Care Home: The Lindens

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What the care home does well Lindens Residential Care Home is registered to provide 24 hour personal care and support to 15 older people. Before care is provided the home ensures prospective residents have a care needs assessment before being offered a service. People using the service have a service contract and personal care plan. Care plans confirmed the delivery arrangements for the care and included risk assessments to ensure clients and care worker safety. Staff training is ongoing and the agency ensures the staff are competent in relation to personal care duties. When a sample of people who use the service were asked to comment about the agency one said, "I`m very happy here, the owners are lovely and work very hard, the girls work hard too and look after me very well". A new activity co ordinator was observed encouraging residents to engage in meaningful activities so their social needs would be met. Currently 80% of the staff team are qualified up to level 2 NVQ in care, 100% in safeguarding, 100% in safe handling of medication and all care staff have received mandatory training in moving and handling, basic first aid, food hygiene and infection control. This means that the staff team are qualified and competent to meet the needs of the people using the service. Good practices, risk assessments, monitoring and record keeping ensure there is a very low number of preventable accidents. The manager complies with statutory reporting requirements and other relevant legislation. What has improved since the last inspection? New residents to the service now receive a full needs assessment before moving to the home so that residents and their relatives know that the home can meet their needs. Residents care plans are now generated from a needs assessment that is reviewed frequently reflect their changing needs and include a risk assessment. The manager ensure that staff adhere to the homes medication policy to prevent mis administration and has introduced robust guidelines for staff to follow so that residents are not at risk of harm due to staff error. The manager has worked towards completing the home improvement plan by purchasing new lounge and bedroom furniture incliuding armchairs, wardrobes and beds and soft furnishings. The recruitment of a new activity co ordinator compliments the new reality orientation equipment ensuring activities meet the social, recreational and cultural needs of peopleusing the service. What the care home could do better: Care staff must receive regular supervision and an annual appraisal so that care staff practices can be monitored to ensure they meet the minimum standards. The manager must introduced regular staff meetings so that care workers have the opportunity to meet with their colleagues to discuss care practices and the philosophy and ethos of the home. This means there will be a more uniformed approach to care tasks and staff views can be known and acted on. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Lindens Market Square Haslingden Lancashire BB4 5PU     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: Christine Mulcahy     Date: 0 4 0 9 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 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 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 Older People Page 2 of 28 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 Older People Page 3 of 28 Information about the care home Name of care home: Address: The Lindens Market Square Haslingden Lancashire BB4 5PU 01623473546 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) : Mrs Roshni Moddia care home 15 Number of places (if applicable): Under 65 Over 65 1 12 0 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 0 0 2 The registered person may provide the following categories of service only. Care home only - code PC, to people 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: 12) Physical disability - Code PD (maximum number of places: 2) Mental disorder, excluding learning disability or dementia over 65 years - Code MD (E) (maximum number of places: 1) The maximum number of people who can be accommodated is: 15 Date of last inspection Brief description of the care home The Lindens is registered with to provide 24 Hour residential accommodation and personal care to 15 older people. The building is Grade 2 listed and accommodation is provided on two floors. There are 11 single bedrooms and 2 double bedrooms that can be shared. The first floor can be Care Homes for Older People Page 4 of 28 Brief description of the care home reached via a chair lift. There is a lounge dining area on the ground floor and shared toilets and bathrooms are within short walking distance from bedrooms and communal areas. There are paved outdoor areas to the front and the rear of the home where the people who use the service can sit out in good weather. There is limited space for parking at the rear of the building. As the home is located in the town centre of Haslingden the residents have good access to nearby shops and local facilities such as public transport, the market, public houses, social clubs and the library. A copy of the homes Statement of Purpose and guide for people who use the service are available when people move into the home. The fee is £323.00 per week and there are no additional charges. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This service received a key (main) visit to the agency offices and it took place over one day on 4th September 2009. Before this visit took place the manager was asked to complete a form called an Annual Quality Assurance Assessment. It gives us information about how the home is meeting the needs of the people using the service and includes future plans for further developments. We felt this form was filled in honestly and that a lot of time and effort had been given to filling it in. Surveys to the people using the service were sent out and 4 were returned. Information was obtained from the returned surveys, care plans of people using the service, staff records and surveys, management systems, observations, policies and procedures and a discussion with the person in charge. The inspector spoke to 4 of the Care Homes for Older People Page 6 of 28 people who use the service and 2 care workers. The Commission have not received any complaints about the service since the last main visit. What the care home does well: What has improved since the last inspection? New residents to the service now receive a full needs assessment before moving to the home so that residents and their relatives know that the home can meet their needs. Residents care plans are now generated from a needs assessment that is reviewed frequently reflect their changing needs and include a risk assessment. The manager ensure that staff adhere to the homes medication policy to prevent mis administration and has introduced robust guidelines for staff to follow so that residents are not at risk of harm due to staff error. The manager has worked towards completing the home improvement plan by purchasing new lounge and bedroom furniture incliuding armchairs, wardrobes and beds and soft furnishings. The recruitment of a new activity co ordinator compliments the new reality orientation equipment ensuring activities meet the social, recreational and cultural needs of people Care Homes for Older People Page 8 of 28 using the service. 