Inspection on 23/01/07 for Linden House

This inspection was carried out on 23rd January 2007.

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 10 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 02/06/06

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 Key Unannounced Inspection 23rd January 2007 09:30 Linden House DS0000033209.V324402.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.V324402.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.V324402.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.V324402.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd June 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 is an adapted three-storey house with the entrance and most of the ground floor being fully accessible. The ground floor 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 used by 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 about the service is shared with service users and other stakeholders either individually, at meetings and on request. A copy of the latest CSCI inspection report is displayed in the home’s entrance hall. 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.V324402.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took approximately seven and a half hours with the manager, Ms Noray Ahmet, being present or available throughout. There were five service users accommodated at the time of the inspection although one was having a specialist re-assessment of their needs carried out in a health residential setting. The home had one vacancy and no new service users had been admitted to the home since the last inspection. The inspection included: meeting the four service users at the home during the inspection although meaningful communication was very limited because of the communication needs of these service users; detailed discussion with the manager and independent discussion with five care staff. The inspector had also received comment cards from a number of relatives since the last inspection and had telephone conversations with two of them relating to these. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: What has improved since the last inspection? The home has made significant improvements since the last inspection in a range of areas. The two most important improvements have been in ensuring that there is sufficient staff on duty to meet the service users needs and in providing a range of qualification training, skills training and refresher training for staff. At the last inspection eighteen requirements were made, thirteen of these had been complied with leaving five that are restated. The areas in which the improvements have been made are: making sure the home understands the changing needs of one of the service users; making sure that the home understands the needs of any new service user referred and has the staffing Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 6 levels and other resources available to meet that persons needs; two identified areas relating to medication administration; two areas relating to improving the furniture and equipment in the building; core skills training for staff; specialist training for staff; qualification training for staff; staffing levels; records relating to staff recruitment procedures; formal supervision sessions for staff and a record relating to a fire officer’s visit to the home. A good practice recommendation was also made relating to accessing transport to assist take service users out in the community. This had also been acted upon. 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. The summary of this inspection report can be made available in other formats on request. Linden House DS0000033209.V324402.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.V324402.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are assessed to ensure that the home can meet their needs. Once admitted service users needs are reassessed to assist the home continue to meet their changing needs. EVIDENCE: 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 and multi-disciplinary assessment information that was available to the home at the time of that person’s admission. One of the current service users was undergoing a significant period of reassessment of their needs in a health setting at the time of this inspection. This complied with a requirement made at the last inspection that the needs of an identified service user were formally re-assessed in a suitable environment by appropriate health and social care professionals. The manager and staff were contributing to this assessment process. A requirement had been made at the last inspection that the home obtained comprehensive assessment information on the needs of any prospective new service user, including their need for staff support. This was to ensure that the Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 9 home had sufficient staffing and other resources to meet both that person’s needs as well as the ongoing needs of the other service users. The manager stated that this requirement was being complied with and told the inspector that the home had recently received a new referral to the home. She went on to say that following its own assessment of that persons needs the home would only consider admission if it had adequate resources to meet the person’s needs. Linden House DS0000033209.V324402.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. 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. Care plans and risk assessments needs to be kept up to date to ensure that all staff are aware of service users changing needs and have up to date guidance on how to effectively address these changes. Staff are working hard to assist service users make as many decisions for themselves as they can about their day to day lives in order to maximise their independence. EVIDENCE: Three service users files were inspected at random. At the last inspection a requirement had been made that all reviews and evaluations of service user care plans were signed and dated by the person undertaking the review. The inspector was disappointed to find that this requirement had not been complied with. There was evidence from the inspection to indicate that staff were undertaking a range of creative and effective work with service users. Some of these ways of working had been further developed since the last inspection. This included different interventions with individuals to diffuse potentially Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 11 challenging situations. One example of this was that the home had developed, in consultation with speech and language health care professionals, an improved way of communicating on a day-to-day level with one service user