Care Home: Linwood

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What the care home does well The service carries out detailed pre admission assessments prior to any person moving in to ensure that they will be able to meet their needs. The residents live in an home that is friendly and homely providing a one person living in the home for respite stated that Linwood is a "great place to Live in and the staff can not do enough to make life comfortable" The service has a structured activity programme, which is designed to ensure that all residents of the home can participate in an appropriate leisure pursuits. They service has introduced more reminiscence and multi sensory equipment and materials. People receive well balanced and presented meals which meet with their preferences and they are provided with choices and alternatives, in an environment which is present and well presented. What has improved since the last inspection? The communal areas of the home have been redecorated and the process has begun to redecorate residents bedrooms. The home has plans to open open up the communal areas on the first and second floor to provide a more scope for social interaction by the residents. The service has purchased a large flat screen TV for one of the communal areas. To provide an alternative source of entertainment the residents have access to a Wii sports, which is linked to the flat screen TV and was described as "very successful especially the golf simulator". What the care home could do better: The service must ensure that the residents daily notes a completed by all staff. The privacy and dignity of the residents must be maintained at all times. The high dependency of the home on agency staff must be addressed to ensure that the residents receive care, which is consistent and provided by staff that they can identify. The home must have a registered manager. Key inspection report Care homes for older people Name: Address: Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kenneth Dunn     Date: 2 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS 02083356800 02083393485 lorraine.hillsavery@anchor.org.uk www.anchor.org.uk Anchor Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Michelle Nathan Type of registration: Number of places registered: care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 66 The registered person may provide the following categories of service: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within`any other category (OP) Dementia (DE) Physical disabilty (PD) Date of last inspection Brief description of the care home Linwood is a purpose built care home that has been operating since April 2004. Service provision is for personal care for up to sixty-six older people, some of whom may have moderate dementia or mental health needs and/or physical disabilities. Care Homes for Older People Page 4 of 26 Over 65 0 66 0 66 0 66 0 6 0 7 2 0 0 9 Brief description of the care home The home is owned and managed by Anchor Homes who are the registered providers. Linwood is located in a residential area within walking distance of Thames Ditton village where there are a small number of shops and other community amenities. A GP practice is nearby. There are car-parking facilities to the front of the building and further parking spaces and an enclosed garden to the rear. The accommodation is divided into six named living units over three floors. Upper floors are accessible by one passenger lift and stairs. The home is wheelchair accessible throughout, however wheelchair users are restricted to two per unit other than on the ground floor, for health and safety reasons. There are eighteen single bedrooms on the ground floor, all with fully functioning ensuite shower rooms. There are forty-eight single bedrooms over the first and second floors. These are all fitted with en-suite shower rooms for which a single charge applies for showers to be made functional. Communal facilities are arranged on each floor comprising of small kitchens, dining rooms, lounges, toilets and assisted bathing facilities. The weekly fees range from 514 to 781 Pounds Sterling per week these fees do not include personal items. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit was part of a key inspection. The visit was unannounced. We arrived at 9.15 am and left at 13.30 pm. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment. (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date, which provided us with all the information we asked for. Reference is made to this assessment throughout this report. The inspection process took into account further detailed information provided by the care manager on duty during the site visit and any information that CQC has received about the service since the previous inspection. A part tour of the premises took place . Care Homes for Older People Page 6 of 26 On the day of this visit the inspector spoke with a number of service users, relatives and staff on-duty. Other methods used to inform our judgements made in this report include discussions with members of staff and community health based professionals. We looked at staff recruitment, and training records, care plans, risk assessments, menus, quality assurance systems, medication administration policies, health and safety records and policies and procedures were sampled. We also reviewed other information that we have received since our previous inspection including notifications that the service is required to inform us about Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission procedures at the home continue to ensure that the needs of prospective residents and their aspirations are fully assessed prior to admission to make sure that their needs can be effectively met. Evidence: At the time of this site visit the service had 51 residents and 16 vacancies. The service has a robust set of policies and procedures in place to ensure that potential residents of Linwood will be fully assessed prior to being offered a place at the home. The assessment process has been designed to ensure that the service can effectively meet the needs of prospective residents. The care manager on duty during this site visit confirmed that the people who wish to use the service benefit from a pre-admission assessment from a suitably qualified person and all staff involved in this process have undertaken all relevant and required Care Homes for Older People Page 10 of 26 Evidence: training to ensure admission into Linwood will be successful. The documentation used by the home for these assessments allow a through assessment to take place and care plans can then be generated from this documentation. Information contained in the AQAA submitted by the home in 2009 continues to provide accurate information pre admission assessments take place at the home to establish care needs can be met. this enables