Inspection on 10/10/08 for Linden Cottage

This inspection was carried out on 10th October 2008.

CSCI found this care home to be providing an Good service.

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.

Other inspections for this house

Linden Cottage 13/10/06

Linden Cottage 16/01/06

Linden Cottage 24/05/05

Linden Cottage 11/01/05

Linden Cottage 01/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Linden Cottage Linden Chase Uckfield East Sussex TN22 1EE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alexis Reilly     Date: 1 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Linden Cottage Linden Chase Uckfield East Sussex TN22 1EE 01825763872 01825763787 lindencottage@efitzroy.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Elizabeth Fitzroy Support care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - 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 Linden Cottage provides care and accommodation for six people with a learning disability; up to four of them may also have a physical disability. The house is a detached property set in a quiet residential area of Uckfield. The High Street, with its shops and access to bus and rail routes, are a short level walk away. The building is a converted bungalow; ground floor accommodation is adapted to accommodate people who have a physical disability and require the use of a wheelchair. First floor accommodation is allocated to those service users who can manage stairs. There is a large rear garden with a patio and lawn area, most of which can be accessed by wheelchair users. The fees charged range from £800 to £1,400 per week and include the cost of the staffing for a 7-day annual holiday. Additional charges are made for chiropody, personal toiletries, clothing, meals out, activities, music therapy, and Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 6 Brief description of the care home transport. The home makes the Inspection Report available upon request and the last report is included in the homes Service user guide. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home 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: Our inspection began at 11.30am and finished at 3.30pm. As part on the inspection the inspector case tracked three service users, one of which was the newest resident placed in the home. This allowed the inspector to assess whether the service was identifying the needs of the service user from the preassessment documentation provided to the home, and whether this was followed through into the care plans and risk assessments. The inspector also looked at the record of activities in the home, and evidence of external health input. The record of accidents and incidents in the home including copies of any notifiable incidents sent to the CSCI, the record of concerns and complaints in the home, menus, residents finances, staff recruitment files, supervision dates and team meeting records. The inspector also interviewed two staff members, carried out a full environmental tour and watched a medication audit being carried out. Care Homes for Adults (18-65 years) Page 6 of 27 Residents were seen in the home, however no residents was spoken to individually. On the day of the inspection the service was full and had six residents residing. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 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 9 of 27 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. The service understands the importance of having sufficient information when choosing a care home. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted by a central assessment team and involves the individual and their family or representative where appropriate. Prospective residents are given the opportunity to spend time in the home prior to moving in thus ensuring the person feels comfortable in their surroundings and that they can test drive the home. Evidence: As part of the inspection the inspector examined the care plan of the last service user admitted into the home. The service has had one admission in the last eight years. The inspector can confirm that in relation to external health care needs dietitian reports, physiotherapy and psychology referrals had been made. The service has a policy in place for admissions into the service. The initial referral would be done by the central referral team, and then this would be passed to the Registered Manager to become involved in the continuing assessment of the person. The last resident that came into Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: the home had visited it six times prior to moving in. Care Homes for Adults (18-65 years) Page 11 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans in the service are excellent, they are person centered written in plain language are easy to understand and look at all areas of the individuals life and include a range of information that is important to them. The care plan is a working document reviewed regularly involving the person and their representatives as appropriate. Comprehensive care plans ensure that residents receive a good comprehensive package of care. Evidence: As part of the inspection the inspector examined three care plans of service users in the home, as part of these the risk assessments and supporting health input documentation was also viewed. The inspector found the care plans to be excellent, they were detailed, informative, comprehensive and clear. The inspector was able to gain a clear picture of the individual person, and preferred ways of communicating. The care plans were person centered and demonstrated the service access health input Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: for the service users. Risk assessments were comprehensive and informative and the service had been proactive in protecting service users but also balancing their rights over risk. An example of this was with regard to a service user refusing to take medication. The Registered Manager ensured that this was discussed with the GP, and collaborative care contact record sheets were in place to confirm this. Care Homes for Adults (18-65 years) Page 13 of 27 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. The service has a strong commitment to enabling residents to develop or maintain their skills including social emotional communication and independent living skills. The staff practices promote individual rights and choice but also consider the protection of individuals in supporting them to make informed choices.The staff team help with communication skills both within the service and in the community to enable residents to fully participate in daily living activities. The service is currently short of staff and this is affecting the amount of activities that are able to be carried out with the residents. The service is currently recruiting staff to resolve this issue. Evidence: As part of the inspection the inspector case tracked three residents and looked at the activities these residents attended, information was also gained from care staff, and the Registered Manager. The service operates a 15 hour activity scheme for each Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: person each week, this is regardless of whether they are funded for the full 15 hours or not. These activities range from visits to the hydro pool, fish and chips and evenings out, attendance at college, sensory sessions, swimming, bus trips, walk and a drink in the local community and having time in the home to prepare and make lunch. Currently the service is running with less staff and due to this some of the residents have had activities canceled. This was discussed with the Registered Manager on the day of the inspection. The Registered Manager could demonstrate that activities are still carried out with individuals and that even though they