since the last inspection. This involved using a range of photographs including of a drink, a meal, an electric shaver and a range of other relevant objects. The photographs were displayed on a board in the home and also contained in a book that staff could take out of the home with the service user. These were being used effectively to assist that service user indicate what they wanted and the inspector was informed that this had reduced incidents of frustration for that service user. However, this was not recorded on the service users care plan as an improved way of meeting their assessed needs. The care plans seen appeared to be approximately 12 months old. As at the last inspection there was some evidence from the plans that they had been reviewed and some hand written additions or modifications were seen to have been made. One handwritten modification had a date by it indicating the modification had been written since the last inspection. However, the majority of the changes were not dated or signed by the person making the modification. One of the three files also contained an additional handwritten draft care plan, the inspector was told that this was evidence of work in progress. However, this draft was not signed or dated to verify its current status and was not particularly clear. Although the care plans seen were detailed the inspector could not tell if the content was current or not. This means that new or agency staff cannot be confident that they have up to date written guidance on how to address service users needs. The requirement is restated. All of the four service users accommodated at the time of the inspection were non-verbal and had significant support needs regarding communication. As described in the above paragraph, staff are working hard to assist service users in communicating their wishes and to make decisions regarding their daily lives. The home operates a key worker system that staff stated was helpful in ensuring that a clear overview was kept of service users needs. The home continues to promote the use of makaton sign language to assist this process. A makaton sign chart was displayed in the home’s entrance hall with a designated “sign for the week” being displayed. Each of the three service user files inspected contained detailed risk assessments. At the last inspection a requirement had been made that all reviews and evaluations of service user risk assessments were signed and dated by the person undertaking the review. One of the three service user risk assessments seen had been reviewed and rewritten in January 2007 and had been signed by the person that had done this. The other two showed no evidence to indicate they had been reviewed since the last inspection. As with the care plans these showed some hand written additions or modifications but these were not dated or showed who had written them or when. The requirement is restated. Linden House DS0000033209.V324402.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. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users have access to increased resources to assist them participate in appropriate activities including within the local community. Service users also benefit from clear efforts being made to assist them relate to their cultural origins. Contact with relatives is promoted and encouraged, which benefits service users. Service users rights and responsibilities are respected and promoted within their daily lives. Service users also enjoy healthy and varied meals. EVIDENCE: The service users accommodated had a weekly programme of activities displayed in the home. The four service users accommodated all attended external day service as part of their programme although the number of days they attended varied from five days a week to one day a week. Other activities were shown for each of the service users that were undertaken both in the home and in the local community. These included individual activities including one service user that attended a trampoline session in the local community. All Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 13 of the service users need substantial staff support, especially when out in the community. The inspector was pleased to see that following a requirement made about staffing levels at the last inspection the home had secured additional staff hours to assist with this. This consisted of an additional two support workers that were currently being employed from 9am to 4pm Monday to Friday. These two additional staff were on duty during the inspection and were seen to assist taking individuals out into the local community. The manager stated that the home had the flexibility to use these additional 70 staff hours per week during the evening or at weekends and the home’s management group were currently looking at this. At the last inspection a good practice recommendation was made that the home tried to access a dedicated vehicle to transport service users in the community where appropriate. This was to assist in providing more options to improve the quality of life for the service users who all have complex needs. The inspector was pleased to learn that the home now had access to a minibus owned by a London Borough of Haringey day centre on a Saturday and a Sunday each week. The manager and staff continue to promote and celebrate the cultural diversity of both service users and staff in the home. There is a large world map in the dining room with stickers indicating the parts of the world where service user’s families and those of staff originated. There was evidence that the home had celebrated Black History month with a range of relevant information displayed. There was a list of different religious festivals displayed and the inspector was informed that a special meal had been prepared to assist celebrate Diwali. A photograph collection relating to Cyprus had been compiled and given to one service user whose family originated from there. The inspector was informed that the plan was to do the same for other service users in relation to the country their family originated from. One staff member spoken to told the inspector that they were undertaking a project to compile a CD that contained tracks of music representing countries of origin of staff. This included music from Ghana, Cyprus, Albania, Kenya, Sierra Leone, the Caribbean and Nigeria. The four service users accommodated at the time of the inspection have regular contact with relatives. This includes relatives visiting the home and service users visiting and staying with relatives most weekends. Comment cards were received from relatives since the last inspection and the inspector had spoken to two of these relatives following this. Relatives confirmed that they had regular contact with the home although had not always been happy with some aspects of care at the home. However, the inspector was informed by the relatives that they knew how to make a complaint and who to complain to should they wish to. The manager is working hard to develop a positive relationship with relatives including by holding regular relative meetings. A relatives meeting was planned for the Saturday following this inspection and a list of monthly dates for meetings was planned for the rest of 2007. Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 14 Staff were seen to interact sensitively and appropriately with service users throughout the inspection. Staff were seen working hard in communicating with service users using a combination of makaton signs and other means of verbal and non verbal communication. There remain a number of limitations placed on all the service users and details of these were seen recorded on the service user files sampled. The home had further developed its menu since the last inspection. Continued emphasis was seen to be placed on promoting healthy eating including information displayed of the benefits of “five portions a day” of fruit and vegetables. The inspector was also shown some recipes from different countries that were going to be tried. These included dishes from Cyprus, Spain, Nigeria, Turkey and Ireland. There was sufficient food stored in the home that matched the menu. The inspector was informed that relatives joined service users for a meal at the home at Christmas and this was appreciated by all involved. Evidence was seen of significant improvements to the furniture and equipment in the home and this included the kitchen. The home had replaced the old cooker that had become increasingly inefficient with a new one. There was also a new electric juicer, a new portable grill appliance that needed no additional fat to assist with the cooking and some new pans and utensils. Although the kitchen was generally clean and tidy it was noted that the upper walls and ceiling had become increasingly greasy over time and needed deep cleaning. A requirement is made regarding this. Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 15 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. Service users receive sensitive personal support in accordance with their needs and preferences. Service users mental and physical healthcare needs are appropriately addressed including through referrals to a range of community based health professionals as required although more proactive planning may further assist in this area. Service users are also generally well supported with their medication although identified improvements are needed to ensure that they remain fully protected in this area. EVIDENCE: All of the service users accommodated continue to have significant support needs regarding their personal care. Evidence was seen from records in the home and from discussion with staff that serious efforts continue to be 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. Each shift has at least one female member of care staff on duty to ensure that female service users can access sensitive and gender specific personal care. Service users are also supported with regard to their cultural Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 16 needs where appropriate including with hair and skin care. Staff were observed interacting with service users, including with some personal care tasks, in a sensitive and appropriate manner. Evidence was seen that the physical and emotional health needs of service users are taken seriously. Service users are all registered with a G.P. and evidence seen that service users are supported to attend a range of appointments with relevant healthcare professionals as required. One service user was undergoing a significant period of reassessment of their needs in a health setting at the time of this inspection. Evidence was seen that service users have access to specialist healthcare professionals including psychiatrists, psychologists and speech and language therapists. Evidence was seen that service users are also referred by their G.P. to mainstream outpatient and other hospital appointments as required. It was noted that because of the complex needs of service users these appointments could often be considered problematic. This may be because healthcare professionals in such facilities are not used to treating patients with such complex needs. The inspector was told that this was an issue for one service user currently and that staff were working hard to assist overcome these difficulties. It was noted that there was a section in the service user files seen entitled health action plans. However, on the files sampled these sections were either empty or else had general guidance about health care plans and how to undertake these. A good practice recommendation is made that health care action plans are completed for each service user in consultation with local health care professionals. This recommendation is made to try to assist staff proactively develop strategies in advance for tackling the difficulties that can arise when a service user with very complex needs has to access mainstream health services. A requirement was made at the last inspection that all staff that assist service users with the administration of their medication must have received current training in this area. The inspector was pleased to see evidence that this requirement had been complied with. Medication and medication administration record (MAR) charts were inspected for three service users. At the last inspection a requirement was made that when staff support service users with the administration of their medication this is recorded at the time the medication is administered. This requirement was being complied with and no mistakes or omissions were noted in the records of administration sampled. However, it was noted that the home is not now using the MAR chart supplied by the dispensing pharmacist and is using a MAR chart produced by the home. The inspector was informed that the change had been prompted because the standard MAR chart supplied by the dispensing pharmacist did not have a big enough space for two people to initial when staff assisted individual service users with their medication. The majority of the home’s own MAR sheets had directions for administering the medication typed and directly copied from the directions on the original medication container/ MAR chart supplied by the dispensing pharmacist. However one MAR chart that was sampled had been hand written by staff and the directions for administration summarised from Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 17 the original directions supplied by the pharmacist. This is not acceptable as the full directions need to be recorded to minimise the risk of a mistake being made in the administration of the medication. A requirement is made that if the home uses its own MAR charts these must accurately and fully record the directions regarding administration of each medicine as supplied from the dispensing pharmacist. The inspector was also informed that details of medication received and disposed of by the home was kept in a separate record book. However, the inspector was unable to check the medication stocks held in the home as this record book could not be located during the inspection. A requirement is made regarding this. Linden House DS0000033209.V324402.