Inspection on 18/09/08 for Linden House

This inspection was carried out on 18th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linden House 12/09/07

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 13/03/2009.

CARE HOME ADULTS 18-65 Linden House 205 Linden Road Gloucester GL1 5DU Lead Inspector Mr Simon Massey Unannounced Inspection 18th September 2008 10:00 Linden House DS0000069034.V371947.R02.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.V371947.R02.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.V371947.R02.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 Acting manager in post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linden House DS0000069034.V371947.R02.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. 2. Date of last inspection 12th September 2007 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 fees are negotiated on an individual basis depending on the needs of the individual service user. Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced Key inspection took place on 17th September 2008. The Inspector met with the Acting Manager, the Responsible Individual, several members of the care staff and all the service users. Records relating to care planning, medication, health and safety and staffing were examined. An inspection of the environment was also carried out. A number of surveys were also distributed in respect of this inspection. The service has been in operation for over a year and is currently operating with only two service users, though two previous service users have moved to the other home run by the same Provider and with which it shares a manager. There have also been a number of management changes during this period and during this visit the inspector was informed that the deputy manager had left their post. What the service does well: What has improved since the last inspection? What they could do better: The home must improve its recruitment procedures and pre-employment checks. The home must ensure that the induction completed by staff covers basic health and safety issues such as fire safety before staff commence work in the home. Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 6 The service must ensure that the management structure that is in place is appropriate and effective for the two homes, which are being managed by the same manager. The home must ensure that there is an up to date fire risk assessment in place and that all staff have completed fire safety training. The home should provide service users with Health Action Plans. 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.V371947.R02.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.V371947.R02.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): Standards 2 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Statement of Purpose provides accurate and accessible information to prospective admissions to the home but could be produced in different formats to increase understanding for some people. EVIDENCE: The service currently has four vacancies and two service user in residence. Assessments were completed and information gathered prior to admission and both people expressed satisfaction about their admission process. They had opportunities to visit and meet staff before making a decision about moving into the home. There is Statement of Purpose and Service User Guide in place, which provide information about the service, but this could be improved by the developing of these documents in different formats using more pictures and symbols. Linden House DS0000069034.V371947.R02.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): Standards 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have care plans in place but their needs could be better met with the development of a more person centred approach to identifying goals and objectives EVIDENCE: Both service users have detailed care plans in place and also additional information about needs, which help inform the practice the care staff. Service users have been involved in the reviewing of their plans and were able to demonstrate some understanding of the content and purpose of their care plans. There is scope for greater involvement and ownership of these plans by the service users and the development of a more person centred approach to care planning. Records seen showed good regular recording of activities and daily events relating to the service users care and support. There was good recording of any antecedent behaviour and the subsequent action and decisions made by the care staff. Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 10 Risk assessments were in place with regards to accessing the community and the support levels required. Service users explained how they are involved in making decisions about their daily lives both in terms of social activities and also vocational activities. Both people described how they are being supported to develop their independence skills and how this was an important part of their care and support. Any limitations or restrictions on choice and movement are recorded and these have been agreed in consultation and agreement with the service users. Staff demonstrated a degree of understanding of the process of care planning and the need to review and update on an ongoing basis but there is scope for the care staff to develop greater ownership and understanding of the process and the connection between documentation and practice. It is recommended that staff receive training and input on the principles and practice of person centred planning. Linden House DS0000069034.V371947.R02.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): Standard 12,13,15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports the service users to develop individual lifestyles and plan for the future by encouraging the development of independence skills. Service users appear confident about their right to make choices and decisions about their lives EVIDENCE: Both service user express general satisfaction with the range of activities inside the home and in the community that they are supported to follow. They did however say there were times when they wished to go out more but the staffing levels were not always available to do this. Records show regular trips out and a range of activities being undertaken and it was evident that there is progress being made in supporting successful excursions into the community. Due to the high staffing ratios risk assessed as being necessary for some of the activities it is understandable that occasionally some spontaneous trips out are not possible to support. However records and interviews with service and staff Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 12 showed that planned trips are provided with the correct staffing and appropriately supported. It is the goal of both the service users to access the community more independently in the future and both said that they felt they were being supported to do this. Service users are supported to maintain their family and personal friendships and both were very positive about this aspect of their support. Feedback from relatives also said that the home kept them well informed and that they were made to feel welcome at the home. The kitchen was well stocked with fresh and packaged food at the time of this visit and all items were appropriately stored and labelled. 