We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Lindsay House Lindsay Avenue, Abington, Northampton, NN3 2JS Tel: Date of Inspection: 05 February 2014 Date of Publication: March 2014 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Staffing Supporting workers Assessing and monitoring the quality of service provision Records Action needed Met this standard Met this standard Met this standard Met this standard Inspection Report Lindsay House March

2 Details about this location Registered Provider Registered Manager Overview of the service National Schizophrenia Fellowship Miss Camelia Bernadette Marsh Lindsay House provides personal care for people with long term mental health needs. Type of service Regulated activity Personal care Inspection Report Lindsay House March

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 What we have told the provider to do 4 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Staffing 8 Supporting workers 10 Assessing and monitoring the quality of service provision 12 Records 14 Information primarily for the provider: Action we have told the provider to take 15 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report Lindsay House March

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 5 February 2014, talked with people who use the service and talked with staff. What people told us and what we found We went back to review the improvements the provider had made following an inspection visit during October We found that the provider had made changes to the service in line with local commissioning requirements. This meant that the service provided people with more support which enabled them to live as independently as possible. We spoke with two people who used the service. We also spoke with two members of staff and the registered manager. We reviewed the support records of three people and looked at staff training and development records. We also looked at the systems in place to assess and monitor the quality of service provided. People told us they were happy living at Lindsay House and that staff supported them to live an independent life. One person told us they had not been very well and the staff were supporting them to take their medicines. They also told us that they would like a hand rail put in place to make sure they could use their shower in a safe way. During our inspection visit, we observed that people looked well cared for and staff provided support in a relaxed and friendly way. We found that most people received care that met their needs. However, we had some concerns that support plans had not been put in place to meet one person's individual needs. We also found that staff were well supported and trained to do their jobs. We found that the provider had a system of quality assurance in place and that records were stored safely and securely. You can see our judgements on the front page of this report. What we have told the provider to do We have asked the provider to send us a report by 18 March 2014, setting out the action they will take to meet the standards. We will check to make sure that this action is taken. Inspection Report Lindsay House March

5 Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Lindsay House March

6 Our judgements for each standard inspected Care and welfare of people who use services Action needed People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was not meeting this standard. Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement During our last inspection visit to Lindsay House, we found that staff had not reviewed the risk assessments and care plans in line with people's needs and when they were due for review. During this inspection visit we found that each person had received a new and individual support plan and staff had re-assessed people's needs using a "recovery" style plan. The recovery model of care planning is used to enable people who have mental health needs to recover from their illness. For example, one person needed additional support to maintain personal hygiene. We saw that staff had put in place a support plan and this included the steps staff needed to take to "prompt" the person to care for themselves. We also saw that staff had reviewed people's support plans to make sure that support was tailored to each person's individual needs. We saw that new support plans had been put in place as people's needs had changed. We found that staff had a good understanding of the support that people required. The provider might find it useful to note that the most recent reviews of people's support plans had not been undertaken in detail. Staff had used comments such as "reviewed" and "achieved" with the date of review and their signature. This level of review did not demonstrate whether people had progressed in line with the "recovery" model of support being used. The registered manager told us that the support plans were due to be reviewed again by the staff and that they used clinical supervision meetings to check reviews had been properly undertaken. However, we also had some concerns that people's physical health needs were not always Inspection Report Lindsay House March

7 assessed to make sure they stayed healthy. For example, one person had returned to live at the service after needing nursing care. We saw that staff had organised the appropriate support from health professionals such as an occupational therapist. However, we also found that new support plans had not been put in place. We were concerned that the person's physical needs had changed and that no new plans of support had been developed. For example, the person needed special support to help them reduce the risk of an infection. However, there were no support plans for staff to follow. We also saw that some advice given by a health professional to help manage a health condition had not been used to develop a continence support plan. This meant that people's care was not always planned with their health and wellbeing in mind. After the inspection visit the registered manager sent us copies of new support plans that had been put in place. We saw these were sufficiently detailed with information to make sure people were well looked after. The registered manager also confirmed that a nurse working for the provider would be available to review each person's physical health needs on a periodic basis. However, we were unable to substantiate that the provider had fully reached compliance. The provider might also find it useful to note that one person told us they would benefit from a hand rail in their shower room. After the inspection visit, the registered manager told us they had ordered this new equipment. Inspection Report Lindsay House March