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 Older People Page 9 of 28 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 10 of 28 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. Care needs assessments were done for prospective residents so that care staff would know how to fully meet their care needs. Evidence: Written information about the home, its objectives and philosophy was being updated and made user friendly for people using the service. This document clearly shows what type of service people can expect and the standard of the accommodation. To help people get a better view of the home photographs of the home are included in the brochure. New people to the service received a full and thorough needs assessment before moving into the home. We looked at 3 of the residents individual care plans using the case tracking process and these confirmed that this had been done. Care Homes for Older People Page 11 of 28 Evidence: Intermediate care is not provided at this home Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of the people using the service were recorded in a plan of care. The homes medicine policies and procedure ensured residents were protected from mis management. Evidence: Examination of personal care plans that belonged to 3 of the people using the service showed the written details in them were up to date and there was sufficient health and social care information for staff to meet the identified needs. People received personal and health care support using a person centred approach. Evidence of contact with General Practitioners, and other health professionals was clearly recorded and kept in the residents care plan. Discussion with the registered manager and new records that monitor residents health and wellbeing confirmed that the health care and support delivered to people using the service was consistent, sensitive, and met the identified needs of the people using the Care Homes for Older People Page 13 of 28 Evidence: service. Observations of the care provided showed that care and support was responsive to the residents varied needs and preferences. Staff respected privacy and dignity and were responsive to changing needs. A medicines policy supported by robust written procedures and practices was available for staff to follow. The manager had temporarily introduced an additional procedure for staff to work in pairs when administering medication to prevent the occurrence of mis management. This means that people using the service can be sure their health and wellbeing is safeguarded. The manager now ensures that all care staff have done the assessment of learning outcomes and the practical assessments. Also if care staff request additional support in this area, the managers will act immediately to address the learning needs to develop the confidence of the care worker when administering medication. Examination of the medicines cabinet and MAR sheets showed that medication in the home was stored and managed appropriately. The supplying pharmacy supports the home by providing regular medication updates and storage checks. Medicine records were fully completed and signed by appropriate staff. There is a good record of compliance with the receipt and safekeeping of medicines in the home and 100 of the staff team have received accredited training in safe handling of medication. When asked about the standard of care at the home one of the residents told us, Im very happy here, the owners are lovely and work very hard, the girls work hard too and look after me very well. Care Homes for Older People Page 14 of 28 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. Leisure and recreational activities available met the social needs and interests of people using the service. Visiting from relatives and friends is supported. A regularly reviewed menu ensured meals and snacks provided variety and nutrition. Evidence: Observations of the care provided and the variety of activities available in the home confirmed that as far as possible the needs around the lifestyle of people using the service was met and supported. The use of daily newspapers, televisions and radios in the home actively encouraged their independence. Routines in the home were flexible and residents were seen using their own rooms at different times during the day. Religious and cultural needs had been assessed and identified at the initial assessment process before moving into the home and where appropriate arrangements were made for people to be involved in these activities. Residents friends and relatives were seen visiting during the course of the inspection and one relative said, My dad gets well looked after here. The home has employed an activity co ordinator who was observed getting residents Care Homes for Older People Page 15 of 28 Evidence: involved in meaningful activities like armchair exercise, motor skill activities and reminiscence talks. The registered manager showed us copies of the new menu and residents when asked about this confirmed they were asked about their choice of meal and these were included in the menu.The menu was varied with a number of choices and included foods for residents with special dietary requirements. Care staff were sensitive to the needs of residents who found it difficult to eat and were aware of the importance of feeding at the pace of the resident. Care Homes for Older People Page 16 of 28 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. Complaints made by residents and relatives were acted on and recorded. Staff training and the homes safeguarding policies and procedures ensure residents are protected from abuse and have their rights protected. Evidence: The registered manager was aware of the need to ensure any complaints were dealt with efficiently and the outcomes for the complainant would be satisfactory. There is an effective, clearly written, easy to understand complaints procedure and a copy is given to all residents on admission to the home. The document is due to be reviewed along with other policies