Inspection on 02/06/06 for Linden House

This inspection was carried out on 2nd June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linden House 09/07/07

Linden House 23/01/07

Linden House 27/01/06

Linden House 28/09/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Linden House 10 Linden Road Tottenham London N15 3QB Lead Inspector Peter Illes Unannounced Inspection 2 & 7th June 2006 10:15 nd Linden House DS0000033209.V295870.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 DS0000033209.V295870.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 DS0000033209.V295870.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linden House Address 10 Linden Road Tottenham London N15 3QB 020 8888 0565 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) London Borough of Haringey Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th January 2006 Brief Description of the Service: The home is owned and managed by London Borough of Haringey Social Services Department and is registered to accommodate six younger adults with a learning disability. The home currently accommodates service users with complex needs and behaviour that can challenge services. The home reopened at the end of 2005 with new service users and a new staff team following a closure period to allow a major refurbishment of the building. The home is a three-storey house and the configuration of the accommodation was significantly changed during the refurbishment. The entrance and most of the ground floor are now fully accessible. The ground floor now consists of two communal lounges, kitchen, dining room and a toilet/ bathroom, separate toilet and staff facilities. The first floor, which is not accessible to wheelchair users, contains six service user bedrooms, a visitor’s room and further toilet, bath and shower facilities. The second floor is kept locked and used for storage, it is not accessible to service users. The home is situated in a pleasant residential area of Haringey and is within walking distance of a range of local shops, pubs, restaurants, transport facilities and the other multicultural amenities of nearby Wood Green. The home is currently only used by service users that are the responsibility of the London Borough of Haringey and the unit cost of a placement could not be ascertained at this inspection. The manager stated that a range of information, including CSCI inspection reports will be shared with service users and other stakeholders either individually, at meetings and on request. The stated aim of the service is to take a creative and diverse approach to the care and support offered to service users and to promote their participation in all aspects of their daily lives. The home’s statement of purpose goes on to say that the home works in close partnership with service users to actively promote participation in everyday experiences, opportunities and decision-making. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The provider organisation had appointed a new manager, Ms Noray Ahmet, to the home since the last inspection. This unannounced inspection took approximately ten and a half hours over two days. There were five service users accommodated at the time of the inspection and one vacancy. On the first day of the inspection the manager was not present and a team leader was in charge of the home. The inspector was able to talk independently to the team leader when the inspector first arrived at the home. However, soon after the inspection started the team leader and other staff on duty needed to attend to a service user to manage a serious episode of challenging behaviour. In view of the complexity of the circumstances the inspector deferred the majority of the inspection activity to another day. The inspector was however able to talk independently on the first day to a consultant psychiatrist who attended the home to assist the staff manage the situation. On the second day of the inspection the new manager was present throughout the day. The inspection activity on the second day included: meeting and observing the five service users accommodated, the inspector was able to have a basic independent conversation with one service user but not the other four. Communication with all the service users was limited by their complex communication needs; independent discussion with five care staff; sitting in on a staff hand-over meeting between the early and late shifts and discussion with the home’s manager. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: The home continues to strive to provide good quality care to service users with a range of complex needs including needs relating to their communication. The home is also working hard to develop and improve communication with service users, relatives and other stakeholders. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Linden House DS0000033209.V295870.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 DS0000033209.V295870.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users have access to appropriate information about the home to assist them and other stakeholders make informed choices about living there. The home has an effective assessment procedure to ascertain the needs and wishes of prospective service users. However the changing complex needs of existing service users need to be re-assessed in a timely manner. In addition, the decision making process about accommodating new service users must ensure that their assessed needs can be met, along with existing service users needs, within the finite resources available at the home. EVIDENCE: The home has a satisfactory statement of purpose and a service user’s guide, the latter being illustrated to assist make it more accessible. A copy of the service user guide was seen in one of the service user’s rooms. The manager is aware that once she is registered with the Commission as the registered manager of the home both of these documents will need to be amended to include her details. No new service users had been admitted to the home since the last inspection. Three service user files were inspected at random and each showed a range of satisfactory assessment information that was available to the home at the time of that person’s admission. The manager and a visiting consultant psychiatrist informed the inspector that a multi-disciplinary professionals meeting was due Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 9 to be held to discuss the changing and complex needs of one service user. A requirement is made that the