8 Staffing Met this standard There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement During our last inspection visit, people told us that staff were always busy working and did not have much time to spend with them. We also found that staff had reduced their working hours and were undertaking additional cooking and cleaning responsibilities. During this inspection visit, we found that the provider had made changes to the service in line with local commissioning requirements. This meant that the service provided people with support to live an independent life; this included learning how to prepare their own meals and to clean their personal environment. Staff told us that there were enough staff to look after people's needs, and that most people living at the service had low care needs and could look after themselves quite well. However, they were undertaking cleaning and cooking duties which meant they had less time to spend with people developing their daily living skills. They told us the provider was planning to buy in the services of a contract cleaner and cooking company to provide people with these services. This was confirmed by the registered manager who showed us copies of quotations they had obtained. The registered manager showed us information which demonstrated they had assessed people's needs and the numbers of staff required. They told us they needed three staff during the daytime and two staff during the night time. We looked at a sample of staff working rotas and these confirmed the staffing arrangements were in place. Staff also told us that the provider had recruited new staff to work at the service and that they were still advertising some staff vacancies. However, at present they had an established team of bank and agency staff to cover any staff vacancies. One member of staff told us they checked the level of support that people required each day and checked staff working rotas to make sure there were enough staff. They told us that sometimes they required more staff to work at the service, such as when permanent staff needed to assist people to attend their healthcare appointments. However, they told us that the registered manager encouraged them to book bank or agency staff to make sure there were enough staff working at the service at all times. During the inspection visit, we observed that bank staff provided cover for two permanent staff who were assisting Inspection Report Lindsay House March

9 one person out into the community. This meant that the provider had systems in place to make sure there were sufficient staff to meet people's needs. Inspection Report Lindsay House March

10 Supporting workers Met this standard Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement During our last inspection visit, we found that some staff had not completed their mandatory training requirements. Staff received appropriate professional development. During this inspection visit, we found that most staff had been recently recruited by the provider. Staff told us that they had received comprehensive induction training when they came to work at the service. This had included training to complete care and support plans and mental health awareness training. They also told us that they had completed a range of mandatory training which included the safeguarding of vulnerable adults. They told us that they had received additional training in regards to people's individual needs, such as diabetes training which had been delivered by the local diabetic nursing team. After the inspection visit the registered manager provided us with information to show the training staff had undertaken. We saw this had included safeguarding of vulnerable adults, mental health awareness, health and safety, first aid, food hygiene, and risk and safety management. We also saw that medication competency assessments had been undertaken to make sure staff were competent to assist people to take their medications safely. The provider might find it useful to note that staff had not completed training around the mental capacity act and deprivation of liberty safeguards. The registered manager told us that staff had received some training on these important subjects during their induction. They also told us that staff had received additional support from the local funding authority to enable them to understand people's capacity in making decisions around their medication and finances. The provider might also find it useful to note that staff had not completed moving and handling training and a few people might require additional support from staff to move their position safely. After the inspection visit the registered manager sent us confirmation that moving and handling training had been booked with the local funding authority and that an electronic training package had been provided for mental capacity and deprivation of liberty safeguards training. They told us all staff would receive this training before the end Inspection Report Lindsay House March

11 of March We looked at three staff files. We found that staff had received a recent one to one supervision with their manager. We looked at copies of one to one staff supervisions and saw that the manager had reviewed each member of staff and the progress they had made in their jobs. We saw one staff who had worked at the service for 12 months had received an appraisal of their performance and this had included feedback about how they worked with people using the service. Staff also told us that they had received regular supervisions with their manager and felt well supported. This meant that staff received sufficient support and supervision to enable them to do their jobs. Inspection Report Lindsay House March