and procedures and currently explains the complaints process and deadlines in detail. Residents spoken to knew who to complain to and felt confident that problems would be resolved before she needed to complain. She told us, I have no complaints and can talk to the owners at anytime. There is policy and procedure for safeguarding adults and gives clear guidance to those using them. 100 of the staff team is trained in safeguarding adults. A member of staff when asked about safeguarding policy and procedure was fully aware of where to find the policy and how it should be used. Care Homes for Older People Page 17 of 28 Care Homes for Older People Page 18 of 28 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 standard of decoration and furnishings in the home ensured the environment was comfortable and homely. The home was clean, pleasant and hygienic Evidence: The manager is committed to providing a suitable and appropriate living environment for people using the service. The environment is well maintained, bedrooms have been redecorated and newly furnished to a good standard. New lounge furniture has improved the appearance of the communal area and one resident told us Theyve done a lot here since they took over, new furniture in the bedrooms. Hes spent a lot of money on the place. Residents bedrooms meet the needs of current occupants and they are encouraged to personalise their own bedrooms with personal belongings. A resident told us that she preferred not to have the new bedroom furniture and has kept her own furniture because it reminded her of her home. The home is well lit, clean and tidy and smelled fresh. Care Homes for Older People Page 19 of 28 Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and in sufficient numbers to support the people using the service to meet their identified needs. Recruitment policies and procedures ensured the protection of people using the service. Evidence: The staff rota showed there were sufficient staff on duty to meet the needs of the people using the service. Particular attention was given to busy times of the day and specific needs of the residents like medical appointments. A new activity co ordinator was observed encouraging residents to engage in meaningful activities so their social needs would be met. A copy of the training matrix was examined and showed staff training was ongoing. New and refresher training was always focused on delivering improved outcomes for the people using the service. Currently 80 of the staff team are qualified up to level 2 NVQ in care, 100 in safeguarding, 100 in safe handling of medication and all care staff have received mandatory training in moving and handling, basic first aid, food hygiene and infection control. There is a good recruitment procedure that clearly defines the process to be followed and ensures the protection of people using the service. 4 Staff files examined showed that staff were only recruited after essential pre employment checks were carried out. Care Homes for Older People Page 21 of 28 Evidence: The manager recently arranged for new up to date staff CRB checks to be done to ensure the protection, safety and well being of the residents at the home. Staff were observed working effectively with residents demonstrating a variety of skills required to meet the residents needs. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and clear systems of working. Policies and procedures in the home ensure safe working practices with routines that safeguard the people who live there. Evidence: Discussion with the manager and examination of staff files showed a lack of staff supervision and appraisal sessions. This means that it could not be shown that staff were clear about their roles and responsibilities and the ethos of the home. Also the lack of staff meeting records showed there was little opportunity for the staff team to let their views be known and assure them their views would be addressed. The manager said that staff were always able to talk to the management team and they operated an open door policy. The registered manager has the required qualifications, experience and competency to Care Homes for Older People Page 23 of 28 Evidence: run the home. Through discussion he was able to demonstrate a clear understanding of the key principles and focus of the service. He is person centred in his approach, is key in the planning and implementation of developments in the home. The manager has scheduled time and finances for the homes existing policies and procedures to be replaced and updated through a professional legal company already assigned to give the service employee, legal and safe working practice advice. This shows that the manager is committed to the key principles and focus of the service based on organisational values and priorities. Records and documents showed appliance, equipment and safety checks were done regularly and staff are trained and know how to follow these. Good practices, risk assessments, monitoring and record keeping ensure there is a very low number of preventable accidents. The manager and the staff team have a good understanding of the risk assessment process and this is taken into account in all aspects of running the home. All staff are trained in health and safety matters. Training records reflect this and regular updates are planned. All staff have have received fire training and the last fire zone test was done during the week. Record keeping was of a good standard and records are kept securely. The manager complies with statutory reporting requirements and other relevant legislation. The AQAA contained clear relevant information that was supported by a range of evidence and how they were going to meet the scheduled priorities. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 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 36 18 The registered person shall 21/09/2009 ensure that persons working in the care home are appropriately supervised. So that residents can benefit from the ethos, leadership and management approach of the home, the registered manager must ensure that care staff receive formal supervision at least 6 times a year. 2 36 38 The registered person shall 21/09/2009 ensure that persons working in the care home are appropriately supervised. The registered manager must ensure that staff employed at the home are given the opportunity to discuss care home issues with their colleagues at formal staff meetings so that their views can be known. Care Homes for Older People Page 26 of 28 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 27 of 28 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 Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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