current needs of this service user are formally re-assessed in a suitable environment by appropriate health and social care professionals. This is to review the suitability of the placement at this time in the light of these changing needs. The home had one vacancy and the inspector was informed that the home had undertaken an assessment of need on a prospective new service user since the last inspection. The manager stated that the outcome of that assessment was that the person was not considered suitable to be accommodated at the home. This was because the person was much more independent than the other service users currently accommodated and would benefit from a different sort of environment. In the Staffing section of this report a requirement is made that the home must ensure that it has sufficient staffing to meet the needs of the current service users. One of the reasons for this requirement is because the inspector was informed that the provider organisation had recently imposed a reduction in the home’s staffing resources. The inspector was concerned regarding the consequences of that reduction. Given this, a requirement is also made that the home must ensure that they have comprehensive assessment information on the needs of any prospective new service user, including their need for staff support. This is to ensure that the home has sufficient staffing and other resources to meet the needs of an additional new service user in addition to meeting the needs of the existing service users. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. Service users needs are included in their care plans to assist staff in meeting these although further attention is needed regarding reviewing and recording their changing needs. Service users are supported with their communication and supported with opportunities for exercising appropriate choices for themselves. Service users are supported to take responsible risks to assist them keep safe although again further attention is needed regarding reviewing and recording their changing needs in this area. EVIDENCE: The three service users files inspected all contained care plans that were informed by their assessment of needs and by risk assessments. The care plans were appropriately detailed and included clear guidance for staff on how to address the identified needs. Two of the three care plans inspected recorded that the respective service user required two to one staff support for a range of activities including for outings and trips outside of the home. There was some evidence from the plans that they had been reviewed and hand written additions or modifications were seen to have made since the last Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 11 inspection. There was no clear evidence however on when these additions or modifications had been made or by whom and a requirement is made regarding this. All of the service users accommodated have support needs with communication. The inspector was pleased to see that the manager had introduced a system of promoting the use of makaton sign language within the home since her appointment. A makaton sign chart was displayed in the home’s sitting room with a designated “sign for the week” being displayed. The manager and staff were seen to communicate well with service users including using makaton. It was the inspector’s impression from observing this interaction that the service users enjoyed and benefited from using makaton. The inspector was also pleased to learn that a referral had been made to Mencap for an independent advocate for one service user. This was to assist the service user with an identified issue that the home felt was problematic. The three service user files inspected included a range of detailed risk assessments that included appropriate guidance for staff on how to minimise the risk. There were general risk assessments seen on all three files including restrictions regarding accessing the kitchen. There were also appropriate individual risk assessments seen that included: managing aggression, medication, personal care and personal support. One service user had a new risk assessment completed since the last inspection to give revised guidelines for staff on managing physical risks related to episodes of challenging behaviour. There was some evidence that other risk assessments had been reviewed. However, as with the care plans, this was from hand written additions or modifications that were not dated or indicating who reviewed them. A requirement is made regarding this. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users enjoy some appropriate activities including within the local community. However these are now substantially restricted primarily because of the current limited staff resources now available to support them with these activities. Contact with relatives and friends is maintained and encouraged in accordance with the service users wishes. Efforts are also being made to develop different social contacts where appropriate to widen an identified service user’s social opportunities. Staff are working hard to promote and respect service users rights and responsibilities and increase their awareness of their cultural backgrounds. Service users also enjoy balanced and varied meals that meet their needs and preferences. EVIDENCE: At the last inspection the same five service users that are currently accommodated were living at the home. Two of the service users were then attending day services and an application had been made to a local college for a third service user. Two other service users had no structured day activities at Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 13 that time. A requirement was made that structured activities were identified for them and they be supported by the home to participate in these. Following this the inspector was informed that weekly outings had been arranged for the two service users. These included visits to local parks and to a local gymnasium with the intention that if successful the two service users would participate in a Sports for London project. This effectively complied with the requirement. At this inspection one service user was still attending day services but the other had not attended for some months. The inspector was informed that the arrangement became unviable for several reasons including that the service user did not appear happy attending. Evidence was seen that the new manager and staff had worked hard to arrange individual activities in the community