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Service users and relatives are able to express their views and concerns and have these appropriately dealt with by the home. Service users are also protected by satisfactory adult protection policies and procedures that staff are aware of. 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 procedure also states that complainants can use the London Borough of Haringey’s complaints procedure if they are not happy with the way the home has dealt with their complaint. The manager stated that no complaints had been received at the home since the last inspection. The home had a satisfactory adult protection procedure that had been reviewed since the last inspection. The home also had a copy of the local authority procedure, London Borough of Haringey’s, which is the local authority the home is situated in. At the last inspection a requirement had been restated that all staff must receive current training or refresher training in adult protection. The inspector was pleased to see evidence that this requirement had been complied with both from training records seen and from staff spoken to. Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 19 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. Service users live in a home that is increasingly more comfortable and homely although still needs ongoing expenditure to ensure that it is decorated, maintained and equipped to meet their particular complex needs. The home was clean and tidy creating an satisfactory environment for those that live and work at the home as well as for those that visit it. EVIDENCE: The home is an adapted three-storey house with the entrance and most of the ground floor being fully accessible. The ground floor 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 has a large enclosed rear garden and the inspector was pleased to note that in part of this a sensory garden had been Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 20 constructed. This had a range of elements including wind chimes, mirrored mobiles, a bird table with hanging feeders, raised plant beds and a Mediterranean style seating area. The inspector was informed that the ethos of the garden was to encourage exploration, touching and listening and that service users enjoyed using the garden and got substantial benefit from it, especially in fine weather. A requirement had been made at the last inspection that the dining room fire door closure was repaired and the inspector was pleased to see that this had been complied with. Good progress had been made following the last inspection in improving the physical environment in the home. This included upgrading a range of furniture and equipment following a requirement made regarding this at the last inspection. New sofa’s, chairs, coffee tables and a wall mounted flat-screened television all added to the comfort and overall improved feel of the building. The communal areas also now benefit from a range of new pictures, photographs and relevant information displayed on the walls that assist make the building look more like a home for the service users. At the last inspection a requirement was made that the windows in the front ground floor rooms of the home have curtains or blinds fitted to assist protect service user’s privacy. Evidence was seen that the manager had obtained quotes for this and that work was in hand to comply with this requirement. The requirement is restated with an extended timescale. Although clear improvements have been made with the home’s physical environment it was noted during a tour of the premises that five of the service user bedrooms and the team leader’s sleeping-in room were now in need of redecoration. The manager acknowledged this although stated that there was no written plan for redecoration of the building. A requirement is made that the home develops a cyclical and costed programme for redecoration of all areas of the building. This is particularly important given the complex needs of the service users and the subsequent hard wear and tear of the building. It was also noted that the room that had been used as a sensory room had been flooded following an accident on the first floor since the last inspection. The inspector was pleased to learn that relevant water taps had now been fitted with spring loaded mechanisms to minimise the risk of them being left running unattended. However, the equipment from the sensory room had been badly damaged and had been disposed of. The inspector was informed that there was no budget to replace this equipment in the near future. Given the needs of the service users and the potential benefits of the sensory room a good practice recommendation is made that the sensory room and its equipment is reinstated. The home had satisfactory laundry facilities and storage for chemical cleaners. The inspector was pleased to see that some laundry equipment had been replaced and a new more solid plinth had been fitted for the washing machine. The inspector was also pleased to see that staff had been able to access Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 21 infection control training as required at the last inspection. The home was appropriately clean and tidy throughout during the inspection. Linden House DS0000033209.V324402.