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Inspection on 09/12/09 for Link House

Also see our care home review for Link House for more information

This is the latest available inspection report for this service, carried out on 9th December 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The two people who use the service who previously returned surveys both stated that they were happy living at Link House. Individuals we spoke to told us that they felt “quite comfortable” and that they liked their bedrooms. There are kitchenettes on each floor to assist with provision of extra snacks and drinks. There are bells on all the bedroom doors, of all people who use the service, to promote dignity and privacy. The building was particularly hygienic and clean at the time of this and previous inspections. Link House DS0000019135.V378752.R01.S.doc Version 5.2

What has improved since the last inspection?

There had been improvements made in care planning although these will need to be carried over to the new care planning computer system, as its set up. Senior staff now ensure that the assessments provided by social services are up to date and relevant. This will ensure that staff have some information on which to base an initial care plan. Pain has been included in assessments, to improve pain management. The recording of wound care now includes clearer details of the nursing care provided and the condition of wounds. Care planning now also includes wound and pressure area care, including details of any equipment to be used. To ensure the safety of people who use the service and staff risk assessments now include details of the size of sling to be used for the individual. A clear record of food is now kept for each person. A review of the menu has been carried out along with how individuals are provided with choices. To provide a more homely atmosphere notices and information which relate to staff or working practices have now been restricted to staff areas. A review of the staffing levels on the nursing unit has been carried resulting in one extra staff member being on duty in the mornings. Staff have been given clear information on what is acceptable, professional behaviour at work and maintaining dignity. To ensure the health and safety of people who use the service and staff, updated checks on hoists and fixed electrical equipment has been carried out.Link HouseDS0000019135.V378752.R01.S.docVersion 5.2

What the care home could do better:

The complaints procedure is only available in standard type size. To promote access and peoples rights, the complaints procedure must be made accessible to all resident groups. This must start with a large print alternative, and other forms of accessible documentation must be sought, for example pictorial. The Menus in the dementia unit were text only. To promote access and choice, a pictorial menu must be provided on this unit. Risk assessments for any restriction of liberty should record alternative that were considered. This limits restrictive practices being continued without exploring all the alternatives first. The home should continue to look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person centred and less task based. Care plans need to give specific information about how the person likes the care and support to be delivered.