for service users although this required substantial staff support. The inspector was informed that one service user currently attends a college based communication group once a week and a cookery group once a week with one to one staff support. Another service user’s programme includes attending a Monday Club, a trampoline session on a Tuesday and an activity session on a Saturday. However, these three sessions need two staff to attend to support the service user. The inspector was informed that these sessions were now significantly at risk and sessions had needed to be cancelled recently because of lack of staff. There are currently four staff on a morning and evening shift so if two staff accompany one service user this leaves two staff for the other four and this is deemed as being unsafe. Two of the service users are female and three male. If a female service user goes out who needs two staff to support her then one of the staff needs to be female. The inspector was informed that on some shifts it is not always possible to guarantee two female staff on every shift. This means that two male staff would be left in the unit with the other female service user and would not be able to provide appropriate gender based care. A requirement is made in the Staffing section of this report that the home must have sufficient staff on duty to support service users to participate in the activities specified in their care plans. The home does not have its own transport and the inspector was informed that only two members of staff had passed the provider organisations own driving test to validate them to drive vehicles when on duty. A good practice recommendation is made that the home tries to obtain access to a dedicated vehicle to transport service users in the community where appropriate. It is also recommended that the home supports more staff to undertake the provider organisation’s driving test to facilitate this. Despite the above issue of transport evidence was seen that the manager and staff have undertaken significant work to develop opportunities to access local community resources generally. This included assisting service users on an individual basis to go shopping and organising outings for service users in two’s or threes to a local café, park, pub and a disco. However, the manager and staff spoken to individually indicated to the inspector that the above Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 14 activities were likely to be fundamentally affected by the recent reduction in staffing at the home. A requirement is made in the Staffing section of this report regarding staff resources. It is the inspector’s judgement that the effect of the reduced staffing on the opportunities for service users to undertake meaningful activities and access the local community will be detrimental. It could increase the possibility of them displaying episodes of challenging behaviour that will further reduce their quality of life. This is the reason why the judgement of outcomes for service users in this Lifestyle section of the report is poor. Evidence was seen that the manager and staff have worked hard to assist service users understand their different cultural backgrounds. An example of this was a large world map displayed in the dining room with stickers indicating the parts of the world where service users families and those of staff originated. The inspector was informed that further work had started to explore a range of different cultural issues for individual service users including food and relevant issues relating to personal care. Four of the five service users have regular contact with relatives including visits to relative’s homes where appropriate. The inspector was informed that the home had made a referral to Mencap to assist find a befriender for the service user that has no contact with their relatives. Relatives are made welcome at the home with one service user’s relative visiting most days. The new manager had convened an initial series of three monthly meetings for relatives to better assist communication between themselves and the home. Now that the manager has been appointed on a permanent basis she stated that it was her intention to formalise ongoing meetings with relatives. Staff were observed interacting with service users in an appropriately friendly and individual way. Communication was effective and personalised to meet the service users varying degrees of communication needs. Interactions observed often included a mixture of speech, makaton signing and individual gestures and signals that appeared to work well. Staff were seen to have learnt some of the triggers that may lead to service users becoming upset or frustrated and utilised agreed mechanisms aimed at minimising the service user’s potential distress. The home also has an appropriate sensory room with the equipment having been relocated to a more convenient room in the home since the last inspection. There are a number of limitations placed on all the service users and details of some of these were seen recorded on the service user files inspected. The new manager and staff had developed a new menu since the last inspection that was seen. The manager stated that service users preferences had been re-evaluated and the menu changed to reduce the use of more “heavy” food and to encourage them to eat more fresh vegetables, fruit and salad. One service user was on a weight reducing diet. Sufficient food was stored in the home that matched the menu including fresh vegetables and Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 15 fruit. A requirement had been made at the last inspection that the cooker in the kitchen be repaired or replaced and this had been complied with. The manager told the inspector that although the cooker now worked she felt it was old, large and not the most functional for this type of home. However, because of the service users needs the kitchen was locked when main meals were being cooked and the non-staffing budgets were also currently frozen so it was not a priority for the non-staffing resources available. One service user was supported to make a batch of cakes in the kitchen during the inspection. The home does not have a cook so food preparation and cooking, especially for main meals is undertaken by the care staff. The inspector was informed that this is another significant task for care staff as it is not appropriated for service users to participate in this because of their needs. While main meals are being prepared care staff cannot be attending to any other of the service user’s direct needs. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. Service users receive appropriate personal support in accordance with their needs, including their cultural needs and in individual ways that they prefer. Their mental and physical healthcare needs are met including through referrals to a range of community based health professionals as required. The policy and written procedures for supporting service users with their medication is satisfactory although the implementation of these procedures and evidence of current training for staff in this area needs improving to ensure that service users are fully protected. EVIDENCE: All of the service users accommodated have significant support needs regarding their personal care. Evidence was seen from records in the home and from discussion with staff that serious efforts are being made by the home to provide personal care in the way that service users prefer. This included that personal care was provided in a way that met service users cultural needs. A specific section in the care plans and/ or risk assessments inspected gave good quality guidance to staff on assisting with personal care. The inspector observed a number of occasions throughout the inspection where staff were Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 17 working hard and skilfully to encourage service users to accept personal care and support in a way that maximised their dignity and privacy. At the last inspection a requirement was made that two service users that had recently been admitted at that time were registered with a G.P. and the local Primary Healthcare Trust be contacted to facilitate this if necessary. The inspector was pleased to see that the requirement had been complied with. Evidence was seen that the home makes suitable referrals to community health professionals to assist promote their physical and emotional health. One service user had been supported to receive required dental care since the last inspection. A consultant psychiatrist had been called to the home on the first day of the inspection to assist meet an urgent health need of one of the service user’s. The psychiatrist was spoken to briefly although independently. He confirmed that service users emotional and mental health needs were kept under review, including by his team. A requirement was made at the last inspection that a clear audit trail was available regarding medication prescribed to be given to service users as required. The inspector was pleased to see that this had been complied with. The prescribed medication and medication administration record (MAR) charts were inspected for three service users. These were generally satisfactory although one service user’s MAR chart had not been signed at the time the medication was administered on the day of the inspection. A requirement is made regarding this. The inspector was not able to verify that all staff that currently administer medication had received up to date training in this area and a requirement is made in relation to this. Evidence was seen that the dispensing chemist checked the home’s medication procedures when the home first re-opened in November 2005 and these were considered satisfactory. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. Service users and their relatives can be confident that their views will be listened to and any concerns raised taken seriously. The home has clear policies and procedures to deal with adult protection issues although further staff training is still needed in this area to maximise protection to service users. EVIDENCE: The home had a satisfactory complaints procedure that was seen with a summary displayed in the entrance hall. The procedure gave the information required in this standard including the details of CSCI. The Commission had received one complaint about the home since the last inspection that had been referred to the provider organisation to be investigated using its complaints procedure. Evidence was seen that this had been dealt with properly including informing the complainant if they were still not satisfied that they could refer the complaint to the London Borough of Haringey for it to be considered using their complaints procedure. The manager stated that no other complaints had been received at the home since the last inspection. The home had a satisfactory adult protection procedure and had a copy of the local authority procedure, London Borough of Haringey’s, which is the local authority the home is situated in. Staff spoken to were able to describe to varying degrees the main actions that the home would need to take should an allegation or disclosure of abuse be made. However, at the last inspection a requirement was made that all staff had received current training or refresher Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 19 training in adult protection. This had not been fully complied with and the requirement is restated in the Staffing section of this report. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is generally comfortable and domestic in scale although needs ongoing and higher than average expenditure to ensure that it is decorated and maintained to meet their particular needs. The home was generally clean and tidy creating an acceptable environment for those that live and work at the home as well as for those that visit it. EVIDENCE: The home underwent major refurbishment work to the fabric of the building, including the provision of a range of new furniture and soft furnishings, in 2004/ 05. The home reopened in November 2005 and at this inspection the feel of the newness of the environment had largely gone. This is primarily because of the heavy usage the physical environment is subject to given the assessed needs of the service user group. The inspector was informed that as well as the home’s staffing budget being reduced the non-staffing budget had been effectively frozen apart from essential health and safety priorities. On a tour of the building it was noted that the decorations were starting to be marked and many of the soft furnishing starting to show signs of significant Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 21 wear. The ground floor front rooms of the home had no curtains or blinds and the manager stated that this was having a negative effect on the home, especially after dark. This was because activity in the home is clearly visible to passers by and this is not acceptable especially when service users