Care Home: Lindsay House Nursing Home

What the care home does well Very positive feedback was received in surveys from a sample of people who use the service, relatives and professionals involved with the service confirming that people are satisfied with the care and support given at Lindsay House. These comments included "offers a long term placement `home` to very vulnerable individuals most of whom come from in patient, institutional care" and "maintain excellent physical and mental health and well being". People are treated as individuals and their beliefs are respected. A relative commented - " ---- is a decent catholic and this is encouraged. Priests come and visit ----- etc." A relative also told us that staff provide them with a good level of support which enables them to keep in touch and be comfortable with visiting their relative. Staff were heard to speak respectfully to people who use the service. We noted throughout the inspection that conversations between staff and people who use the service were professional, relaxed and supportive. Staff including agency staff were aware of people`s individual needs and the support they required and work as a team to meet people`s needs. What has improved since the last inspection? We made requirements at the last inspection about care planning and record keeping relating to medication. These specific requirements have been met. Since the last inspection a no smoking policy has been implemented in the downstairs lounge which provides people with a `smoke free` area. What the care home could do better: We found that there were some inconsistencies in completions of care plans and associated care and support records. Some were completed to a very good standard and it was relatively easy to confirm actions taken and those that needed to be taken, however information in some of the records was more fragmented making it difficult to confirm the actions agreed and taken in respect of peoples physical and mental health. Improvements are also needed in records relating to staff recruitment to confirm that all the necessary information has been obtained and to support decisions made about employing staff. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lindsay House Nursing Home 110 - 116 Lindsay Avenue Abington Northampton Northants NN3 2JS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kathy Jones     Date: 0 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Lindsay House Nursing Home 110 - 116 Lindsay Avenue Abington Northampton Northants NN3 2JS 01604406350 01604409689 lindsayhouse@rethink.org 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) : National Schizophrenia Fellowship care home 15 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 15 Service user numbers: No one falling within category MD may be admitted into Lindsay House Nursing Home where there are 15 persons of category MD already accommodated within this home. Date of last inspection Brief description of the care home Lindsay House is a home situated in the residential area of Abington in Northampton. The home is close to the main local bus routes in to the town centre where community resources include shops, pubs, leisure centres and restaurants. The home is managed by Rethink, which is the operating name of the National Schizophrenia Fellowship and is registered to provide nursing care for fifteen adults with severe mental health problems. Purpose built, the accommodation for residents is provided across two floors. All bedrooms are single occupancy with en suite facilities; the home also has two sitting areas, two kitchens and two dining areas. The home has its own transport, which enables all the residents to access local facilities and a further range of activities. Rear and side gardens are accessible to the residents and there is a parking area to the front and rear of the home. Information about fees was provided by the Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home registered manager as being current at the time of inspection. Fourteen of the fifteen beds are block booked and funded under contract between Northamptonshire County Council (NCC) and Rethink. The current fees per resident paid to Rethink are #745.95. (The registered manager advised that this figure has been significantly reduced as from April 1st 2007 by the County Council) The fees quoted do not include the housing cost which is paid to Leicestershire Housing. This cost was not available at the time of the inspection. Additional costs to residents as stated in the statement of purpose are dry cleaning, personal clothing, bed linen, toiletries and other personal expense. If required private telephone installation and calls and insurance for personal belongings and purchases. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Standards identified as key standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for people who use the service. Inspection of the standards was achieved through review of existing evidence and an unannounced inspection visit. Prior to the inspection we reviewed the information we had received about the service through correspondence or contact with the service and people associated with the service. This included an annual quality assurance self assessment which was submitted by the registered manager. We used this information to plan an inspection visit which was carried out by one inspector, unannounced over the period of a day. On Care Homes for Adults (18-65 years) Page 6 of 29 this occasion this was a weekday. Prior to the inspection we had sent surveys to a sample of people involved with the service. Following the inspection visit we received completed surveys from people associated with the service and have taken this information into account as part of the inspection. We received surveys from four people who use the service, two relatives, two professionals who have been involved with the service and one member of staff. The unannounced inspection visit involved a method of inspection called case tracking, which includes