Key inspection report CARE HOMES FOR OLDER PEOPLE Link House 15 Blenheim Road Raynes Park London SW20 9BA Lead Inspector Barry Khabbazi Key Unannounced Inspection 9th December 2009 10:00 DS0000019135.V378752.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Link House DS0000019135.V378752.R01.S.doc Version 5.2 Page 2 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 Link House DS0000019135.V378752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Link House Address 15 Blenheim Road Raynes Park London SW20 9BA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8545 4920 020 8332 1044 tessa.atkinson@ccht.org.uk Central & Cecil Housing Trust Margaret Connor Care Home 52 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (34) of places Link House DS0000019135.V378752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Nursing Places To include no more than twenty service users requiring nursing care at any one time. Nursing Unit 1st Floor - Qualified Staff A qualified 1st level nurse must be available on the nursing unit at all times. This person must not have any management responsibilities for the home other than within the nursing unit. Nursing Unit 1st Floor - Care Staff 7.30am to 3pm three care staff must be available on the unit. 2.45pm to 9.30pm two care staff must be available on the unit. 9.30pm to 7.30am one care assistant must be available on the unit. Dementia Care Unit 2nd Floor - Care Staff 7.30am to 3pm three care staff must be available. 2.45pm to 9.30pm three care staff must be available. 9.30pm to 7.30am two care staff must be available, one of which will be the designated senior carer in charge of the home, in the absence of the Manager or Deputy Manager and able to offer assistance and guidance for carers throughout the home. Residential Unit Ground Floor - Care Staff 7.30am to 3pm two care staff must be available. 2.45pm to 9.30pm two care staff must be available. 9.30pm to 7.30am one care assistant must be available. Management One full time Manager 40 hours per week. One full time Deputy Manager 40 hours per week. A member of the management team to be available seven days each week. Ancillary Staff Administrative Staff 37.5 hours per week. Domestic Staff 136.5 hours per week. Cook 49 hours per week. Kitchen Assistants 102 hours per week. Laundry Staff 70 hours per week. Reviews The organisation must ensure that the above minimum staffing levels remain under review and that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. Distribution of Staff The number and distribution of nurses, care staff and ancillary staff must be reviewed at regular intervals. If at any time, the evidence indicates that there are insufficient staff of any category available to meet the assessed needs of service users, the NCSC will require DS0000019135.V378752.R01.S.doc Version 5.2 Page 5 3. 4. 5. 6. 7. 8. 9. Link House additional staffing as appropriate. Date of last inspection 10th March 2009 Brief Description of the Service: Link House is a purpose built care home which has the capacity to provide nursing care for twenty older people and residential care for thirty two older people, eighteen of whom may have dementia. The home is owned and managed by Central and Cecil (CC) a charitable organisation who own and manage four other similar services in the Merton and Richmond area. Accommodation is provided over three floors with a lounge, dining room, kitchenette, bathrooms and single bedrooms available on all three floors. Access to enclosed gardens is to the rear and side of the home. Each floor is serviced by a lift. Link House is situated in a residential area of Raynes Park, close to the main A3 road, local bus services, churches of a number of denominations and local shops. The home is staffed twenty-four hours a day by trained nurse staff and care assistants. Three meals are provided each day with drinks and snacks available between meal times. The current range of fees for this home are from £472.04 for residential care £511.14 dementia care £ £638.22 per week. for nursing care Link House DS0000019135.V378752.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating of the service is 2 star. This means the people who use this service generally experience good outcomes. This inspection was unannounced. At this inspection the new registered manager was interviewed and policies, care plans, and the building were also examined. We spoke to people who use the service. Comments from them on this occasion included: ‘its ok here’ ‘they make sure I’m Ok here’, and ‘the food’s not bad’. People were generally relaxed and happy during the inspection period. All the key Standards identified throughout this report were re-assessed at this inspection. This inspection also focussed on following up on previous requirements and recommendations, and any new issues arising. Due to the the inspection being brought forward for monitoring reasons, the manager’s self assessment {AQAA} was not available at the time of this inspection to support this report. By the time of this inspection, all previous actions required by us had been implemented and a significant improvement in the home had been identified. Please see the section ‘ what has improved since the last inspection’ for details. Information provided from all of the above sources along with our observations during visits to the service have been used to reach the judgements made in this report. What the service does well: The two people who use the service who previously returned surveys both stated that they were happy living at Link House. Individuals we spoke to told us that they felt “quite comfortable” and that they liked their bedrooms. There are kitchenettes on each floor to assist with provision of extra snacks and drinks. There are bells on all the bedroom doors, of all people who use the service, to promote dignity and privacy. The building was particularly hygienic and clean at the time of this and previous inspections. Link House DS0000019135.V378752.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? There had been improvements made in care planning although these will need to be carried over to the new care planning computer system, as its set up. Senior staff now ensure that the assessments provided by social services are up to date and relevant. This will ensure that staff have some information on which to base an initial care plan. Pain has been included in assessments, to improve pain management. The recording of wound care now includes clearer details of the nursing care provided and the condition of wounds. Care planning now also includes wound and pressure area care, including details of any equipment to be used. To ensure the safety of people who use the service and staff risk assessments now include details of the size of sling to be used for the individual. A clear record of food is now kept for each person. A review of the menu has been carried out along with how individuals are provided with choices. To provide a more homely atmosphere notices and information which relate to staff or working practices have now been restricted to staff areas. A review of the staffing levels on the nursing unit has been carried resulting in one extra staff member being on duty in the mornings. Staff have been given clear information on what is acceptable, professional behaviour at work and maintaining dignity. To ensure the health and safety of people who use the service and staff, updated checks on hoists and fixed electrical equipment has been carried out. Link House DS0000019135.V378752.R01.S.doc Version 5.2 Page 8 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. Link House DS0000019135.V378752.