became agitated. A requirement is made regarding this. At the last inspection a requirement was made that two identified fire door closures be repaired. The inspector was pleased to see that this had been complied with. However, it was noted that the dining room fire door closure had recently been broken. The manager stated that this had been reported to the provider organisation and she was hopeful that this would be rectified shortly. A requirement is made regarding this. It was noted that the kitchen had minimal cooking utensils, pots and pans. It was also noted that mattresses in service users bedrooms were all plastic covered and staff indicated that these were not particularly comfortable for service users to sleep on. Staff also indicated that they believed that in hot weather particularly this might contribute to some service users displaying challenging behaviour. The manager stated that items such as kitchen equipment, furniture and soft furnishings, including bedding, were not considered as essential health and safety expenditure and these budgets were effectively frozen. Given the specific needs of the service users accommodated a requirement is made that the home is allocated a costed furniture, equipment and redecorations budget for the year. This is to allow expenditure to be made by the home to ensure that service users needs regarding basic comfort and dignity can be met as well as expenditure being authorised for essential health and safety items. The home has satisfactory laundry facilities and staff were aware of the need to ensure that infection control procedures are implemented at all times. The home has allocated cleaning hours although the inspector was informed that sometimes identified service users would undertake such actions as licking the windows before being dissuaded from doing so by staff. The manager stated that these and similar activities needed the attention of staff as a health and safety priority. Care staff need to undertake these domestic tasks during the majority of the hours in the week that the cleaner is not on duty. The home was acceptably clean and tidy during the inspection given the service users assessed needs. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Currently the home is not deploying enough staff on duty each day and night to ensure that service users assessed needs are being fully met. Improvement is needed to the availability of documentation to evidence that service users are protected by a robust staff recruitment procedure. Significant improvements are also needed to core staff training, staff qualification opportunities and staff supervision. This is to ensure that service users needs are properly addressed and that staff are properly equipped to do this. EVIDENCE: There are nine full time support worker posts and four team leader posts established at the home. At the last inspection the rota showed that on the majority of early and late shifts there were one team leader and four support staff on duty. At that time additional bank and agency staff were supporting the permanent staff team. At that time there were also two waking night staff and one sleeping-in staff on duty at night. The previous manager had indicated then that as the service users became settled in the home the provider organisation’s expectation was that their needs would be reassessed and staffing levels would be reviewed if necessary. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 23 At this inspection the staff rota was inspected. Although it accurately reflected the staff on duty at the time the inspector was informed and noted that the early and late shift staffing levels had recently been reduced to one team leader and three support staff. The inspector was also informed and noted that the night staff had also just been reduced from two to one waking night staff and one sleeping in staff. The inspector spent a significant amount of time at this inspection looking for evidence that the service users needs for staff support had decreased since the last inspection. The inspector did not find evidence in support of this either in the documentation inspected or from talking to the manager or the staff. The inspector adjourned the majority of the inspection activity from the 2nd June 2006 to the 7th June 2006 as the staff on duty on the 2nd June were dealing with a complex situation involving one of the service users. Before leaving the home on that day the inspector was briefly able to talk independently to the consultant psychiatrist who attended the home to assist staff. His view was that four staff on duty could be adequate for five service users on the basis of a one to one staffing ratio for three service users and two to one for the other two service users. However, the consultant did acknowledge that the service user he had attended the home to support had currently got escalating needs. He also acknowledged that the current situation was urgent enough for a professionals meeting to be called the following week to consider how best to address these needs. When the inspector resumed the inspection on the 7th June particular attention was paid to relevant documentation including assessment information and care plans. These clearly specified that two of the service users needed two to one staff support on many key activities and another required one to one staff support when undertaking many activities. There was no assessment information available to indicate that these needs had decreased. The home’s incident records were inspected. These showed that: 15 significant incidents were recorded in April 2006, 21 incidents in May 2006 and 9 incidents from the 1st to the 7th June 2006. Virtually all these recorded incidents involved service users support needs. As stated above the inspector did not find any documentary evidence to validate a reduction in staff numbers at the home. A requirement is made that the home must have sufficient staff on duty at all times to ensure that service users assessed needs are fully met. This must include sufficient staffing ratio’s to support service users participate in activities as specified in individual service users care plans as well as to keep both them and staff safe at all times. If the requirement regarding ensuring there is sufficient staff on duty to meet the service users needs is not complied with the Commission will consider taking enforcement action against the registered provider. At the last inspection a requirement was made that at least 50 of