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. Staff and service user were very positive about the quality and quantity of food provided. Due to the needs of one service user the kitchen is at times kept locked and they expressed their agreement for this arrangement. However when more service users move into the home this arrangement will need to be reviewed to ensure that other peoples rights and opportunities are not being adversely affected. Linden House DS0000069034.V371947.R02.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): Standards 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Guidance and recording supports service users to receive their personal care in a way that promotes their privacy and dignity. EVIDENCE: The home has addressed the issue of recording of health appointments which was identified at the last inspection and clear recording is now in place. Records are kept of all health appointments and outcomes and actions are noted in the personal files of the service users. There is however a need for Health Action Plans to be developed and put into place Personal files contain good information about how personal care needs are to be met. Both service users receive support with their personal care and both expressed satisfaction with how this is delivered by the staff team. Medication was correctly stored and records were up to date. Staff must complete training in this area before they are allowed to administer medication. Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 14 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): Standards 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has satisfactory arrangements and procedures in place for the protection of service users but these would be improved if information is given to relatives around the complaints procedure and staff receive training in adult protection and the managing of challenging behaviours. EVIDENCE: Records are kept in the personal files of service user’s personal monies and the finances had been regularly checked. However during this inspection the details of some irregularities were shared with inspector. This has resulted in changes to the process of auditing and checking of personal monies. Some of the current staff group have undertaken Adult Protection training as part of their induction but due to the departure of the staff member who was co-ordinating this training it was unclear what exactly this training included and how detailed it was. A requirement has been made that staff are supported to attend the training that it is provided by the local authority Adult Protection service. Staff occasionally have to manage some challenging behaviours but staff stated that so far this has been managed without physical intervention. Staff would benefit from training in this area to ensure they are fully aware and trained to meet these needs that require techniques such as diversion and deescalation. Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 15 The home has a complaints procedure in place but some staff spoken with, and both service users, were unclear about the formal process. Staff stated that they felt confident about raising issues or concerns with either the acting manager or Responsible Individual. Relatives expressed confidence in raising issues with the home but also commented they were not fully aware of the formal complaint process that is in place. Service users are protected in the home but this could be improved by further staff training and ensuring that all relatives and staff are aware of the formal complaint process. Linden House DS0000069034.V371947.R02.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): Standards 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well maintained and decorated throughout and provides a comfortable homely environment. EVIDENCE: The home has been renovated and decorated to a high standard throughout, with all bedrooms having en-suite facilities. The home has begun to be personalised by the service users and staff, and provides comfortable and homely accommodation. Service users expressed satisfaction with their accommodation. Both bedrooms currently in use were seen and these were personalised and reflective of personal taste and interests. Service users explained how they took some responsibility for their rooms. Service users can have keys to their rooms if they choose. The home was clean and hygienic throughout at the time of this inspection. The home is well situated for accessing local amenities and facilities. Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 17 Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 18 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): Standards 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 service is developing a staff team that is motivated and caring but the safety of the service users could be compromised by poor recruitment procedures and inconsistent induction of care staff. EVIDENCE: The home currently only has two service users but has generally managed to maintain the required staffing levels. As additional supervision is required to support some community based activities this has occasionally stretched the staff team. Both service users expressed some frustration at not occasionally having sufficient staff to support spontaneous trips out. As more admissions are made to the home careful consideration will have to be given to the staffing ratios required and the times of day when these are provided. With the developing of independence skills and self-confidence it is intended that the occasional limitations on accessing the community will be minimised. An inspection of staffing recruitment was undertaken and the following shortfalls were identified. Not all staff had two references in place and a complete employment history. Also some references from previous employers were not actually from the employer but from colleagues who worked at the Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 19 time with the staff member. Some references were also not provided in a formal enough way, being handwritten and not on headed paper of any kind. One person had also not provided a reference from their last employment in care. There is also a need to provide the files with