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use this service experience Good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Peoples needs are assessed before they start at the home to ensure that all needs are known by the staff. This home does not provide intermediate care with a view to return to the community and Standard 6 is therefore not applicable. EVIDENCE: People who use the service told us that family members visited the service on their behalf to “see if it was the right sort of place” for them. Individuals told us that everything was explained to them when they visited. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 11 These were examined and these contained all the required pre-admission assessments. Previous shortfalls in the area had been addressed with new procedures. Although the home provided res-pite care, this home does not provide intermediate care with a view to return to the community following rehabilitation, and Standard 6 is therefore not applicable. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, and, 10. People who use this service experience Good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Plans of care record health and social care needs to ensure these needs are all known and met. Peoples are protected by the home’s health monitoring procedures. People are protected by the home’s medication procedures. People are treated with respect and their privacy is maintained. EVIDENCE: All previous shortfalls identified in this section had been addressed by the time of this inspection. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 13 There had been improvements made in care planning although these will need to be carried over to the new care planning computer system, as its set up. In the meantime, two different care planning systems are being used and the new computer system. There is room here for error, and information was not consistent across the two types of care plan. A recommendation is made as follows: The home should continue with the process of unifying care planning information. The home should continue to look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person centred and less task based. Care plans need to give specific information about how the person likes the care and support to be delivered. We looked at a sample of care plans and health care documents on each floor of the service. We found there have been improvements in the information available which assists staff in meeting individual needs. Staff have taken time to add personal likes, dislikes and preferences. On this occasion there was improved and clear information for staff on maintaining pressure relieving equipment . Moving and handling assessments now include the size of sling to be used and did not always state which type of hoist to use. Care plans contained all the information required and were being reviewed and updated regularly. Evidence was seen of regular monitoring of health. A record of all appointments and check ups are kept. The manager demonstrated knowledge of the health status of individuals. Pain has been included in assessments, to improve pain management. The recording of wound care now includes clearer details of the nursing care provided and the condition of wounds. Care planning now also includes wound and pressure area care, including details of any equipment to be used. To ensure the safety of people who use the service and staff risk assessments now include details of the size of sling to be used for the individual. However, the following recommendation is set. Risk assessments for any restriction of liberty should record alternative that were considered. This limits restrictive practices being continued without exploring all the alternatives first. Medication profiles and clear medication administration record sheets were seen in records sampled. Medication and the M.A.R sheets are kept. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 14 Peoples were seen to be treated with respect and personal care was carried out in a manner that promoted privacy and dignity. As the home’s staff were seen to promote dignity and privacy in their own interactions with the people. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 12,13,14,and,15. People who use this service experience Adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People experience a lifestyle in the home that generally matches their expectations. People are provided with opportunities to remain part of the local community and are able to take part in appropriate activities. The daily routines and the home’s policies promote choice and rights, to ensure equality and that all rights are enjoyed by all. Dietary needs are catered for and a balanced diet is provided, to ensure health and enjoyment of food. However, choice can still be improved. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 16 EVIDENCE: Two people who use the service told us through previous surveys that they enjoyed quizzes, outings, parties and painting classes. One person told us during the inspection that they enjoyed the activities. Another person told us they liked the decorations and were looking forward to Christmas”. On the ground floor we saw people in the lounge listening to music and watching television. Staff were seen to spend time talking with individuals. We saw people in smiling and chatting and there was generally a happy atmosphere. Staff were seen to communicate in a caring manner spending time with individuals as well as drawing in the whole group. Activities included: chair based exercises; sing along; art; quiz; film show; bingo; what the papers say; darts; music and movement; aromatherapy; musical quiz and religious service. Similar activities were noted on the top floor. To provide a more homely atmosphere notices and information which relate to staff or working practices have now been restricted to staff areas. A clear record of food is now kept for each person. A review of the menu has been carried out along with how individuals are provided with choices. One person told us that the food was “all right” another person told us that they liked the food. The manager informed us that the menu for the service had been reviewed after the last inspection. The new menu appeared nutritious and to provide choice and special diets. The Menus in the dementia unit were text only. This meant that some people would not have an informed choice about what is available to eat and drink. The following requirement is now set. To promote access and choice, a pictorial menu must be provided on the dementia unit. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience Good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Complaints are managed well which should ensure that concerns are listened to and acted upon. However the complaints procedure needs to be made more accessible. The home’s policies and procedures help protect people from abuse and help staff if they need to tell someone about any bad care practice they may see. EVIDENCE: People who use the service told us they would talk to staff or their relatives if they had a complaint. The complaints procedure is only available in standard type size. The following recommendation is set at this time, and will become a requirement if not met. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 18 To promote access and peoples rights, the complaints procedure must be made accessible to all resident groups. This must start with a large print alternative, and other forms of accessible documentation must be sought, for example pictorial. The complaints procedure was clear and contained all the elements required including a written maximum response time of less than 28 days and details of how to contact the Commission. The home has a copy of the local Adult Protection procedure. Staff have had safeguarding training. The home has Gifts Policy that precludes staff from being involved in the making or being the beneficiary of residents wills, a Whistle Blowing Policy, an Abuse Policy and a a restraint policy. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 19, and 26: People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The home is in good condition externally and internally, and is decorated in a homely fashion. This creates a pleasant environment that promotes dignity and emotional well-being. The home is hygienic and clean, homely and comfortable; this environment therefore promotes a pleasant environment, health, and emotional well-being. EVIDENCE: All areas of the service we saw during our visits were well decorated and maintained. There was new flooring in one lounge since the last inspection. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 20 Each person is provided with their own single bedroom accommodation with en suite toilet facilities. Individuals told us they liked their rooms and had everything they needed. A number of bedrooms we saw had been personalised by the addition of photographs, ornaments and pictures. The provision and use of door bells was seen as good practice. All areas we saw at the time of this inspection were clean and hygienic, as was also reported at the last inspection. People who use the service told us that staff were “very good” at keeping the home clean. This was also seen as good practice. Providing room sizes and further environmental information at the next inspection would help evidence that this area has exceeded the minimum standard. The home has specific policies covering the disposal of clinical waste, control of infection, use of cleaning materials, storage and preparation of food, and dealing with spillages. Protective clothing was observed to be present. Laundry facilities have easily cleanable non-permeable floors and walls. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, and 30. People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Staff numbers are of sufficient quantity to meet needs and provide consistency. People are supported by a staff group where 50 or more have the required qualifications. This raises the quality of staff, their knowledge and their practices. The current staff vetting procedure does protect from undesirable staff. Induction and foundation training to National Training Organisation’s specifications is in place. This ensures a well inducted staff group. EVIDENCE: A review of the staffing levels on the nursing unit has been carried resulting in one extra staff member being on duty in the mornings. Since the last inspection, staff have been given clear information on what is acceptable, professional behaviour at work and maintaining dignity. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 22 The minimum standards require at least 50 of care staff to have a NVQ2. This has been achieved. This creates a well qualified staff group. We observed some good interactions between staff and individuals who use the service. Staff were seen to offer support and guidance in a sensitive and caring manner. Individuals gave positive comments about the staff telling us “I like her” and “she’s nice”. One person told us “I am very happy with the staff here” and “staff are always there and listen to what you say to them”.. All elements of Schedule 2 {staff files} were available for inspection. Staff recruitment documents were examined for new staff and these included Checks, references and proof of identification. No shortfalls were identified in the staff recruitment process. The home has an induction and foundation training, which meets National Training Organisation specifications and targets. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, and 38. People who use this service experience Good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service now benefit from a well run home, with a qualified manager. The home has implemented a quality assurance system and an annual development plan, with both involving people. This should ensure that the home is run in a way that involves peoples and a way that is in their best interests. The financial interests of people are managed in a way that protects their rights. The home promotes the health and safety of the residents, so that practices and the environment do not place their health and safety at risk. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 24 EVIDENCE: The manager has been registered with the commission as the registered manager since the last inspection. The registered manager is suitably qualified and experienced. There are clear lines of accountability within the service with the manager supervising the deputy, the deputy providing supervision for senior and qualified staff who then supervise care staff. However the records of supervision we looked at had not been completed and signed by the staff or supervisor. A review of the staffing levels on the nursing unit has been carried resulting in one extra staff member being on duty in the mornings. To ensure the health and safety of people who use the service and staff, updated checks on hoists and fixed electrical equipment has been carried out There is a quality assurance system that involves people, and provides feedback to them, to allow them to be involved in improvements and measure improvements in the home for themselves. Procedures are in place to protect service users’ money and no anomalies were identified at this or the last inspection. Infection Control, and Handling and Disposal of Clinical Waste policies are all also included in staff induction. All of the health and safety policies and procedures required were seen to be present. Moving and Handling, Fire Safety, First Aid, Food Hygiene, Infection Control, and Handling and Disposal of Clinical Waste policies are all also included in staff induction. The testing of systems required were also present and inspected. These included fire fighting equipment testing, fire warning testing, Portable Appliance Testing, 5-year wiring testing gas testing, and bacterial analysis and testing of the water supply. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP15 Regulation 12(2)(3) (4b) Requirement The Menus in the dementia unit were text only. To promote access and choice, a pictorial menu must be provided on this unit. The complaints procedure is only available in standard type size. To promote access and peoples rights, the complaints procedure must be made accessible to all resident groups. This must start with a large print alternative, and other forms of accessible documentation must be sought, for example pictorial. Timescale for action 01/04/10 2. OP16 12(2)(3) (4b) 01/04/10 Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations The home should continue with the process of unifying care planning information. The home should continue to look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person centred and less task based. Care plans need to give specific information about how the person likes the care and support to be delivered. 3. OP10 Risk assessments for any restriction of liberty should record alternative that were considered. This limits restrictive practices being continued without exploring all the alternatives first. Link House DS0000019135.V378752.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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