care staff had achieved the NVQ level 2 qualification in care or have confirmed Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 24 arrangements in place to achieve this by 31st March 2006. This had not been achieved and the requirement is restated. At the last inspection three staff files were inspected at random to evidence a robust staff recruitment procedure. One staff file did not contain evidence of satisfactory proof of identity and another only contained a copy of one reference instead of two. A requirement was made that all staff files contain all the documentation specified in Schedule 4 of the Care Homes Regulations 2001 and were to be kept available for inspection in the home. At this inspection none of the staff files could be located to evidence compliance. The requirement is restated. The inspector did see separate evidence that criminal record bureau (CRB) clearances with protection of vulnerable adult POVA) checks had been undertaken. Those sampled were satisfactory. At the last inspection a requirement was made that all staff employed in the home had received training in: food hygiene, adult protection, fire safety, infection control, first aid and health and safety, by 31st March 2006. There was no documentary evidence available at this inspection to confirm compliance with this requirement. Staff spoken to stated that they had not received the required training although two staff stated that they had undertaken some of this training in previous employment. It was also noted that there had been no clear training in proactively dealing with challenging behaviour although some staff stated they had undertaken a form of breakaway training, i.e. reactive training. The requirement is restated and amended to include that staff receive proactive training in meeting the needs of service users with challenging behaviour. The requirement also includes that the home must develop a training plan that records the dates that all staff undertake training and indicates when refresher training in core skills is required. If the requirement regarding staff training is not complied with within the timescales specified the Commission will consider taking enforcement action against the registered provider. The inspector was pleased to learn that the manager had undertaken individual appraisals with staff since her appointment and permanent staff spoken to independently confirmed this. The manager also stated that she was aware that staff were not receiving regular and recorded supervision and was planning to reintroduce this to the home. Staff spoken to stated that they felt well supported by the new manager although confirmed that they were not receiving formal recorded supervision. A requirement is made regarding this. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are starting to benefit from a new manager being appointed to the home who has professional and management qualifications and substantial experience in both of these areas. They are also starting to benefit from the home’s quality assurance system that seeks theirs and relevant others views about the service. Health and safety procedures contribute to protecting service users, staff and visitors to the home. However identified overall improvements need to be made in this area. A key area in relation to improving health and safety is in relation to minimising potential risks to service users by ensuring sufficient staff support is available to them at all times. EVIDENCE: The previous registered manager left the home in January 2006 to take up a manager’s post with another organisation. A requirement was made at the last inspection that the provider organisation appoints a new manager and informs the Commission of the interim management arrangements they were to put in Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 26 place. The inspector was pleased that this requirement was complied with. The current manager was initially seconded to the home in March 2006 for 11 weeks to allow permanent recruitment to take place. She then successfully applied for the permanent post and was appointed on 18th May 2006. The new manager has a social work and management qualification in addition to many years experience in working with vulnerable people and managing services. The inspector was informed that the recent staffing reductions and other budget freezes were imposed on the home by the provider organisation for financial reasons. Despite this there is evidence that the new manager has made a positive contribution to the home in the short time she has been in post within the resources constraints she has been required to work within. This included addressing issues of staff morale, promoting the use of the Makaton sign language, developing regular contact with relatives, proactively and positively addressing service user’s cultural identities and making a significant contribution to developing a quality assurance team plan for the home for 2006/ 07. In addition the inspector was reassured that she was clearly able to identify the current issues the home is facing. A standard requirement is made that the manager must apply to the Commission to become the registered manager of the home. At the last inspection a requirement was made that the provider organisation informs the Commission who the nominated responsible individual is following the resignation of the former responsible individual in September 2005. The Commission is in separate correspondence with the registered provider regarding this. As stated above, there is evidence that the home is taking quality assurance seriously. The inspector was given a copy of the home’s 2006/ 07 team plan and has instigated regular meetings with relatives. Feedback is sought from service users via the key worker system and the inspector has received reports of the provider organisation’s unannounced visits to the home. However, the latest report from a visit in May 2006 did not indicate the possibility of the imminent staff reductions that were to be made at the home. At the last inspection two requirements were made regarding fire protection issues and consulting with the fire officer about these. One of the requirements related to ensuring the fire officer’s previous requirements had been complied with in relation to improving the home’s fire risk assessment. The other related to consulting with the fire officer regarding revised fire drill procedures. The inspector was informed that the fire officer had visited the home three times since the