selecting samples of peoples records and tracking their care and experiences. We were introduced to people who use the service, however on this occasion people did not choose to discuss their experiences of the service. We spoke with staff and a community psychiatric nurse who was visiting the service and observed interactions between staff and people who use the service. The management of peoples medication was checked through reviewing prescribed medication for a sample of people. A sample of staff files were also reviewed to check the adequacy of the recruitment procedures in safeguarding people who use the service and looked at the training staff receive. Shared areas such as lounges and dining rooms were seen during the inspection. Verbal feedback was given to the deputy manager during the inspection and we have had some telephone discussion with the registered manager following the inspection. This report contains reference to The Commission for Social Care Inspection (CSCI) and the Care Quality Commission (CQC). Regulatory responsibilities under the Care Standards Act 2000 transferred to CQC on 1st April 2009. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People have information and opportunities to visit several times prior to admission which helps them to decide if Lindsay House is the right place for them. Evidence: We received completed surveys from four people who use the service in which we asked if people were asked if the wanted to move into the care home and if they had enough information to help them to decide if Lindsay House was the right place for them. Three people confirmed they were asked and had enough information, while the fourth didnt. Completed surveys received from two relatives confirmed that they felt that enough information was available. A professional who has been involved with the service told us that one of the things Lindsay House does well is offers a long term placement home to very vulnerable individuals most of whom come from in patient, institutional care. This makes it particularly important that people receive information and are supported in making decisions about the move. We looked at the care file for one of the more recent Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: admissions to Lindsay House to see how this had been managed. We found that prior to a months trial the person had visited Lindsay House a total of nine times. The visits started with an afternoon visit and then several visits for a full day leading up to a six day visit. This provided opportunities for the person to see what it would be like to live at Lindsay house and to get to know people and it also gave staff an opportunity to assess and decide if they could meet the persons needs. This is important in helping to ensure that peoples needs and expectations can be met following admission. The annual quality assurance self assessment submitted by the registered manager identifies that one of the things they want to do better is to implement more user friendly paperwork. They also acknowledge the need to update the service user guide. This was not available at the time of the inspection and we were advised that it was in the process of being updated. It is important that people have written information in a format that they can access to support the verbal information received. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Peoples individual needs and choices are respected. Evidence: We received positive feedback in surveys from people who use the service, relatives and health professionals about how peoples individual needs and choices are supported. People who use the service confirmed that they are able to make decisions. A relative commented rights and autonomy are respected and --- is given all the support and encouragement --- needs. These views are supported by professionals involved with the service, one of whom commented under what they do well, supports/promotes independence/individuality. The annual quality assurance self assessment submitted by the registered manager tells us that everyone who uses the service has a key-worker (a member of staff allocated to oversee their care) who co-ordinates and assesses their goals through recovery. We looked at the care file for one of the more recent admissions, which Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: confirmed that this was the case. There was evidence that the key-worker had worked with the person to develop the recovery plans and agree the care and support that would be provided with some initial small goals. The recovery or care plans provided staff with guidance as to how to support this individual according to their needs and choices. A staff member spoken with was aware of this persons needs and risk assessments, which helps to ensure that they receive the support they need and choose. We did look at some recovery plans for two other people who use the service and found that although they appeared to be reflective of peoples individual needs, they were not in all cases as detailed about how the support was going to be given. For example there were some general statements such as enhance social networks, rather than detailing the specific actions required which could then be more easily evaluated. Staff told us that a new tool was being implemented which would help people be more involved in reviewing their progress in meeting agreed goals. We found that there was clear information on peoples care file about any risks to people or others including staff. A staff member confirmed that they worked as a team which helped to minimise the risks. Staff were clear about peoples rights in relation to taking risks. We have given advice about the need for clearer evidence that decisions and management strategies regarding some high risk behaviors are supported and agreed by a multi-disciplinary group. Peoples individual beliefs are respected and supported. For example a relative responded to a question in a survey as follows: he is a decent catholic and this is encouraged. Priests come and visit him etc. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support to make decisions and pursue their chosen lifestyle. Evidence: Four people who use the service confirmed in surveys that they can do what they want during the day, in the evening and at the weekend. Two relatives confirm that people are supported to live the life they choose. Areas identified by people for improvement include a relative and someone who uses the service who say that they would welcome more outings and some short breaks away. This was discussed with the registered manager following the inspection, who confirmed that opportunities continue to be explored, although people have tended to change their minds and plans have not always come to fruition. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: A professional involved with the service felt that one of the areas that could be improved is more community involvement. We found that there is some evidence within care files of people accessing community facilities. Peoples needs vary with some able to do this independently while others require varying levels of support. On the day of the inspection it was unavoidable that someones plans were changed as a result of a member of staff being taken ill. We looked at the care plan for one of the more recently admitted people and found weekly sessions with the key worker had been arranged to help establish some activity and meaningful occupation and discussed this with the key worker. There was evidence that staff were working to support the person in establishing some interests and routines and were aware of the need to work at the pace of the individual taking account of the difficulties of moving from institutional care. Relationships are an important part of peoples lives. The annual quality assurance self assessment submitted by the registered manager confirm an understanding of the importance of relationships with family and also friends. Feedback from two relatives tells us that the service helps people stay in touch with their families and one person described the help and support that staff had given them to enable them to visit and feel comfortable about spending time with their relative. People with a mental illness can be very isolated and this support for relatives to enable them to have a better understanding of people and how to deal with situations is crucial in helping to maintain relationships and improve the quality of peoples lives. Peoples rights in relation to daily routines are respected. The annual quality assurance confirms that daily routines are flexible to fit around peoples activities. We observed this to be the case during the inspection in relation to meals. The annual quality assurance self assessment identifies that over the next twelve months there are plans to continue to look at more creative ways of involving people in the running of the service. People told us that they were happy with th meals provided and that there are alternatives. People are involved in the planning of menus through residents meetings. People can choose where they eat their meals and there is a shared dining room which the majority of people choose to use. The lunch time meal on the day of inspection was hot and looked appetising. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People receive good healthcare support. Evidence: We received very positive feedback from relatives and professionals about support for peoples healthcare. Two professionals confirmed that the service always seeks advice and acts to manage and improve individuals health care needs and additional comments included, prompt communication with any concerns/changes and maintain excellent physical and mental health and well being. We also spoke with a Community Psychiatric Nurse who was visiting someone on the day of the inspection. He told us that staff work with him in the persons interests and also that he sees how much people who he knew while in hospital have improved. Surveys received from two relatives confirm that people always get the support they expect and agreed, one refers to someone having been ill for many years and says, care receiving at Lindsay House is far superior to anything he has received during his long illness. He is happier than I have seen him for many years. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: A survey received from a staff member confirms they always have up to date information about the needs of people they support or care for. We spoke with a member of staff who works for an agency but has worked at Lindsay house a number of times. Discussion confirmed that he was aware of peoples individual needs and that staff work together to support each other in meeting the needs. We found evidence within staff files that peoples physical and mental health is being monitored and that relevant health professionals are accessed for advice and support as and when necessary. We looked at a physical health check document which was in the process of being completed. The document is designed for staff to work through with people who use the service. This is positive in that it encourages and enables people to be involved with and responsible for their health and decision making. However from reading other records we found that there were some inconsistent recording practices in relation to professional visits and health issues that arise. There is a record called medical appointments record, however the reason for the appointment and the outcome is not always clear. It does show if staff accompanied the person or not, demonstrating that people are encouraged to develop some independence in managing their healthcare needs. We looked at a sample of peoples medication and the associated records to see how this is being managed. From the sample check we found that peoples prescribed medication was available. We had made a requirement at the previous inspection that records needed to be kept of all medication received. We found that this was being