This inspection was carried out on 12th May 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI 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.
CARE HOME ADULTS 18-65
Linden Lea 11 Toller Road Quorn Loughborough Leicestershire, LE12 8AH Lead Inspector
Steve Hunnybun Unannounced 12 May 2005 at 9:30am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Linden Lea Address 11 Toller Road Quorn Loughborough Leicestershire LE12 1AH 01509 415665 01509 415842 None. Aspire Lifestyle Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant Care Home 4 Category(ies) of LD Learning disability (4) registration, with number of places Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 17th December 2004. Brief Description of the Service: Linden Lea is a residential home for 4 adults with learning disabilities. Service users all have complex needs including autistic spectrum disorder and epilepsy. The home is situated in a quite residential part of Quorn Village and is close to local amenities such as shops and public transport links. The home is well maintained and decorated and has a large garden to the rear. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over four hours and was the first statutory unannounced inspection this year. The inspector tracked all four residents’ files and spoke to the manager and a member of staff. What the service does well: What has improved since the last inspection? What they could do better:
Residents’ needs should be assessed using a consistent format that is dated and reviewed to indicate when the assessment was completed. Care plans and risk assessments must be completed for all residents. They need to be dated and regularly reviewed. All records regarding the administration of PRN medication must be completed. When medication is not given a clear reason must be recorded on the sheet. Care must be taken not to obscure the instructions for administration of medication when placing the sheets in a folder. A full programme of training needs to be organised as soon as possible with particular focus on adult protection. The manager needs to be registered with the Commission for Social Care Inspection. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Residents needs have been assessed but the lack of consistency and the lack of dates and evidence of review mean that it is impossible to ascertain how up to date such assessments are. This could lead to residents not receiving appropriate care. EVIDENCE: All files tracked contained assessment documents but they used a range of different formats and several elements were not dated. There was no evidence of review in many cases. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,9 Care plans and risk assessments are not regularly reviewed and are not consistent. This could lead to residents needs not being met appropriately. EVIDENCE: Care plans were present in all files tracked but again there was inconsistency and the plans had not been reviewed or dated. There was also some lack of detail in some of the plans. All files tracked contained risk assessments except one. Where risk assessments were present they needed to be reviewed and updated. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 Residents are enabled to access meaningful activities and to keep in touch with friends and families. EVIDENCE: Three of the four residents attend local colleges and other day care facilities with one regularly going swimming. The other resident remains at the home and is offered meaningful activities such as drawing, trips to local shops and trips out in the car. Residents are enabled to maintain contact with families and friends; all files include a list of birthdays and contact details for significant people. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Residents’ support and healthcare needs are recorded and their needs are met in a way that they prefer. The administration of PRN medication is not always recorded appropriately, this could give rise to maladministration of medication. The reason for a resident not taking medication is not always recorded correctly which could lead to difficulties in reviewing the effectiveness of medication. The use of a hole-punch to fix medication sheets in a folder could lead to essential information being missed when giving medication. EVIDENCE: All files tracked contained a self-help assessment that indicated their personal care needs. The resident who was present during the inspection is clearly happy with the care he receives from staff at the home. The resident’s file contained a number of incident sheets where PRN (as required) medication had been given. Although three PRN sheets had been completed on one day there was only one incident sheet and no reference in the daily log. Furthermore there was no record of any criteria for giving the medication. All files contained a record of residents’ health care needs. All residents are registered with a local GP; appointments are recorded along with any advice given and any outcomes. Medication is stored in a lockable cabinet. All medication was found to be stored appropriately. Records of medication given were completed appropriately except for one sheet where a letter ‘O’ had been
Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 12 used to indicate that medication had not been taken without any explanation of what ‘O’ means. This should have been indicated at the bottom of the form. On one form a hole-punch had been used that obscured part of the instruction for administering the medication. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents feel that their views are listened to. Policies and procedures are designed to keep residents safe but staff need training to increase their awareness of adult protection issues. It is possible that an incident of abuse could be missed until such training occurs. EVIDENCE: The home has a comprehensive complaints procedure that is displayed throughout the home. Complaints are recorded in a book; no complaints had been entered since 2001. The home has its own adult protection procedure and also uses the Multi-Agency Vulnerable Adult Protection document No Secrets. The manager stated that staff have not had adult protection training. She also stated that she is in the process of organising breakaway training for the management of challenging behaviour. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 Residents live in a homely, comfortable clean and tidy environment that they are able to personalise to their taste. The areas mentioned below need to be attended to as soon as possible. EVIDENCE: The home was generally pleasantly decorated, well maintained and homely on the day of the inspection. The house was clean and tidy and appeared hygienic. Residents personalise their rooms with décor and belongings. One resident showed the inspector round and was clearly proud of his home and in particular his bedroom. During the home tour the inspector noticed that a chest of drawers in the upstairs bedroom belonging to resident EB was broken. The end panel on the bath upstairs is broken and the plaster to the right of the bathroom on the landing wall needs repairing. There are other areas of plaster throughout the home that need repairing. The manager stated that other areas of repair and redecoration throughout the home are part of a work schedule and will be completed shortly. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34,35 The recruitment procedure enables residents to be supported and protected. Staff are able to meet residents needs but this needs enhancing with further training. EVIDENCE: The home has a recruitment procedure that is robust and aims to protect residents. All recruits require two references, which are confirmed by telephone. A clear Criminal Records Bureau check is required before a candidate can start work at the home. The manager and a manager from another home interview candidates. The home has a programme of training, three staff have completed medication training one has attended infection control training and one has a food hygiene certificate. The manager stated that she is investigating fire safety and abuse training as well as suitable NVQ courses for staff. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,42 The home is well run and provides for the health and safety of all who use it. The manager needs to be registered. EVIDENCE: The manager is competent and skilled to run the home but is not currently registered. The home has a comprehensive set of risk assessments regarding health and safety. Fire drills are regularly carried out. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 x x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x 3 x x Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Linden Lea Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score 1 x x x x x 3 C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 18 No. Are there any outstanding requirements from the last inspection? 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 20 Regulation 13 Requirement It is required that when medication is administered as required, the correct records are completed. When medication is not given the reason must be recorded accurately. It is required that care is taken not to obscure parts of the instructions for administering medication when fixing the sheets in a folder with a holepunch. It is required that the manager register with the Commission. Timescale for action Upon receipt of this report. 2. 20 13 Upon receipt of this report. 3. 37 8 30th June 2005 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. 3. Refer to Standard 2 6 9 Good Practice Recommendations It is recommended that residents needs are assessed using a consistent format and that assessments are dated and regularly reviewed. It is recommended that care plans use a consistent format and that they are reviewed and dated. It is recommended that all residents have risk assessments, that these are dated and regularly reviewed
C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 19 Linden Lea 4. 5. 6. 7. 23 24 35 It is recommended that all staff receive training regarding the protection of vulnerable adults. It is recommended that the areas of repair and decoration detailed are carried out. It is recommended that all staff receive a full programme of training. Linden Lea C51 S1758 Linde Lea V226873 120505.doc Version 1.30 Page 20 Commission for Social Care Inspection The Pavilions 5 Smith Way Grove Park, Enderby Leicester, LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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