12 Assessing and monitoring the quality of service provision Met this standard The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement During our last inspection visit, we saw that a checklist to show the cleaning tasks completed in the home had not been completed and the premises were lacking in cleanliness. During this inspection visit, we found that the premises were clean and that staff maintained check lists in bathrooms and toilets to show to show that cleaning had taken place. We also found a series of checks were in place that included checking the viability of the fire alarm system, and the temperature of the fridge freezer. We found that there was a system in place to check the decorative condition of people's bedrooms. We also found that the registered manager had introduced community meetings, in order that people could feedback their experiences of living at the service. We looked at some recent copies of community meeting minutes and found that people had been asked for their feedback on ways to improve the quality of service provided. For example, we saw that one person had suggested that they would like to go out on day trips more often. We also saw that staff had fed back to people using the service in regards to the improvements being made. We saw a recent example was to update people on the progression of a new heated smoking shelter that was going to be built in the garden area. The registered manager showed us that they had an action plan to record the improvements needed at the service. We saw that the action plan included improvements to be made to the management of medicines, staffing, safeguarding people from abuse, health and safety and supporting people who used services. The action plan stated the improvements required and a timeframe for each action to be completed. For example, all people needed to have support plans in place by the end of The registered manager told us that they also planned to improve quality monitoring at the service. For example, they wanted to improve the checking systems in place to make sure that people's medicines were managed appropriately. Staff also told us the registered manager asked for their ideas in improving the service at staff meetings. The provider had completed a quality account for the year 2013 to 2014 which reviewed Inspection Report Lindsay House March

13 the quality improvements made at Lindsay House and made suggestions for further improvement. We saw the quality account stated that team clinical supervision meetings needed to be put in place before the end of March Staff and the registered manager confirmed that these were due to start in order to review the quality of support each person was receiving and for staff to share their ideas for supporting people who used the service. This meant that the provider had a system in place to identify the improvements needed and to make sure these were implemented in a timely way. During our last inspection visit we found that the manager had not routinely checked whether care plans and risk assessments were up to date. The registered manager told us that they had personally checked the quality of each person's support plans and had introduced staff training to continue to improve the quality of support planning provided. The provider might find it useful to note that there were no records which showed that these checks had been undertaken. However, we noted that the quality of the support plans had improved and staff confirmed that they had received training in how to complete support plans. Inspection Report Lindsay House March

14 Records Met this standard People's personal records, including medical records, should be accurate and kept safe and confidential Our judgement The provider was meeting this standard. Records were kept securely and could be located promptly when required. Reasons for our judgement During our last inspection visit, we were unable to gain access to staff training and supervision records because the previous registered manager was the only person who had access to the locked file. We were also unable to gain access to quality assurance information because it was stored electronically and staff did not have access to this information. The previous registered manager was also unable to forward this information to the Care Quality Commission. During this inspection visit, we found that staff training and supervision records were stored in a locked cabinet and that the registered manager was the main key holder. However, we also observed that a key safe box had been installed. Staff told us that this was to store keys safely and securely in order to gain access to files and records in the registered manager's absence. We also saw that people's care records were stored in a lockable cabinet within the staff working area. This meant that staff and people's records were stored safely and securely and were accessible during the inspection visit. The provider might find it useful to note that there were several records which were not available during the inspection visit. This included missing minutes of a community meeting held during November 2013, recent records of staff meetings and records confirming mandatory training levels of staff working within the service. The registered manager forwarded this information to the Care Quality Commission within an agreed timeframe. Inspection Report Lindsay House March

15 This section is primarily information for the provider Action we have told the provider to take Compliance actions The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards. Regulated activity Personal care Regulation Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Care and welfare of people who use services How the regulation was not being met: The planning and delivery of care did not ensure the welfare and safety of people who used services. Regulation 9 (1)(b)(ii) This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations The provider's report should be sent to us by 18 March CQC should be informed when compliance actions are complete. We will check to make sure that action has been taken to meet the standards and will report on our judgements. Inspection Report Lindsay House March

16 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Lindsay House March

17 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Lindsay House March

18 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Lindsay House March

19 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Lindsay House March

20 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Lindsay House March

21 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report Lindsay House March

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