Inspection on 12/09/07 for Linden House

This inspection was carried out on 12th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linden House 18/09/08

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Linden House 205 Linden Road Gloucester GL1 5DU Lead Inspector Simon Massey Key Unannounced Inspection 12th & 13th September 2007 09:30 Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 1 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 Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 2 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 Stationery 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 House DS0000069034.V347719.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linden House Address 205 Linden Road Gloucester GL1 5DU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01452 523700 01452 524555 info@carecommunity.co.uk Care Community Ltd Mrs Elaine Hughes Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning Disability (Code LD) The maximum number of service users who can be accommodated is 6. This is the first Inspection of this service which was registered in April 2007 2. Date of last inspection Brief Description of the Service: Linden House is a large detached property situated approximately two miles from the centre of Gloucester. To the rear of the house is a private garden where there is a separate building that has a living room and a laundry room. Two of the bedrooms are on the ground floor and the rest are upstairs, where the office is also situated. All have en-suite facilities. The home is situated in a residential area but is close to local amenities. The range of fees were still being developed at the time of this visit. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of this service that was registered April 2007. The Inspector met with the Manager, the two service users in residence and five of the care staff. Records relating to staffing, medication, care planning and health and safety were examined. An inspection of the environment was also carried out. Two people are currently living at the home, with one having only moved in a week prior to this visit. A staff team has been recruited which will be expanded as additional service users move in and the home becomes full. What the service does well: What has improved since the last inspection? What they could do better: The service needs to ensure that the Registered Manager is provided with the appropriate support, and scrutiny. This must include regulation 26 visits being completed. The home needs to develop the range of day care opportunities for service users. The home should ensure that all staff have undertaken training in the area of Adult Protection. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Linden House DS0000069034.V347719.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedure ensures that people’s needs and aspirations are assessed prior to prospective residents moving into the home EVIDENCE: As part of the registration process recently completed the home have produced a Statement of Purpose and Service User Guide. Assessments were in place for the two service users currently living at the home. There is an assessment of needs, which was completed by the manager and an additional assessment that had been provided by the placing authority. These were detailed documents that covered a range of needs that were to be met by the home. The manager explained how the assessments were completed and also how trial visits and introductions are encouraged and catered for. One service user explained how they had come for a preliminary visit to meet the staff and see their potential accommodation. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Initial care planning systems have been put into place but service users will benefit from the further development of these and increased staff understanding and involvement in the process. EVIDENCE: The personal files contain care plans that are still in the process of being developed. These detail the support required around personal care, social skills and the aims to develop independence skills. There is also information about likes and dislikes. The manager explained the person centred approach that is being developed and how service users will be fully involved in the reviewing and updating of their plans. There is a need to record the nature and extent of the service user’s involvement in their care planning and also to ensure that all documents are dated and signed. The plans should also contain more detailed advice and guidance for staff on how needs are to be met, approaches and strategies to Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 10 be utilised for each individual and, where necessary, how this links to policies and procedures that are in place in the home. One service user spoken to explained how they intended to make use of the opportunities to make decisions about their daily lives in relation to their daily routines and day-time occupation. With both people only having been at the home for a short time it is understandable that there is scope for the development of the care planning process and the provision of clear links between documentation and practice. Staff spoken to also explained how they were getting to know service users and building relationships that would help them to support people to make choices about their daily lives. Some risk assessments were in place and these were being utilised to develop independence and minimise risk, but there is need for this to be further developed as the home identifies increased opportunities and activities for service users. Staff have been completing good regular recording, with entries being dated and signed and there was evidence that monitoring of behaviours, health and welfare is being undertaken. There is also provision for the recording of accidental bruising and injuries with the use of charts and written records. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are to be given opportunities to take part in a variety of activities in the community but sufficient variety and choice is not yet provided, as these aspects of the service are still being developed. Service users would also benefit from a more structured approach towards the development of independence skills. EVIDENCE: At the time of this visit the home were still developing the day time activities that are being undertaken by the service users. The manager explained what was being investigated and developed. There is need to support activities, work experience and vocational activities that meet the identified needs and aspirations of the service users. One person presently has two days a week at a day centre whist the other service user at present has no regular structured or organised activity, though it is hoped that some work experience will be started soon. As the number of service users living at the home increases there will be a greater need for this aspect of support and care to be well Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 12 organised and co-ordinated to ensure that peoples’ needs are met. At present people are enjoying regular trips out into the community and spending time in the home. The home was stocked with fresh and packaged food at the time of the visit and one service user said that the food was excellent and that a healthy diet was being encouraged. The staff team have the knowledge to provide halal meals if required and the kitchen is organised so as to be able to meet the needs of different cultural diets. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal care needs are being met but service users would benefit from the recording systems being fully organised. The home must ensure that it can access the specialist health services that are required and, where identified, that appropriate staff training is provided. EVIDENCE: At the time of the visit the home were yet to register the newest admission to the home with a local GP and this needs to be actioned. The home also needs to ensure that the files are set up to include any records of health appointments and outcomes that may ensue. These files should also provide the evidence that all aspects of health needs are being monitored. A need has been identified for specialist input for one service user but it has yet to be resolved from which community service this will be accessed and this issue needs to be resolved by the home. Some guidance has been provided around behaviour management and how inappropriate behaviour should be managed, though interviews with staff showed varying degrees of understanding around this. However it was evident that these aspects of staff understanding are being developed through training and supervision. The home currently has some inexperienced staff and it is Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 14 important that a consistency of approach is maintained in dealing with behavioural issues. Some staff interviewed were able to demonstrate how reflection on their practice was improving their understanding and approach to their work. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Basic policies and procedures are in place to ensure that people are protected but this will be improved when staff have undertaken training in protection issues. EVIDENCE: Records are kept in the personal files of service user’s personal monies and the finances have been regularly checked. The home has a complaints procedure and policy in place. None of the current staff group have undertaken any Adult Protection training and this needs to be organised by the home. It is recommended that the home access the training provided by the local authority Adult Protection team. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The newly registered property has been renovated to a good standard and provides the service users with spacious and homely accommodation. EVIDENCE: The home has been renovated and newly decorated prior to opening and it provides spacious accommodation with two adjoining downstairs communal areas, a large kitchen and also a separate living room/activity room which is located in the garden adjoining the laundry room. The house has been decorated to a good standard and staff explained how they intended to make it more homely as the service users settled in. The two service users have started personalising their accommodation with support from the staff. Both said they were pleased with the accommodation. All bedrooms have en-suite facilities. The rear of the property has a secure and private garden for use by the service users. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 17 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has recruited a relatively inexperienced staff team who appear motivated to delivering a good service but it is important that professional supervision and training is provided and supported to ensure that the team develops the required skills to meet the needs of the service users. EVIDENCE: The home has recruited a number of staff with more to be recruited when the home takes more admissions. The recruitment files were largely in order with the appropriate checks having been completed. There were two references that had been received that appeared to not be correctly signed and not fully completed and also one person had not provided a reference from their most recent employment in care. In was explained that this staff member, who is not full time, was still working with in their previous post. It is still appropriate in these circumstances to provide a reference from this setting. The home has recruited a mixture of experienced staff and staff who are working in care for the first time. New staff considered they were well supported by the management and that they were learning together as a team. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 18 The home is intending to provide a service that can meet the needs of a variety of different cultural backgrounds, and staff have been recruited with an understanding of meeting the needs of service users who have an Asian background, and may also be of the Muslim faith. The staff team have shared their knowledge on how to meet these particular needs in terms of diet and religious observance. The staff team are very positive in their commitment to be able to meet a diverse range of cultural and religious needs and this represents a very positive aspect of the service that is being developed. Some training has been undertaken and the manager explained they are providing all the statutory required training in first aid, food handling and fire safety. Some of the newly recruited staff had already completed this in their previous posts. The manager explained that the intention was to begin enrolment on NVQ training once the induction and probation periods have been completed. Staff will be receiving formal supervision from the senior staff. The home has been having regular staff meetings. Both service users appeared relaxed and comfortable in their new home and one person commented that the staff were, “very friendly” and that, “we are getting along fine.” Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 19 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs to ensure that a new Manager is registered and that they are provided with the appropriate support and supervision to undertake the responsibilities required. EVIDENCE: The manager has the appropriate qualifications and experience to undertake their role. Staff stated that they felt they were well-supported and provided with leadership and direction. One service user spoken with was very positive about the manager and said that they were able to talk to them about issues or concerns. The manager has implemented a number of systems, which should promote the efficient running of the home. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 20 The Manager has had the responsibility for setting up the home and taking it through registration. They have also had the same responsibility for another home owned by the same Provider, which was registered at the same time. This other home is yet to admit any service users or recruit staff. It is the view of the Commission that additional support and help is required if both homes are to progress to being fully operational. To simultaneously recruit two staff teams and fully accommodate two care homes without additional management support and limited involvement from the Provider represents a very large range of responsibilities. Immediately prior to this Inspection visit the Commission were informed by the Registered Manager that they would be leaving their post in early October 2007. The Provider needs to ensure that satisfactory arrangements are put in place to cover this absence until another Manager is appointed. The Provider also needs to ensure that the required support and scrutiny for the new Registered Manager is in place. It was found during this visit that no Regulation 26 visits had been completed since the home opened and that the Manager received no structured professional supervision in relation to the role they were undertaking. Considering the wide span of responsibilities they were covering over two homes it would have been of benefit for additional support and guidance to have been provided. It would also appear that the decision to make the Registered Manager also the Responsible Individual has not worked well, and the Commission will be requiring that a separate RI is appointed for this service. This person will be responsible for completing the required Regulation 26 visits and providing a degree of scrutiny and support to the Manager. Copies of these reports must be supplied to the Commission in the first instance. The Commission has been subsequently informed that a new manager, recently appointed, will initially have responsibility for just the one home. The Inspector met with the newly appointed manager and also clarified that the Responsible Individual is fulfilling this role for an initial six-month period. It was explained how a more structured approach to the developing of the two homes opened by the Provider was being undertaken. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 21 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 Standard No Score 1 3 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 22 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 2 3 4 Standard YA37 YA41 YA23 YA19 Regulation 7&8 17(a) 13(6) 13(1)(b) Requirement Timescale for action 31/12/07 The home must register a Manager and a Responsible Individual. The home must ensure that all 31/12/07 documentation is correctly dated and signed. All staff should undertake 31/12/07 training in Adult Protection. The home must ensure that it 31/12/07 can access the specialist health care required to meet the service users needs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA9 Good Practice Recommendations The home should develop the care planning to ensure it is identified how individual needs are to be met The home needs to ensure that correct risk assessments are in place to support activities undertaken and the degree of independence supported. Linden House DS0000069034.V347719.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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