the needs of the residents. Residents said there were sufficient staff. One resident said ‘there are enough staff around, they answer the ‘buzzer’ and come almost straight away’. One resident said ‘The girls are very good, they look after me properly’. Comments from visitors included ‘staff have the skills, experience and most of all they care’, ‘staff are excellent friendly and caring’, ‘they are an excellent team and work together well’ and ‘staff are pleasant, easy to talk to and approachable’. The recruitment procedure was clear and had been followed to ensure that residents were protected from harm; staff confirmed that appropriate checks had been done before they started work. A record of interview had been Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 22 introduced to show an equal opportunities procedure and the registered manager had completed a verbal check of one of the references. Clear and accurate job descriptions defined the responsibilities of the carers to ensure they understood what their roles were. Residents were not involved formally in the selection of new staff but would be introduced to new applicants; consideration should be given to involving residents in the choice of new staff. Staff training was seen as essential to make sure the home provided a good quality service. Records showed that staff had received appropriate training to help them to understand the needs of residents in their care. Staff said they received appropriate training that was relevant and kept them up to date. Staff meetings were held regularly and records show they had been consulted about and kept up to date with changes and new practices. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 23 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents benefited from a well managed home and their health, safety and welfare was promoted and protected. People were involved in decisions about how the home was run. EVIDENCE: The registered manager was Mrs Lindsay Craddock; she has the necessary skills and experience required to support the staff and residents and enable the home to meet its stated purpose and objectives. She had updated her skills and knowledge and also met with other managers within the region. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 24 A relatives survey had been introduced to determine people’s views and opinions about whether the service was meeting their needs and expectations; the registered manager said the results of this survey would be collated and made available. Monthly ‘surgeries’ had been introduced to give visitors the opportunity to meet with the registered manager and discuss any concerns, compliments or suggestions they might have; initial meetings have been poorly attended and the manager states discussions usually take place informally. A health & safety committee meets each month to discuss any areas of risk; any areas of concern were forwarded to head office for action to ensure people’s safety was not at risk. The registered manager said residents meetings had not been held for some time although there was evidence that residents had been consulted informally about various aspects of the day to day running of the home including activities and menus; residents should be given the opportunity to voice their concerns or compliments about the service either during meetings or as part of an anonymous user survey. A number of systems were in place to monitor whether the home was safe and whether staff were following policies and procedures; these were being extended to cover all aspects of the day-to-day management of the home. The home had recently been re-assessed and had achieved the Investors In People award (IIP); this award is an external quality assurance system that monitors various areas of management and staff training and development. Staff were issued with handbooks and had access to training courses and materials. Regular supervisions gave staff the opportunity to discuss their practice and performance and there was evidence to support the registered manager had observed staff during practice to ensure they had followed procedures correctly. The responsible individual had visited the service each month to monitor whether the home was being managed properly. Two residents finance records were looked at; records showed resident’s finances were safe guarded by the systems and record keeping. Records support that equipment and systems were safe and well maintained to ensure people were safe and protected and staff had received regular training to keep them and others safe. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 25 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 4 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 2 X 2 2 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 Requirement Medications must not be administered to residents unless they are clearly labelled. Timescale for action 25/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Care staff should ensure any changes to care are included in the residents care plan and risk assessed if appropriate. Clear directions should be developed to support staff with their decisions to administer ‘PRN’ or ‘as needed’ medicines. Prescriptions should be returned to the home for checking prior to dispensing. Action should be taken to ensure medicines were stored at the recommended temperatures. 3. 4. OP15 OP18 Records of food served should be maintained at all times. The contact numbers for local agencies should be included in the safeguarding adults procedures. DS0000071070.V365916.R01.S.doc Version 5.2 Page 27 Lindsay House 5. OP19 Staff should be provided with training to support them with dealing with verbal and physical aggression. A regular tour of the home should be undertaken to identify any areas in need of repair or replacement. Areas in need of attention should be recorded, referred either to the estates department or the handy man and a record of dates the work was requested and completed maintained. Records should support that further improvements are planned to develop the home and provide a safe and pleasant place for residents to live. The fly screens in the kitchen should be replaced to discourage pests. The flooring in the kitchen should be replaced to prevent the risk of trips and falls. The holes in the fire doors should be repaired to make them effective in the case of a fire. The automatic door closure should be replaced to ensure the door operates in the event of the fire alarm sounding. The toilet and bathroom areas should be included as part of a maintenance programme. The roof of the lift should be replaced. All residents should be provided with an accessible alarm facility lead. Reasons for non-provision of a ‘call lead’ should be supported by a risk assessment. Residents should be provided with lockable storage for personal items, reasons for non-provision should be risk assessed. Residents should be provided with appropriate locks and keys to their bedroom doors unless a risk assessment determines otherwise. 6. 7. OP21 OP22 8. OP24 9. OP25 Vanity units should be replaced or repaired. Damaged and leaking window frames (particularly in room 21) should be replaced as a priority. Window restrictors to the first floor should be in place unless a risk assessment determines otherwise. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 28 10. OP26 The aluminium ‘pie-dish’ surround to the light fitting in the storeroom should be removed and replaced with an appropriate fitting. The rusted radiator in the laundry should be re-painted or replaced. Lindsay House DS0000071070.V365916.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@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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