a recent photo. All staff had had POVA first checks and CRBs completed but there is an urgent need for the recruitment process to be organised in a uniform way and ensure that all the correct processes are followed. Service users were very positive about the staff team, one comment was, “they are a great bunch, I do not have any complaints at all” and another was “they are really nice, I can talk to them and have a laugh”. Service users said they could discuss issues with the staff and that they were always treated with respect and that their privacy was respected. The service has recently had one staff member complete a training course which would enable them to supervise and assess the induction of new staff. This person has left their post and the current situation was a little unclear as the home were still waiting for certificates for some staff, who have completed various training. The training package purchased appears to be very detailed and covers a wide range of areas and staff whom had undertaken part of it were positive about the content. However the basic initial induction to working in the home has been inconsistent. Some staff were not provided with the basic guidance in relation to fire safety and other health and safety issues within the home. There was also no competency-based assessment of staff in relation to basic tasks within the home and staff were undertaking shifts after a minimal period when ideally they should still have been supernumerary. Some staff were working unsupervised after only a few days working in the home. The home needs to produce a clear procedure and process for induction to be followed by all new staff. There is a need for the home to establish a training matrix, which will provide clarity over what training has been completed and what is due. Some staff have completed medication training and food handling training and are enrolled onto NVQ courses. Staff have received regular supervision and people said they thought they worked well as a team with good support and communication between staff. At the time of this visit the Deputy Manager had left their position at short notice and this was having a disruptive affect, but the staff appeared motivated to meeting the needs of the service users and developing the care and support that the service provides. Staff were observed relating and interacting with service users in a calm and caring manner and were able to demonstrate an understanding of the needs of the service users and the content of the care plans. Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 20 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): Standards 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 management of the home provide direction in terms of care and support but shortfalls in various administrative processes could compromise the safety of the service users. EVIDENCE: The acting manager has provided direction to the staff in establishing the routines and care practices that are required. All staff spoken to were positive about the support and advice they receive from the manager and it was evident that a positive and team approach was being promoted. There are serious concerns about some of the administrative processes, particularly in relation to staff recruitment and staff training, and requirements have been made in relation to these. Whilst these tasks had been delegated it is the responsibility of the manager to ensure that the correct procedures are Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 21 in place and also, in respect of staff training, that staff are fully prepared before they work without close supervision. Prior to this inspection the Deputy Manager had left their post but a temporary replacement had been quickly found from within the organisation. This was a positive step as previous inspections of this and the sister home, run by the same Provider, have expressed some reservations about the management structure over the two homes. If one registered manager is to run both homes it must be possible to delegate certain tasks to senior staff who are competent to complete these. The home has had regulation 26 visits and also completed some surveys of service users and relatives, but no formal quality assurance is yet in place. Due to the short time it has been occupied this is reasonable, but it is recommended that plans are made for a more formal system to be put into place. There were inconsistencies in the recording of the fire safety testing and evacuations and some confusion as to where information was being recorded. There was also no current fire risk assessment in place and staff were yet to receive any formal fire safety training. These issues were taken on board during the visit and at the end of the inspection the manager informed the Inspector that a contractor had been hired to compete the fire risk assessment and also provide staff training. All potentially hazardous substances were correctly stored and records were kept of fridge and freezer temperatures. Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 22 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 X 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 1 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 X 3 3 X 3 X X 3 x Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 23 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. 2. Standard YA34 YA34 Regulation 19 19 Timescale for action The home must ensure that pre- 31/10/08 employment checks comply with the regulations The home must ensure that all 31/10/08 current staff have supplied a full employment history and two references including one from their last employer in care All staff should undertake 31/12/08 training in Adult Protection. 31/10/08 Requirement 3. 4. YA23 YA32 13(6) 5. 6. 7. YA42 YA42 YA19 18(1)(a)(c) The home must ensure that all staff complete a thorough induction process before working unsupervised within the home. 23(4)(a) The home must ensure that it has fire risk assessment in place 23(4)(d) The home must ensure that all staff complete fire safety training 13(1) The home must develop Health Action Plans for individual service users. 30/12/08 30/12/08 30/01/09 Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 24 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. 4. Refer to Standard YA1 YA23 YA39 YA6 Good Practice Recommendations The home could produce its Statement of Purpose and Service User Guide in different formats The home should provide the staff with training in the managing of challenging behaviours The home should develop a formal quality assurance system The home should provide the staff with training in Person Centred Planning Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI Linden House DS0000069034.V371947.R02.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!