Inspection on 09/10/09 for Linsell House

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

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linsell House 03/09/07

Linsell House 28/12/06

Linsell House 09/01/06

Linsell House 24/06/05

Linsell House 02/11/04

Linsell House 21/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Linsell House Ridgeway Avenue Dunstable Bedfordshire LU5 4QT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nicky Hone     Date: 0 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Linsell House Ridgeway Avenue Dunstable Bedfordshire LU5 4QT 01582699438 01582477844 linsell@bedscc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Central Bedfordshire Council care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: LD - Learning Disability (Longstay) - Maximum 12 places LD - Learning Disability (Respite) - Maximum 4 places Period of stay for respite users - Maximum 6 weeks Service Users may also have additional physical disabilities The maximum number of service users who can be accomodated is: 16 The registered person may provide the following category/ies of service only: Care home only - Code PC; To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) Date of last inspection Brief description of the care home Linsell House is owned and managed by Central Bedfordshire Council and is located in a residential area of Dunstable. The home has 12 long stay places and 4 respite care places for adults with profound learning and physical disabilities. Community nursing support is accessed as required. The home comprises three single storey interlinked bungalows (Green, Peach and respite), each with their own sleeping, living, bathing, and kitchenette facilities. A large main kitchen, staff rooms/offices, laundry room, and a shared lounge are also provided. The organisation of the home and the building is Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 16 2 1 0 1 2 0 0 9 Brief description of the care home institutional in a number of aspects. To this end, a long-term plan for the home is re provision, but there are no known timescales for this. Community facilities and shops are situated reasonably close to the home, which is also in easy access of local public transport routes. Transport is provided by the home. Parking is to the front of the property, and a fair sized garden surrounds the buildings. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: For this inspection we (the Commission for Social Care Inspection) looked at all the information that we have received, or asked for, since the last key inspection of Linsell House. This included: - The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in September 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live and stay here. The AQAA also gives us some numerical information about the service; - Surveys which we sent to the home to give to people who live and stay here, and to staff. We received 4 replies from service users and none from staff. Care Homes for Adults (18-65 years) Page 6 of 33 - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues that have arisen; and - Information we asked the home to send us following our visit. This inspection of Linsell House also included a visit to the home on 09/10/09. No-one who lives or works at the home knew we were going to visit on this day. We spent time talking to the assistant manager, and to some of the other staff. We looked round the home and spent time in the bungalows, observing what happens. We looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. We returned to the home on 14/10/09 to look more closely at the management of medication. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 33 Although the home has met a number of the requirements we made last year, and the number of requirements we have made following this inspection is significantly less, we are concerned that we have had to repeat 3 requirements, relating to staff training and medication. We are particularly concerned about the way medication is managed. Required information about some of the new staff was not available. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available about the service so that people know what to expect, and assessments are carried out so that people know the home can meet their needs. Evidence: Linsell House has produced a service user guide which gives good information about the home. It includes pictures and symbols, is written in large print, and uses easyread language, so is suitable for some of the people who live and stay here. We found a copy of the guide on the records we looked at. The service user guide tells people what they can expect from the home, and what the home expects of them, so gives useful information to anyone thinking about staying here for a respite stay or moving here. The service user guide, statement of purpose and inspection reports are available in the front entrance hall, along with a lot of other useful information for people who live here, and visitors to the home, to read. Some of the people who live at Linsell House have lived here for a very long time. An Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: annual review of their needs is carried out by a social worker, and the homes staff update support plans when peoples needs change. Full assessments of the needs of people who come for respite stays are carried out before they start to use the service, and are updated each time they visit. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans give good guidance to staff on the way each person prefers their needs to be met; people are supported to make decisions about their lives; and risk assessments enable people to be as independent as possible. Evidence: 2 of the people who live at Linsell House were happy to show us their support plans. Each plan included a brief profile of the person, giving a good pen picture. The persons daily routines, for morning, evening and night, were described in good, clear detail. There was also a support plan giving much more detail about the persons life and the support they need. This plan was very person-centred, using I to describe the support the person needs, and the way they want to live their life. Risk assessments had been carried out for all risks that each individual could encounter, such as being out in the community, using an electric bed, bed rails and manual handling. The assessments and guidelines for managing the risk, particularly for manual handling, were clear and detailed. The support plans and risk assessments Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: had all been reviewed in January 2009, and some had been reviewed again in May and September. Each person who lives here has a communication passport which they take with them wherever they go. This is a small folder containing information, and lots of photographs, to show how this person communicates, how they express their feelings, their likes and dislikes, and gives brief, relevant personal information. People take these passports with them so that the same methods of communicating which are used by staff and by their family are used wherever they go, (day service, college and so on). Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a range of opportunities so that they can choose to lead full, satisfying and interesting lives, and menus show that a variety of healthy, nutritious meals are prepared. Evidence: One of the staff we spoke with explained that each of the people who live at Linsell House has a keyworker and a co-keyworker. These roles are not to do the day-to-day support and care that people need, but to make sure the person lives the life they want to live. So they look at things like what activity the person wants to do each day, plan holidays and outings, make health appointments and follow them up, communicate with family, assist the person to integrate into the community and so on. The keyworkers meet monthly with the person they offer this extra support to: these meetings are minuted and an action plan is drawn up. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: On the files we looked at we saw that each person has an activity plan. Everyone who lives at Linsell House spends four days a week at a day service away from the home, and then has one day off to do whatever they choose to do. Staff told us that in the new year each person will be accessing college for some sessions, rather than the day services they currently attend, so that they have a greater variety of things to do. Some activity takes place at the home, with a number of festivals, including Diwali, Christmas, bonfire night, Halloween, Easter and so on, being celebrated. Staff told us that outings, for example to the zoo, Southend and the theatre have been organised. On the evening we visited staff in one bungalow said they had not planned anything for the evening, but would probably offer the women a pampering session. They said that the men often get together in the main lounge to watch a football game, and sometimes they have take-away pizza. Staff told us that every week there are things happening: people go shopping, go to the theatre, have an aromatherapy session from the aromatherapist who visits the home, go to the pub, go to discos, use the foot spa, have their nails done and so on. Unfortunately we noted that on the files we looked at activity records are not completed well enough to show what activities people had actually done. One of the people we spoke with was very pleased to be able to show us a scrapbook containing a number of photographs of the activities s/he had been involved in. Staff told us that people also have a diary which is used for communication between the home and the day services. On one bungalow, staff said that all 6 people will have had a holiday by the end of October: 2 people chose to go to Wroxham, 2 to Centre Parcs, and 2 to Weymouth. Families of the people who live and stay at Linsell House are encouraged to be involved in their relatives lives as much as they want to be. Several people spend weekends, or days with their relatives. If needed, staff support people to keep in contact with their families. An advocacy service is available for anyone who needs support. The advocate is involved with the person who has shown an interest in moving to supported living. One person we met has a friend who does not live at Linsell House. Staff support this person to meet the friend for a meal, or for the friend to visit Linsell House every 2 weeks. Linsell House still has one main kitchen where most of the food is planned, ordered and cooked. We spoke to the cook who said she and the permanent cook are very good at involving the people who live here in planning their meals, and at encouraging people to try new meals. Pictures of meals are used so that people can make choices about what they would like to eat. During the week, breakfast is whatever each Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: person wants: a choice of cereals, porridge, toast, baked beans, scrambled eggs and so on. Lunch is provided by the day services and people who are at home during the day make their own arrangements for lunch (either out or making a snack lunch in their bungalow). The main meal is in the evening. The cooks have started offering fruit smoothies which are very popular and they make sure fresh fruit is always available. They have also started making lighter puddings, using more fruit. On Saturdays, a big brunch is cooked and then a meal in the evening, and on Sundays a traditional roast is cooked at lunchtime. Snacks are available at any time and there is always a range of things available for people who dont want what is on the menu. Each bungalow can also choose to have a take-away of their choice. A chart is completed each Sunday showing what each person has chosen to eat for the week ahead. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their personal care in the way they prefer and their health needs are met so that they remain as healthy as possible. Medicines are not handled and administered well enough to make sure people are kept safe. Evidence: The folders we looked at contained detailed support plans for all aspects of the care and support the person needs, for example, with personal care, dressing, using the toilet, gastrostomy and so on. It was clear from these that staff had spent a lot of time working out the ways in which each person prefers to be supported, and the detail of the guidelines makes sure that the person gets consistent staff support. On one of the files we looked at we found a Health Action Plan (HAP). This showed that this person is weighed regularly and has regularly visits from the dietitian as s/he receives food through a tube directly into the stomach. Staff told us that keyworkers are responsible for keeping the plans up to date. The plan included an All about me document which is kept ready and up to date in case the person has to go into hospital. For the people in the respite unit, their main Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: carers are responsible for making sure their health needs are met, although the home will arrange for medical treatment if it is needed during the persons stay. We looked at the way the home handles medication. Any medicines in current use are kept in a locked cupboard in each bungalow. Additional locked cupboards in the medication room hold any extra stock: these had been replaced since our last inspection. We looked at the medication, and the records, in each of the three bungalows. In the respite bungalow we found excellent records which show that peoples medicines are handled very well. People who arrive for a short stay know that they must bring enough of all the medicines they take to last the whole of their stay, and the medicines must be in their original containers. Medicines are counted when they arrive, a record made, and then counted each time they are administered so that there is a running record of what is left. In the other two bungalows we found that generally medicines are administered safely. However, we found that some careless mistakes had been made, which should not happen. For example, an audit of one persons soluble paracetamol indicated that there were 70 tablets missing: the disposal record showed that 70 tablets had been returned to the chemist, but had not been included in the audit. We found that in a number of cases, medicines remaining from the previous month had not been brought forward to the new Medication Administration Record (MAR) charts, meaning the audit showed discrepancies. There were some tablets in one cupboard that were out of date. Changes to MAR charts had been made and were not signed/dated; PRN (that is, when needed) had been added to the MAR charts with no explanation; and one persons medicines had not been signed in correctly when they arrived. In two of the three bungalows the keys to the medicine cupboard are kept in the drawer beneath the cupboard: the keys should be held at all times by the person designated to administer the medicines. One of the team leaders told us that an error in administration of medicines had taken place the previous week: a doctor had reduced someones dose of a medicine from two to one tablet. One member of staff had given two. Since the inspection we have been notified that there have been a number of errors in administration: the home has been very efficient in reporting these to the safeguarding team who have investigated. The home has also followed its own policy so that staff who have made the errors are re-trained and re-assessed before they are allowed to administer medicines. Each person, or their representative, has signed a form to show that they consent to the staff giving them their medication, and a Mental Capacity Act assessment has recorded the decision that the person does not have the mental capacity to administer Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: their own medicines. We saw clear guidelines on How I like to take my medicines for each person and in one bungalow staff are particularly good at writing explanations when a medicine has not been given. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. Evidence: Linsell House has a complaints procedure which is displayed so that people know who they can complain to. This is available in a pictorial format so is suitable for most people who live and stay here. It had been brought up to date to reflect all the changes in the Council, and in CQC, since April 2009. The complaints file showed that no complaints have been received. One of the people we spoke with said s/he is happy to discuss any concerns with their keyworker, or with the managers. None of the people who live at Linsell House are able to deal with their own financial affairs without support. The assistant manager said that everyone has their own building society account, and a small amount of cash is kept in the safe for each person. A record is made of any money that goes in or out: we checked the records for two people and both were accurate. Staff said that each person has had a Mental Capacity Act assessment carried out to decide whether they have capacity to make decisions about, for example, finances, medication, holidays, buying furniture and so on. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: All staff are introduced to safeguarding in their induction and 17 of the 25 staff have done a safeguarding training course, with the rest booked to go on a course in the near future. In the AQAA the manager told us that there is a new, up-dated SOVA policy which has been read and explained to all the people who live and stay at Linsell House. The home has demonstrated it understands safeguarding as staff have made 2 safeguarding alerts when a person who came for a respite stay alleged abuse by their family. Staff we spoke with were confident that they would recognise abuse and they demonstrated that they would know what to do if they suspected someone was being abused. In the AQAA the manager said that the home has an anti-bullying DVD which is shown to people so that they can start to understand and recognise what bullying is, and that it is not acceptable. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Linsell House offers a comfortable, homely, clean and well-maintained home for the people who live and stay here. Evidence: We had a look round the 3 bungalows and were pleased to note that all the decorating has been completed. The home was clean and smelt fresh everywhere, which means staff work hard to make sure peoples continence issues are managed properly. The lounges were also less cluttered with furniture than when we visited last time: some additional storage space has been identified for wheelchairs, and will be built as soon as funding is available. Each person who lives at Linsell House is supported to choose, and buy, what they would like in their room, so every bedroom is different to all the others. Staff are trying to find pictues and so on, which everyone will enjoy, to put in the respite rooms. Staff we spoke with said that one person is going to be getting a new wardrobe. Each of the drawers in this persons room was labelled: staff said this was her choice so that her clothes are always put away in the right place. The dark room is being turned into a light room, so that people have a quiet place, with no television, to sit and relax, listen to music if they want to, or meet with family Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: and friends. Overhead tracking is available in some rooms so that people can be hoisted more easily, and there are mobile hoists when needed. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers have improved, and generally staff are recruited and supervised well. Staff training lapsed for a while so that not all staff are up to date with all the required training. Evidence: The assistant manager said that staffing is pretty good, with vacancies only for 1.5 residential workers, a part-time domestic assistant, and a part-time cook. She said, and rotas showed, that the aim is to have 7 staff on the morning and evening shifts, 2 waking night staff and 1 sleeping-in. She said that shifts are now much more flexible and staff are put on the rota when people are going out. One of the staff said staffing levels have come up lovely - its much improved. Unfortunately, on the day we inspected there were only 5 staff because 2 had rung in sick at the last minute and no agency staff were available. Because most of the people who live/stay at Linsell House do not use words to communicate, we spent time observing the way people interact with the staff. This was very positive and showed that staff and the people who live/stay here get on well and enjoy each others company. One person we spoke with said staff are good. Another person said s/he gets on well with all the staff except two. This person commented that one staff member is rude to them, and the other one refuses to take Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: this person to their preferred place of worship. A member of staff was assisting us to communicate with this person, so we asked her to report this complaint to the manager. We also discussed this with the manager. A team leader has responsibility for each bungalow, and for the staff who usually work in that bungalow. One team leader told us he supervises 6 staff monthly, and does their annual personal development review (PDR). We looked at the records the home keeps about 3 of the staff. There was a pro-forma in place, showing that all the necessary documentation is in place in their personnel files, which are held centrally at County Hall. These had been verified by a senior manager. However, when we asked for the information for the 3 most recently appointed members of staff (one of whom has already left), there was no information available. We spent a morning in June 2008 checking a random selection of files of staff who work across the County Councils registered services. Generally all the required information was available on the files we looked at. Some staff have been employed for many years, and started long before the current requirements were in place. The Council has worked hard to get as much information as possible, and has ensured, for example, that Criminal Record Bureau (CRB) checks have been done, and are renewed every three years. An aromatherapist visits the home regularly to offer aromatherapy sessions to some of the people who live here. She has been visiting for a number of years. Although she is not employed by the home, the manager has obtained a copy of her CRB and of her qualifications. Staff told us that there was a period of about 6 months when there was no training available but in the last couple of months theres been a real turn-around with training - its gone crazy; and training is now coming thick and fast. Central Bedfordshire Council took several months to sort out training but, by the time of this inspection there was evidence that training had started, and staff had been booked onto a number of courses. A few courses had taken place but most were planned to be during the next few months. An audit had been completed to show what training each staff member had had, and therefore what they needed. The audit showed, for example, that all staff were up to date with moving and handling; 18 staff needed first aid training; 18 needed food hygiene; 8 needed safeguarding; 11 needed infection control; and 23 staff needed fire safety training. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: We looked at staff training records. At our last inspection we said that the records were not good enough to show us that staff had received enough training for them to be able to do their jobs well. We concluded that they had not received enough training. At this inspection we found that the records of training were still not accurate enough to evidence that training has taken place. The assistant manager (who is responsible for staff training) told us that one of the problems is that staff have been given responsibility for keeping their own training records up to date, and not all of them do. He said that he plans to put a matrix in place so that there is an overview of who has done which courses. According to information given to us in the AQAA, 19 of the 25 permanent staff (76 ) have been awarded a National Vocational Qualification (NVQ) in care, level 2 or 3. Supervision is cascaded down, so the manager supervises the assistant managers, they supervise the team leaders, who supervise the rest of the staff team. Staff we spoke with said that they now have monthly supervision sessions with a senior, and a PDR each year. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally this home is managed well, but the repeated requirements show that the management needs to improve even further so that people are offered the best possible quality of life, and are kept safe. Evidence: Staff we spoke with said that the managers are very supportive and work as part of the team when needed. They felt the home has moved forward and were feeling positive about their job. The managers responses in the AQAA show areas where she feels the home is improving, and where there are still improvements to be made. The home has a number of ways to check out whether it is offering a quality service, and the service that people want. Each year a questionnaire is sent to all the people who use the service, their relatives/representatives, and other stakeholders. The results are collated into a report. The manager told us that the only issue raised was some concern about communication between keyworkers and parents. Meetings for parents/carers are held 3-monthly, with the most recent one having been held about 2 weeks before our inspection. The assistant manager reported that parents, and the Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: advocate who was also at the meeting, said that communication has improved, particularly between peoples keyworkers and their families. The manager completes a number of audits regularly which go to her managers, and visits by a representative of the provider (as required by regulation 26 of the Care Homes Regulations) are carried out each month, and a report left in the home. Residents meetings are held regularly: the minutes are typed using easy-read language with symbols and pictures. Keyworker meetings and staff meetings are also minuted. A number of audits have been set up: keyworkers, team leaders, assistant managers and the manager each have a number of audits to complete, so eventually almost every area of work is checked. We checked records of fire alarm and emergency lighting tests for the previous 12 months. The fire alarms had been tested almost every week (12 gaps, so 77 ), and the emergency lighting almost every month (2 gaps - 84 ). The assistant manager told us that one of the staff who used to be a fire warden and who has done numerous fire courses, had led a training session in fire safety at a recent staff meeting, when 14 staff and 1 service user were present. He had also compiled a questionnaire for staff to complete. From the training records, it is not clear that all staff have had enough training in some of the topics related to health and safety (that is fire safety, infection control, first aid, and food hygiene). Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 20 13 Medicines must be administered correctly. So that people receive the medicines they need in a safe way. 02/03/2009 2 35 18 Records must be available to 31/05/2009 show that all staff have received sufficient training. So that they can do their job in the best way possible. 3 42 18 All staff must receive training 31/05/2009 in the topics related to health and safety (that is, fire safety, moving and handling, first aid, food hygiene and infection control). So that staff know how to keep people safe. Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Medicines must be handled and administered correctly. This requirement is repeated. So that peoples health is maintained. 31/12/2009 2 34 19 Evidence must be available 31/12/2009 to show that all the required checks have been carried out before staff start work at the home. So that people are protected from staff who might do them harm. 3 35 18 Records must be available to 31/03/2010 show that all staff have received sufficient training. So that they can do their job in the best way possible. 4 42 18 All staff must receive 31/03/2010 training in the topics related to health and safety (that is, fire safety, first aid, food Care Homes for Adults (18-65 years) Page 31 of 33 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 hygiene, and infection control) So that staff know how to keep people safe. 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 Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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