prospective residents the opportunity to meet others living in the home and to view the environment they may choose to live in. This was confirmed during the site visit by the commission on the 6th of July 2009, again this site visit and a review of the assessment procedures highlighted that the procedures will provide a full picture of a potential resident and their care needs. The home does not offer intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service should receive health and personal care that is based upon their individual needs. The people using the service also have support from health care professionals when it is required. Evidence: As part of the site visit four randomly selected care plan folders were reviewed and one file was selected specifically because of complaints received regarding the care of one resident. The care plans sampled were all found to contain detailed information about the person using the service and areas of specific need. The care plans were informative and provided appropriate information regarding the needs of each individual. The files all contained areas to be completed by the care staff on a daily basis to demonstrate how they had supported individuals with their care needs. It was however noted that the bathing chart of the resident whose family had previously Care Homes for Older People Page 12 of 26 Evidence: raised concerns, had not been completed since the 9th of December 2009 indicating that the resident had not received a bath for 40 days. The care manager in charge of the home stated that this resident frequently rejects the assistance offered by staff to have a bath and made assurances that the offer of assistance with bathing is made daily and stated that the individual had certainly been bathed since the date on the chart. This was supported by members of staff who insisted that the residents had received assistance with bathing several time since the 9th of December. The need for appropriate recording of care and especially the refusal of care was discussed with the care manager who emphasised that measure will be implemented to ensure that the daily charts are completed by staff. There was evidence that the care plans had been reviewed every month and that people using the service had also participated and agreed the plans. Individual care plans contain detailed risk assessments for all identified risks. The care manager stated that the people using the service are all registered with a local GPs and that the home had a very good relationship with the medical team they use. The home has its medications delivered every month by a large chain pharmacy and this is dispensed in blister packs. Policies and procedures are in place for staff that administer the medicines and also protocols for those people using the service that wish to self medicate. During the visit staff were observed to knock on doors prior to entering and were using the preferred names of the people using the service as documented in their care plans. It was however noted that on one occasion a staff member who was asked to assist with a residents personal care walked straight into the bedroom without knocking or finding out if the resident was ready for the carer. The care manager immediately took appropriate action to ensure the resident was not compromised and that the staff member knew what they had done was inappropriate. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a varied activity programme which is constantly under review to improve the lifestyle expectations of the residents. Menus are varied and offer choice and the dining arrangements should offer a pleasant mealtime experience. Evidence: The home continues to employs two activity organisers one full and one part time and that activities are now organised for the residents 7 days a week. The activities coordinators have developed a flexible programme depending on the wishes and needs of the residents. On the day of inspection a notice board in the reception area detailed the activities arranged for that week. The home offers a range of activities including group walks, knitting and sewing, pub afternoons, picnics, film nights, bingo, rummage boxes and tea dances. Trips out in the homes transport are also organised for the residents. The home has recently purchased a large flat screen TV and an interactive computer sports game, the care manger stated that this has been very successful specifically the golf game which has proved very popular with the residents. Care Homes for Older People Page 14 of 26 Evidence: The care manager stated that the home has developed plans to construct a hobbies room/shed in the garden to encourage the involvement primarily of the male residents to work with staff in woodwork and basic maintenance. The care manager did state that the hobbies room is open for all residents and not designed to be gender specific. The service ensure that the religious and cultural needs of the residents are explored. The manager stated that the service will always assist the residents to attend what ever service the wish and will endeavour to met any cultural requirements of the residents. Family and friends are welcome at the home at any time. Visiting times to the home remain unrestricted and people using the service can return to their bedrooms if they wish to see their visitors in private. During the site visit several residents had Friends and families visiting them. One resident spoke very highly of the care he has received at the home and how the staff always make his visitors very welcome providing them with tea or coffee in the privacy of his own room and ensuring they have privacy to talk and enjoy the visit. The previous AQAA stated that in order to improve the food delivery of the home a survey of residents preferences for catering choices was undertaken and from this a new menu was developed. Evidence was available during this site visit to demonstrate that this statement continues to be relevant. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Provisions are in place which should ensure that the people who use the service can be confidant that their complaints are listened to. The residents should be protected from abuse as the staff team have received training in safeguarding adults. Evidence: The care manager on duty during the site visit stated that the service has received 9 complaints since the previous key inspection by the commission 06/07/2009. All complaints are recorded in a book by the manager or the deputies. The complaints log provided evidence of the complaints and the outcome of the investigations. The commission has been contacted directly by three people with complaints about the service, two in respect of care family members were receiving at the home and one from a staff member raising issues over staffing and working conditions. The service was provided with the details of all complaints received by the commission. The care manager provided evidence during the site visit of how the home has dealt with the complaints and any resolutions that may have been reached. It was however noted that one of the compliant received by the commission was still not resolved as staff were still failing to record the care being offered to the resident. Care Homes for Older People Page 16 of 26 Evidence: The complaints procedure is available at the home and is also made available to all people who use the service and their representatives. The home follows the local authoritys procedures for the safeguarding of adults. Staff have access to these procedures and the homes own internal policy. This policy complies with local authoritys procedures for safeguarding adults. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service live in a, comfortable responsive, relatively well maintained home and have access to a suitable gardens. Evidence: A part tour was undertaken during this site visit, concentrating on all communal areas and a random sample of residents bedrooms where we were invited by the individual occupying the room. All communal areas of the home had been fully redecorated since the previous site visit by the commission 06/07/2009 and a new stair lift has been fitted in one stair well to be used with assistance of staff. The care manager stated that the service is developing plans to remove the partition doors in the dining/sitting rooms on the first and second floor. The care manager stated that the removal of doors would greatly enlarge the space available to residents and allow them to mix with ease. The bedrooms seen had been personalised by the residents and were well decorated and maintained. All bedroom doors have locks and the keys are available to the residents. Care Homes for Older People Page 18 of 26 Evidence: On the day of the site visit however the communal areas on the ground floor had a residual mal odour which was still evident after cleaning. This was discussed with the care manager who in turn brought this to the attention of the house keeping team. The gardens are accessible and are well maintained. Paper towels and soap dispensers were available for staff for hand washing and aprons for use during personal care. The home has a laundry room and documentation confirmed that infection control training had taken place. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is staffed with sufficient numbers to support the people using the service. Recruitment practises are robust which should protect the individuals living at the home. Evidence: On the day of the site visit the staffing numbers appeared sufficient to meet the assessed needs of the people using the service. It was however noted that the service operates with over 80 agency staff covering all shifts. The commission was contacted directly by a staff member raising concerns regarding the staffing arrangements at the home and the excessive use of agency staff. This was discussed with the care manager on duty who stated that where ever possible the home requests that only agency staff who have worked at the home are offered the opportunity to work at Linwood. The agency staff all undertake a basic induction to the home and the residents to ensure that they can support the residents. The manager provided details of the plans that the home has introduced in order to overcome the staffing issues at the home. In order to achieve 0 agency staff the service undertook an open day to attract staff to fill the vacancies which includes team leaders, care staff, house keeping and catering staff. The care manager stated that Care Homes for Older People Page 20 of 26 Evidence: the open day was very successful and it was hoped that the vacant positions would be effectively filled. Six employment folders for the staff were randomly sampled during the site visit. The documentation in the staff folders confirmed that the home had policies and procedures in place necessary employ staff. The training records for the home were observed and confirmed that mandatory training takes place. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users benefit from the management approach that provides an open, positive and inclusive atmosphere. The home has a quality assurance and monitoring system in place that is based on seeking the views of the residents. Policies and procedures are in place to ensure, so far as is reasonably practicable, the health, safety and welfare of service users. Evidence: At the time of the site visit the service was still without a registered manager. The person appointed to manage the home on behalf of Anchor Homes has still to finalise the process of registration with the commission. The manager stated during the previous site visit 06/07/2009 the issue of registration would that be resolved by the end of August 2009. During a telephone conversation with the manager she stated that unfortunately extenuating issues arose that halted the progress of her application, this has now been resolved and the registration will be completed by April 2010. Care Homes for Older People Page 22 of 26 Evidence: The manager has the support care managers in the home and regular visits from her line manager. The care manager on duty confirmed that the manager operates an open door policy so that people using the service and relatives or representatives can speak to her at any time The views of the residents are sought on a regular basis. The service carry out surveys, which seeks the views of service users. The manager advised that the results of the surveys are correlated, actions for improvement are identified and then added to the managers continuous improvement plan for the home. The results of the most recent survey carried during April 2009 was reviewed during the previous site visit by the commission. The care manager stated that the surveys continue to provide the basis of changes at the home. The operations manager for the home visits every month and these visits are called Regulation 26 visits. Records of these visits were sampled during this site visit and identified areas where improvements could be made and where previous recommendations have been adopted. The home does not manager the finances for any people using the service. Documents sampled demonstrated that the home has the necessary health and safety certificates in place. Fire alarms are tested regularly and fire awareness training takes place for all staff. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 27 18 The registered provider must ensure that the residents needs are met by sufficient employed staff at all time the residents must receive support from a consistent staff group 23/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. 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