are short of staff currently trips which have been arranged for holiday on ice the ballet and concert and theater trips are still going ahead. However an example of areas where service users are not doing the set activities, are one service user missed a day at college that week and that evening two service users were due to go out for fish and chips, due to lack of staff only one could go. The Registered Manager keeps a count on the hours of activities used and if any are missed out of the 15 hours they are carried over on to the next week. The service is currently in the process of recruiting more staff. Pictorial menu cards are used within the service. Care Homes for Adults (18-65 years) Page 15 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal and health care support using a person centered approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal health care needs including specialist health, nursing and dietary requirements are clearly recorded in each person centered plan or health action plan. Residents are given the support and choice with regard to taking their medication and risk assessments are in place to manage this. The service ensures that residents health as well as personal care needs are addressed comprehensively. Evidence: As part of the inspection the inspector observed the Deputy Manager carrying out a medication audit in the home. The procedure in giving out medication is that one staff member signs and a second member of staff checks to make sure the signature has been recorded and the medication has been administered. Then a further member of staff will go through the whole of the medication for that part of the day and check it has been both administered correctly recorded and the medication has been used. Staff have had training to use Bucclemadizipan for one particular service user and only staff with this training are allowed to support the service user on trips out. Each Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: service user has a medication file which states how they like to take their medication and has a risk assessment in place and includes the reasons for medication and protocol for as and when medication. Care Homes for Adults (18-65 years) Page 17 of 27 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. Complaints are dealt with effectively clearly and speedily. The service has a pictorial complaints procedure in place. Staff have completed the required training in Protection of Vulnerable Adults and staff spoken with demonstrated that they had the required knowledge with regard to Safeguarding the adults in their care. Evidence: As part of the inspection the inspector examined the list of complaints and notifiable incidents within the home. The inspector can confirm that the home takes complaints seriously and addresses them speedily. There is a pictorial complaints procedure in place. Two staff were spoken with on the day of the inspection and both know the correct procedure for referring concerns through to Adult Protection. Staff have completed the mandatory training in Protection of Vulnerable Adults. Care Homes for Adults (18-65 years) Page 18 of 27 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. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is a safe place to live. Individual rooms are personalized and comfortable. Evidence: The Inspector had a tour of the building on the day of the site visit. The home was found to be both clean and hygienic and decorated and furnished adequately All rooms are domestic in character have a homely and comfortable feel to them and are fully accessible. There are bedrooms on both the ground and first floor and a new lift as been installed to provides access for residents with mobility difficulties. Residents own rooms are decorated and furnished to their own tastes and personalized with their belongings. Residents rooms are individualized, several rooms have sensory equipment and one has a water bed and all rooms are reflective of the individual taste and interests. Hand washing facilities are appropriately sited in the kitchen and in the separate laundry. Adjoining the kitchen is a conservatory that provides an alternative dining space and the space for all residents and staff to eat together if required. Adjoining the Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: conservatory and off the ground floor hall way is a lounge area providing seating to accommodate all residents. There is an enclosed garden to the side and rear. Care Homes for Adults (18-65 years) Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All staff receive relevant training that is focused on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training and supervision to meet the individual needs of people in a person centered way. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognizing the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Evidence: As part of the inspection the inspector examined a sample of staff recruitment files, training matrix and list of staff supervision. Evidence from these documents and also confirmation from the staff interviewed confirm that staff have regular supervision, attend monthly team meetings and have attended a variety of training over the last 12 months. Staff interviewed were able to demonstrate they had an understanding of promoting peoples dignity and independence getting x to choose food, encouraging x to walk and not to be led, close bathroom door to maintain privacy.and were aware of the correct procedure to follow in the event of Safeguarding Vulnerable Adult referral. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: However in discussion with Registered Manager, staff members and evidence from the activities documents it is clear that there are insufficient staff on duty to ensure that the residents attend the prearranged activities. Due to this some activities have been canceled. However the Registered Manager was in the process of recruiting staff to work in the home on the day of the inspection, and this is hoped to resolved the present situation. Care Homes for Adults (18-65 years) Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service, based on organizational values and priorities. They work to continuously improve services. They provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centered thinking. The Registered Manager is currently addressing the short fall in staffing to ensure residents have a comprehensive package of activities. Therefore ensuring residents receive a comprehensive package of care in a well run home. Evidence: As part of the inspection the inspector spoke to the Registered Manager, interviewed two staff members, saw service users in the home and gained the views of placing professionals. Comments received from placing professionals were minor concerns around the actual level of support provided for x in relation to 1:1 when out, otherwise very Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: happy,excellent paperwork. Care plans were found to be excellent and staff were found to be receiving appropriate training and support from the Registered Manager. The Quality Assurance questionnaires were due to be sent out at the time of the inspection, so the comments for these have not been recorded in the report. Surveys were sent out from the CSCI comments from these were I would like to see the contract! Not aware what x eats every day. Otherwise answers are Yes/Usually or Always. During the inspection the inspector established and saw evidence of contracts in the home and the menus was pictorial and varied. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 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 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 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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