done, however when any medication was left at the end of the monthly cycle, the quantity was not always being carried forward to the next cycle making it difficult to check that medication had been administered correctly. It is important that managers have systems in place which allows them to easily check that people are receiving their medication as prescribed. It is also important in the event of a suspected error. Where the medication carried forward had been recorded a sample check identified some discrepancies between medication in stock and administered. We were informed that a new monitored dose system was about to be implemented which staff felt would simplify the system for them and reduce the risk of error, however the need for regular audit checks remain to ensure that safe practice is followed and people are receiving their medication as prescribed . In addition to the medication administration records which staff sign to confirm that they have administered mediation as prescribed, there were additional recording sheets (audit sheets) for medication prescribed by the hospital rather than the General Practitioner. These additional records were not being completed. Advice was given to clarify the need and use for these records and have consistent policies regarding their Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: use. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. There is a complaint procedure which people are aware of and staff are aware of their responsibilities in relation to safeguarding vulnerable adults. Evidence: The Commission for Social Care Inspection whose regulatory responsibilities passed to the Care Quality Commission on 1st April 2009 have received no complaints about the service provided at Lindsay House. The annual quality assurance self assessment submitted by the registered manager tells us that the service have not received any complaints in the twelve months prior to submission on 10th February 2009. We received four surveys from people who use the service which confirm that people are aware of the complaint procedure and feel able to access it. All four say that they know who they can speak to if they are not happy and know how to make a complaint. Comments include tell my keyworker, I would speak to -----, he listens to what I say. There is a sign on the noticeboard. Relatives and staff also confirmed that they know about the procedure. The annual quality assurance self assessment (AQAA) states Training is given to all staff on protection of residents from various forms of abuse this is done on induction and also in house. We spoke with staff who confirmed their understanding of their responsibilities in relation to safeguarding people. The AQAA refers to plans to Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Facilitate an optional training day for service users, using the No Secrets resource pack. This would be very positive in supporting people to fully understand their rights to feel safe. We spoke with some people who use the service during the inspection and no concerns were raised about how they are treated. Four people told us in surveys that staff treat them well. Observations indicated positive and professional relationships between staff and people who use the service. The registered manager is aware of safeguarding procedures and following the inspection we have discussed a particular situation where it is not clear from the evidence available, that an individual is properly safeguarded by having the support of a multi-disciplinary group in agreeing and regularly reviewing management strategies regarding high risk behaviors. Following these discussions we have made a safeguarding alert through safeguarding vulnerable adults procedures to Northamptonshire County Council who have responsibility for safeguarding vulnerable people in the county. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a clean and comfortable place to live. Evidence: People all have single rooms with en-suite facilities. People spoken with were happy with their rooms and confirmed that staff respect their privacy. We noted that all areas seen were clean and people told us that this is always the case. The annual quality assurance self assessment confirms that staff receive training in infection control. Shared spaces consist of two lounges and dining rooms which were comfortable. People were observed to access all areas of the home as they wished. Since the last inspection the lounge on the ground floor has become a no smoking lounge. People are still able to smoke in the upstairs lounge. This now gives people a choice of a smoke free environment. The AQAA confirms that there is a maintenance and redecoration programme in place, will all shared areas having been re-decorated in the last twelve months. The need for renewal of the hall and stairs carpets is acknowledged and to develop and promote the individual and homely atmosphere of the environment. One of the areas planned was to look at introducing more pictures into the corridors. Care Homes for Adults (18-65 years) Page 21 of 29 Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by an experienced staff team who work together to meet their needs. Evidence: We received surveys from four people who use the service, three confirmed that carers listen and act on what they say and the fourth said they usually do, but not straight away. Positive comments were received from relatives such as staff are kind and friendly and have the best interests of the patients/residents as a priority, The staff endeavour to make ------s life comfortable and enjoyable. Comments in a survey from a staff member said that they felt that there are usually enough staff to meet peoples individual needs. On the day of inspection a staff member was taken ill, however arrangements were made to cover the shift with an agency member of staff. This agency worker told us that they have worked regularly at Lindsay House and are aware of peoples needs and that there is good communication between staff about any changes in peoples needs. They also told us that staff work together as a team, supporting each other in meeting peoples needs. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: We received a survey from a staff member which said they felt they had the right support, experience and knowledge to meet the different needs of people who use the service. This was confirmed in surveys from two professionals, with one saying that staff always have the right skills and experience to support individuals social and health care needs and the other saying they usually do. One made the additional comment excellent mental health skills. A relative believes staff have the necessary skills and experience due to the positive changes in their relative. Staff confirmed that there is an induction programme that covers what they need to know and that they receive training appropriate to their role. The annual quality assurance self assessment identifies that registered nurses are employed and that twelve of the care staff have obtained a National Vocational Qualification, with the remaining two working towards it. The AQAA also acknowledges the need for continuous development, for example the introduction of a knowledge and skills framework which will provide more focus for developing staff competence in their work. A survey received from a member of staff confirmed that their employer carried out checks before they started work, which includes a criminal record bureau checks and references. We looked at records for two of the more recently recruited staff. We found that criminal record bureau checks had been obtained before they started work which helps to safeguard people who use the service. However advice has been given of the need to be more thorough in recording any telephone conversations relating to peoples previous employment and to pursue an additional reference in respect of one of the people. We also advised that the application form be altered as it only asks for details of employment in the last ten years. The Care Homes Regulations 2001 require a full employment history to be obtained. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Lindsay House is managed in the best interest of people who use the service. Evidence: There is an experienced registered manager in post who has managed Lindsay House for six years. The registered manager is a registered nurse qualified in mental health and he has achieved a National Vocational Qualification (NVQ) at level 4 in management and care. Two deputy managers, who are also registered nurses and have achieved NVQ level 4, support the registered manager with the management of the service. Feedback received in surveys suggest that the service is well managed. Comments include: from a staff member who confirms that their manager meets with them regularly to give them support and discuss how they are working. A professional states - excellent care providers providing care to a varied/challenging group. not afraid of risk and very perceptive and a relative under the question about what the service does well says - it focuses on meeting the needs of the patients/residents and Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: encouraging them to get those needs met but with a very light touch. The atmosphere is relaxed with rules kept to a minimum. There is a routine of expectations regarding behaviour which means it runs smoothly. The organisation have various quality assurance tools to help them monitor the quality of care, one of which is a monthly unannounced visit by the responsible individual. The responsible individual who is the person responsible for overseeing the service and the care provided on behalf of the organisation has an office in the building. There was evidence that he carries out regular sample checks of aspects of the service, talks to people who use the service and where applicable recommends improvements. An annual quality assurance self assessment (AQAA) was submitted to the Care Quality Commission prior to the inspection. This was a very detailed document which identified what the service does well and what could be improved, which is important in maintaining and improving the quality of care and support that people receive. Confirmation that regular maintenance and servicing of equipment to reduce the risk to people who use the service was received in the annual quality assurance self assessment submitted by the registered manager. We looked at the fire risk assessment and gave advice to include some more specific information about the individual needs of people who use the service and associated risks to enable staff and fire service personel to assess risk in the event of the need to evacuate. The registered manager has confirmed that the fire risk assessment has been revised since the inspection and confirmed that it will be kept under review. Financial records were not viewed during the inspection, however the registered manager advised that since the last inspection a reduction in agency staff due to the recruitment and retention of more permanent staff had allowed them to work within their budget without any impact on people who use the service. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Regular audits of medication 15/07/2009 must be carried out to ensure that there is evidence medication is being administered safely and as prescribed. To safeguard peoples health. 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 6 More consistent and clearer record keeping in relation to care plans and evaluations would provide better evidence of the work done to support people. The application form should be altered to ensure that a full employment history is obtained as required by the Care Homes Regulations 2001. Record keeping relating to information obtained as part of an application, and of the rationale for decisions about employment should be improved to demonstrate that people are suitable to work with vulnerable people. 2 34 3 34 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!