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent and effective staff team are now deployed in sufficient numbers to more effectively address service users needs. The home was able to evidence a robust recruitment procedure that contributes towards service users protection. Service users are also supported by staff who now have access to appropriate training and formal supervision to assist them further in both meeting service users needs and in there own personal development. EVIDENCE: The inspector was pleased to see that significant progress had been made with requirements made at the last inspection in relation to staffing and related matters. At the last inspection a requirement was made that at least 50 of care staff must achieve the national vocational qualification (NVQ) level 2 in care or have confirmed arrangements in place to achieve this. The inspector was pleased to see this requirement had been complied and a clear programme had been put in place for permanent care staff to achieve this. Care staff spoken to Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 23 confirmed that these arrangements were in hand. Team leaders have either achieved or are working towards NVQ level 3 in care. At the last inspection a requirement was made that the home had sufficient staff on duty at all times to ensure that service users assessed needs were met. This included having sufficient staffing ratio’s to support service users to participate in activities as specified in their individual care plans as well as to keep both them and staff safe at all times. The inspector was pleased to find that staffing levels had subsequently been improved since that inspection. Staffing levels now comprise: 1 team leader and three care staff on both the early and late shifts and 1 waking night staff, a sleeping-in member of care staff and a sleeping-in team leader at night. The manager’s hours are in addition to the above and the home also has some dedicated domestic and administrative hours each week. Following the above requirement the home was allocated an additional 70 care worker hours per week to assist service users on a 1 to 1 basis with daytime activities. The funding for these hours is currently being used to purchase an additional 2 support workers from 9am to 4pm Monday to Friday. Regular agency staff that had become familiar with service users needs were covering these hours. The manager stated that she had the flexibility to use the additional hours of an evening or at weekends should that better meet the service users needs in the future. The home also ensures that at least one female member of care staff is on duty on each shift to assist meet the personal care needs of the female service users. Staff spoken to independently confirmed that they felt the staffing ratios were more manageable than before. The staff on duty during the inspection reflected the staff recorded on the staffing rota that was inspected. This level of staffing enables the current service users needs to be more effectively addressed. This will need to continue to be monitored however as at the time of the inspection the home still had one service user vacancy and another service user had been undergoing a significant period of reassessment of their needs in a health setting. The home has not recruited any new permanent staff since the last inspection. At that inspection it was noted that a number of documents to evidence a robust recruitment procedure were not available for inspection and that some staff files contained minimal information. A requirement was made at the last inspection that 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. The inspector was pleased to see that this requirement had been met. Evidence was seen that the manager had undertaken significant work to obtain copies of relevant documentation from Haringey social services humans resources department. Three staff files were inspected at random at this inspection. Each contained: proof of identity, written references and evidence that a satisfactory criminal records bureau (CRB) check, which included a protection of vulnerable adults (POVA) Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 24 clearance, had been received by Haringey social services department, the provider organisation. At the last inspection a requirement was restated that all staff employed in the home receive training including in: food hygiene, adult protection, infection control, first aid and health and safety. The inspector was pleased to see that this requirement had been complied with and evidence was seen that staff had undertaken a range of core training since the last inspection. The training included: food hygiene, adult protection, infection control, first aid, health and safety, needs of people with epilepsy, moving and handling and medication. A requirement was also made at the last inspection that staff receive training re proactively meeting the needs of service users with challenging behaviour. Again evidence was seen that this requirement had been complied with. Staff spoken to stated that they found all the above training useful. The inspector was shown a training matrix that showed which staff had undertaken which training and when. The inspector was informed that this would be used to plan further refresher training as required. At the last inspection a requirement was made that all staff receive formal, recorded supervision on an individual basis at least every two months. The inspector was pleased to see that this requirement had also been complied with. Evidence was seen from the staff files inspected and from staff spoken to that staff now have supervision sessions at least 2 monthly and often monthly. Evidence was also seen that the home has introduced and is implementing an annual performance appraisal. Linden House DS0000033209.V324402.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. 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. Service users benefit from clear leadership within the home by an effective and enthusiastic manager. However, some further work is still needed, including improving the management on-call arrangements at the home, to maximise the effective management of the home. Service users also benefit from the homes quality assurance system that contributes to improving the service offered by the home. The home is working hard to implement health and safety procedures to contribute to protecting service users, staff and visitors although some further work is needed to improve this further. EVIDENCE: The current manager has been in post for approximately one year. The manager has both a social work and management qualification in addition to many years experience in working with vulnerable people and managing services. The inspector was pleased to see significant improvements in the Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 26 home since the last inspection and was of the view that the manager had made a large and effective contribution to implementing these improvements. The inspector was concerned to learn however that the manager had been effectively on call when off duty for the majority of that year. The inspector learnt that the manager was often called, both for advice by telephone and more onerously to attend the home when off duty if the need arose. This is unacceptable especially given the