last inspection: on the 23rd February 2006, the 3rd March 2006 and the 15th May 2006. The manager stated that on the last visit in May the fire officer had stated that he was satisfied with all the fire prevention arrangements put in place by the home and would confirm that in writing. The written confirmation had not been received at the time of this inspection and a Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 27 requirement is made that a copy of this written confirmation is forwarded to the Commission when it is received. At this inspection a range of health and safety documentation was inspected. Satisfactory documentation was seen in respect of fire precautions, portable appliance testing and water tank maintenance to reduce the risk of legionella. The home’s current gas safety certificate, electrical installation certificate and certificate of third party liability insurance could not be located and a requirement is made regarding these. Despite some positive developments described in this section of the report the inspector’s overall judgement on the outcomes for service users is that they are poor. This is because of the health and safety issues relating to the current overall staff to service user ratio, described in the Staffing section of this report. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 28 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 2 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 1 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14(2) Requirement Timescale for action 07/07/06 2 YA2 14(1) 3 YA7 15(2) 4 YA9 13(4) The registered provider must ensure that the current needs of an identified service user are formally re-assessed in a suitable environment by appropriate health and social care professionals and to review the suitability of their placement in the home. The registered provider must 07/07/06 ensure that the home has comprehensive assessment information on the needs of any prospective new service user, including their need for staff support, to ensure that the home has sufficient staffing and other resources to meet both their needs as well as other service users needs. The registered provider must 31/07/06 ensure that all reviews and evaluations of service user care plans are signed and dated by the person undertaking the review. The registered provider must 31/07/06 ensure that all reviews and evaluations of service user risk assessments are signed and DS0000033209.V295870.R01.S.doc Version 5.2 Linden House Page 30 5 YA20 13(2) 6 YA20 13(2) 7 YA24 23(2) 8 9 YA24 YA24 23(4) 23(2) 10 YA32 18(1)(a) dated by the person undertaking the review. The registered provider must ensure that when staff support service users with the administration of their medication this is recorded at the time the medication is administered. The registered provider must ensure that all staff that assist service users with the administration of their medication have received current training in safe administration of medication. The registered provider must ensure that the windows in the front ground floor rooms of the home have curtains or blinds fitted to ensure that service user’s privacy is protected. The registered provider must ensure that the dining room fire door closure is repaired. The registered provider must ensure that the home is allocated a costed furniture, equipment and redecorations budget for the year to allow expenditure to be made to ensure that service users needs regarding basic comfort and dignity can be met. The registered provider must ensure that at least 50 of care staff have achieved NVQ level 2 in care or have confirmed arrangements in place to achieve this (previous timescale of 31/03/06 not met). The registered provider must ensure that the home has sufficient staff on duty at all times to ensure that service users assessed needs are met. This must include sufficient DS0000033209.V295870.R01.S.doc 07/07/06 31/07/06 31/07/06 07/07/06 31/07/06 30/09/06 11 YA33 YA13 18(1)(a) 07/07/06 Linden House Version 5.2 Page 31 staffing ratio’s to support service users to participate in activities as specified in individual service users care plans as well as to keep both them and staff safe at all times. 12 YA34 17(2) The registered provider must ensure that copies of all the documentation specified in Schedule 4 of the Care Homes Regulations 2001 are kept available for inspection in the home (previous timescale of 28/02/06 not met). The registered provider must ensure that all staff employed in the home have received training in: food hygiene, adult protection, fire safety, infection control, first aid and health and safety (previous timescale of 31/03/06 not met). The registered provider must ensure that all support staff receive training re proactively meeting the needs of service users with challenging behaviour and develop a training plan that records the dates that all staff training is undertaken and indicates when refresher training is required. The registered provider must ensure that all staff receive formal, recorded supervision on an individual basis at least every two months. The registered provider must ensure that an application for registration is made to the Commission in respect of the newly appointed manager. 31/07/06 13 YA35 YA23 18(1)(c) 30/10/06 14 YA35 18(1)(c) 30/09/06 15 YA36 18(2) 31/07/06 16 YA37 8 31/07/06 Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 32 17 YA42 23(4) 18 YA42 13(4) The registered provider must send a copy, when received, of the fire officer’s letter that confirms that all the fire authority’s requirements regarding the home have been complied with. The registered provider must ensure that the following documents are current and a copy available for inspection at the home at all times: a gas safety certificate, electrical installation certificate and certificate of third party liability insurance. 31/07/06 31/07/06 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 Refer to Standard YA13 Good Practice Recommendations The registered provider should obtain access to a dedicated vehicle to transport service users in the community where appropriate and support more staff to undertake the provider organisation’s driving test to facilitate this. Linden House DS0000033209.V295870.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 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 DS0000033209.V295870.R01.S.doc Version 5.2 Page 34 - 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. 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