pressures of managing such a complex service and means that the manager cannot be guaranteed any uninterrupted time when off duty. This problem had been recognised by an external manager from Haringey social services department who had undertaken an unannounced regulation 26 monitoring visit to the home in November 2006. The report of that visit recorded in the concluding section, called “Action Required From This Visit”, that “An on call system should be put in place so that the home manager does not have to be on call at all times”. This had not been actioned by Haringey social services and a requirement is made that this must be addressed. At the last inspection a requirement was made that the registered provider must ensure that an application for registration is made to the Commission in respect of the newly appointed manager. This requirement had not been complied with and is restated. The home operates a key worker system. Given the complex needs of all the service users, including their communication needs, this system is used as a primary mechanism for ascertaining their views and preferences regarding the service. Evidence was seen that the home consults regularly with relatives and other stakeholders. This includes an annual schedule of planned monthly meetings with relatives. Haringey social services department has overall annual aims and objectives and a copy of these were seen. The home has its own annual aims and objectives, developed from the consultation mechanisms described above, which relate and contribute to Haringey’s overall objectives. A copy of the home’s current aims and objectives were seen displayed on the home’s notice board. At the last inspection a requirement was made that the home must send a copy, when received, of the fire officer’s letter confirming that all the fire authority’s requirements regarding the home had been complied with. This was following a visit to the home by the fire officer in May 2006. This requirement had been complied with and the inspector noted that the letter stated that the home was deemed to comply with the fire regulations at the time of that visit. The home’s fire plan and fire risk assessment were seen as well as evidence of 3 monthly fire drills and that the home’s fire alarm and fire fighting equipment had recently been serviced. The manager stated that the home was considering fitting keypad locks to identified external doors in the home. A good practice recommendation is made that the home liaises with the fire officer regarding this as new fire regulations (Regulatory Reform -Fire SafetyOrder 2005) have come into force from October 2006. The regulations now state that such locks must be connected to the fire alarm system to ensure they unlock automatically when the fire alarm is activated. A good practice Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 27 recommendation is also made that the home ensures that its current fire plan and fire risk assessment complies with new fire regulations. A requirement was made at the last inspection that the home ensured that the following documents were 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. The majority of this requirement had been complied with although a current gas safety certificate could still not be located at this inspection. Although the manager and staff spoken to stated that the necessary inspection of the gas supply had been undertaken this element of the requirement is restated. Linden House DS0000033209.V324402.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 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 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.V324402.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 YA6 Regulation 15(2) Requirement The registered provider must ensure that all reviews and evaluations of service user care plans are signed and dated by the person undertaking the review (previous timescale of 31/07/06 not complied with). The registered provider must ensure that all reviews and evaluations of service user risk assessments are signed and dated by the person undertaking the review (previous timescale of 31/07/06 not complied with). The registered provider must ensure that the kitchen is deep cleaned. The registered provider must ensure that if the home uses its own MAR charts these must accurately and fully record the directions regarding administration of each medicine as supplied from the dispensing pharmacist. The registered provider must ensure that a record is kept of medication received into and disposed of by the home and that this record is kept available DS0000033209.V324402.R01.S.doc Timescale for action 28/02/07 2. YA9 13(4) 28/02/07 3. 4. YA17 YA20 23(2) 13(2) 31/03/07 28/02/07 5. YA20 13(2) 28/02/07 Linden House Version 5.2 Page 30 for inspection. 6. YA24 23(2) 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 (previous timescale of 31/07/06 not complied with). The registered provider must develop a cyclical and costed programme for redecoration of all areas of the building. The registered provider must ensure that an effective on call system is put in place so that the home manager does not have to be on call at all times when off duty. The registered provider must ensure that an application for registration is made to the Commission in respect of the newly appointed manager (previous timescale of 31/07/06 not complied with). The registered provider must ensure a copy of a current gas safety certificate is available for inspection (previous timescale of 31/07/06 not complied with). 30/04/07 7. YA24 23(2) 28/02/07 8 YA37 10(1) 28/02/07 9. YA37 8 28/02/07 10. YA42 13(4) 28/02/07 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 YA19 Good Practice Recommendations The home should complete health care action plans for each service user in consultation with local health care professionals. This recommendation is made to try to assist staff proactively develop strategies in advance for tackling the difficulties that can arise when a service user with very complex needs to access mainstream health DS0000033209.V324402.R01.S.doc Version 5.2 Page 31 Linden House 2 3 YA24 YA42 4 YA42 services. The home should re-equip and reinstate the use of the sensory room. The home should liaise with the fire officer before proceeding with ordering keypad locks for external doors to ensure that the locks fitted meet the requirements of the new fire regulations. The home should check that its current fire plan and fire risk assessment complies with new the fire regulations. Linden House DS0000033209.V324402.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 DS0000033209.V324402.R01.S.doc Version 5.2 Page 33 - 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!